ABSTRACT
No disponible
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Professional Competence/standards , Science , Medicine/methods , Medicine/standards , Medicine/organization & administration , Medicine , Medicine/trends , Ethics, Medical/educationABSTRACT
No disponible
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Mental Health , Reading , Periodicals as Topic/standards , Periodicals as Topic/trends , Periodicals as Topic , Book Industry/standards , Book Industry/organization & administration , Book Industry , Book Industry/trendsABSTRACT
Objetivo: Determinar la efectividad, tolerabilidad y seguridad del tratamiento con mirtazapina en un amplio grupo de pacientes con depresión (criterios ICD-10) en España. Pacientes y métodos: Estudio observacional, abierto, prospectivo y multicéntrico con controles los meses 1, 2 y 6. Se emplearon las escalas de Hamilton de depresión de 17 ítems, la escala ICG y la escala de discapacidad de la OMS. La tolerabilidad se recogió mediante un cuestionario de 27 síntomas específicos (escala UKU-P), más un cuestionario abierto y analíticas periódicas. Se obtuvo información válida de 1.019 pacientes. Resultados: La respuesta al tratamiento, definida como una reducción >= 50 por ciento en la puntuación de la escala HAMD17, se dio en un 33,3 por ciento de los pacientes al mes de tratamiento, en un 62,9 por ciento a los 2 meses y en un 87,2 por ciento a los 6 meses. Abandonó el tratamiento por ineficacia un 1,86 por ciento de la muestra. La discapacidad (escala de la OMS, ámbitos de cuidado personal, funcionamiento familiar, social y ocupacional) mejoró significativamente en todas las visitas. El tratamiento fue bien tolerado (abandono por intolerancia: 13,73 por ciento de la muestra). Entre los efectos adversos más frecuentes cabe destacar somnolencia e incremento del apetito/peso. No se registraron desviaciones en los parámetros analíticos. ConclusiÓn: Mirtazapina demostró tener una muy buena eficacia, con un alto índice de tolerabilidad, entre los pacientes de la muestra (AU)
Subject(s)
Adolescent , Adult , Female , Male , Middle Aged , Humans , Drug Tolerance , Antidepressive Agents/administration & dosage , Antidepressive Agents/therapeutic use , Depression/drug therapy , Mood Disorders/complications , Mood Disorders/diagnosis , Antidepressive Agents/adverse effects , Antidepressive Agents/pharmacokinetics , Antidepressive Agents/metabolism , Sleep Stages , Multicenter Studies as Topic/methods , Prospective StudiesABSTRACT
A 24-week, double-blind, randomized trial was performed to compare the efficacy and tolerability of venlafaxine and paroxetine in patients with major depression or dysthymia. Outpatients aged 18-70 years with a baseline score of 17 on the 21-item Hamilton Depression Rating Scale (HAM-D) were eligible. Patients were randomly assigned to venlafaxine, 37.5 mg, in the morning and evening or paroxetine, 20 mg, in the morning and placebo in the evening, which could be increased to venlafaxine, 75 mg twice daily, or paroxetine, 20 mg twice daily, after 4 weeks. Efficacy was assessed with the 21-item HAM-D, the Montgomery-Asberg Rating Scale, the Hamilton Anxiety Rating Scale, and the Clinical Global Impressions Scale. Forty-one patients were randomized to venlafaxine and 43 to paroxetine. At week 6, a response was observed in 55% of patients on venlafaxine and 29% on paroxetine (P = 0.03). At week 12, significantly (P = 0.011) more patients in the venlafaxine group had a HAM-D remission score of 8 or less (59% versus 31%). Discontinuation for any reason occurred in 16 (39%) patients on venlafaxine and 11 (26%) on paroxetine. The most common adverse events were nausea (28%), headache (18%) and dry mouth (15%) with venlafaxine and headache (40%) and constipation (16%) with paroxetine. Venlafaxine was effective and well tolerated for the treatment of patients with mild to moderate depression or dysthymia. A consistently higher proportion of patients had a response or remission on venlafaxine than on paroxetine.
Subject(s)
Antidepressive Agents, Second-Generation/adverse effects , Antidepressive Agents, Second-Generation/therapeutic use , Cyclohexanols/adverse effects , Cyclohexanols/therapeutic use , Depressive Disorder/drug therapy , Dysthymic Disorder/drug therapy , Paroxetine/adverse effects , Paroxetine/therapeutic use , Adolescent , Adult , Aged , Depressive Disorder/psychology , Double-Blind Method , Dysthymic Disorder/psychology , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Venlafaxine HydrochlorideABSTRACT
With the arrival of atypical antipsychotic drugs, questions have arisen as to their efficacy, compared with classical antipsychotics, and their impact on the clinical and psychosocial behavior of schizophrenic patients. This paper reviews the development of antipsychotic drugs from the prototype chlorpromazine in the 1950s to the atypical antipsychotics--clozapine, risperidone, olanzapinein--in the 1990s. Particular attention is given to the medications' effect on positive and negative symptoms and on patients' quality of life. Experience to date with the atypical antipsychotic drugs is that they are as effective as traditional treatments, with a possibly greater action in treating negative symptoms and with a lower extrapyramidal side effects profile. For comprehensive treatment of schizophrenia, the author advocates a polydimensional approach encompassing psychopharmacology, psychotherapy, psychosocial interventions (particularly with family members), and vocational training.
Subject(s)
Antipsychotic Agents/pharmacology , Behavioral Symptoms/drug therapy , Schizophrenia/drug therapy , Benzodiazepines , Clozapine/pharmacology , Family Health , Humans , Olanzapine , Pirenzepine/analogs & derivatives , Pirenzepine/pharmacology , Risperidone/pharmacology , Schizophrenia/rehabilitation , Social AdjustmentABSTRACT
BACKGROUND: To study the prevalence of use and the characteristics of current utilization of electroconvulsive therapy (ECT) in Barcelona. METHODS: A descriptive study was carried out in August of 1993. A structured interview designed by the authors was administered to psychiatrists in 20 hospitals, including general hospitals with Department of Psychiatry and psychiatric hospitals. RESULTS: In 12 hospitals of the sample (60%) ECT was practised. The most frequent indication was depression (83%) followed by schizophrenia (17%). In all these hospitals pharmacological treatment was simultaneously used and the application of electrodes was bilateral. Most of them used stimulation by sinusoidal wave, thiopental was used as anesthetic agent, the duration of seizures was not evaluated, EEG monitoring was not performed and treatment in a surgeon's room was not applied. In 10 hospitals written consent was obtained. CONCLUSIONS: ECT was used in general hospitals with psychiatric department of Barcelona, Spain, with high coincidence in indications but not in the technical aspects.
Subject(s)
Electroconvulsive Therapy , Depression/therapy , Electroconvulsive Therapy/trends , Humans , Schizophrenia/therapy , SpainABSTRACT
Evolution of psychopharmacology is discussed from the viewpoint of the growth of the number of psychotropic drugs, their use and the rate of scientific reports related to them. Power is discussed from the standpoint of economic perspectives, although it is not the only aim. On the other hand, the influence of the psychopharmacological "boom" on the development of the specialty is analyzed. The limits of psychopharmacology achieve their maximum extent when they are combined with the study of psychological, social and cultural factors and determinants and, hence, to other therapeutic methods.
Subject(s)
Mental Disorders/drug therapy , Psychotropic Drugs/therapeutic use , Combined Modality Therapy , Cost-Benefit Analysis , Humans , Mental Disorders/economics , Mental Disorders/psychology , Psychotropic Drugs/adverse effects , Psychotropic Drugs/economics , Social AdjustmentABSTRACT
The second generation of antidepressants have been developed with the goal to reduce cardio-toxic effects and to further a more specific action on neurotransmitter systems. However some standardized actual parameters, clinical, biological and pharmacological may be accepted as reasonable elements in evaluating the therapeutic effects. Among them we will distinguish the diagnostic instruments which define categories of affective disorders; rating scales to assess gravity, the type of clinical test, duration of the test and finally those biological variables which should be an integral part of the evaluation of new antidepressants.
Subject(s)
Antidepressive Agents/therapeutic use , Depressive Disorder/drug therapy , Clinical Trials as Topic , Depressive Disorder/diagnosis , Diagnosis, Differential , HumansSubject(s)
Mental Disorders/diagnosis , Adolescent , Adult , Age Factors , Educational Status , Female , Humans , Male , Mental Disorders/physiopathology , Middle Aged , Socioeconomic FactorsABSTRACT
This instrument has been constructed with the purpose of quantifying the severity of depressive states, i.e. to identify the depressive patient and to measure the response to treatment with an antidepressant. Type of instrument: Ordinal rating scale, 11 items, 5 grades. Eleven variables are assessed: Activity (motor); Activity (verbal); Retardation (intellectual); Anxiety (psychic); Suicidal impulses; Lowered mood; Self-depreciation and guilt feelings; Emotional retardation; Sleep disturbances; Tiredness and pain; Work and interests. Tests were done to verify concurrent validity with the Hamilton Depression Scale (HDS); some data on inter-observer reliability are given.
Subject(s)
Affective Disorders, Psychotic/diagnosis , Psychiatric Status Rating Scales , Female , Humans , Male , SpainABSTRACT
At present anxiety and depression are being considered as different syndromes. However, the depressive syndromes are associated with a sever or less grave component of anxiety. In this communication distinctions between anxiety and depression as nuclear or accompanying syndrome, respectively, as well as some of their more frequent pathogenetic mechanisms are established. Finally, the most appropriate psychodrugs for each one of the depression-anxiety association forms, depending on their nuclear syndrome, are mentioned.
