The Journal of clinical psychiatry
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Increased morbidity and mortality in persons with severe mental illness (SMI) are due in large part to preventable medical conditions. An array of factors contributes to the development of obesity and other medical problems, such as diabetes and cardiovascular disease. ⋯ Nonpharmacologic interventions focusing on lifestyle changes can help to prevent and manage psychotropic-associated weight gain. Furthermore, monitoring and treatment guidelines are underutilized in people with SMI; increased use of these guidelines could help to detect and possibly prevent some cardiometabolic problems.
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Aripiprazole is the first of a new generation of antipsychotics that possesses a unique mechanism of action as a partial dopamine agonist. After the release of aripiprazole, case reports appeared conveying an acute psychosis/agitation reaction occurring after the initiation of treatment, most specifically after patients were switched from a previous antipsychotic to aripiprazole. The primary objective of this study was to compare relapse rates among patients with schizophrenia who were switched to aripiprazole with those who switched to a second-generation antipsychotic (SGA) from another antipsychotic. ⋯ Our study found that rates of relapse and time to relapse with aripiprazole were comparable to other SGAs during a 6-month period. Thus, aripiprazole appears to be an appropriate first-line agent along with the other SGAs.
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Randomized Controlled Trial
Escitalopram maintenance treatment for prevention of recurrent depression: a randomized, placebo-controlled trial.
Major depressive disorder is a recurrent illness that often requires maintenance antidepressant treatment. Escitalopram is a selective serotonin reuptake inhibitor (SSRI) that has shown efficacy in both acute and continuation treatment of major depressive disorder. The current trial examined the efficacy of maintenance escitalopram treatment in preventing depression recurrence in patients who responded to acute SSRI therapy. ⋯ Maintenance treatment with escitalopram was well tolerated and significantly reduced the risk for recurrence of depression. Patients with few residual symptoms following continuation treatment with escitalopram experienced a high rate of depression recurrence when switched to placebo, demonstrating the need for maintenance therapy of recurrent major depressive disorder beyond 4 to 6 months of initial symptom resolution even if few residual symptoms are present.
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Randomized Controlled Trial
Association between enhanced soluble CD40 ligand and proinflammatory and prothrombotic states in major depressive disorder: pilot observations on the effects of selective serotonin reuptake inhibitor therapy.
Major depressive disorder (MDD) is associated with low-grade inflammation, and it is considered a risk factor for coronary artery disease (CAD). CD40 ligand (CD40L) plays an important role in inflammation, platelet activation, and clotting system activation. We investigated soluble CD40L (sCD40L) expression in MDD and assessed whether it may represent a molecular mechanism that links inflammation and a prothrombotic state and whether this condition may be modified by selective serotonin reuptake inhibitor (SSRI) therapy. ⋯ This pilot study shows that CD40/ CD40L pathway up-regulation in MDD patients relates increased levels of sCD40L to a prothrombotic state and, preliminarily, indicates that SSRI therapy may significantly reduce sCD40L and CD40L levels associated with proinflammatory and prothrombotic states.