A review of trazodone use in psychiatric and medical conditions.

Trazodone is an antidepressant that is FDA-approved for the treatment of depression. It has been used by mental health and primary care providers for the treatment of multiple psychiatric and medical conditions .This review describes trazodone mechanism of action, formulation, dosage and adverse effects and then summarizes the beneficial effects of trazodone in the treatment of various psychiatric and medical conditions such as major depression, as well non-approved FDA indications such as insomnia,anxiety disorders, posttraumatic stress disorder, obsessive compulsive disorder, feeding and eating disorders, substance use disorders, behavioral disturbances associated with cognitive dysfunction, sexual dysfunction, certain pain conditions, and rehabilitation after acute ischemic stroke. Despite trazodone's favorable effects in the treatment of FDA-unapproved psychiatric and medical conditions, large, randomized controlled clinical trials are still needed to confirm its efficacy in the treatment of the multiple conditions for which it is often used in clinical practice.

Psychopharmacology of chronic pain: a focus on antidepressants and atypical antipsychotics.

Chronic pain is considered one of the most prevalent causes of costly and disabling medical conditions. This review will define chronic pain and its categories and then will summarize the effectiveness and side effects associated with the use of various antidepressants, including the tricyclics, the selective serotonin reuptake inhibitors, the serotonin norepinephrine reuptake inhibitors, other miscellaneous antidepressants and the atypical antipsychotics in the treatment of chronic pain.

Identification and management of tardive dyskinesia: A case series and literature review.

Tardive dyskinesia (TD) is a serious, disabling and potentially permanent, neurological hyperkinetic movement disorder that occurs after months or years of taking dopamine receptor-blocking agents. The pathophysiology of TD is complex, multifactorial and still not fully understood. Although there is no identified effective and standard treatment for TD, several agents have been tried for the management of this motor disturbance. The aim of this case series is to review the literature in regard to the identification, diagnosis and the treatment of TD with anticholinergics, anticholinergic medication withdrawal, cholinergic agents, botulinum toxin intramuscular injections, tetrabenazine, levetiracetam, propranolol and zolpidem, and to describe one case of TD that responded favorably to clonazepam and two cases of TD that responded favorably to Ginkgo biloba.

The diagnosis and treatment of depression in the geriatric population.

As the elderly population increases, the number of older psychiatric patients with depression will also increase. Although depression may be manifested by characteristics that are different from depression in the younger population, it responds readily to appropriate therapy. When untreated, this disorder may result in increased morbidity, mortalityand suicide.

The effect of mental illness on language regression to the mother tongue in bilingual teenagers.

Affective disorders in children and adolescents could impair the acquisition of a second language in bilingual individuals. The acute exacerbation of a preexisting mental illness may also lead to a loss of the ability to speak the second language for a period of time and the regression to the first (native) language as the only mode of communication. The effect could be lasting since the second language seems to have a critical period of optimal acquisition and proficiency. The underlying neural mechanisms indicated that the second language was more vulnerable to the effects of mental illness than the native language.

Posttraumatic stress disorder and aging.

The evidence base on effective treatments for posttraumatic stress disorder (PTSD) in the elderly population is scarce. The assessment and treatment of PTSD could pose a challenge for primary care providers and residents in training involved in treating PTSD in older adults. This article will review the epidemiology, the morbidity, the mortality, the biological perspective, the prognosis, and the psychosocial and pharmacological treatment options, in addition to the spiritual dimensions of PTSD and aging.

Quetiapine in the treatment of postoperative delirium. A report of three cases.

I summarize the effects of atypical antipsychotic quetiapine on reversing postoperative delirium in three elderly patients and review the historical and general clinical presentation of delirium. Quetiapine pharmacodynamics and pharmacokinetics effects are also described. Although quetiapine was effective in reversing postoperative delirium without adverse events in all three patients, such effectiveness cannot be generalized until confirmed by prospective controlled studies.

Late life psychosis: assessment and general treatment strategies.

With the increased number of elderly patients suffering from mental illness, an increased incidence of psychiatric conditions including psychotic disorders is also expected. When psychosis occurs in the elderly, its assessment and treatment may pose a challenge for primary care clinicians and caregivers. This article will review the assessment and treatment of late life psychosis.

Pilot trial of memantine in the treatment of posttraumatic stress disorder.

This multiple case series was initially designed as a prospective, open-label, 12-week trial investigation evaluating memantine (Namenda) for the treatment of psychiatric and cognitive symptoms associated with PTSD. In a selected, small sample of individuals (n = 4) with combat PTSD, treatment with memantine produced consistent improvement on a delayed recall measure of memory, variable reduction of depressive symptoms, and variable reduction in hyperarousal symptoms. These data suggest potential positive treatment outcomes, both cognitively and psychiatrically, and provide rationale for future double-blind, placebo-controlled studies of memantine in PTSD.

Bipolar disorder: historic perspective, current pharmacologic treatment options and a review of quetiapine.

Bipolar disorder is a complex mental illness that is frequently both under-diagnosed and under-treated. The symptoms of bipolar disorder can be confused with other medical illnesses or drug effects or may even be overlooked entirely as extreme character traits. The consequences of delayed diagnosis or misdiagnosis are potentially devastating, including loss of employment, impaired relationships and a severely impaired quality of life. This article will review the historic perspectives of bipolar disorder, the diagnostic criteria for the phases of the illness, and the pharmacologic options available to treat this condition. Quetiapine, an atypical antipsychotic, will be reviewed indepth. Based on extensive trial data, reviewed in this article, quetiapine is approved by the US Food and Drug Administration for use as monotherapy or as adjunctive therapy with other mood stabilizers for the treatment of acute manic episodes of bipolar I disorder. Clinical trials describing the efficacy of quetiapine in other phases of bipolar disorder and in other patient populations are also reviewed. A discussion of the drug profile of quetiapine includes its chemistry, availability, pharmacodynamics, pharmacokinetics and metabolism. Preclinical studies, postmarketing surveillance, safety, tolerability and regulatory issues are also evaluated. Finally, potential future directions for quetiapine are discussed, together with a review of key issues in bipolar disorder management and details of the information resources used in preparing this article.

Use of a religious hymn in remission of symptoms of social phobia (social anxiety disorder): a case study.

This case report described a veteran with social anxiety disorder who reported fears of negative evaluation by others, social avoidance, and accompanying physiological symptoms of heart palpitations, gastrointestinal discomfort, muscle tension and mental confusion. The symptoms of social anxiety disorder subsided with the use of a Christian hymn "Be Still My Soul" and its accompanying musical poem, in Finlandia. The veteran attributed the symptom remission to the feeling of stillness and surrender to God conveyed by the words and music of the hymn. Although previous studies have shown that both music and religious beliefs can affect mental health, the findings in this case cannot be generalized without conducting further prospective empirical studies.

Psychoses in late life: evaluation and management of disorders seen in primary care.

As the ranks of Baby Boomers move into later life and develop age-related cognitive conditions, an increased incidence in the number of psychotic conditions is expected. When psychotic conditions occur after age 60, the causes and management pose challenges for clinicians caring for the older adult. This article will review the differential diagnosis and management of psychoses in late life.

Asperger's disorder: a review of its diagnosis and treatment.

Asperger's disorder is a pervasive developmental disorder that shares similar features of social impairment disorder, restricted interests, and repetitive behaviors with autistic disorder. Although both Asperger's disorder and autistic disorder persist into adulthood, autistic disorder is usually apparent before the age of 3, while Asperger's disorder usually manifests itself at preschool age. Asperger's disorder in the majority of cases is not associated with delay in language development and there is an increased likelihood to seek social interactions and to engage in activities and friendship with others. In contrast to autistic disorder, most Asperger's disorder patients have normal intellectual functioning and some have motor clumsiness. Although the etiology of Asperger's disorder is still undetermined, this article will review the assessment and treatment interventions that could improve the prognosis of this illness. The historical background, epidemiology, diagnostic features, differential diagnosis, and course and overall management/treatment of Asperger's disorder will be discussed. Despite the absence of a cure for Asperger's disorder, the awareness of its distinctive clinical features that differentiate it from autistic disorder could improve its prognosis and differentiate response to treatment and comorbid conditions.

Thyroid hormones therapy: a review of their effects in the treatment of psychiatric and medical conditions.

Although thyroid hormones are indicated for hypothyroidism, their therapeutic benefit in treating other medical and psychiatric conditions has not been adequately studied. We review the use of thyroid hormones in treating psychiatric and medical conditions in the euthyroid patients.

The antidepressant sertraline: a review of its uses in a range of psychiatric and medical conditions.

Although sertraline was initially introduced as an antidepressant, it can be prescribed for a wide range of psychiatric and medical conditions. We review the pharmacology, the adverse effects, the dosing guidelines, as well as the indications of sertraline.

Religion and motion pictures' effects on reversing suicidal intentions: two case studies.

Case studies of two veterans contemplating suicide are described. Their suicidal intentions subsided as a result of a rekindling of their Christian faith. Although their Christian beliefs were awakened following their attendance at a motion picture, they both attributed the remission of their suicidal intentions to the practices of their Christian faith in their lives. Despite the favorable outcome, these findings are not generalizable to other cases.

An overview of trichotillomania and its response to treatment with quetiapine.

There is a lack of consensus about the pharmacological agent of choice to treat trichotillomania and which rating scales are best suited to measure the clinical severity and improvement of this condition. This overview summarizes the historical background, etiology, diagnostic criteria, epidemiology, course, prognosis, and various pharmacological treatments of trichotillomania. The case report describes a favorable clinical response of a 33-year-old female veteran with trichotillomania to the atypical antipsychotic quetiapine. It also provides data from the Massachusetts General Hospital (MGH) Hair Pulling Scale, a 7-item self-report scale that monitors symptom severity and treatment progress.

Capgras syndrome responding to the antidepressant mirtazapine.

A new onset of Capgras syndrome, delusional misidentification, developed in an elderly gentleman. Treatment with the antidepressant mirtazapine led to the remission. Suggestions are made for both dynamic and medical bases for Capgras syndrome and possible antipsychotic effects of mirtazapine.

The use of buspirone in primary care.

1. Although clinical trials have demonstrated the effectiveness of buspirone in treating generalized anxiety disorder, more studies are needed to confirm its efficacy in treating other anxiety disorders, depression, behavior disorders, substance abuse disorders, movement disorders, and other medical conditions. 2. Clinicians prescribing buspirone must know its basic pharmacology, adverse effects, and dosing guidelines. 3. Buspirone appears to be an alternative attractive medication to traditional benzodiazepines due to its low addictive potential and lack of lethality.