scholarly journals Detailing the effects of polypharmacy in psychiatry: longitudinal study of 320 patients hospitalized for depression or schizophrenia

2021 ◽  
Author(s):  
H. H. Stassen ◽  
S. Bachmann ◽  
R. Bridler ◽  
K. Cattapan ◽  
D. Herzig ◽  
...  
Keyword(s):  
Side Effects ◽  
Time Course ◽  
Adverse Reactions ◽  
Previous History ◽  
Depression Scale ◽  
Mood Stabilizers ◽  
Hamilton Depression Scale ◽  
Adverse Side Effects ◽  
Natural Time ◽  
Icd 10

AbstractCurrent treatment standards in psychiatry are oriented towards polypharmacy, that is, patients receive combinations of several antidepressants, antipsychotics, mood stabilizers, anxiolytics, hypnotics, antihistamines, and anticholinergics, along with other somatic treatments. In tandem with the beneficial effects of psychopharmacological drug treatment, patients experience significant adverse reactions which appear to have become more frequent and more severe with the rise of ubiquitous polypharmacy. In this study, we aimed to assess today’s acute inpatient treatment of depressive and schizophrenic disorders with focus on therapeutic strategies, medications, adverse side effects, time course of recovery, and efficacy of treatments. Of particular interest was the weighing of the benefits and drawbacks of polypharmacy regimens. We recruited a total of 320 patients hospitalized at three residential mental health treatment centers with a diagnosis of either schizophrenic (ICD-10: “F2x.x”; n = 94; “F2 patients”) or depressive disorders (ICD-10: “F3x.x”; n = 226; “F3 patients”). The study protocol included (1) assessment of previous history by means of the SADS Syndrome Check List SSCL-16 (lifetime version); (2) repeated measurements over 5 weeks assessing the time course of improvement by the Hamilton Depression Scale HAM-D and the Positive and Negative Syndrome Scale PANSS, along with medications and adverse side effects through the Medication and Side Effects Inventory MEDIS; and (3) the collection of blood samples from which DNA and serum were extracted. Polypharmacy was by far the most common treatment regimen (85%) in this study. On average, patients received 4.50 ± 2.68 medications, consisting of 3.30 ± 1.84 psychotropic drugs, plus 0.79 ± 1.13 medications that alleviate adverse side effects, plus 0.41 ± 0.89 other somatic medications. The treating psychiatrists appeared to be the main determining factor in this context, while «previous history» and «severity at baseline» played a minor role, if at all. Adverse drug reactions were found to be an inherent component of polypharmacy and tended to have a 2–3 times higher incidence compared to monotherapy. Severe adverse reactions could not be attributed to a particular drug or drug combination. Rather, the empirical data suggested that severe side effects can be triggered by virtually all combinations of drugs, provided patients have a respective vulnerability. In terms of efficacy, there were no advantages of polypharmacy over monotherapy. The results of this study underlined the fact that polypharmacy regimens are not equally suited for every patient. Specifically, such regimens appeared to have a negative impact on treatment outcome and to obfuscate the “natural” time course of recovery through a multitude of interfering factors. Evidence clearly speaks against starting just every therapeutic intervention in psychiatry with a combination of psychopharmaceuticals. We think that it is time for psychiatry to reconsider its treatment strategies, which are far too one-sidedly fixated on psychopharmacology and pay far too little attention to alternative approaches, especially in mild cases where psychotherapy without concurrent medication should still be an option. Also, regular exercises and sports can definitely be an effective therapeutic means in a considerable number of cases. General practitioners (GPs) are particularly in demand here.

Depressive Mixed States: Symptomatology, Prevalence and Principles of Treatment

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
W. Drozdz ◽  
A. Borkowska
Keyword(s):  
Affective Disorders ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Depression Scale ◽  
Assessment Tools ◽  
The Other ◽  
Mood Stabilizers ◽  
Hamilton Depression Scale ◽  
Principles Of Treatment ◽  
Bipolar Patients

Current diagnostic systems (DSM-IV-TR and ICD-10) do not include depressive mixed state (DMS) as a separate category. However, both historical descriptions and data from recent research clearly indicate that cooccurrence of (hypo)maniacal and depressive symptoms is standard in clinical picture of affective disorders. Most frequently employed criterion for DMS is the presence of at least three symptoms of (hypo)mania for 7 days during a major depressive episode. Not only formal diagnostic criteria for DMS are lacking but also psychometric assessment tools (for example the Hamilton Depression Scale or the MADRS) were designed around the features of “classical” depression. The other obstacles to recognize DMS could be lack of insight into the (hypo)maniacal symptoms in patients and cognitive dysfunctions present during an episode. On the other hand, newly created instrument, the Bipolar Depression Rating Scale, may assist clinical evaluation of DMS. Despite predominating depressive symptomatology, the principles of treatment of DMS suggest avoidance of antidepressant monotherapy in favor of mood stabilizers' administration. Actually DMS may emerge as a complication of antidepressant monotherapy in some bipolar patients or may be induced with interferon-alpha treatment in some chronic hepatitis C patients. Important consequences of both spontaneous and drug-induced DMS could be the roughening of affective symptomatology, resistance to antidepressants and the increase of suicidality. Thorough appraisal of symptoms seen in patients with affective disorders for indicators of DMS could have critical consequences for functional outcomes.

scholarly journals Amitriptyline or Not, That Is the Question: Pharmacogenetic Testing of CYP2D6 and CYP2C19 Identifies Patients with Low or High Risk for Side Effects in Amitriptyline Therapy

2005 ◽  
Vol 51 (2) ◽  
pp. 376-385 ◽  
Author(s):  
Werner Steimer ◽  
Konstanze Zöpf ◽  
Silvia von Amelunxen ◽  
Herbert Pfeiffer ◽  
Julia Bachofer ◽  
...  
Keyword(s):  
Side Effects ◽  
High Risk ◽  
Case Reports ◽  
Depression Scale ◽  
Therapy Response ◽  
High Risk Group ◽  
Fixed Dose ◽  
Hamilton Depression Scale ◽  
Pharmacogenetic Testing ◽  
Drug Concentrations

Abstract Background: Amitriptyline has been replaced in many countries by alternative and more expensive drugs based on claims of improved tolerability and toxicity and despite slightly reduced efficacy. Preliminary studies indicate that adverse effects could be linked to polymorphisms of drug-metabolizing enzymes, but information on their clinical impact remains scanty and includes mainly case reports. We conducted a prospective blinded two-center study seeking correlations between CYP2C19 and CYP2D6 genotypes, drug concentrations, adverse events, and therapy response. Methods: Fifty Caucasian inpatients with at least medium-grade depressive disorder received amitriptyline at a fixed dose of 75 mg twice a day. Blood samples for concentration monitoring of amitriptyline and nortriptyline were taken weekly until discharge along with evaluations of depression (Hamilton Depression Scale and Clinical Global Impression Scale) and side effect (Dosage Record and Treatment Emergent Symptoms Scale; DOTES) scores. Results: In a ROC analysis, nortriptyline but not amitriptyline concentrations correlated with side effects (DOTES sum score ≥5; area under the curve, 0.733; P = 0.008). Carriers of two functional CYP2D6 alleles had a significantly lower risk of side effects than carriers of only one functional allele (12.1% vs 76.5%; P = 0.00001). The lowest risk was observed for carriers of two functional CYP2D6 alleles combined with only one functional CYP2C19 allele [0 of 13 (0%) vs 9 of 11 (81.8%) for the high-risk group; P = 0.00004]. We found no correlations between drug concentrations or genotypes and therapeutic response. Conclusions: Combined pharmacogenetic testing for CYP2D6 and CYP2C19 identifies patients with low risk for side effects in amitriptyline therapy and could possibly be used to individualize antidepressive regimens and reduce treatment cost. Identification of genotypes associated with slightly reduced intermediate metabolism may be more important than currently anticipated. It could also be the key to demonstrating cost-effectiveness for CYP2D6 genotyping in critical dose drugs.

scholarly journals Efficacy and safety of Xiaoyao pills for mild to moderate depression: study protocol for a randomized controlled trial

Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Zhe Xue ◽  
Zhen Huang ◽  
Shu-li Cheng ◽  
Xi-hong Wang ◽  
Xuan Zhou ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Adverse Reactions ◽  
Controlled Trial ◽  
Depression Scale ◽  
Secondary Outcome ◽  
Controlled Clinical Trial ◽  
Hamilton Depression Scale ◽  
Efficacy And Safety ◽  
Moderate Depression

Abstract Background Depression is one of the most frequent and severe psychiatric conditions. Many chemical drugs to treat depression are associated with adverse reactions and have shortcomings. Traditional Chinese medicine is of great significance in the prevention and treatment of depression. Xiaoyao pills has achieved good results in clinical application, which has the advantages of quick effect and no obvious adverse reactions. The aim of our study is to evaluate the efficacy and safety of Xiaoyao pills on mild to moderate depression patients. Methods This study is a multi-centre, double-blinded, randomized and placebo-controlled clinical trial. A total of 108 participants are assigned to three groups: Xiaoyao pill group taking Xiaoyao pills twice daily for 4 weeks, placebo group taking placebos twice daily for 4 weeks and normal group without taking any drug. The primary and secondary outcome measures are the Hamilton Depression Scale (HAMD) and Traditional Chinese Medicine (TCM) Syndrome Scale. The assessment is at baseline (before treatment initiation), 1 week, 2 weeks 4 weeks after the first treatment. Exploratory outcome is also assessed to explore the mechanism of Xiaoyao pills at baseline and 4 weeks. Discussion The results from this study will provide clinical evidence on the efficacy and safety of Xiaoyao pills in patients with mild to moderate depression with syndrome of liver stagnation and spleen deficiency. Trial registration ClinicalTrials.gov ISRCTN12746343. Registered on September 25, 2020.

The internal and external validity of the Major Depression Inventory in measuring severity of depressive states

2003 ◽  
Vol 33 (2) ◽  
pp. 351-356 ◽  
Author(s):  
L. R. OLSEN ◽  
D. V. JENSEN ◽  
V. NOERHOLM ◽  
K. MARTINY ◽  
P. BECH
Keyword(s):  
Major Depression ◽  
External Validity ◽  
Depression Scale ◽  
Internal Validity ◽  
Depressive Illness ◽  
Hamilton Depression Scale ◽  
Major Depression Inventory ◽  
Icd 10 ◽  
Internal And External Validity ◽  
Depressive States

Background. We have developed the Major Depression Inventory (MDI), consisting of 10 items, covering the DSM-IV as well as the ICD-10 symptoms of depressive illness. We aimed to evaluate this as a scale measuring severity of depressive states with reference to both internal and external validity.Method. Patients representing the score range from no depression to marked depression on the Hamilton Depression Scale (HAM-D) completed the MDI. Both classical and modern psychometric methods were applied for the evaluation of validity, including the Rasch analysis.Results. In total, 91 patients were included. The results showed that the MDI had an adequate internal validity in being a unidimensional scale (the total score an appropriate or sufficient statistic). The external validity of the MDI was also confirmed as the total score of the MDI correlated significantly with the HAM-D (Pearson's coefficient 0·86, P[les ]0·01, Spearman 0·80, P[les ]0·01).Conclusion. When used in a sample of patients with different states of depression the MDI has an adequate internal and external validity.

scholarly journals Time course of drug-related treatment-emergent adverse side effects of brivaracetam

2020 ◽  
Vol 111 ◽  
pp. 107212
Author(s):  
Kimford J. Meador ◽  
Cedric Laloyaux ◽  
Sami Elmoufti ◽  
Teresa Gasalla ◽  
Jesse Fishman ◽  
...  
Keyword(s):  
Side Effects ◽  
Time Course ◽  
Adverse Side Effects

Effectiveness and Tolerance of the Hypericum Extract LI 160 Compared to Maprotiline: A Multicenter Double-Blind Study

1994 ◽  
Vol 7 (1_suppl) ◽  
pp. 24-28 ◽  
Author(s):  
G. Harrer ◽  
W.-D. Hübner ◽  
H. Podzuweit
Keyword(s):  
Depression Scale ◽  
Blind Study ◽  
Double Blind Study ◽  
Hamilton Depression Scale ◽  
Double Blind ◽  
Mean Values ◽  
Mouth Dryness ◽  
Treatment Groups ◽  
Icd 10 ◽  
Hypericum Extract

A randomized, double-blind study examining the effectiveness and tolerance of a standardized hypericum preparation when compared to maprotiline was performed in a group of 102 patients with depression, in accordance with ICD-10, F 32.1. The study was conducted in the offices of neurology and psychiatry specialists. The patients received, over a period of 4 weeks, either 3 x 300 mg of the hypericum extract or 3 x 25 mg maprotiline pills of identical appearance. Effectiveness was determined using the Hamilton Depression Scale (HAMD), the Depression Scale according to von Zerssen (D-S), and the Clinical Global Impression Scale (CGI). The total score of the HAMD scale dropped during the 4 weeks of therapy in both treatment groups by about 50%. The mean values of the D-S scale and the CGI scale showed similar results, and after 4 weeks of therapy, no significant differences in either treatment group were noticed. The onset of the effects occurred up to the second week of treatment, but were observed earlier with maprotiline than with the hypericum extract. On the other hand, maprotiline treatment resulted in more cases of tiredness, mouth dryness, and heart complaints.

scholarly journals Efficacy of hyperbaric oxygen combined with escitalopram in depression and its effect on cognitive function

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Kun Mi ◽  
Qiang Guo ◽  
Bao-yan Xu ◽  
Man Wang ◽  
Hao Bi
Keyword(s):  
Cognitive Function ◽  
Hyperbaric Oxygen ◽  
Depression Scale ◽  
Control Group ◽  
Hamilton Depression Scale ◽  
Observation Group ◽  
Creative Commons ◽  
Significant Difference ◽  
Hamd Score ◽  
Icd 10

Objective: To investigate the efficacy of hyperbaric oxygen (HBO) combined with escitalopram in patients with depression and its effect on cognitive function. Methods: From 2016 to 2018, seventy patients with depression aged 18-65 years treated in Affiliated Hospital of Hebei University were selected. Seventy patients with depression meeting the diagnostic criteria of ICD-10 were selected and randomly divided into control group and observation group using a random number table, with 35 patients in each group. The control group was treated with escitalopram, while the observation group was additionally treated with HBO on this basis. The patients were assessed using the Hamilton Depression Scale (HAMD) and Montreal Cognitive Assessment Scale (MoCA) before treatment and two, four and six weeks after treatment. Results: Two weeks after treatment, HAMD score showed a statistically significant difference between the two groups (P < 0.05). No statistically significant differences were found in HAMD score between the two groups four and six weeks after treatment (P > 0.05). Four and six weeks after treatment, MoCA score presented statistically significant differences between the two groups (P < 0.05). Conclusion: Escitalopram combined with HBO in the treatment of depression presents rapid efficacy and a certain effect in improving cognitive function. doi: https://doi.org/10.12669/pjms.37.4.3993 How to cite this:Mi K, Guo Q, Xu BY, Wang M, Bi H. Efficacy of hyperbaric oxygen combined with escitalopram in depression and its effect on cognitive function. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.3993 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Demenz im Zusammenhang mit Diabetes und Familienanamnese Diabetes

2008 ◽  
Vol 27 (S 01) ◽  
pp. S16-S17
Author(s):  
E. Orso ◽  
G. Hajak ◽  
M. Stadlober-Degwerth ◽  
H. Klünemann ◽  
M. Zintl
Keyword(s):  
Diabetes Mellitus ◽  
Depression Scale ◽  
Hamilton Depression Scale ◽  
Körperliche Untersuchung ◽  
Neuropsychologische Testung ◽  
Icd 10 ◽  
Dsm Iv ◽  
Positive Familienanamnese

ZusammenfassungAnliegen: Untersuchung des Zusammenhangs zwischen Diabetes und positiver Familienanamnese Diabetes (jeweils Verwandte ersten und zweiten Grades) bei Demenzpatienten mit Krankheitsbeginn bis zum 70. Lebensjahr. Methode: Eigen- und Fremdanamnese, körperliche Untersuchung, neuropsychologische Testung mittels CERAD und Uhrentest. Beurteilungsskalen waren GDS, Hoehn-Yahr- Stadien, FBI, Hamilton-Depression-Scale. Einteilung der Demenzform anhand Hachinski-/Rosen-Scores, ICD-10-, DSM IV-, NINCDS-ADRDA-, NINDS-AIREN-, ADDTC-, Lund- Manchester-, Neary und McKeith-Kriterien. Zudem metabolisches Laborprofil und ApoE Genotypisierung. Kontrolle waren die kognitiv intakten Lebenspartner. Ergebnisse: Probandenanzahl war n = 213, davon waren n = 35 Kontrollen. Während nur 14,3% der Kontrollen an Diabetes litten, war der Anteil der Diabetiker in der Gruppe der Vaskulären Demenz (VD) mit 36,8% deutlich am höchsten. Der Anteil der Probanden mit vaskulärer Demenz und positiver Familienanamnese Diabetes war im Vergleich zur Kontrollgruppe um 7% erhöht. Schlussfolgerungen: Diabetes mellitus und eine positive Familienanamnese Diabetes mellitus korrelieren besonders stark mit der Entwicklung einer VD. Im Gegensatz zur Demenz vom Alzheimertyp (DAT) ergab sich kein Zusammenhang zwischen Apo ॉ4 und VD. Es besteht ebenfalls keine Beziehung zwischen Apo ॉ4 und Diabetes oder einer positiven Familienanamnese Diabetes.

Effectiveness and Tolerance of the Hypericum Extract LI 160 in Comparison with Imipramine: Randomized Double-Blind Study with 135 Outpatients

1994 ◽  
Vol 7 (1_suppl) ◽  
pp. 19-23 ◽  
Author(s):  
E.-U. Vorbach ◽  
W.-D. Hübner ◽  
K.-H. Arnoldt
Keyword(s):  
Side Effects ◽  
Depression Scale ◽  
Adjustment Disorder ◽  
Double Blind Study ◽  
Hamilton Depression Scale ◽  
Double Blind ◽  
Single Episode ◽  
Treatment Groups ◽  
Safety Parameters ◽  
Hypericum Extract

In a double-blind comparative study, 135 depressed patients were treated in 20 centers. Inclusion diagnoses were typical depressions with single episode (296.2), several episodes (296.3), depressive neurosis (300.4), and adjustment disorder with depressed mood (309.0) in accordance with DSM-III-R. The dosage was 3 x 300 mg hypericum extract LI 160 or 3 x 25 mg imipramine daily. The treatment lasted for 6 weeks. Main assessment criteria were the Hamilton Depression Scale (HAMD), the Depression Scale according to von Zerssen (D-S) and the Clinical Global Impressions (CGI). In both treatment groups, a parallel reduction of the Hamilton score from 20.2 to 8.8 (LI 160, n = 67) or from 19.4 to 10.7 (imipramine, n = 68), and the transformed D-S point values from 39.6 to 27.2 (LI 160) and 39.0 to 29.2 (imipramine) were found. The analysis of CGI revealed comparable results in both treatment groups. Clinically relevant changes of the safety parameters were not found. In the LI 160 group fewer and milder side effects were found as compared to imipramine.

scholarly journals Diagnosis, phenomenology and treatment of poststroke depression

2002 ◽  
Vol 24 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Sergio E Starkstein ◽  
Alicia Lischinsky
Keyword(s):  
Daily Living ◽  
Rating Scales ◽  
Antidepressant Treatment ◽  
Depression Scale ◽  
Preliminary Evidence ◽  
Depression Symptoms ◽  
Hamilton Depression Scale ◽  
Icd 10 ◽  
Post Stroke Depression ◽  
Dsm Iv

Diagnosing depression in stroke patients is a challenge in neuropsychiatry since depression symptoms may overlap neurological deficit signs. The best approach is to assess the presence of depressive symptoms using semi-structured or structured psychiatric interviews, such as the Present State Exam, the Structured Clinical Interview for DSM-IV or the Schedules for Clinical Assessment in Neuropsychiatry. The diagnosis of a depressive syndrome should be made according to standardized diagnostic criteria for mood disorders due to neurological disease such as in the DSM-IV or ICD-10. Depression rating scales such as the Hamilton Depression Scale and the Center for Epidemiologic Scales for Depression may be used to rate the depression severity and monitor the progression of antidepressant treatment. Most studies have reported the effectiveness of pharmacological treatment in patients with post-stroke depression, and there is preliminary evidence that the degree of impairment in activities of daily living (ADL) may improve as well.

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