Long-term outcome of anxiety disorders: a review of double-blind studies.

PURPOSE OF REVIEW: Although anxiety disorders are acknowledged as chronic, the issue of the pharmacological treatment duration remains unsettled. This review focuses on the long-term outcome of patients with anxiety disorders as demonstrated by randomized controlled trials. RECENT FINDINGS: Results from long-term randomized controlled trials of antidepressants in anxiety disorders indicate that maintenance treatment significantly reduces the odds of relapse, whatever the anxiety disorder is. This result appears to be similar to what is reported in long-term studies in depressive disorders. In addition, regarding the natural course of depressive disorders, acknowledged as mostly recurrent, some patients may require very long-term treatment, that is, more than 2 years. Moreover, naturalistic studies in anxiety disorders indicate that the relapse risk after discontinuation is not associated with the treatment duration. Finally, there is no predictor to identify those patients who require long-term pharmacotherapy for anxiety disorders. SUMMARY: In light of this review, other long-term studies in anxiety disorders have to be undertaken to identify predictors of relapse after treatment discontinuation. As it is now acknowledged for depressive disorders, some patients may require very long-term pharmacological treatment for anxiety disorders.

Characteristics of voluntary participants versus nonparticipants in a psychoeducation program for euthymic patients with bipolar disorder.

We aimed to assess the participation rate and predictive factors of participation in psychoeducation programs for euthymic outpatients with bipolar disorder. Ninety-five consecutive euthymic outpatients with bipolar disorder treated with lithium were recruited in a university department of psychiatry. The participants and nonparticipants in a program of psychoeducation were compared for sociodemographic, clinical, and psychological characteristics. According to univariate statistics, a younger age, a higher education level, a shorter duration of illness, a better initial knowledge about lithium, and a less external locus of control were predictive of participation in the program. A binary logistic regression model showed that an external locus of control was an independent predictor of participation. Among bipolar patients, the older, the less educated, those who have less knowledge about their treatment, and those with a more external locus of control were less likely to participate in hospital-based psychoeducation programs.

Night eating syndrome and winter seasonal affective disorder.

Night eating syndrome (NES) and winter seasonal affective disorder (SAD) share some features such as snacking for high-carbohydrate/high-fat food with increased weight, emotional distress, circadian disturbances, good response to serotoninergic antidepressants (SSRIs) and bright-light therapy. This study assessed the prevalence and socio-demographical and clinical correlates of the NES in a sample of 62 consecutive depressed outpatients with winter seasonal features (DSM-IV criteria). Depression was assessed with the 29 item-HDRS and Sigh-SAD version and with the 7-item depression subscale of the Hospital Anxiety and Depression scale. The prevalence of NES was low (4.8%). Patients suffering from NES were significantly older with a greater duration of the illness. NES was not related to depression and to Body Mass Index. NES and winter SAD are not overlapping disorders.

Modafinil as an adjunctive treatment to sleep deprivation in depression.

Sleep deprivation (SD) is a rapid-acting treatment for depression, but its clinical efficacy is hampered by high relapse rates after recovery sleep, and its effectiveness is reduced by the demanding effort needed for the patient to stay awake. To our knowledge, this is the first reported case of a successful treatment of depression with the combination of SD and the wakefulness-promoting agent modafinil. We suggest that modafinil may reinforce the action of SD, possibly by preventing daytime naps and microsleep, and may sustain the antidepressant effect of SD, possibly by stabilizing the resynchronization between the circadian clock and the sleep-wake cycle.