MANAGEMENT OF DEPRESSION IN THE PRESENCE OF PAIN SYMPTOMS

Somatic illness is frequently associated with depression and anxiety and major depression significantly increases risk of severe medical conditions, e.g. cardiovascular illness. One of the most frequent comorbidities is that of depression and pain. Alterations in or adrenergic and serotonergic neurotransmissions in the central nervous system have been implicated in the joint pathophysiology of depression and chronic pain. Antidepressants, alone or in combination with psychotherapy, are an effective treatment option in such cases. The newer dual action antidepressants (milnacipran, venlafaxine, duloxetine) acting specifically on both noradrenergic and serotonergic neurotransmitter systems are presumably more reliable in pain management. So far, the most extensively studied drug has been duloxetine. Twelve randomized placebo-controlled trials with the total number of 4,108 patients suffering from pain associated with major depressive disorder suggested consistent analgesic efficacy of duloxetine, especially in fibromyalgia and peripheral neuropathic pain

MANAGEMENT OF DEPRESSION IN THE PRESENCE OF PAIN SYMPTOMS

Somatic illness is frequently associated with depression and anxiety and major depression significantly increases risk of severe medical conditions, e.g. cardiovascular illness. One of the most frequent comorbidities is that of depression and pain. Alterations in or adrenergic and serotonergic neurotransmissions in the central nervous system have been implicated in the joint pathophysiology of depression and chronic pain. Antidepressants, alone or in combination with psychotherapy, are an effective treatment option in such cases. The newer dual action antidepressants (milnacipran, venlafaxine, duloxetine) acting specifically on both noradrenergic and serotonergic neurotransmitter systems are presumably more reliable in pain management. So far, the most extensively studied drug has been duloxetine. Twelve randomized placebo-controlled trials with the total number of 4,108 patients suffering from pain associated with major depressive disorder suggested consistent analgesic efficacy of duloxetine, especially in fibromyalgia and peripheral neuropathic pain

Lifetime Bipolar Disorder comorbidity and related clinical characteristics in patients with primary Obsessive Compulsive Disorder: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS)

IntroductionBipolar disorder (BD) and obsessive compulsive disorder (OCD) are prevalent, comorbid, and disabling conditions, often characterized by early onset and chronic course. When comorbid, OCD and BD can determine a more pernicious course of illness, posing therapeutic challenges for clinicians. Available reports on prevalence and clinical characteristics of comorbidity between BD and OCD showed mixed results, likely depending on the primary diagnosis of analyzed samples.MethodsWe assessed prevalence and clinical characteristics of BD comorbidity in a large international sample of patients with primary OCD (n = 401), through the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) snapshot database, by comparing OCD subjects with vs without BD comorbidity.ResultsAmong primary OCD patients, 6.2% showed comorbidity with BD. OCD patients with vs without BD comorbidity more frequently had a previous hospitalization (p < 0.001) and current augmentation therapies (p < 0.001). They also showed greater severity of OCD (p < 0.001), as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).ConclusionThese findings from a large international sample indicate that approximately 1 out of 16 patients with primary OCD may additionally have BD comorbidity along with other specific clinical characteristics, including more frequent previous hospitalizations, more complex therapeutic regimens, and a greater severity of OCD. Prospective international studies are needed to confirm our findings.Peer reviewe

Psychotic disorder due to hypothyroidism: a case report

Endocrine diseases, especially thyroid disorders can solely cause psychiatric symptoms or can aggravate preexisting psychiatric disorders. Among thyroid disorders, hypothyroidism especially manifests with psychotic and depressive symptoms. In this case report, we presented a 39 years old male patient, who had been suffering from symptoms related with hypothyroidism for 5 years, also had additional depressive, cognitive and psychotic symptoms for 3 years. The patient has been followed up for a period of 9 months at a frequency of once a week at the beginning, afterwards once a month. He has been put on thyroid hormone replacement (levothyroxine sodium 0.1 mg/ day) therapy and an atypical antipsychotic drug (risperidone 4-6 mg/day, later on olanzapine 10 mg/day). In the second week, his delusions became significantly less remarkable, at the end of three weeks he showed a dramatic recovery. As illustrated in this case, thyroid diseases may occur with psychiatric symptoms varying in a broad spectrum of from depression to psychosis and if not correctly treated within this period, they may lead to prominent disabilities. Therefore routine thyroid function screening in patients with such symptoms is always warranted

Acute and maintenance transcranial magnetic stimulation (TMS) in a pregnant woman with major depression: A case report

Introduction In pregnant women with depression, there are a few case reports and studies showing the efficacy and reliability of transcranial magnetic stimulation. This report presents the acute and maintenance treatment results of transcranial magnetic stimulation in a pregnant woman who meets the diagnostic criteria for a major depressive episode. Case report A 24-year-old, 17-week pregnant housewife was admitted to ER with 10-week ongoing crying, distress, loss of appetite, weight loss, insomnia, sadness, loss of daily functioning, request of pregnancy termination and suicidal thoughts. Conclusion Transcranial magnetic stimulation is promising as an effective alternative in pregnant patient

The correlations of nicotine addiction with the levels of impulsiveness, depression and anxiety in obsessive-compulsive patients.

Objective: Few studies comparing smoking and non-smoking obsessive compulsive disorder (OCD) patients have found results contradicting research on other anxiety disorders. OCD is a disorder with compulsive and impulsive features. Investigating the relationships among addiction, compulsivity and impulsiveness might contribute to the understanding of the interaction of those concepts. Method: This study compared impulsiveness in smoking and non-smoking OCD patients. Then, we measured the correlations among the severities of impulsiveness, OCD and addiction. Depressive symptoms and anxiety were also included in the analysis since they are frequently accompanied by OCD, addictive disorders and pathological conditions characterized by high impulsiveness. Patients with OCD (n=121) were given Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Barratt Impulsiveness Scale-Version 11 (BIS-11), Fagerström Test for Nicotine Dependence (FTND), Hamilton Depression Rating Scale-17 Item (HDRS-17) and Beck Anxiety Inventory (BAI). Results: The prevalence of smoking was 42.14 %. The current and never-smokers did not show any statistically significant differences regarding the scores of the Y-BOCS, HDRS-17, and BAI. The BIS-11 total and non-planning subscales were significantly higher in the current smokers. The Y-BOCS scores showed a positive correlation with the BIS total, cognitive, and non-planning scores only in the current smokers. Only in the smokers, the compulsion scores showed a positive correlation with the BIS-11 total and cognitive impulsiveness subscale. The FTND scores were correlated with the scores of the BIS-11 total and of the subscales of behavioral impulsiveness and non-planning. The FTND scores were also correlated with the scores of the Y-BOCS and BAI but not with the HDRS-17. Conclusion: More severe OCD in more impulsive smokers is related to higher compulsivity rather than obsessiveness, supporting the relationship among compulsivity, impulsiveness, and addiction

Tedaviye dirençli obsesif kompulsif bozuklukta transkranyal manyetik uyarım ve bilişsel-davranışçı terapinin birlikte kullanımı

Objective: A non-negligible percentage of patients with obsessive-compulsive disorder (OCD) do not respond satisfactorily to treatments. Inpatient cognitive-behavioral therapy (CBT) has provided some relief in even refractory and chronic patients. Repetitive transcranial magnetic stimulation (rTMS) has also provided promising results. However, no studies have combined these two strategies. Methods: Eighteen patients with treatment resistant and chronic OCD who had been hospitalized in order to receive pharmacotherapy, inpatient CBT and rTMS were evaluated on the Yale-Brown Obsession and Compulsion Scale (Y-BOCS) and the Hamilton Depression Rating Scale-17 (HDRS-17). rTMS was applied every day over the left dorsolateral prefrontal cortex for 5 days in a week with parameters of 25 Hz and 1000 pulses. Results: Y-BOCS scores decreased by 59.14%; from 30.72 ± 6.12 at admission to 12.55 ± 7.44 when discharged. HDRS-17 scores decreased by 56.80%; from 18.38 ± 3.94 at admission to 7.94 ± 5.70 at discharge. The mean numbers of rTMS and CBT sessions were 23.28 ± 6.78 and 17.17 ± 5.04 respectively. Discussion: The combination of pharmacotherapy, CBT and rTMS may be effective in treatment resistant and chronic OCD in the short term

Benzodiazepine prescription patterns of psychiatry and non-psychiatry residents and specialists

Objective: The aim of this study was to evaluate the thoughts aboutusing benzodiazepines in the treatment and the prescription patterns ofpsychiatry and non-psychiatry residents and specialists in Turkey.Method: Total number of 169 residents and specialists from both rural(city/town) and urban (metropolis) regions, who have been attending anational congress, were assigned to the study. A questionnaire formincluding items about sociodemographic and occupational properties ofthe physicians, pharmacodynamics and pharmacokinetics ofbenzodiazepines, with open and closed-end questions were completedby the volunteering physicians. Results: Anxiety disorders were found tobe the most frequent (89%) indication for benzodiazepine prescription.Twenty five percent of physicians other than psychiatrists usedbenzodiazepines for patients with a clinical presentation of somatization(p<0.001). The usage for indications of depression and anxiety werefound to be more frequent in rural areas (p=0.009, p=0.03), deliriumtremens and EPS, in urban areas, respectively (p=0.04, p=0.001). 11-50%of physicians were knowledgeable about features such as euphorizanside effects, being abused by the patients who do not abuse otherpsychoactive substances, and need to avoid benzodiazepines to thepatients abusing alcohol. There were significant differences about thoseitems among psychiatrists at the urban and rural regions at the level ofp<0.05. Conclusion: The pattern of benzodiazepine prescription seemsto be closely related with some characteristic features of the physician,geographical and regional differences. It is noteworthy to say thatpsychiatry residents and -to some extent- specialists do not haveenough knowledge about pharmacodynamics and pharmacokinetics ofbenzodiazepines. Physicians other than psychiatrists seemed to haveconfusion about management of somatization disorde

Aripirazole augmentation in clozapine-associated obsessive-compulsive symptoms in schizophrenia.

Objective: Patients with schizophrenia often experience comorbid obsessive-compulsive symptoms. Within these patients, a significant subgroup developed secondary obsessive-compulsive symptoms during treatment with clozapine. Method: In this paper, we report on four cases in which adjunctive therapy with aripiprazole was tested to alleviate obsessive-compulsive symptoms in schizophrenia. Results: All four patients had a significant improvement in obsessive-compulsive symptoms. The combination of clozapine and aripiprazole was well tolerated. Conclusion: This case series demonstrates the clinical efficacy of aripiprazole adjunctive therapy with clozapine in schizophrenic patients with comorbid obsessive-compulsive symptoms. Larger-sampled and controlled studies are required in order to test and confirm these observations

Extended-release trazodone in the treatment of major depressive disorder

###EgeUn###Major depressive disorder is a common psychiatric disorder. The aim of the treatment is to improve daily functions with remissions in symptoms, and antidepressants are the first-line treatments for a major depressive episode (moderate-severe depressive episode). In this paper, the pharmacological properties, clinical efficacy and safety of extended-release trazodone (TzCOAD) are studied. Expert opinion: A single daily dose of TzCOAD may provide similar efficacy and increased tolerability to immediate-release trazodone (TzIR) and other antidepressants