Clinical issues in the use of carbamazepine in psychiatry: a review

SynopsisEvidence is presented here in support of the efficacy of carbamazepine (CBZ) in a variety of different psychiatric conditions. While there is now considerable evidence to support the use of CBZ in the acute treatment of mania and in the prophylaxis of bipolar affective disorder, particularly as a second-line drug, its usefulness in other conditions is less well documented. Overactivity, aggression and poor impulse control appear to improve in a variety of different diagnostic categories, and it may possibly be more appropriately prescribed to control or prevent these symptoms than as a treatment for a particular disease entity. The use of CBZ as an antidepressant is not well proven. Most of the adverse effects reported are due to rapid initial escalation of dosage, which can be avoided, or are reversible such as drug rashes. Severe adverse effects have been reported but are rare. Frequent monitoring of drug plasma concentration is not required. Some reports of synergism with lithium have appeared and combination therapy may be a useful strategy. Drug interactions, the need for clinical monitoring, and the possible pharmacological mode of action of CBZ are also discussed.

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Aripiprazole as a risk factor for impulse control disorders: a systematic review

BJPsych Open ◽

10.1192/bjo.2021.795 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S300-S301

Author(s):

Benjamin Williams ◽

Kishen Neelam ◽

Saumya Singh

Keyword(s):

Systematic Review ◽

Adverse Drug Reaction ◽

Drug Reaction ◽

Dopamine Agonist ◽

Impulse Control ◽

Bipolar Affective Disorder ◽

Impulse Control Disorders ◽

Risk Of Bias ◽

Potential Association ◽

Increased Risk

AimsAripiprazole is an anti-psychotic medication widely used for bipolar affective disorder and depression. It's primary mechanism of action is as a partial dopamine agonist. Aripiprazole's effect on dopamine signalling in the mesolimbic and mesocortical pathways may lead to impulse control disorders, as seen with other dopamine agonist medications. Aripiprazole is often chosen by prescribers because of its favourable side effect profile. There is a need to synthesise the available epidemiological literature on the potential association between aripiprazole use and impulse control disorders. This is needed to inform patients and prescribers of the best available evidence regarding this potential association. Our aim is to conduct a systematic review of the available non case-study evidence on the potential association between aripiprazole and impulse control disorders.MethodDatabases were searched using MEDLINE, PsychINFO, EMBASE, Cochrane Clinical Trials and Web of science. All studies from no earliest date to December 2020 were included; adult patients with a severe and enduring mental illness prescribed antipsychotic medication were included. Cinician diagnosis, structured interview diagnosis, and interviewer or self-completion questionnaires were used to measure prevalence. The study designs included were experimental designs, cohort study, cross-sectional survey and administrative databases. Exclusion criteria being those with traumatic brain injury, psychosis secondary to autoimmune, iatrogenic, chromosomal or metabolic disorder, those with Learning disability or Autistic Spectrum disorders. studies with majority of participants <18yrs. Those who were on other antipsychotic medications in addition to Aripiprazole, were excluded. To ensure quality assurance, we used ROBINS-I tool and GRADE assessment to measure the risk of bias.Result240 records were retrieved, 187 after duplicates were removed. 8 full text articles were assessed for eligibility, of which 4 were included in the qualitative synthesis. 2 studies were analyses of spontaneous adverse drug reaction reporting systems and 2 of health insurance claims databases. All 4 studies found aripiprazole to be associated with greater risk of impulse control disorders. The single study which compared directly with other antipsychotics had a much smaller effect size. Study heterogeneity precluded meta-analysis. All studies were at high risk of bias. The quality of evidence is very low.ConclusionThe available evidence is consistent with the existing warnings regarding increased risk of impulse control disorders in patients prescribed aripiprazole. Clinicians may wish to monitor for this adverse drug reaction. Further research which can account for potential confounders, examines specific impulse control disorders and which is less susceptible to detection and ascertainment biases is required.

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Neuropsychiatric consultation in mentally retarded patients: a clinical report

European Psychiatry ◽

10.1016/s0924-9338(97)83298-1 ◽

1997 ◽

Vol 12 (5) ◽

pp. 242-248 ◽

Cited By ~ 13

Author(s):

WMA Verhoeven ◽

S Tuinier

Keyword(s):

Impulse Control ◽

Bipolar Affective Disorder ◽

Mentally Retarded ◽

Pharmacological Intervention ◽

Clinical Report ◽

Specific Syndrome ◽

Somatic Comorbidity ◽

Behavioural Condition ◽

Icd 10 ◽

Atypical Autism

SummaryThe present study describes the results of neuropsychiatric consultations in 70 institutionalized mentally retarded patients. On the basis of their major complaint, patients were assigned to eight overlapping categories. Diagnoses of a certain probability were established during multidisciplinary consensus meetings and classification was achieved according to ICD-10 criteria. In ten patients mental retardation was related to a specific syndrome; seizures or somatic comorbidity were present in 40 patients. The most frequent psychiatric diagnoses were: unspecified bipolar affective disorder (n = 14), depressive disorder (n = 6), impulse control disorder (n = 12), cycloid, transient, or schizoaffective psychotic disorder (n = 14), and (atypical) autism (n = 7). Recent history revealed a high occurrence of serious side effects of psychotropics or pharmacokinetic interactions. Appropriate pharmacological intervention resulted in an amelioration of the behavioural condition in about half of the patients. It is emphasized that psychiatric disorders frequently present with an atypical psychopathology and that stress- and anxiety-related disorders are most probably underdiagnosed.

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Prevalence and Severity of Psychiatric Comorbidities

10.1093/med/9780190625085.003.0020 ◽

2018 ◽

Author(s):

Stephanie Yarnell ◽

Ellen Edens

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Impulse Control ◽

Clinical Case ◽

Psychiatric Comorbidities ◽

National Comorbidity Survey Replication ◽

Psychiatric Conditions ◽

Study Intervention ◽

Landmark Study

Chapter 20—The Prevalence and Severity of Psychiatric Comorbidities provides a summary of a landmark study in epidemiology, the The National Comorbidity Survey Replication (NCS-R). This chapter study sought to answer some fundamental questions. How common are comorbid psychiatric conditions? What are the prevalence and severity rates for comorbid anxiety, mood, impulse control, and substance use disorders? Starting with these questions, this chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

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Doses of carbamazepine and valproate in bipolar affective disorder

Psychiatric Bulletin ◽

10.1192/pb.21.4.221 ◽

1997 ◽

Vol 21 (4) ◽

pp. 221-223 ◽

Cited By ~ 10

Author(s):

David Taylor ◽

Denise Duncan

Keyword(s):

Affective Disorder ◽

Acute Treatment ◽

Bipolar Affective Disorder ◽

Depressive Illness ◽

British National Formulary ◽

National Formulary ◽

Manic Depressive Illness ◽

Manic Depressive ◽

The Uk

Carbamazepine and valproate are now well established treatments for bipolar affective disorder (BAD). Both drugs are used in the acute treatment of mania and, more frequently, as longer-term mood stabilisers. The British National Formulary (BNF, Vol. 32, 1996) provides information on the use of carbamazepine in the ‘prophylaxis of manic depressive illness' and suggests that the ‘usual range’ of doses is between 400 mg and 600 mg daily. No guidance on the use of valproate in BAD is given in the BNF because the drug is not licensed for this indication in the UK.

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Sumatriptan: A Selective 5-Hydroxytryptamine Receptor Agonist for the Acute Treatment of Migraine

Annals of Pharmacotherapy ◽

10.1177/106002809202600611 ◽

1992 ◽

Vol 26 (6) ◽

pp. 800-808 ◽

Cited By ~ 7

Author(s):

Terence Fullerton ◽

Fran M. Gengo

Keyword(s):

Clinical Trials ◽

Adverse Effects ◽

Drug Interactions ◽

Clinical Efficacy ◽

Clinical Studies ◽

Acute Treatment ◽

English Language ◽

Headache Severity ◽

Severity Scores ◽

Headache Recurrence

OBJECTIVE: The clinical pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and associated drug interactions of the novel antimigraine drug sumatriptan are reviewed. DATA SOURCES: English-language publications pertaining to sumatriptan were identified via a search of the MEDLINE computerized database. STUDY SELECTION: Open and controlled clinical studies were reviewed in assessing clinical efficacy, although only the results of controlled, randomized trials form the basis for the conclusions pertaining to the effectiveness of sumatriptan. DATA EXTRACTION: The primary measure of drug effectiveness in all clinical studies was significant improvement in headache severity scores. Secondary measures included functional ability, time to relief, rescue medication use, associated symptoms of nausea/vomiting and photo/phonophobia, and, in some studies, headache recurrence rate. These data were obtained from each published clinical trial and used in the overall analysis of sumatriptan efficacy. DATA SYNTHESIS: Sumatriptan is a serotonin agonist that has been studied for the acute treatment of migraine and cluster headache. The drug appears to work via specific serotonin receptors to mediate selective vasoconstriction within the cranial vasculature and to prevent the release of inflammatory mediators from trigeminal nerve terminals. The recommended dose of sumatriptan is 6 mg given subcutaneously at the onset of headache; an oral formulation is under investigation. In the published clinical trials of the oral and subcutaneous dosage forms to date, sumatriptan was effective in reducing headache severity from moderate/severe to mild/absent in approximately 70–80 percent of patients treated with active drug, compared with only 20–30 percent in the placebo groups, and 48 percent in the oral ergotamine tartrate/caffeine (Cafergot)-treated group. Secondary measures of effectiveness also favored sumatriptan. There may be a higher rate of headache recurrence with sumatriptan compared with placebo or Cafergot, although further study is necessary to confirm this observation. Adverse effects associated with sumatriptan administration generally were mild and transient and included tingling, warm/hot sensations, and pressure and tightness in the chest and neck. No significant drug interactions have yet been identified. CONCLUSIONS: Sumatriptan appears to represent a safe and effective alternative to the ergot alkaloids for the abortive treatment of acute migraine. However, further clinical trials, especially those yielding comparative data with current antimigraine agents, are needed to determine the full therapeutic contribution of sumatriptan.

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Obsessive-compulsive spectrum disorders

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2003.5.3/aallen ◽

2003 ◽

Vol 5 (3) ◽

pp. 259-271

Keyword(s):

Impulse Control ◽

Body Dysmorphic Disorder ◽

Patient Characteristics ◽

Autism Spectrum ◽

Sexual Compulsivity ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Diagnostic Categories ◽

Spectrum Disorders ◽

Fruitful Research

The obsessive-compulsive spectrum is an important concept referring to a number of disorders drawn from several diagnostic categories that share core obsessive-compulsive features. These disorders can be grouped by the focus of their symptoms: bodily preoccupation, impulse control, or neurological disorders. Although the disorders are clearly distinct from one another, they have intriguing similarities in phenomenology, etiology, pathophysiology, patient characteristics, and treatment response. In combination with the knowledge gained through many years of research on obsessive-compulsive disorder (OCD), the concept of a spectrum has generated much fruitful research on the spectrum disorders. It has become apparent that these disorders can also be viewed as being on a continuum of compulsivity to impulsivity, characterized by harm avoidance at the compulsive end and risk seeking at the impulsive end. The compulsive and impulsive disorders differ in systematic ways that are just beginning to be understood. Here, we review these concepts and several representative obsessive-compulsive spectrum disorders including both compulsive and impulsive disorders, as well as the three different symptom clusters: OCD, body dysmorphic disorder, pathological gambling, sexual compulsivity, and autism spectrum disorders.

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Peran Spiritual Emotional Freedom Technique dalam Penanganan Nosocomephobia

ESOTERIK ◽

10.21043/esoterik.v5i2.6514 ◽

2019 ◽

Vol 5 (2) ◽

pp. 282

Author(s):

Rinova Cahyandari

Keyword(s):

Data Collection ◽

Adverse Effects ◽

Anxiety Disorders ◽

Hospital Anxiety ◽

Risk Of Death ◽

Before And After ◽

Psychiatric Conditions

The Role of Spiritual Emotional Freedom Technique in Handling Nosocomephobia. This article aims to find out how the role of SEFT in dealing with psychiatric conditions, namely in cases of anxiety disorders, especially in hospital anxiety (nosocomephobia). Nosocomephobia can be defined as excessive fear associated with hospitals. Efforts to manage nosocomephobia become very important to do because in general patients with nosocomepobia will refuse to go to the hospital and as a result, adverse effects include the risk of death. The data collection in this article was obtained through the subject's statement regarding judgments related to anxiety that arises. Analysis of the data in this article is done by comparing the level of anxiety before and after therapy. The result showed a decrease in judgment related to the condition of perceived anxiety. The success of SEFT in reducing anxiety can be influenced by the existence of faith, solemnity, sincerity, resignation, and grateful to Allah Swt.

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HIV infection and its psychiatric manifestations: A clinical overview

BJPsych Advances ◽

10.1192/apt.bp.116.016311 ◽

2017 ◽

Vol 23 (4) ◽

pp. 265-277 ◽

Cited By ~ 1

Author(s):

Mark Jonathan Knights ◽

Alexandros Chatziagorakis ◽

Surendra Kumar Buggineni

Keyword(s):

Life Expectancy ◽

Hiv Infection ◽

Highly Active Antiretroviral Therapy ◽

Psychiatric Symptoms ◽

Bipolar Affective Disorder ◽

Adjustment Disorder ◽

Hiv Positive ◽

Highly Active ◽

Psychiatric Conditions ◽

Psychiatric Manifestations

SummaryHighly active antiretroviral therapy (HAART) has led to a reduction in HIV-related morbidity and mortality, and the life expectancy of HIV-positive individuals has improved significantly. It is therefore becoming more likely that clinicians will encounter patients with psychiatric manifestations of the disease. This review summarises the evidence on prevalence, manifestations and treatment of psychiatric conditions in HIV-positive adults. The most prevalent psychiatric illness in this population is depression (35.6%), followed by substance misuse, anxiety, psychosis, adjustment disorder and bipolar affective disorder. Neurocognitive impairment is also common, ranging in severity from asymptomatic (the most frequent) to dementia (the least frequent). Effective treatment of both HIV and psychiatric manifestations is essential to maximising life expectancy and quality of life.Learning Objectives• Comprehend the prevalence, manifestations and treatment of psychiatric conditions in HIV-positive individuals• Learn about the HIV-associated neurocognitive disorders• Develop an understanding of the relationship between HIV infection and psychiatric symptoms

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Brain Dysfunctions, Psychopathologies, and Body Image Distortions

European Psychologist ◽

10.1027/1016-9040/a000203 ◽

2015 ◽

Vol 20 (1) ◽

pp. 72-81 ◽

Cited By ~ 3

Author(s):

Christine Mohr ◽

Sabrina Messina

Keyword(s):

Eating Disorder ◽

Impulse Control ◽

Body Dysmorphic Disorder ◽

Brain Network ◽

Obsessive Compulsive ◽

Esthetic Surgery ◽

Compulsive Disorder ◽

Diagnostic Categories ◽

Food Body ◽

The Right

The major features in eating disorders are a preoccupation with food and its consumption and body dissatisfaction. Diagnostic manuals provide clusters of criteria according to which affected individuals can be categorized into one or other group of eating disorder. Yet, when considering the high proportion of comorbidities and ignoring the content of the symptoms (food, body), the major features seem to yield obsessional-compulsive, addictive, and impulsive qualities. In the present article, we review studies from the neuroscientific literature (mainly lesion studies) on eating disorder, obsessive-compulsive disorder, impulse control disorder, and addiction to investigate the possibility of a wider phenotype that can be related to a common brain network. The literature localizes this network to the right frontal lobe and its connectivities. This network, when dysfunctional, might result in a behavior that favors the preoccupation with particular thoughts, behaviors, anxieties, and uncontrollable urges that are accompanied by little scope for ongoing behavioral adjustments (e.g., impulse control). We reason that this network may turn out to be equally involved in understudied mental conditions of dysfunctional body processing such as muscle dysmorphia, body dysmorphic disorder (including esthetic surgery), and xelomelia. We finally consider previous notions of a wider phenotype approach to current diagnostic practice (using DSM), such as the possibility of a model with a reduced number of diagnostic categories and primary and secondary factors, and to etiological models of mental health conditions.

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