The effectiveness of anticonvulsants in psychiatric disorders.

Posted on November 11, 2008 by Maurice Preter MD
Dialogues Clin Neurosci. 2008;10(1):77-89.
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The effectiveness of anticonvulsants in psychiatric disorders.

Grunze HC.

University of Newcastle School of Neurology, Neurobiology and Psychiatry, Leazes Wing, Royal Victoria Infirmary, Queen Victoria Rd., Newcastle upon Tyne NE14LP, United Kingdom. heinz.grunze@ncl.ac.uk

Anticonvulsant drugs are widely used in psychiatric indications. These include mainly alcohol and benzodiazepine withdrawal syndromes, panic and anxiety disorders, dementia, schizophrenia, affective disorders, bipolar affective disorders in particular, and, to some extent, personality disorders. A further area in which neurology and psychiatry overlap is pain conditions, in which some anticonvulsants, and also typical psychiatric medications such as antidepressants, are helpful. From the beginning of their psychiatric use, anticonvulsants have also been used to ameliorate specific symptoms of psychiatric disorders independently of their causality and underlying illness, eg, aggression, and, more recently, cognitive impairment, as seen in affective disorders and schizophrenia. With new anticonvulsants currently under development, it is likely that their use in psychiatry will further increase, and that psychiatrists need to learn about their differential efficacy and safety profiles to the same extent as do neurologists.

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PMID: 18472486 [PubMed – indexed for MEDLINE]

Posted in Psychiatry/Neurology |

Nocturnal sleep panic and depression: Relationship to subjective sleep in panic disorder.

Posted on November 11, 2008 by Maurice Preter MD
J Affect Disord. 2008 Jun 14. [Epub ahead of print]
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Nocturnal sleep panic and depression: Relationship to subjective sleep in panic disorder.

Singareddy R, Uhde TW.

Department of Psychiatry (H073), Penn State College of Medicine, 500 University Drive, PO box 850, Hershey, Pennsylvania 17033, United States.

BACKGROUND: Patients with panic disorder (PD) often complain of sleep disturbances. PD patients have high co-morbid depression and almost 65-70% reports a history of nocturnal panic attacks. It is possible that both nocturnal-sleep panic attacks and depression contribute to sleep disturbances in PD patients. However, the individual and interactive effects of nocturnal-sleep panic attacks and lifetime depression on subjective sleep in PD are unknown. METHODS: The National Institute of Mental Health Panic Disorder Questionnaire (NIMH-PQ) was administered to 773 individuals who met DSM-IV criteria for PD. All of these subjects completed queries related to nocturnal-sleep panic attacks, lifetime depression, difficulty sleeping, and sleep duration. RESULTS: We examined difficulty in sleeping and sleep duration in four subgroups [PD without nocturnal panic attacks or lifetime depression (NP-D-), PD with nocturnal panic attacks (NP+D-), PD with lifetime depression (NP-D+), and PD with both nocturnal panic attacks and lifetime depression (NP+D+)]. Significantly greater proportions of NP+D+ subjects reported difficulty sleeping compared to other three subgroups. In addition, the NP+D+ patients reported significantly decreased subjective sleep durations compared to the other three subgroups. Using </= 5h as a criteria for severe sleep restriction, approximately 20% of the NP+D+ patients, compared to 9.2%, 9.6%, and 2.5% in the NP+D-, NP-D+, NP-D- subgroups, respectively, reported sleeping 5h or less. 8.2% of panic disorder patients reported excessive sleeping per sleeping period. CONCLUSIONS: A high percentage of panic disorder individuals report subjective sleep disturbances. Not surprisingly, an unusually high prevalence of patients with nocturnal panic attacks or depression have sleep problems and 92.3% of patients with both nocturnal panic attacks and depression report striking extremes in sleep duration or insomnia. Thus, nocturnal-sleep panic attacks and depression are independently as well as interactively associated with increased sleep disturbances in panic disorder. Although these findings are expected, they underscore the importance of assessing sleep functions, including over-sleeping, in panic disorder patients.

PMID: 18558437 [PubMed – as supplied by publisher]

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Psychiatric comorbidity in patients with chest pain without a cardiac etiology.

Posted on November 11, 2008 by Maurice Preter MD
Isr J Psychiatry Relat Sci. 2008;45(1):49-54.
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Psychiatric comorbidity in patients with chest pain without a cardiac etiology.

Hocaoglu C, Gulec MY, Durmus I.

Department of Psychiatry, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. chocaoglu@superonline.com

OBJECTIVE: Throughout the world and among different cultural groups, physical symptoms are the most common expressions of social problems and distress; chest pain is one of the most widely seen, medically unexplained physical symptoms. Most of the time, chest pain cases in which an organic etiology cannot be determined over time and in those presenting with atypical features should be evaluated as a component or an accompanying symptom of various specific psychiatric disorders, primarily such as panic disorder and depression. The aim of this study was to determine the psychiatric comorbidity rate in patients with chest pain without a cardiac etiology. METHOD: Seventy patients admitted to the cardiology clinic with a complaint of chest pain but without any detectable cardiac etiology were included in the study. All patients were evaluated using a Sociodemographic Data Collection Form and Structured Clinical Interview for DSM-IV. RESULTS: Panic disorder was diagnosed in 47.1% of the non-cardiac chest pain group, depressive disorders in 21.4%, generalized anxiety disorder in 5.7%, anxiety disorders not otherwise specified in 5.7%, obsessive compulsive disorder in 5.7%, and undifferentiated somatoform disorder in 2.9%. Two psychiatric diagnoses were established in 12.9% of the patients and no psychiatric diagnosis in 24.3%. CONCLUSION: Psychiatric disorder rates are quite high in patients with chest pain that cannot be explained cardiologically. These results show the importance of psychiatric evaluations in patients with non-cardiac chest pain or unexplained chest pain (UCP). In addition, understanding the psychiatric symptom profile of these patients will make an important contribution to the treatment of non-cardiac chest pain.

PMID: 18587169 [PubMed – indexed for MEDLINE]

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Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome: a case/control study.

Posted on November 11, 2008 by Maurice Preter MD
J Urol. 2008 Oct;180(4):1378-82. Epub 2008 Aug 15.
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Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome: a case/control study.

Clemens JQ, Brown SO, Calhoun EA.

Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-5330, USA. qclemens@umich.edu

PURPOSE: We compared the rate of mental health disorders in male and female patients with pelvic pain and control subjects. MATERIALS AND METHODS: Male patients with chronic prostatitis/chronic pelvic pain syndrome (174) and female patients with interstitial cystitis/painful bladder syndrome (111) were identified from a urology tertiary care clinic population. A control group consisting of 72 men and 175 women was also recruited. Subjects completed self-administered questionnaires that included items about demographics, medical history, medication use and urological symptoms. The Patient Health Questionnaire was used to identify depression and panic disorder. Multiple logistic regression was used to determine odds ratios for the presence of a mental health diagnosis. RESULTS: Mental health disorders were identified in 13% of the chronic prostatitis/chronic pelvic pain syndrome cases and 4% of male controls (OR 2.0, p = 0.04), as well as in 23% of interstitial cystitis/painful bladder syndrome cases and 3% of female controls (OR 8.2, p <0.0001). Disease status (case vs control) (OR 10.4, p = 0.001) and income greater than $50,000 (OR 0.34, p = 0.008) were the only 2 variables independently predictive of the presence of a mental health diagnosis. Age, gender, race/ethnicity and education were not predictive. Medications for anxiety, depression or stress were being taken by 18% of patients with chronic prostatitis/chronic pelvic pain syndrome, 37% of those with interstitial cystitis/painful bladder syndrome, 7% of male controls and 13% of female controls. CONCLUSIONS: Depression and panic disorder are significantly more common in men and women with pelvic pain conditions than in controls. Medication use data suggest that anxiety and depression may be more difficult to treat in patients with urological pain syndromes than in controls.

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PMID: 18707716 [PubMed – indexed for MEDLINE]

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Reducing anxiety sensitivity with exercise.

Posted on November 11, 2008 by Maurice Preter MD
Depress Anxiety. 2008;25(8):689-99.
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Reducing anxiety sensitivity with exercise.

Smits JA, Berry AC, Rosenfield D, Powers MB, Behar E, Otto MW.

Department of Psychology, Southern Methodist University, Dallas, Texas 75275, USA. jsmits@smu.edu

BACKGROUND: Exercise interventions repeatedly have been shown to be efficacious for the treatment of depression, and initial studies indicate similar efficacy for the treatment of anxiety conditions. To further study the potential beneficial role of prescriptive exercise for anxiety-related conditions, we examined the role of exercise in reducing fears of anxiety-related sensations (anxiety sensitivity). METHODS: We randomly assigned 60 participants with elevated levels of anxiety sensitivity to a 2-week exercise intervention, a 2-week exercise plus cognitive restructuring intervention, or a waitlist control condition. Assessment of outcome was completed at pretreatment, midtreatment, 1-week posttreatment, and 3-week follow-up. RESULTS: We found that both exercise conditions led to clinically significant changes in anxiety sensitivity that were superior to the waitlist condition, representing a large controlled effect size (d=2.15). Adding a cognitive component did not facilitate the effects of the exercise intervention. Consistent with hypotheses, changes in anxiety sensitivity mediated the beneficial effects of exercise on anxious and depressed mood. CONCLUSIONS: We discuss these findings in terms of the potential role of exercise as an additional psychosocial intervention for conditions such as panic disorder, where anxiety sensitivity is a prominent component of pathology. Copyright 2008 Wiley-Liss, Inc.

PMID: 18729145 [PubMed – in process]

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