Expert review of neurotherapeutics
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Expert Rev Neurother · Jan 2011
ReviewMood stabilizers for patients with bipolar disorder: the state of the art.
Bipolar disorder (BD) is a prevalent and disabling condition, often comorbid with other medical and psychiatric conditions and frequently misdiagnosed. International treatment guidelines for BD recommend the use of mood stabilizers - either in monotherapy or in association - as the gold standard in both acute and long-term therapy. ⋯ To date, different compounds are included within the broad class of mood stabilizers, with lithium, anticonvulsants and, more recently, atypical antipsychotics being the most representative agents. This article is aimed at providing an updated review of the available literature in relation to the role of mood stabilizers in BD, with particular emphasis on their mechanism of action, main clinical aspects and specific use in the different phases of BD treatment, according to the most recently published international treatment guidelines.
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Expert Rev Neurother · Jan 2011
ReviewQutenza®: a capsaicin 8% patch for the management of postherpetic neuralgia.
Despite currently available treatments, postherpetic neuralgia continues to be a challenging pain condition to treat. Many patients remain in pain or suffer side effects from the (combination) therapies. ⋯ This review will summarize clinical trial evidence on the safety, efficacy and unique attributes of this capsaicin 8% patch in the treatment of postherpetic neuralgia. The action of capsaicin on the transient receptor potential cation channel, subfamily V, member 1 receptors will be discussed.
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Expert Rev Neurother · Jan 2011
CommentRole of the mTOR signaling pathway in the rapid antidepressant action of ketamine.
Some patients with major depressive disorder remain resistant to antidepressant medication. A randomized, placebo-controlled, double-blind trial demonstrated that a single subanesthetic dose (0.5 mg/kg) of the N-methyl-D-aspartate receptor antagonist ketamine caused a rapid antidepressant effect within hours in treatment-resistant patients with major depressive disorder. ⋯ Recently, Li et al. reported the role of the mammalian target of rapamycin (mTOR) signaling pathway, a ubiquitous protein kinase involved in protein synthesis and synaptic plasticity, in ketamine's rapid antidepressant effects. Here, these findings are put into context and their significance is discussed.
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Substitution of antiepileptic drugs with generic formulations may affect individual people, as well as healthcare systems. Analyses of large medical claims databases suggest that generic substitution of antiepileptic drugs is associated with increased morbidity and greater use of healthcare resources. ⋯ Importantly, substitution is often carried out at the dispensing level, without the knowledge or consent of physicians and affected individuals. Therefore, regulatory and professional bodies advocate that substitution should not be carried out without specific counseling of the individual by healthcare professionals on the details and implications of the change.
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Expert Rev Neurother · Nov 2010
ReviewFear reduction in patients with chronic pain: a learning theory perspective.
Acute pain informs the individual that there is an imminent threat of body damage, and is associated with the urge to escape and avoid. Fear learning takes place when neutral stimuli receive the propensity to predict the occurrence of pain, and when defensive responses are initiated in anticipation of potential threats to the integrity of the body. ⋯ In this article, we discuss mechanisms underlying the acquisition, the assessment and extinction of pain-related fear through the cognitive-behavioral treatment of pain-related fear. Finally, we provide a number of critical notes and directions for future research in the field of chronic pain and pain-related fear.