Psychopharmacol Bull
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Major depression is recognized as a common, often chronic and recurrent illness that is associated with significant disability and comorbidity. The treatment of patients with major depressive disorder has advanced tremendously in the past decade as a result of the availability of effective and well-tolerated antidepressants. ⋯ Evidence for the efficacy and tolerability of anew controlled-release formulation of paroxetine also has been published. Findings from paroxetine clinical studies have added considerably to our knowledge and understanding of the treatment of major depressive disorder, particularly with regard to duration of treatment, the need for treating to full remission and with full doses, and treatment of patients with concurrent symptoms of anxiety.
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Modeling in animals is an invaluable tool in exploring the pathophysiology of human diseases and developing better therapies. Models can be generated using a variety of pharmacological, behavioral, and genetic approaches, but they all require extensive subsequent validation. Ideally, validation should be based on the following 3 axes: face validity (commonalties between the behavioral features of the model and of the human disorder being modeled), predictive validity (the specificity and degree to which drugs that are effective in humans have a corresponding effect in the model), and construct validity (a possible common mechanistic theory that can explain both the model and the human disorder being modeled). ⋯ New construct validity-driven models focusing on signaling pathways include models based on perturbations of G proteins, phosphoinositide signaling, and mitogen-activated protein (MAP) kinase cascades. These new models hold much promise in delineating the underlying pathophysiology of bipolar disorder and for the development of novel, improved therapeutics. Psychopharmacology Bulletin.
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Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal complication precipitated by the use of antipsychotic medications, most notably haloperidol. Criteria previously described include: exposure to the neuroleptic class of medications; hyperthermia; muscle rigidity; a cluster of laboratory and physical findings that may include mental status changes, autonomic instability, creatine phosphokinase elevation and leukocytosis, and exclusion of other causes for the patient's condition. A prodrome of mental status changes, autonomic instability, tremors, diaphoresis, excess salivation, and extrapyramidal signs may precede NMS. ⋯ This report describes a case of NMS associated with olanzapine in a patient who had not previously been exposed to the neuroleptic drug class. At the time this patient presented, there were no reports in the literature of NMS associated with olanzapine alone. Treatment of NMS includes: immediate withdrawal of all neuroleptics; supportive care; fever control; management of autonomic instability (tachycardia, tachypnea, blood pressure fluctuations); and pharmacologic management with dantrolene and bromocriptine.
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Psychopharmacol Bull · Jan 1998
Randomized Controlled Trial Clinical TrialAggression classification and treatment response.
This preliminary study investigated whether the aggression subtypes derived from the Aggression Questionnaire (AQ) are related to treatment response. The subjects were 28 aggressive conduct-disordered children (25 males, 3 females), ranging in age from 9.8 to 17.0 years (mean age = 12.69 years), who participated in a double-blind, placebo-controlled study of lithium as a treatment for reducing aggression. We used the Predatory-Affective Index of the AQ to classify subjects into "predatory" (planned) or "affective" (explosive) subtypes of aggression and then related this classification to treatment response. ⋯ However, the Index did significantly differentiate responders and nonresponders during the experimental treatment period, regardless of whether they received lithium or placebo. Treatment response was associated with a more affective and less predatory subtype of aggression. To the best of our knowledge, this is the first study in children to show an association between the aggression subtype and treatment response.
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Psychopharmacol Bull · Jan 1998
ReviewEvaluation of mental health and depression during pregnancy: position paper.
Women in their reproductive years constitute the population at greatest risk for major depression. Consequently, many women will experience depression during the course of conception and pregnancy. ⋯ A small number of rating instruments have been validated among pregnant women and should take precedence in research studies until new instruments are developed specifically for this group. Other issues that require further exploration are risk factors for depression during pregnancy and the course of depression during pregnancy.