ABSTRACT
OBJECTIVE: To compare the rates of suicidal behaviour during vs. after discontinuation of treatment with antidepressants, and to determine the comparative rates of suicidal behaviour for patients maintained on tricyclic (TCA) vs. selective serotonin reuptake inhibitor (SSRI) antidepressants. METHOD: Charts were reviewed for 521 patients with major depressive disorder and/or dysthymic disorder. Periods of active treatment or discontinuation with SSRIs or TCAs were determined. Rates of completed suicide, suicide attempts, and hospitalization for suicidality were analyzed. RESULTS: There was greater than a five-fold increase in risk for suicidal behaviour after discontinuation of antidepressant treatment (P < 0.0001). The rates of suicidal behavior during treatment with SSRIs or TCAs were similar. CONCLUSION: Suicidal behaviour in unipolar depressed patients treated with antidepressants increases substantially after medication discontinuation. This effect occurred in both patients who were maintained on SSRIs and TCAs. The findings support a possible protective effect on suicidal behaviour for both SSRIs and TCAs.
Subject(s)
Antidepressive Agents, Tricyclic/therapeutic use , Depressive Disorder/drug therapy , Selective Serotonin Reuptake Inhibitors/therapeutic use , Suicide, Attempted , Adult , Antidepressive Agents, Tricyclic/adverse effects , Depressive Disorder/epidemiology , Drug Monitoring , Female , Humans , Male , Retrospective Studies , Selective Serotonin Reuptake Inhibitors/adverse effects , Substance Withdrawal Syndrome/etiology , Suicide, Attempted/statistics & numerical data , United States/epidemiologyABSTRACT
BACKGROUND: Previous research has identified a high rate of anxiety disorders comorbidity in patients with a primary mood disorder diagnosis. Discrepancies between studies in the comorbidity prevalence of specific anxiety disorders in mood disorders, and of anxiety disorders comorbidity between unipolar depression and bipolar mood disorder are in part due to differences in sampling and diagnostic assessment methodology. METHOD: The authors reviewed the charts of 138 patients who received the SCID-P for DSM-III on enrollment in a Mood Disorders Clinic during the period 1982 through 1988. The comorbidity of specific DSM-III Anxiety Disorders with specific mood disorders was determined and comparatively examined using non-parametric statistics. RESULTS: There was high overall comorbidity of anxiety disorders that did not differ between bipolar and unipolar subjects. There were no differences in the comorbidity of individual anxiety disorder diagnoses in the unipolar vs. bipolar groups. However, in unipolar patients with, compared to those without an additional diagnosis of dysthymia, there was greater overall anxiety disorders comorbidity, with a particularly high prevalence of generalized anxiety disorder. LIMITATION: The subgroup of patients with bipolar I disorder was relatively small (N=8). CONCLUSION: Mood and anxiety disorders comorbidity is complex and presents a continuing challenge for both clinicians and researchers.
Subject(s)
Anxiety Disorders/psychology , Mood Disorders/psychology , Adult , Anxiety Disorders/epidemiology , Comorbidity , Female , Humans , Male , Middle Aged , Mood Disorders/epidemiology , Prevalence , Psychometrics , Retrospective StudiesABSTRACT
BACKGROUND: previous research has been inconclusive about the nature of hemispheric asymmetry in emotional processing. METHOD: 13 patients with DSM-IV bipolar disorder received repeated QEEGs over 2 years in different mood states. Z-score measures of asymmetry were assessed. RESULTS: asymmetry in frontotemporal slow-wave activity appeared to be in opposite directions in depression compared to mania/hypomania. CONCLUSIONS: mood change in bipolar disorder is associated with change in QEEG asymmetry. LIMITATIONS: study of larger numbers of more homogenous patients under similar conditions is needed. CLINICAL RELEVANCE: study of mood state-dependent asymmetry changes in bipolar disorder may lead to better understanding of hemispheric processing of emotion.
Subject(s)
Bipolar Disorder/complications , Bipolar Disorder/diagnosis , Brain/physiology , Depressive Disorder/complications , Depressive Disorder/diagnosis , Electroencephalography , Functional Laterality/physiology , Adult , Female , Humans , Longitudinal Studies , Male , Middle Aged , Psychiatric Status Rating Scales , Severity of Illness IndexSubject(s)
Catatonia/drug therapy , Electroconvulsive Therapy , Lorazepam/therapeutic use , Treatment Refusal , Administration, Oral , Adult , Aged , Catatonia/therapy , Depressive Disorder/drug therapy , Depressive Disorder/therapy , Drug Administration Schedule , Female , Forensic Psychiatry , Humans , Informed Consent , Injections, Intramuscular , Lorazepam/administration & dosage , Male , Treatment OutcomeSubject(s)
Antipsychotic Agents/adverse effects , Bipolar Disorder/chemically induced , Risperidone/adverse effects , Adult , Antipsychotic Agents/therapeutic use , Depressive Disorder/drug therapy , Depressive Disorder/psychology , Humans , Male , Risperidone/therapeutic use , Serotonin Antagonists/adverse effects , Serotonin Antagonists/therapeutic useABSTRACT
Two cases of acute laryngeal dystonia (laryngospasm), a rarely reported extrapyramidal reaction to neuroleptics, occurred in a public psychiatric hospital. A review of the literature revealed only seven well-documented case reports. This article discusses the clinical significance of this rare, alarming, and probably underreported phenomenon. Factors related to recognition, prediction, and management are also discussed. The review strongly advocates immediate intravenous administration of anticholinergic drugs to relieve dystonia.
