Selected abstracts

VENLAFAXINE XR IN THE TREATMENT OF ANXIETY

D. HACKETT, Central Nervous System, Clinical Research and Development, wyeth - Ayerst Research, Paris, France.
Objective : To present the results of numerous studies that assessed the efficacy, safety and toleratity of venlafaxine extended release (XR) in treating anxiety disorders, particularly generalized anxiety disorder (GAD)
Method : Efficacy was assessed with the Hamilton Rating Scale for Anxiety, Clinical Global Impressions scale, Hospital Anxiety and Depression scale and other instruments. Standard safety and tolerability assessments were used.
Results : In four placebo-controlled trails, venlafaxine XR was effective in treating anxiety associated with social phobia, obsessive - compulsive disorder and panic disorder.
Conclusion : Venlafaxine XR has both short- and long term efficacy and tolerability in treating symptoms of long term anxiety and co-morbid anxiety and depression, and in achieving remission in GAD patients. These characteristics, combined with early onset of anxiolytic action and dose-response effects, make it a logical choice for treating anxiety occuring alone or co-morbidly with depression

(Acta Psychiatric a Scandinvica 2000 : 102 (Suppl 406) : 30-35).

A TYPICAL ANTIPSYCHOTICS AND WEIGHT GAIN-A SYSTEMATIC REVIEW

D.M. TAYLOR, R. MCASKIL MAUDSLEY HOSPITAL, LONDON,U.K.
Objective : To review systematically data relating to weight changes with atypical antipsychotics.
Method : We conducted A Medline search on October 29-1999 and covered the period 1980-99. All recovered papers were examined for further relevant reports. In addition, we wrote to pharmaceutical manufacturers and 10 practicing clinicians to ask them to provide other relevant reports known to them.
Results : Elighty reports mentioning change in body weight were retrieved. Data relating to weight changes were of variable quality. Weight changes were indicated by a variety of measures. The majority of reports related to short-term changes.
Conclusion : All atypical drugs, with the exception of ziprasidone, have been associated with weight increase. Clozapine seems to have the highest risk of weight gain, followed by olanzapine. There is probably a lower risk with risperidone, sertindole and zotepine and a still lower risk with amisulpride. Ziprasidone appears not to be associated with weight gain in the absence of more compelling data, these rankings must be considered approximate and preliminary. Longer, more robust trials are needed. 

(Acta Psychiatric a Scandinvica 2000 : 101 416-432)

Clozapine and risperidone: combination / augmentation treatment of refractory schizophrenia : a preliminary observation

A.RASKIN. G. KATZ, ZISLIN, H.Y. KNOBLER, R. DURST THE KAR SHAUL MENTAL HEALTH CENTRE, AFFILIATED WITH THE HEBREW UNIVERSITY-HADASSAH MEDICAL SCHOOL, JESRUSALEM, ISREAL
Objectives :Clozapine and risperdone were the fist two antipsychotic drugs of a new class of agents for the pharmacotherapy of schizophrenia. It has been suggested that refractory schizophrenic patients who fail to responds to neither clozapine nor risperidone may respond to a combination / augmentation strategy of both medicaments.
Methods : There cases of individuals with unremittent schizophrenia treated via this combination are presented. Response was evaluated by clinical follow-up and PANSS rating scale.
Results : Good clinical results with no noticeable adverse side effects, ascertained by a reduction from baseline scores of the Positive and negative Syndrome Scale (PANSS) were obtained in all three patients.
Conclusion : The findings from this pilot study suggest this combination as a possible therapeutic approach for treating resistant schizophrenic patients.

(Acta Psychiatrica Scandinvica 2000 : 101 : 334 - 336)

ANTIDEPRESSANT USE PATTERNS IN CLINICAL PRACTICES : COMPARISONS AMONG TRICYCLIC ANTIDEPRESSANTS AND SELECTIVE SEROTONIN REUPTAKE INHIBITORS

J. DONOGHUE SCHOOL OF PHARMACY AND CHEMISTRY, LEVER POOL JOHN MOORES UNIVERSITY, LEVER POOL
Objective : Antidepressant use in clinical practice may differ from that in randomized controlled trials due to the complex interaction between patients, prescribes and the healthcare system.
Method: A review of studies using data from actual clinical practice has found consistent difference in the prescribing patterns of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).
Results : Patients who initiate therapy on SSRIa are more likely to complete a course of adequate dose and duration of antidepressant therapy than patients who initiate therapy on a TCA. Differences in prescribing patterns have also emerged among the most common SSRIs, Fluroxetine, sertaline, and paroxetine that are also consistent over time, settings and countries.
Conclusion : Given that the drugs studied are one constant across all the studies, the antidepressants' underlying pharmacological differences in tolerability and other properties may provide an explanation for differences in prescribing patterns.

Acta Psychiatrica Scandinvica 2000 :(Suppl 403):51-61

A RANDOMIZED, PLACEBO-CONTROLLED 12 MONTHS TRIAL OF DIVALPROEX AND LITHIUM IN TREATMENT OF OUTPATIENTS WITH BIPOLAR I DISORDER

Charles L. Bowden, MD; Joseph R. Calabrese, MD; Susan L. McElory, MD; Laszio Gyulai, MD; Adel Wassef, MD; Frederick Petty, MD, PhD; Harrison G. Pope, jr. MD; James C.Y Chou, MD; Paul E. Keck, Jr, MD; Linda,J. Rhodes, MD; Alan C. Swann, MD; Robert M.A. Hirschfeld, MD; Paricia J. Wozniak, PhD;
Background : Long-term outcome are often poor in patients with bipolar disorder despite treatment; more effective treatments are needed to reduce recurrences and morbidity. This study compared the efficacy of divalproex, lithium, as placebo as prophylatic therapy.
Methods : A randomized, double-blind, parallel-group multicenter study of treatment outcomes was conducted over a 52-week maintenance period. Patients who met the recovery criteria within 3 months of the inset of an index manic episode (N=372) were randomized to maintenance treatment with divalproex, lithium, or placebo in a 2:1:1 ratio, Psychotropic medications were discontined before randomization, except for open-level divalproex or lithium, which were gradually tapered over the first 2 weeks of maintenance treatment. The primary outcome meassurers were time to a manic episode. Secondary measures were time to recurrence of any manic episode, time to depressive episode, average change from baseline in Schedule for effective Disorders and Schizophrenia-change Version subscale scores for depression and mania and Global Assessment of Function scores.
Results : The divalproex group did not differ significantly from the placebo group in time to any mood episode. Divalproex was superior to placebo in terms of lower rates of discontinuation for either a recurrent mood episode or depressive episode. Divalproex was superior to lithium in longer duration of successful prophylaxis in the study and less deterioration in depressive symptoms and Global Assessment Scale scores.
Conclusion : The treatments did not differ significantly on time to recurrence of any mood episode during maintenance therapy. Patients treated with divalproex had better outcomes than those treated with placebo or lithium on several secondary outcome measures.

(Acta gen Scandinvica 2000 : 57:481-489)
ATTENTION-DEFICIT HYPERACTIVITY DISORDER IN CHILDREN AND YOUTH: A QUANTITAVE SYSTEMATIC REVIEW OF THE EFFICACY OF DIFFERENT MANAGEMENT STRATEGIES

ANNE KLASSEN, BA, DPHIL, ANTON MILLER, MBCHB, FRCP2, PARMINDER RANIA, BSC, PHD, SHOO K LEE, M.B.B.S, FRCPC, PHD4, LISE OLSEN, BSN, MHP5
Objective : To obtain esteems of the relative efficacy of 3 main treatment stratergies for attention-deficit hyperactivity disorder (ADHD) in children and youth (age<18 years).
Methods : Design: quantitative systematic review of randomized trails. Subject:999 patients with ADHD from 26 randomized trails. Interventions: medications alone, behavioural interventions alone and a combination of these 2 modalities. Main outcome measure: Differences in scores between treatment groups on commonly used teacher and parent-completed behaviour rating scales.
Results : Medication-only therapy was efficacious in ADHD. Behavioural therapies used alone appeared not to be efficacious in ADHD. Combination therapy was more efficacious than placebo or no treatment for parent but not teacher ratings, not more efficacious than drug therapy alone, and more efficacious than behavioural treatments alone based on parent but not teacher ratings.
Conclusion : Though stimulant medications were found to be an effective treatment strategy for ADHD in children and youth, it proved difficult to assess the relative benefits of behavioural interventions alone and combined medication and behavioural therapy because of the paucity of treatment studies other than medication-only treatment studies and heterogeneity of various kinds that exist in relation to ADHD studies and treatments.

(Can J Psychiatry 1999; 1007-1016)

PSYCHOSOCIAL AND PSYCHIATRIC RISK FACTORS FOR SUICIDE  CASE-CONTROL PSYCHOLOGICAL AUTOPSY STUDY

ANDREW T.A. CHENG, TONY H.H CHEN, CHWEN-CHEN CHEN AND RACHEL JENKINS
Background : Few studies of suicide have simultaneously examined the individual and combined effects of psychosocial and psychiatric risk factors.
Aims :To do so in a representative sample of suicides.
Method : A case-control psychological autopsy was conducted among 113 consecutive suicides 226 living controls matched for age, gender, ethnicity and area of residence in Taiwan.
Results : Five major risk factors (loss event, suicidal behaviour in first-degree relatives, ICD-10 major depressive episode, emotionally unstable personality disorder and substance dependence) were found to have independent effects on suicide from multivariate conditional logistic regression analysis.
Conclusions : Effective intervention and management for loss event and major depressive episode among emotionally unstable subjects with a family tendency of suicidal behaviours , frequently also co-morbid with alcohol or other substance dependence, may prove to be most effective for suicide prevention in different populations.
Declaration of interest: The work was supported by a grant from the National Science Council, Taiwan (NSC79-0301-H002-04/ NSC80-0301-H002-07)

British Journal of Psychiatry (2000,117,360-365).