Smoking and psychiatric disorders: a comorbidity survey

Epidemiological and clinical studies have shown a positive correlation between smoking and psychiatric disorders. To investigate the prevalence of cigarette smoking, 277 psychiatric outpatients with anxiety or depressive disorders (DSM-IV) answered a self-evaluation questionnaire about smoking behavior and were compared with a group of 68 control subjects. The diagnoses (N = 262) were: 30.2 percent (N = 79) major depressive disorder, 23.3 percent (N = 61) panic disorder, 15.6 percent (N = 41) social anxiety disorder, 7.3 percent (N = 19) other anxiety disorders, and 23.7 percent (N = 62) comorbidity disorders. Among them, 26.3 percent (N = 69) were smokers, 23.7 percent (N = 62) were former smokers and 50.0 percent (N = 131) were nonsmokers. The prevalence of nicotine dependence among the smokers was 59.0 percent (DSM-IV). The frequency of cigarette smoking did not show any significant difference among the five classes of diagnosis. The social anxiety disorder patients were the heaviest smokers (75.0 percent), with more unsuccessful attempts to stop smoking (89.0 percent). The frequency of former smokers was significantly higher among older subjects and nonsmokers were significantly younger (chi² = 9.13, d.f. = 2, P = 0.01). Our data present some clinical implications suggesting that in our psychiatric outpatient sample with anxiety disorder, major depression and comorbidity (anxiety disorder and major depression), the frequency of cigarette smoking did not differ from the frequency found in the control group or in general population studies. Some specific features of our population (outpatients, anxiety and depressive disorders) might be responsible for these results

Dysthymia - Review - New Findings - Treatment Guindelines

Open trials with tricyclics, classical MAOIs or Lithium in dysthymia yielded a response rate in 45 per cent of subjects. A liong-term treatment of dysthymia with 276 patients treated during four years with eithermoclobemide,tranylcypromine or a combination of amitryptiline plus chlordiazepoxide is described. After discontinuation there was a relapse rate of 89.1 per cent. The controlled studies with tricycles, classical MAOIs, RIMAs, SSRs or benzamides showed that drugs well tolerated work better in dyathymia, due to the fact that the treatment has to be long-term. Sertraline was studied versus placebo or imipramine in primary dysthymia. Moclobemide, imipramine and polacebo were also studied in 315 patients. Mean doses were 650.0 mg-day of moclobemide, 203.2 mg-day of imipramine. Moclobemide and sertraline were both efficacious and well tolerated. In a long term treatment the clinician should assess the risk-benefit ratio. Dysthymic patients are very sensitive to unwanted effects and compliance is a serious issue