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C.11.05 Expanding the therapeutic options for behavioural disorders
P8 Other topics bipolar mania and in the prevention of relapse in patients with stabilised disease.
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Expanding the therapeutic options for behavioural disorders
C. Arango *. University General Hospital Gregorio Maranon, Madrid, Spain Disruptive behaviour disorders (DBDs), including conduct disorder and oppositional defiant disorder, are the most common childhood psychiatric disorders, affecting between 4% and 9% of the paediatric population. They are characterised by a repetitive and persistent pattern of antisocial, aggressive, or defiant behaviour, which deviates from the social norms appropriate for the age of the individual. DBDs are associated with a poor long-term prognosis for the patient; in 30 50% of individuals, symptoms of DBDs persist into adulthood. The consequences of DBDs can be damaging for the child and family, and expensive for society in terms of law enforcement, damage costs and secure care for the child. Numerous treatments have been investigated for the treatment of DBDs. Non-pharmacological methods include behaviour modification, psychotherapy, and cognitive and social interventions, which have proved effective in certain patients. In cases where pharmacological methods are indicated, antipsychotics, mood stabilisers, antidepressants and psychostimulants have shown varying levels of success. This presentation deals with the role of pharmacological agents, focusing on efficacy, safety and tolerability of typical and atypical antipsychotics, including aripiprazole, a low sedating atypical antipsychotic with a partial agonist profile, in children and adolescents with conduct disorder. Recent clinical studies have highlighted the improved safety and tolerability profiles of atypical antipsychotics over typical agents, indicating a more effective treatment option for patients with DBDs.
C.12 Are there any new developments in depression treatment? Supported by an unrestricted educational grant from The Lilly/Boehringer Ingelheim Alliance
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Differential diagnosis and comorbidities of depression
A. Young*. University of Newcastle, Royal Victoria htfirmaty, Newcastle upon Tyne, United Kingdom For some patients, the diagnosis of depression may be fairly simple and need not go far beyond the statement, "Doctor, I feel depressed". Yet for a great many other patients, depression can be complicated by other symptoms from any number of causes. In some cases, what appears to be depression may in actuality be bipolar depression; however, this may not be evident until treatment with antidepressants abruptly pushes the patient toward mania. In other cases, comorbid conditions or associated symptoms, such as anxiety, sleeplessness, or pain, may mask the underlying depression, leading to diagnoses and treatments that don't address the predominant condition. These issues as well as the effects of comorbid medical illness need to be acknowledged in the diagnosis and treatment of depression. Various diagnostic tools are available for differentiating between possible mood
$663
disorders and methods have been developed to differentiate medical symptoms from psychiatric ones. Patients who present with symptoms that may be consistent with either bipolar depression or unipolar depression require separate treatment options and the consequences of having comorbid mood and medical disorders may be severe in terms of the diagnosis and management of symptoms. There are data suggesting that symptoms may be common to mood and medical disorders, as well as considerations for treatment choice and potential drug-drug interactions.
•
Translating symptoms via neurobiology
S.M. Stahl *. University of California, San Diego, Department of Psychiatry, Carlsbad, USA When considering the course of medical progress, diagnostic tests have improved throughout the decades, with modem diagnoses aided by batteries of laboratory and imaging tests. We unfortunately do not yet have the means to diagnose depression strictly through these means; depression is a condition that still needs to be defined by its symptoms, whether by careful history-taking or by the ratings on screening scales. Although these methods serve us well for most patients, we all know of cases where we wished a complex history could be cleared up with a brain scan or blood test. With this in mind, we can look toward the future, where we may discover a specific genetic marker that signifies a propensity for depression or a depression in brain function in a well-defined cortical area that is common to all patients with MDD. On the other hand, it may become evident that there is no definite biological marker for depression that exists across all individuals. As current neuroanatomical studies on depression progress, data are being gathered that will allow us to attempt to decipher the biological underpinning of depression. The neural circuitry and neurotransmitters that may be connected to the various emotional and physical symptoms of depression should also be delineated. The different classes of antidepressants and how they may differently address these symptoms should be examined, based on their biological activity.
~
Answering your questions about duloxetine
V. Burt *. Women"s Life Centet; Sherman Oaks, USA Duloxetine, the latest addition to the list of dual acting reuptake inhibitors, is a safe and effective agent that exhibits both potency and balance in its action on 5-HT and NE. A question that remains is: Why is a new antidepressant needed when so many others are already available? To answer this question, this presentation will address the data for duloxetine as a first-line antidepressant to treat general and elderly patients. Emphasis needs to be placed on efficacy, tolerability, and the safety of duloxetine, its rapidity of response, its potential for achieving complete remission from all symptoms of depression (emotional, anxious, and somatic) and its ease of use in the elderly. The data suggest that duloxetine is a well-tolerated, safe, and effective agent that robustly treats depression to remission for many adult patients, in ages ranging from young adults to the elderly.
•
Expanding the therapeutic options for behavioural disorders
C. Arango *. University General Hospital Gregorio Maranon, Madrid, Spain Disruptive behaviour disorders (DBDs), including conduct disorder and oppositional defiant disorder, are the most common childhood psychiatric disorders, affecting between 4% and 9% of the paediatric population. They are characterised by a repetitive and persistent pattern of antisocial, aggressive, or defiant behaviour, which deviates from the social norms appropriate for the age of the individual. DBDs are associated with a poor long-term prognosis for the patient; in 30 50% of individuals, symptoms of DBDs persist into adulthood. The consequences of DBDs can be damaging for the child and family, and expensive for society in terms of law enforcement, damage costs and secure care for the child. Numerous treatments have been investigated for the treatment of DBDs. Non-pharmacological methods include behaviour modification, psychotherapy, and cognitive and social interventions, which have proved effective in certain patients. In cases where pharmacological methods are indicated, antipsychotics, mood stabilisers, antidepressants and psychostimulants have shown varying levels of success. This presentation deals with the role of pharmacological agents, focusing on efficacy, safety and tolerability of typical and atypical antipsychotics, including aripiprazole, a low sedating atypical antipsychotic with a partial agonist profile, in children and adolescents with conduct disorder. Recent clinical studies have highlighted the improved safety and tolerability profiles of atypical antipsychotics over typical agents, indicating a more effective treatment option for patients with DBDs.
C.12 Are there any new developments in depression treatment? Supported by an unrestricted educational grant from The Lilly/Boehringer Ingelheim Alliance
~
Differential diagnosis and comorbidities of depression
A. Young*. University of Newcastle, Royal Victoria htfirmaty, Newcastle upon Tyne, United Kingdom For some patients, the diagnosis of depression may be fairly simple and need not go far beyond the statement, "Doctor, I feel depressed". Yet for a great many other patients, depression can be complicated by other symptoms from any number of causes. In some cases, what appears to be depression may in actuality be bipolar depression; however, this may not be evident until treatment with antidepressants abruptly pushes the patient toward mania. In other cases, comorbid conditions or associated symptoms, such as anxiety, sleeplessness, or pain, may mask the underlying depression, leading to diagnoses and treatments that don't address the predominant condition. These issues as well as the effects of comorbid medical illness need to be acknowledged in the diagnosis and treatment of depression. Various diagnostic tools are available for differentiating between possible mood
$663
disorders and methods have been developed to differentiate medical symptoms from psychiatric ones. Patients who present with symptoms that may be consistent with either bipolar depression or unipolar depression require separate treatment options and the consequences of having comorbid mood and medical disorders may be severe in terms of the diagnosis and management of symptoms. There are data suggesting that symptoms may be common to mood and medical disorders, as well as considerations for treatment choice and potential drug-drug interactions.
•
Translating symptoms via neurobiology
S.M. Stahl *. University of California, San Diego, Department of Psychiatry, Carlsbad, USA When considering the course of medical progress, diagnostic tests have improved throughout the decades, with modem diagnoses aided by batteries of laboratory and imaging tests. We unfortunately do not yet have the means to diagnose depression strictly through these means; depression is a condition that still needs to be defined by its symptoms, whether by careful history-taking or by the ratings on screening scales. Although these methods serve us well for most patients, we all know of cases where we wished a complex history could be cleared up with a brain scan or blood test. With this in mind, we can look toward the future, where we may discover a specific genetic marker that signifies a propensity for depression or a depression in brain function in a well-defined cortical area that is common to all patients with MDD. On the other hand, it may become evident that there is no definite biological marker for depression that exists across all individuals. As current neuroanatomical studies on depression progress, data are being gathered that will allow us to attempt to decipher the biological underpinning of depression. The neural circuitry and neurotransmitters that may be connected to the various emotional and physical symptoms of depression should also be delineated. The different classes of antidepressants and how they may differently address these symptoms should be examined, based on their biological activity.
~
Answering your questions about duloxetine
V. Burt *. Women"s Life Centet; Sherman Oaks, USA Duloxetine, the latest addition to the list of dual acting reuptake inhibitors, is a safe and effective agent that exhibits both potency and balance in its action on 5-HT and NE. A question that remains is: Why is a new antidepressant needed when so many others are already available? To answer this question, this presentation will address the data for duloxetine as a first-line antidepressant to treat general and elderly patients. Emphasis needs to be placed on efficacy, tolerability, and the safety of duloxetine, its rapidity of response, its potential for achieving complete remission from all symptoms of depression (emotional, anxious, and somatic) and its ease of use in the elderly. The data suggest that duloxetine is a well-tolerated, safe, and effective agent that robustly treats depression to remission for many adult patients, in ages ranging from young adults to the elderly.