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C.03.04 Do we need another atypical antipsychotic?
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C.04 Anxiety and depression: managing co-conspirators for chronicity – A case-based discussion forum
greater physician–patient interaction. These benefits are increasingly important since antipsychotics side effects or relapse due to lack of compliance can have serious repercussions on patients’ quality of life. Antipsychotics are associated with a range of side effects, some of which will subside if the patient’s dose is suitably adjusted, others are unpleasant and lead to the necessity to switch treatments. One of the key side effects for schizophrenic patients is the effect of antipsychotics on QT interval. For many antipsychotics there is a necessity to carry out an ECG before initiating treatment. Many physicians would suggest that this is good clinical practise for treating patients with schizophrenia, whatever the intended medication. Further continuous monitoring might include weight gain, cognitive effects, and blood tests for hepatic enzyme effects, haematological effects and serum antipsychotic level. In fact, patients appreciate being carefully monitored and it contributes to a good patient/physician relationship. This physician and patient interaction has benefits in terms of impact on improved compliance and better control of symptoms due to treatment adherence (to appropriate doses), since the interaction enables close monitoring of side effects and action before the patient decides to stop taking medication. Good clinical practice in this arena suggests that investment in patient monitoring is offset by improved clinical outcomes. C.03.04 Do we need another atypical antipsychotic? S. Kasper ° . Medical University of Vienna, Department of General Psychiatry, Vienna, Austria Atypical antipsychotics were a great advance in the treatment of schizophrenia. However, thus far, there is no antipsychotic with exceptional efficacy and safety in all patients. The atypical antipsychotics have differing patterns of treatment-emergent side effects. Clinical skills and knowledge are required to find a suitable option for treatment of individual patients. Following its suspension in 1998, the safety and efficacy of sertindole has been investigated in several post-marketing studies based in clinical settings. As well as providing the safety data needed to support the reintroduction of sertindole, these studies have provided specific examples demonstrating that certain patients, in particular, may benefit from a switch from other atypical antipsychotics to sertindole. Sertindole is an effective atypical antipsychotic agent and, as with all the medications in this group, it is well tolerated with a lack of extrapyramidal symptom side effects. Its individual and mostly favourable profile of treatment-emergent effects and safety allows for flexibility in treating patients since they differ in their response and susceptibility to treatment-emergent effects. Sedation and anticholinergic effects are particularly troublesome side effects which may be common to some of the atypical antipsychotics. Sedation may lead to non-compliance during the initial period of treatment. Sedation may also have consequences for patients’ quality-of-life. Anticholinergic effects may adversely influence cognitive performance, and they pose a number of risks especially for older patients. The propensity of sertindole to cause anticholinergic effects is small and, more recently, there have been suggestions that sertindole may have beneficial effects on cognition.
C.04 Anxiety and depression: managing co-conspirators for chronicity – A case-based discussion forum Supported by an unrestricted educational grant from Wyeth C.04.01 Issues and challenges around anxiety and depression: co-conspirators for chronicity M. Pollack ° . Massachusetts General Hospital, Center for Anxiety and Traumatic Stress Disorders, Boston, USA Growing evidence speaks to the high rates of comorbid mood and anxiety disorders in epidemiologic and clinical populations. Unipolar and bipolar disorder each frequently co-occur with anxiety disorders; as a result, criteria for diagnosing patients with mixed anxiety-depressive disorder have been developed. Anxiety states typically, though not always, predate the onset of mood disorders and may be associated with an earlier age of onset of major depression and bipolar disorder. The presence of mood and anxiety comorbidity is associated with a variety of complications including greater severity of illness, increased rates of suicidal ideation and attempts, greater psychosocial and vocational impairment, decreased overall quality of life, increased rates alcohol and substance abuse, decreased periods of remission and increased vulnerability to trauma and loss. Furthermore, mood and anxiety disorder comorbidity is associated with poorer treatment response, greater use of polypharmacy, and the presence of more treatment related adverse effects. Recent studies have investigated the clinical and demographic correlates of comorbidity and the environmental and genetic factors that might contribute to the increased risk of concurrence of these disorders. It appears that a familial and/or genetic predisposition may interact with environmental stressors and experiences in precipitating the development of mood and anxiety disorders. Therefore, timely recognition and effective, innovative treatment approaches are the key to optimizing the care of individuals who are experiencing the morbid burden of comorbid mood and anxiety disorders. References [1] Pollack MH, 2005, Comorbid anxiety and depression, J Clin Psychiatry, 66, Suppl. 8, 22−9.
C.04.02 Managing comorbid anxiety with depression using currently available treatment options P. Roy-Byrne ° . Harborview Medical Centre, Dept. Psychiatry and Behavioral Science, Seattle, USA Anxiety disorders are the most commonly diagnosed mental disorder in the United States and most other countries [1,2]. Furthermore, in patients with major depressive disorder, anxiety, nervousness, and their somatic correlates are common symptoms [3]. This presentation will discuss the spectrum of available treatments for combined syndromes of anxiety and depression, focusing on both pharmacologic and cognitive-behavioral approaches and emphasizing an evidence-based approach whenever possible. A large number of medications have a broad spectrum of efficacy on multiple mood and anxiety disorders, facilitating initial selection of treatment. Other medications, with a more narrow range of efficacy, are useful as adjunctive or combination agents in specific situations. While cognitive-behavioral treatments have
C.04 Anxiety and depression: managing co-conspirators for chronicity – A case-based discussion forum
greater physician–patient interaction. These benefits are increasingly important since antipsychotics side effects or relapse due to lack of compliance can have serious repercussions on patients’ quality of life. Antipsychotics are associated with a range of side effects, some of which will subside if the patient’s dose is suitably adjusted, others are unpleasant and lead to the necessity to switch treatments. One of the key side effects for schizophrenic patients is the effect of antipsychotics on QT interval. For many antipsychotics there is a necessity to carry out an ECG before initiating treatment. Many physicians would suggest that this is good clinical practise for treating patients with schizophrenia, whatever the intended medication. Further continuous monitoring might include weight gain, cognitive effects, and blood tests for hepatic enzyme effects, haematological effects and serum antipsychotic level. In fact, patients appreciate being carefully monitored and it contributes to a good patient/physician relationship. This physician and patient interaction has benefits in terms of impact on improved compliance and better control of symptoms due to treatment adherence (to appropriate doses), since the interaction enables close monitoring of side effects and action before the patient decides to stop taking medication. Good clinical practice in this arena suggests that investment in patient monitoring is offset by improved clinical outcomes. C.03.04 Do we need another atypical antipsychotic? S. Kasper ° . Medical University of Vienna, Department of General Psychiatry, Vienna, Austria Atypical antipsychotics were a great advance in the treatment of schizophrenia. However, thus far, there is no antipsychotic with exceptional efficacy and safety in all patients. The atypical antipsychotics have differing patterns of treatment-emergent side effects. Clinical skills and knowledge are required to find a suitable option for treatment of individual patients. Following its suspension in 1998, the safety and efficacy of sertindole has been investigated in several post-marketing studies based in clinical settings. As well as providing the safety data needed to support the reintroduction of sertindole, these studies have provided specific examples demonstrating that certain patients, in particular, may benefit from a switch from other atypical antipsychotics to sertindole. Sertindole is an effective atypical antipsychotic agent and, as with all the medications in this group, it is well tolerated with a lack of extrapyramidal symptom side effects. Its individual and mostly favourable profile of treatment-emergent effects and safety allows for flexibility in treating patients since they differ in their response and susceptibility to treatment-emergent effects. Sedation and anticholinergic effects are particularly troublesome side effects which may be common to some of the atypical antipsychotics. Sedation may lead to non-compliance during the initial period of treatment. Sedation may also have consequences for patients’ quality-of-life. Anticholinergic effects may adversely influence cognitive performance, and they pose a number of risks especially for older patients. The propensity of sertindole to cause anticholinergic effects is small and, more recently, there have been suggestions that sertindole may have beneficial effects on cognition.
C.04 Anxiety and depression: managing co-conspirators for chronicity – A case-based discussion forum Supported by an unrestricted educational grant from Wyeth C.04.01 Issues and challenges around anxiety and depression: co-conspirators for chronicity M. Pollack ° . Massachusetts General Hospital, Center for Anxiety and Traumatic Stress Disorders, Boston, USA Growing evidence speaks to the high rates of comorbid mood and anxiety disorders in epidemiologic and clinical populations. Unipolar and bipolar disorder each frequently co-occur with anxiety disorders; as a result, criteria for diagnosing patients with mixed anxiety-depressive disorder have been developed. Anxiety states typically, though not always, predate the onset of mood disorders and may be associated with an earlier age of onset of major depression and bipolar disorder. The presence of mood and anxiety comorbidity is associated with a variety of complications including greater severity of illness, increased rates of suicidal ideation and attempts, greater psychosocial and vocational impairment, decreased overall quality of life, increased rates alcohol and substance abuse, decreased periods of remission and increased vulnerability to trauma and loss. Furthermore, mood and anxiety disorder comorbidity is associated with poorer treatment response, greater use of polypharmacy, and the presence of more treatment related adverse effects. Recent studies have investigated the clinical and demographic correlates of comorbidity and the environmental and genetic factors that might contribute to the increased risk of concurrence of these disorders. It appears that a familial and/or genetic predisposition may interact with environmental stressors and experiences in precipitating the development of mood and anxiety disorders. Therefore, timely recognition and effective, innovative treatment approaches are the key to optimizing the care of individuals who are experiencing the morbid burden of comorbid mood and anxiety disorders. References [1] Pollack MH, 2005, Comorbid anxiety and depression, J Clin Psychiatry, 66, Suppl. 8, 22−9.
C.04.02 Managing comorbid anxiety with depression using currently available treatment options P. Roy-Byrne ° . Harborview Medical Centre, Dept. Psychiatry and Behavioral Science, Seattle, USA Anxiety disorders are the most commonly diagnosed mental disorder in the United States and most other countries [1,2]. Furthermore, in patients with major depressive disorder, anxiety, nervousness, and their somatic correlates are common symptoms [3]. This presentation will discuss the spectrum of available treatments for combined syndromes of anxiety and depression, focusing on both pharmacologic and cognitive-behavioral approaches and emphasizing an evidence-based approach whenever possible. A large number of medications have a broad spectrum of efficacy on multiple mood and anxiety disorders, facilitating initial selection of treatment. Other medications, with a more narrow range of efficacy, are useful as adjunctive or combination agents in specific situations. While cognitive-behavioral treatments have