Cognitive effects and antipsychotic treatment.

Cognitive impairment has long been recognized as central to the abnormalities that occur in schizophrenia, since neurocognitive deficits are predictive of a number of outcome indices, and they pose a significant obstacle to any attempts at social rehabilitation. This raises the possibility that treatments producing improvements in cognitive function might, in turn, prove to have synergistic effects with psychosocial interventions. Rather than improving cognitive deficits, conventional antipsychotics may instead contribute to the impairment seen in many patients with schizophrenia. These damaging effects on cognition might be expected not only when antipsychotic drugs with intrinsic anticholinergic properties are used but also when anticholinergic drugs are prescribed for the relief of treatment-emergent extrapyramidal symptoms. The atypical antipsychotic drugs may be effective in this area, either in amelioration of the cognitive impairments that occur in schizophrenia or in arresting any continuing decline. New-generation atypical agents, such as quetiapine and risperidone, have minimal intrinsic anticholinergic effects, which suggest that some of the additional negative effects on cognition can be avoided. A number of large-scale, long-term follow-up studies of atypical antipsychotics are currently underway, in 'real world' settings, to assess not only control of symptoms of schizophrenia but also improvement in social, occupational, and inter-personal functioning.

Panic disorder: the place of benzodiazepines and selective serotonin reuptake inhibitors.

This article reviews the efficacy of the benzodiazepines and the selective serotonin reuptake inhibitor class of antidepressant in the treatment of panic disorder. The benzodiazepine alprazolam has been used successfully in the treatment of panic disorder, but its long-term use presents problems with dependence. Since panic may be mediated by a dysfunction of serotonin neuronal pathways, there is a rationale for treatment with antidepressants that modulate serotonergic systems. In clinical trials, members of the SSRI class of antidepressant reduced panic attack frequency to zero in 36-86% of patients and were well tolerated over long-term administration, all important factors in ensuring patient compliance. In addition, antidepressants are preferable to benzodiazepines in the treatment of panic and comorbid depression, of which there is a high prevalence among panic disorder patients. This review emphasises the need for long-term treatment of this chronic and disabling condition with a therapy that is well tolerated and provides complete and sustained recovery from panic attacks, and resolution of anticipatory anxiety.

Study of family history in seasonal affective disorder.

OBJECTIVE: In our investigation we assessed the risk of morbidity for psychiatric disorders among the first-degree relatives of patients with seasonal affective disorders (SAD) and compared it with a control group of patients suffering from nonseasonal mood disorders (NSMD). METHODS: Over a period of 12 months (June 1994 to May 1995) we recruited patients consecutively admitted to our psychiatric university outpatient clinic in a prospective study. All patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, revised 4th edition. A total of 344 patients presented themselves with a diagnosis of affective disorder. Out of these, 36 were diagnosed as having SAD. From the same group of 344 patients, we selected a matched control group of 36 patients suffering from NSMD. The experimental and control groups were matched according to sex, age, severity of illness and number of siblings. RESULTS: There was no significant difference concerning the lifetime prevalences for psychiatric disorders among the fist-degree relatives in both groups (SAD = 16.5% and NSMD = 19%). CONCLUSION: It seems that there is no difference in familiarity for psychiatric disorders between SAD and NSMD.

Efficacy of noradrenergic-selective agents in the treatment of neuropsychiatric diseases.

In recent years, a number of antidepressants with varying degrees of selectivity for the noradrenergic neurotransmitter system have become available. However, these agents represent a pharmacologically heterogeneous group and differ in terms of their precise side-effect profile and, possibly, their clinical efficacy. Bupropion, which is thought to act on both the dopamine and norepinephrine (NE) systems, has not been widely used as an antidepressant and has more recently been licensed as adjunctive therapy for smoking cessation. The serotonin-NE reuptake inhibitors venlafaxine and nefazodone, the noradrenergic and specific serotonergic antidepressant mirtazapine, and the selective NE reuptake inhibitor reboxetine (the only truly NE-selective agent available) have all demonstrated efficacy in the treatment of depressive disorders. Evidence is now emerging for their use in the treatment of anxiety and panic disorders. There is some suggestion of a role for noradrenergic agents in other disorders, including attention-deficit/hyperactivity disorder and social phobia. The full range of disorders for which noradrenergic agents can be used remains to be seen and further research in this area is necessary.

Effective open-label treatment of tourette's disorder with olanzapine.

Olanzapine is an atypical antipsychotic drug which shows a high antagonistic affinity to the D1, D2 and D4 and the 5-HT2A and 5-HT2c receptors. The goal of our investigation was to assess the efficacy of olanzapine in patients with Tourette's disorder who were either antipsychotic naive or who did not tolerate and/or did not respond to previous antipsychotic treatments in an open-label pilot study. Fourteen patients with a mean (SD 12.4) age of 32.6 years were treated for a period of 6 weeks. Seven patients did not respond to, or did not tolerate, previous neuroleptic treatments and seven patients were antipsychotic naive. All patients received olanzapine in ascending dosage, following a washout period of 1 week. Initial dosage was 10 mg/day with a maximum dosage of 20 mg/day. The Yale Global Tic Severity Scale (YGTSS), Fischer Symptom Check List-Neuroleptika and the Clinical Global Impression Severity Scale (CGI) were used. Two of the 14 patients did not complete the investigation. The mean dosage of olanzapine was 15 mg/day (SD 3.3) at day 42 (end of the study). The YGTSS scores and the CGI significantly decreased over the treatment period. The only side-effect observed was mild sedation which decreased during the course of the investigation and two patients had weight gain of 3-5 kg with increased appetite. In our study, we found that olanzapine was a safe and effective treatment alternative to other antipsychotics. In order to confirm these preliminary results, double-blind placebo controlled trials are warranted.

Schizophrenia and the dopamine-beta-hydroxylase gene: results of a linkage and association study.

Alterations in dopamine neurotransmission and disturbed norepinephrine activity have been implicated in the pathogenesis of schizophrenia. We considered the dopamine-beta-hydroxylase (DBH) gene located on the long arm of chromosome 9 (9q34.3) as a candidate gene for schizophrenia. DBH catalyzes the synthesis of norepinephrine from dopamine in noradrenergic neurons. In addition to DBH we used in the linkage study DNA markers ABL (centromeric) and D9S114 (telomeric). The aim of this study was to test linkage and association between PCR-based genotyped markers and schizophrenia. A simulation was done to investigate the power of our sample. In 34 Austrian families we could not detect linkage between schizophrenia and schizophrenia spectrum disorders and the three genetic markers. We could not find any significant deviation in allelic or genotypic distribution from expectations. Based on our results we conclude that the DBH gene seems to have no strong contribution in the etiology of schizophrenia.

The season of birth of schizophrenics and schizoaffectives.

We examined the birth distribution of 2,450 schizophrenic and 682 schizoaffective patients first admitted between 1971 and 1992 to the University Hospital for Psychiatry in Vienna. Our data showed an excess of schizophrenic births in the first quarter of the year and a deficit in the third quarter compared with expectation from census data. The quarterly distribution of schizophrenic births seemed to be different from the one of of schizoaffective patients. In schizoaffectives an excess of births in the first quarter of the year was present, but no other deviation from expectation.

[Psychological disorders of menopause: on the topic of multifactorial origin]. / Psychische Störungen in der Menopause: Zur Frage der multifaktoriellen Genese.

Interdisciplinary scientific research is an unjustly neglected discipline in the investigation of etiology and therapeutic potential regarding the symptoms of pre-, peri- and postmenopause. Thus the aim of this paper is: 1) the description of psychological disturbances occurring before, during and after menopause, 2) a representation of the etiological interaction between endocrinological, vegetative, psychodynamic and psychosocial factors of influence, and 3) to summarize the possible psychiatric and psychotherapeutic measures which can be taken.