Posttraumatic stress disorder. Safe, effective management in the primary care setting.

PTSD is a severe and chronic psychiatric condition. Because of the complex symptoms, no single treatment is effective. Pharmacologic treatment is an integral component of a multidisciplinary approach that addresses the psychological, social, and spiritual dimensions of PTSD. Psychopharmacologic agents provide symptomatic relief and are beneficial in managing other comorbid psychiatric conditions. Primary care physicians can base treatment decisions on the patient's prevailing symptoms. Specialized psychiatric consultation may be needed in difficult and complicated cases.

The clinical experience of citalopram in the treatment of post-traumatic stress disorder: a report of two Persian Gulf War veterans.

OBJECTIVE: To determine the efficacy of the antidepressant citalopram in the treatment of post-traumatic stress disorder (PTSD). METHOD: The cases of two Persian Gulf War veterans are described to illustrate the effects of citalopram in treating their PTSD symptoms. RESULTS: In these two clinical case studies, citalopram led to remission of some of the PTSD symptoms. CONCLUSION: More controlled studies are warranted to further prove the efficacy of citalopram as an agent of choice for the treatment of PTSD.

The antidepressant nefazodone. A review of its pharmacology, clinical efficacy, adverse effects, dosage, and administration.

Nefazodone is an antidepressant medication which received approval from the Food and Drug Administration for treatment of major depressive disorder in 1994. This article summarizes the pharmacodynamics, pharmacokinetics, adverse effects, and drug interactions of nefazodone as well as its administration and dosing schedule. The potential efficacy of nefazodone in treating anxiety, premenstrual syndrome, chronic pain conditions, and sleep disturbances also is summarized. Nefazodone has a favorable side effects profile which makes it an attractive alternative option for patients who withdraw from treatment when they develop adverse effects to other available antidepressants.

Treatment of bipolar I disorder in an adolescent with olanzapine.

Bipolar I disorder is estimated to affect 0.6% of adolescents. Lithium, sodium valproate, carbamazapine, and adjunctive treatment with benzodiazapines and antipsychotics have been used to treat bipolar I disorders. We report a case of a 17-year-old adolescent male with bipolar I disorder who responded favorably to the treatment with the atypical antipsychotic olanzapine. We hypothesize that olanzapine's broad affinity for both dopaminergic and serotonergic receptors may be related to the beneficial therapeutic outcome.

Treatment of depressive mood in schizophrenia with the atypical antipsychotic quetiapine.

Two patients with schizophrenia and depressive mood experienced remission in both their psychotic and depressive symptoms during treatment with the atypical antipsychotic quetiapine. These case reports illustrate the antipsychotic clinical efficacy of quetiapine and its antidepressant effects in the treatment of patients with schizophrenia and depressive mood.

Obsessive-compulsive disorder. What to do if you recognize baffling behavior.

The prognosis for patients with obsessive-compulsive disorder has improved dramatically in recent years. Primary care physicians, who may be the first healthcare professionals to consult with these patients, can often provide appropriate treatment or therapeutic guidance. Psychiatric consultations and the implementation of a long-term management plan may be needed for complicated cases with comorbid psychiatric conditions and for patients with refractory symptoms of obsessive-compulsive disorder.

Helping your patients beat cocaine addiction. The four dimensions of treatment.

Despite public health efforts aimed at curbing the steady increase of drug abuse in this country, many patients continue to require treatment for cocaine addiction. A comprehensive treatment approach requires integration of pharmacologic, psychological, social, and spiritual dimensions, although research is needed to demonstrate the efficacy of such an approach in maintaining abstinence. Primary care physicians' assessment and treatment of their cocaine-addicted patients is a critical initial step on the way to specialized psychiatric and/or other specialized care for addiction and, hopefully, to sustained recovery.

Remission of cancer chemotherapy-induced emesis during antidepressant therapy with nefazodone.

OBJECTIVE: To emphasize the importance of treating a major depressive episode in an elderly patient with small cell lung cancer (SCLC). METHOD: A case report is described to illustrate the importance of treating depression in an elderly patient with SCLC undergoing chemotherapy. RESULTS: During the course of antidepressant therapy with nefazodone, the patient also experienced a remission of cancer chemotherapy-induced emesis. CONCLUSIONS: This case report suggests that the remission of emesis could be related to the 5-hydroxytryptamine (5-HT) antagonistic property of nefazodone.

Psychiatric morbidity in HIV patients.

OBJECTIVE: To provide an accessible source of clinical information related to the diagnosis and treatment of psychiatric morbidity associated with HIV infection. METHOD: A selective MEDLINE literature search was used to identify 225 relevant articles, 67 of which were selected for inclusion based upon the presence of psychiatric morbidity. Psychiatric morbidity was defined by the presence of a DSM-IV diagnostic code reflecting psychiatric illness. RESULTS: HIV-infected patients have high rates of psychiatric morbidity. CONCLUSION: The psychiatric evaluation and treatment of psychiatric morbidity improve the quality of life of HIV and AIDS patients.

Antidepressant treatment, posttraumatic stress disorder, survivor guilt, and spiritual awakening.

A patient with posttraumatic stress disorder (PTSD) had a major depressive episode that was responsive to treatment with the antidepressant fluoxetine. In contrast to the remission of other symptoms of depression, the associated feature of survivor guilt became more dramatically obvious. Individualized treatment of survivor guilt may be needed for patients with PTSD and major depression.

Promotion of sexual abstinence: reducing adolescent sexual activity and pregnancies.

The prevention of unplanned pregnancies has become a national public health priority. To assure that every newborn child in America is planned and wanted, three strategies are to be implemented: expansion of school-based sex education, expansion of free condom distribution, and expansion of the role of school-based health clinics. Studies show that these strategies may not prevent unplanned pregnancies; furthermore, their implementation may be associated with public health risks. Sexual abstinence is not associated with public health risks and needs to be presented and promoted as the most effective primary prevention for unplanned pregnancies.

Treatment of crack-cocaine-induced compulsive behavior with trazodone.

Foraging is a compulsive behavior of searching for pieces of crack cocaine that the individual believes might have been accidentally misplaced. Three clinical cases of compulsive foraging behavior associated with crack cocaine are described. Due to the development of side effects secondary to the antidepressant desipramine, the patients were switched to the antidepressant trazodone. The use of trazodone led to remission of the foraging behavior. The authors hypothesize this remission was due to trazodone serotonin reuptake inhibitory action. In all three cases, the patients did not relapse into abusing crack cocaine.