Risperidone for controlling aggressive behavior in a mentally retarded child: a case report.

Risperidone is an atypical antipsychotic agent with dopamine and serotonin antagonistic effects. It is an effective treatment for reducing aggressive behavior in adults with mental retardation. The use of risperidone in a severely mental retarded child with aggression is described. Risperidone was able to reduce the aggressive behavior in this patient. No serious side effect was found. This case illustrated that risperidone is effective and well tolerated in treating aggressive behavior in children with severe mental retardation. However, the anti-aggressive effect of risperidone in mentally retarded children remains to be seen in a larger sample-size study.

Tricyclic antidepressants for depressive disorders in children and adolescents: a meta-analysis of randomized-controlled trials.

The tricyclic antidepressants (TCAs) are effective for the treatment of adult depression. However, their efficacy of these in the treatment of children and adolescents with depression is equivocal. Therefore, it is necessary to determine the efficacy and acceptability of TCAs in the treatment of depressive disorders in children and adolescents. The databases of MEDLINE (from 1966 to October 1999) and Controlled Clinical Trials Registered (from 1980 to October 1999) were searched for randomized-controlled trials relevant to the use of TCAs for treating depressed children and adolescents. The reviewers also examined the reference lists of identified papers and that of a previous meta-analysis. In each trial, both nonresponse rates and dropout rates were taken into account and extracted on an intention-to-treat basis. The nonresponse-rate and dropout-rate odd ratios (ORs) with 95 per cent confidence intervals (95% CIs) of each trial and the pooled non-response-rate and dropout-rate ORs (95% CIs) of all trials were computed. Nine trials included in this meta-analysis were 2 amitriptyline, 3 desipramine, 2 imipramine, and 2 nortriptyline studies. By using a fixed-effect model, the pooled nonresponse-rate OR (95% CI) and the pooled dropout rate OR (95% CI) of antidepressant-treated group were 0.92 (0.57 to 1.47) and 2.14 (1.12 to 4.09), respectively. In summary, the evidence so far does not support that TCAs are more effective or more acceptable than placebo in the treatment of depressive disorders in children and adolescents. However, the studies of selective serotonin reuptake inhibitors and newer antidepressants for the treatment of these disorders should be further investigated.

Depression in Thai patients with rheumatoid arthritis.

A wide spectrum of behavioral and psychological disturbances, in particular depression, has been described as a prevalent problem in patients with rheumatoid arthritis (RA). The investigators proposed to evaluate the correlations of depressive symptoms and the disease activity of RA in Thai patients. A variety of aspects of disease activity included in the assessment were the number of swollen joints, the number of tender joints, overall tenderness of the joints (assessed by using the Ritchie Articular Index), overall pain (assessed by using the visual analog scale for pain), joint functional class, and disease duration. The 24-item Hamilton Rating Scale for Depression (HRSD) was the measure used to determine the severity of depressive symptoms. The correlations of HRSD scores and the data relevant to the disease activity were evaluated by using Pearson correlation test. A total of 75 female and 4 male patients participated in this study. Their mean age and mean duration of disease were 49.81 and 7.48 years, respectively. The mean score of HRSD was significantly correlated with those of the number of swollen joints, the number of tender joints, the Ritchie Articular Index, the visual analog scale for pain, and the joint functional class. In conclusion, depression is highly correlated with some respects of the disease activity of RA, especially the number of swollen joints and joint functional class. The results of the present study are not much different from those of previous studies conducted in western countries. Careful evaluation of the disease activity of RA will be helpful in detecting the depression comorbidity in Thai patients suffering from this disease.

Guideline for the pharmacotherapy of treatment-resistant schizophrenia. Royal College of Psychiatrists of Thailand.

The authors proposed to develop an evidence-based guideline relevant to drug use for treatment-resistant schizophrenia (TRS), which will be called "Guideline for the Pharmacotherapy of Treatment-Resistant Schizophrenia or PTRS Guideline". The authors performed a MEDLINE search (between 1966 and December 1998) and classified the study designs of those trials by using the system proposed by the Agency for Health Care Policy and Research (AHCPR). The levels of evidence were graded and recommendations were made by the use of a system modified from that of the AHCPR. One hundred and sixty-three articles met the inclusion criteria for the review. For a schizophrenic patient who does not respond to a classical antipsychotic, physicians should switch from the first classical antipsychotic to the second one, which belongs to a different class. A schizophrenic patient who does not respond to at least two adequate trials of classical antipsychotics should be classified as a TRS patient. Clozapine should be considered as a first-line treatment for TRS. Risperidone should be considered in a TRS patient who refuses to have regular blood monitoring or has contraindication for clozapine. Physicians should use this guideline to accompany others that suggest the overview of treatment for schizophrenia. Appropriate application and the limitations of the guideline are also discussed.

Comparison of the efficacy and acceptability of atypical antipsychotic drugs: a meta-analysis of randomized, placebo-controlled trials.

Knowing the clinical differences of olanzapine, quetiapine, and risperidone would be of benefit for choosing an atypical antipsychotic drug. In order to compare their efficacy and acceptability, we conducted a meta-analysis of published, randomized, placebo-controlled trials by comparing the response and dropout rates of an atypical antipsychotic drug group and those of a placebo group. After a comprehensive search of study reports, the response and dropout rates of patients treated with an atypical antipsychotic drug and those treated with placebo were extracted on the intention-to-treat basis. The effect size with 95 per cent confidence interval (CI) of pooled data comparing the response and dropout rates of an atypical antipsychotic drug group and those of a placebo group were calculated by using the Peto method. The response-rate effect sizes (95% CIs) of olanzapine, quetiapine, and risperidone were 1.75 (1.06 to 2.89), 1.71 (1.20 to 2.42), and 3.28 (1.98 to 5.44), respectively. The dropout-rate effect sizes (95% CIs) of olanzapine, quetiapine, and risperidone were 0.55 (0.35 to 0.88), 0.65 (0.46 to 0.91), and 0.39 (0.24 to 0.62), respectively. In conclusion, olanzapine, quetiapine, and risperidone are more effective and more acceptable than placebo in treating schizophrenic patients. However, they are not different from each other in the respect of efficacy and acceptability. The cost of these agents should play an important role in choosing an atypical antipsychotic drug.

Response and discontinuation rates of newer antidepressants: a meta-analysis of randomized controlled trials in treating depression.

Several attempts to improve antidepressants have recently led to the availability of some newer antidepressants (NAs) including nefazodone, mirtazapine, and venlafaxine. The author proposed to compare both efficacy and discontinuation rates between these NAs and older antidepressants (OAs) which include tricyclic antidepressants (TCAs), nontricyclic antidepressants (NTCAs), and selective serotonin reuptake inhibitors (SSRIs). In each comparison, the author analyzed the heterogeneity of outcomes and computed the pooled odd ratio (OR) with 95 per cent confidential interval (95% CI) by using Peto method. The results show that NAs have slightly higher efficacy than OAs. The overall discontinuation rate of the NA group was also lower than that of the TCA group but not that of NTCA-SSRI group. In conclusion, NAs have slightly but significantly superior efficacy to OAs which probably include SSRIs. They are also more tolerable than TCAs but not NTCAs-SSRIs. However, the efficacy difference between NAs and SSRIs should be viewed as a preliminary result since very few studies have compared their efficacy.

Zopiclone in the treatment of insomnia: an open clinical trial.

The purpose of this study was to examine the efficacy and adverse effects of zopiclone in Thai psychiatric patients. Thirty-two insomniac outpatients with a variety of diagnoses participated in this study. Zopiclone at the dose of 7.5-15 mg was administered 15 minutes before bedtime. The sleep-questionnaire items included: 1) sleep induction; 2) duration of sleep; 3) number of awakenings, 4) sleep quality; 5) dream incidence; and 6) condition in the morning. The mean scores of each item were compared by using pair t-test. One week after treatment, significant improvement was found in all items, except item 5. In comparison between sleep at 1 week and 3 weeks after treatment, further improvement was still found in the first three items. The adverse effects found were bitter taste, drowsiness, and headache. In conclusion, zopiclone is an effective hypnotic with few adverse effects.

Amineptine in the treatment of amphetamine withdrawal: a placebo-controlled, randomised, double-blind study.

Temporary inability to function without amphetamine and the experience of withdrawal syndrome enhance the tendency for repetitive use. The investigators proposed to examine the therapeutic effects of amineptine, an antidepressant with dopamine reuptake inhibition effect, for the treatment of amphetamine withdrawal. The 14-day study was carried out on a randomised, double-blind, placebo-controlled design. The authors assessed the severity of amphetamine withdrawal syndrome by using two measures and performed both end-point and intent-to-treat analyses. The results showed that amineptine helped relieve a depressed mood within one week and improved the general condition within 2 weeks. In conclusion, amineptine is effective in rapid relief of depressed mood and improves the general condition of patients with amphetamine withdrawal. Since the amphetamine withdrawal may last for several weeks, studies with longer duration should be conducted before incorporating amineptine into the clinical practice a of amphetamine withdrawal treatment.

Alprazolam and standard antidepressants in the treatment of depression: a meta-analysis of the antidepressant effect.

Alprazolam differs from other benzodiazepines by the incorporation of a triazolo ring in the basic chemical structure. Several lines of evidence have supported that alprazolam and standard antidepressants have some similar actions, such as beta-adrenergic receptor down-regulation, antipanic effect. Because of the difference in opinions pertaining to the antidepressant effect of alprazolam, this issue could not reach a firm conclusion. In the present analysis, we carried out a meta-analysis of 11 random controlled studies that compared the antidepressant effect of alprazolam and standard antidepressants in depressed patients. The results showed that the weighted mean effect size d (dw) is equal to 0.06. In conclusion, the antidepressant effect of alprazolam is comparable to that of low-dose tricyclic antidepressants. Very few studies have investigated severely depressed patients. Also, in long-term administration, the lack of a long-term treatment study makes the issue of alprazolam's benefits and disadvantages still undetermined.