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10 results

  • Adjunctive therapeutic strategies in Obsessive-Compulsive Disorder resistant to serotonin reuptake inhibitors: a literature review

  • P. Regueira, S. Hall, J. Cerejeira
  • Journal:
    European Psychiatry / Volume 65 / Issue S1 / June 2022
    Published online by Cambridge University Press:
    01 September 2022, p. S645
    • Article
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  • Introduction

    Obsessive-Compulsive Disorder (OCD) is a common mental disorder and a major cause of disability worldwide. Typically, it has a chronic course, marked by recurrent intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Its pharmacological first line of treatment has been well established for several years now, with the Serotonin Reuptake Inhibitors (SRIs). However, about half of the patients are resistant to this approach, representing a therapeutic challenge for clinicians. Evidence suggests that other medications can augment SRIs, enhancing its effects and achieving a bigger efficacy in these patients’ treatment. Also, there is an increasing interest in neurosurgical interventions in these patients.

    Objectives

    The main goal of this work was to assess the clinical efficacy of adjunctive therapeutic strategies in patients with OCD resistant to SRIs.

    Methods

    A literature review was conducted searching PubMed and ScienceDirect databases from the 1st of January 2000 to the 1st of September 2021 to identify clinical trials comparing an active drug/neurosurgical intervention with placebo as an adjunctive therapeutic strategy in SRI-resistant OCD.

    Results

    Sixteen studies were selected for data extraction, including a total of 585 patients. Risperidone, aripiprazole, N-acetylcysteine, lamotrigine, pindolol, riluzole, memantine and methylphenidate were efficacious for augmenting SRIs in OCD. Ablative surgery (ABL) and deep brain stimulation (DBS) were equal effective in the treatment of refractory OCD.

    Conclusions

    Several therapeutic options presented as potentially effective in OCD when it is resistant to SRIs, although this is still an area for further research.

    Disclosure

    No significant relationships.

  • Chapter 25 - Using Pharmacotherapy to Enhance Stroke Recovery

  • from Part VI - Stroke Rehabilitation and Recovery
  • Edited by Jeffrey L. Saver, Graeme J. Hankey, University of Western Australia, Perth
  • Book:
    Stroke Prevention and Treatment
    Published online:
    15 December 2020
    Print publication:
    10 December 2020, pp 517-531

  • Summary

    Pre-clinical studies provide clear and consistent evidence that a variety of centrally acting drugs affecting specific neurotransmitters can either facilitate or interfere with functional recovery after brain injury. Although at least some clinical trials suggest similar effects in humans, results have been inconsistent. The impact of important factors such as drug dose, duration, and intensity of physiotherapy, and timing between injury and treatment are difficult to translate from preclinical studies. Issues related to variability in stroke severity, location of injury, and comorbid conditions further complicate trial design and could obscure a true treatment effect. Because of these and other issues, the design of efficacy trials assessing putative neuro-restorative interventions is not trivial. Although a proven pharmacological approach resulting in a clinically meaningful improvement in post-stroke recovery remains elusive, it is reasonable to avoid medications that may have harmful effects in patients who have had a stroke. It is also important to control for these possible harmful effects in future clinical trials assessing the outcomes of stroke patients after the acute period.

  • Treatment duration of obsessive compulsive disorder

  • OT Dolberg, I Iancu, J Zohar
  • Journal:
    European Psychiatry / Volume 11 / Issue 8 / 1996
    Published online by Cambridge University Press:
    16 April 2020, pp. 403-406

  • The first breakthrough in the treatment of obsessive-compulsive disorder (OCD) came in 1967, when Fernandez and Lopez-Ibor reported on the efficacy of clomipramine (CMI) in the treatment of 16 patients with OCD (Fernandez and Lopez-Ibor, 1967). However, controlled studies with CMI were not published until 1980 (Montgomery, 1980; Thoren et al, 1980), and only in the last 5 years have large well-controlled studies been published (Clomipramine Collaborative Study, 1991). Several studies demonstrated that among the tricyclics (TCA), only CMI is effective in OCD, while effective antidepressants with a noradrenergic profile, such as desipramine (DMI), appear to be totally ineffective (Zohar and Insel, 1987; Goodman et al, 1990; Leonard et al, 1989). This selective response to TCA with a serotonergic profile led to the formulation of the serotonergic hypothesis of OCD and to the development and use of other serotonergic agents in the treatment of this disorder. Several drugs, possessing a serotonergic profile are currently being studied worldwide, among them CMI, fluoxetine, fluvoxamine, sertraline, paroxetine and citalopram. Currently, as the knowledge regarding the pharmacological approach to OCD is only beginning to accumulate, very little is known regarding treatment duration in OCD. In this review we shall attempt to examine the existing data regarding treatment duration in OCD.

  • Introduction

  • JJ Lopez-Ibor
  • Journal:
    European Psychiatry / Volume 12 / Issue S4 / 1997
    Published online by Cambridge University Press:
    16 April 2020, pp. 283s-284s

  • In the past serendipity and good clinical observation were essential for the discovery of new drug treatments for mental disorders. Today, neurochemical and pharmacological research allows development of compounds starting from hypothesis on the origin of the disorders and the actions of available drugs. The new compounds are cleaner from the pharmacological point of view, more specific and therefore with less undesired effects. Venlafaxine is one of these drugs and provides antidepressant efficacy in a broad range of depressed patients, including the most severe ones, with a good safety and tolerability profile.

  • 28 - Brain imaging

  • from Section 5 - The promise of biomarkers and response prediction
  • Edited by J. John Mann, Columbia University, New York
  • Edited in association with Patrick J. McGrath, Columbia University, New York, Steven P. Roose, Columbia University, New York
  • Book:
    Clinical Handbook for the Management of Mood Disorders
    Published online:
    05 May 2013
    Print publication:
    09 May 2013, pp 358-367

  • Summary

    This chapter focuses on a member of a much larger family of interventions known as cognitive behavior therapy (CBT). Cognitive therapy (CT) was first developed as a time-limited treatment of depression. Dysfunctional cognitions about medication can be modified with CT, and behavioral interventions, such as reminder systems and behavioral plans to overcome obstacles to adherence, can be used. The efficacy of CT has been subjected to hundreds of controlled investigations across a wide range of disorders. CT is the most exhaustively studied psychosocial intervention for depressive disorders. The primary analyses of six subsequent studies, all making greater efforts to ensure that pharmacotherapy was adequately administered, found CT and pharmacotherapy to be comparably effective across 12-16 weeks. It is noteworthy that the two most recent studies used selective serotonin reuptake inhibitors and, hence, have greater generalizability to contemporary practice.

  • Chapter 8 - The neuropsychiatry ofpsychosis and headache

  • Edited by Mark W. Green, Philip R. Muskin
  • Book:
    The Neuropsychiatry of Headache
    Published online:
    05 March 2013
    Print publication:
    07 March 2013, pp 75-94

  • Summary

    This chapter presents information on the background, diagnosis, clinical features, pathophysiology, forms, and precipitating factors of migraine. There are three major approaches to the treatment of migraines. It is often useful to view a migraine as a low threshold for the development of headache. There are three major approaches to the treatment of migraines: non-medication therapies; acute treatment; preventive treatment. Evidence-based guidelines support the use of cognitive behavior therapy. Most preventive agents for migraine are associated with weight gain, and this side effect, along with memory loss and depression, are the most common reasons for rejecting a particular agent. The Food and Drug Administration (FDA) in the United States issued an alert in 2006 that there would be a life-threatening risk when triptans were used in individuals taking selective serotonin reuptake inhibitors and selective serotonin/norepinephrine inhibitors.

  • 11 - Evidence-based pharmacotherapy of nicotine and alcohol dependence

  • Edited by Dan Stein, University of Cape Town, Bernard Lerer, Stephen M. Stahl, University of California, San Diego
  • Book:
    Essential Evidence-Based Psychopharmacology
    Published online:
    05 August 2012
    Print publication:
    05 July 2012, pp 214-234

  • Summary

    This chapter reviews the evidence for first-line treatment of major depressive disorder (MDD), and strategies for patients with treatment-resistant depression. Many trials have investigated the efficacy of selective serotonin reuptake inhibitors (SSRIs) compared with other antidepressants. Patients with MDD are at higher risk of suicide, and guidelines indicate that patients should be assessed for suicide at the start of treatment and regularly over the course of treatment. As augmenting agents, atypical antipsychotics, lithium, and triiodothyronine (T3) have been studied the most extensively, and shown to have benefit. However, their risks and side-effect profiles may make them less attractive to patients, and patient preference and safety should determine treatment decisions for refractory or chronic MDD. The use of biomarkers, including pharmacogenetic testing, may one day provide more accurate predictors of response or adverse outcomes, allowing targeted treatments and the promise of personalized medicine.

  • 18 - Molecular imaging of obsessive–compulsive disorder

  • from Section III - Anxiety Disorders
    • By Martijn Figee, Department of Psychiatry University of Amsterdam Amsterdam, The Netherlands, Jan Booij, Department of Nuclear Medicine University of Amsterdam Amsterdam, The Netherlands, Damiaan Denys, Department of Psychiatry University of Amsterdam Amsterdam, The Netherlands
  • Edited by Martha E. Shenton, Bruce I. Turetsky, University of Pennsylvania
  • Book:
    Understanding Neuropsychiatric Disorders
    Published online:
    10 January 2011
    Print publication:
    09 December 2010, pp 260-273

  • Summary

    Functional imaging studies indicate involvement of the cortico-striatal-thalamic-cortical circuit in Obsessive-compulsive disorder (OCD) pathophysiology. This chapter reviews positron emission tomography (PET) and single photon emission computed tomography (SPECT) binding studies on serotonin and dopamine, and all available 1H magnetic resonance spectroscopy (1H MRS) research into glutamate levels in OCD. It combines these findings into a pathophysiological model for dysfunctional neurotransmission in OCD. Eight studies have investigated serotonergic neurotransmission in OCD, by comparing the availability of serotonin transporter (SERT) or 5-HT2a receptors between patients and healthy controls. Five studies used 1H MRS to estimate brain levels of glutamate in OCD patients and healthy controls, including one study that performed measures before and after serotonin reuptake inhibitors (SRI) treatment. Results from SPECT and PET binding studies suggest that OCD is related to decreased presynaptic SERT availability in thalamic and midbrain-pons regions, along with increased post-synaptic 5-HT2a receptor availability in cortical areas.

  • Appendix I: - Treatment Guidelines

  • Edited by Elias Aboujaoude, Stanford University School of Medicine, California, Lorrin M. Koran, Stanford University School of Medicine, California
  • Book:
    Impulse Control Disorders
    Published online:
    06 July 2010
    Print publication:
    08 February 2010, pp 275-279

  • Summary

    This chapter deals with clinical aspects of problematic Internet use. It suggests that formal diagnostic criteria would enhance recognition of and research regarding problematic Internet use. Factor analysis extracted six factors from the Internet Addiction Test (IAT): salience, excessive use, neglect of work, anticipation, lack of control, and neglect of social life. These six factors strongly correlated with each other and showed good to moderate internal consistency. Caplan has described the Generalized Problematic Internet Use Scale (GPIUS), which was reliable and valid in a preliminary study. Patients' Internet use often appears to become problematic soon after they first use the Internet, possibly within 6 months to a year a time when they feel intimidated as well as fascinated by the new technology. Problematic Internet use may respond to serotonin reuptake inhibitors, although larger and longer controlled trials are needed to investigate this possibility.

  • 21 - Diagnosis and Treatment of Male Ejaculatory Dysfunction

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 187-192

  • Summary

    Encompassing a broad spectrum of conditions, ejaculatory dysfunction (EjD) includes premature ejaculation (PE), anejaculation(AE), and retrograde ejaculation (RE). This chapter discusses the incidence rate, diagnosis methods and treatment options available for treating EjD. Behavioral/psychological treatments, topical anesthetic agents, serotonin reuptake inhibitors (SSRIS) and phosphodiesterase (PDE)-5 inhibitors are the treatment options available for PE. Penile vibratory stimulation, electroejaculation, and surgical sperm extraction from the epididymis or testes are all successful methods for obtaining sperm for later use with ART in AE where the success rates of other methods are low. Common causes of RE can be categorized as anatomic, neurogenic, pharmacological, or idiopathic in origin. Anticholinergics, alpha-adrenergic agonists, or similar combinations may be used to modulate bladder neck activity but are not as effective as imipramine, which should be considered the first-line therapeutic agent for RE.