One hundred and ninety-seven outpatients with atypical depression [Atypical Depression Diagnostic Scale (ADDS) score=4] were randomized to 12 weeks of double-blind treatment with sertraline or moclobemide in a multicentre, parallel-group clinical trial. Patients were started on either 50 mg/day sertraline or 300 mg/day moclobemide. If the therapeutic response was not satisfactoryafter 4 weeks, the dose could be increased to either 100 mg/day sertraline or 450 mg/day moclobemide. Primary effcacy evaluations were the 29-item Hamilton Psychiatric Rating Scale for Depression (HAM-D) and the Clinical Global Impression of Improvement (CGI I) response rate (much or very much improved) at study endpoint. Secondary effcacy evaluations included the ADDS, the Hamilton Anxiety Scale (HAMA), the Leeds Sleep Scale, and the Battelle Quality of Life Battery (BQOLB). In the analysis of the 172 patient effcacy-evaluable population, there was significant baseline to endpoint improvement in all primary and secondary effcacy assessments after treatment with either sertraline or moclobemide. At the endpoint, the proportion of responders on CGI-I, was 77.5% in the sertraline group and 67.5% in the moclobemide group (p=0.052). The baseline to endpoint mean 29-item HAM-D score decreased from 35.9 to 14.5 in the sertraline group and from 36.3 to 16.1 in the moclobemide group. Sertraline also resulted in a significantly (p50.05) greater degree of improvement at the endpoint, compared with moclobemide, in the proportion of remitters on the HAMA (total score47), ADDS Category IID (Rejection Sensitivity), Leeds Sleep Factor 4 (Integrity of Behaviour Following Awakening), and on three dimensions of the BQOLB (Energy/Vitality, Social Interaction and Life Satisfaction). There were no other significant differences between treatment groups. Overall, both medications were well tolerated. In this study, both sertraline and moclobemide improved the symptoms of atypical depression.
A case of delirium acutum in the course of a schizofrenic exacerbation is reported. A short review of the literature dealing with nosological and patophysiological aspects of delirium acutum is given. In this case the patient was treated with neuroleptics and diazepaminfusion for some days, but since his clinical condition rapidly deteriorated electrocovulsive therapy (ECT) was commenced, and after several treatments the patient finally improved. Possible mechanisms for the failure of diazepam in the treatment is discussed. It is concluded that ECT is the treatment of first choice in the case of threatening or fully developed delirium acutum.
Twenty-eight patients with schizophrenia were included in this double-blind crossover study and were randomly assigned to treatment with either sulpiride or haloperidol. The study has demonstrated an antipsychotic effect of sulpiride, not significantly different from that of haloperidol. The dose level used for treatment varied from 800 to 3200 mg sulpiride. Even high doses of sulpiride appeared to induce very few extrapyramidal side effects. The observation of good antipsychotic effect of sulpiride, a neuroleptic that selectively binds to a subpopulation of D-2 dopamine receptors, may call for consideration of the relationship between the dopamine receptors and the antipsychotic mechanisms of action of neuroleptic drugs.
Resumen Varias escalas del observador muy conocidas, incluidas la Escala de Valoración Psiquiátrica de Hamilton para la Depresión (HAM-D), la Escala de Evaluación de la Depresión de Montgomery y Åsberg (MADRS), la Escala de Evaluación de la Depresión Mayor (MDS), la Escala de Melancolía (MES) y el Inventario para Síntomas Depresivos (IDS), utilizadas para medir la gravedad de los estados depresivos, se han comparado con arreglo a su sensibilidad en un ensayo abierto que incluía a pacientes tratados con una combinación de citalopram y mianserina. Los pacientes cumplían los criterios del Manual Diagnóstico y Estadístico (DSM)-IV para episodio depresivo mayor y todos puntuaban 18 o más en la HAM-D antes del tratamiento. El comienzo de la acción antidepresiva se definió como una mejoría en las puntuaciones de la escala de evaluación del 25% o más de las puntuaciones previas al tratamiento. Una respuesta al tratamiento se definió como una reducción de 50% o más en las puntuaciones previas. Los resultados mostraron que el número de días de tratamiento hasta la mejoría fue de 11 a 13, sin diferencia entre las escalas. Los días hasta la respuesta fueron entre 18 y 21, sin diferencia entre las escalas. En conclusión, se encontró que las escalas de depresión eran iguales en cuanto a su capacidad para detectar cambios en los síntomas depresivos durante el tratamiento. La media de días hasta la respuesta fue 19 para la combinación de citalopram y mianserina. Esta respuesta es similar a la obtenida para la combinación de fluoxetina y pinolol.
This multinational, randomized, double-blind study was specifically designed to prospectively compare the onset of antidepressant efficacy of mirtazapine orally disintegrating tablets and sertraline at dosages commonly used in clinical practice. A total of 345 patients with major depressive episode (DSM-IV) received mirtazapine (30–45 mg/d) or sertraline (50–150 mg/d) for 8 weeks. Mirtazapine was administered in the newly developed fast dissolving, orally disintegrating tablet formulation. Assessments were performed at baseline and on days 4, 7, 10, 14, 28, 42, and 56. The primary efficacy variable (mean absolute change from baseline in the Hamilton Depression Rating Scale [HAMD] total score [17 items]) showed that mirtazapine was significantly (P < 0.05) more effective than sertraline at all assessments during the first 2 weeks of the study. After this time, HAMD total scores were similar in both groups. These findings were supported by analysis of the HAMD response rate (ie, ≥50% reduction in HAMD total score from baseline), HAMD remission rate (HAMD total score of ≤7), and the Montgomery-Åsberg Depression Rating Scale (MADRS). Both treatments were well tolerated. In addition, mirtazapine had a greater effect than sertraline on sexual functioning. In conclusion, this first prospective onset of action study using the orally disintegrating tablet indicates that mirtazapine has a faster onset of therapeutic effect than sertraline. The orally disintegrating tablet formulation of mirtazapine used in this study is known to enhance the convenience and compliance by the patient.
ABSTRACT During the last 20 years ethological psychiatric research has developed a working method for the systematic and quantitative recording and analysis of the nonverbal behaviour of psychiatric patients in their actual hospital environment. In this study this method was used to follow changes in the behaviour pattern of 5 depressed, hospitalized patients during their entire hospital stay. Parallel to ethological recording, patients were rated according to Hamilton twice a week. The patients who were most depressed at admission showed the greatest behavioural changes; the changes were most conspicuous in the behavioural elements representing social contact and communication. One patient who obviously developed a new depression during the observation period without this being recognized by the Hamilton rating or the clinical control, seemed to have been better described by the behaviour recording. This study shows that ethological psychiatric methods are very suitable for obtaining a better basis for the observations of the staff in the ward environment.
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