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P.1.006 Dimensional study of separation anxiety in adults
P.1 Affective disorders and antidepressants
S136
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Predictors of outcome in depression in treatment with selective serotonin reuptake inhibitors
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Dimensional study of separation anxiety in adults
F. Arias, J.J. Padin, J. Cabo, C. Alv~irez, M.B. Mateos, M.T. Gallego.
F. Atger, P. Aloupis, S. Kentin, M. Fouillet, M-H. Dao-.Castellana, D. Verot, S. Consoli, A. Braconnier. Service du DrA. Braconnier, Centre
Mental Health Unit, Santa Elena, Zamora, Spain
Philippe Paumelle, 11 rue Albert Bayer, 75013 Paris, France
The main purpose of this research was determining predictors of favourable outcome in mood disorders in treatment with SSRI. Methods: The sample consisted of 70 outpatients with DSM-III-R criteria of major depression or dysthymia, consecutively admitted in a Mental Health Unit from Zamora (Spain), without antidepressant treatment in the last month. Exclussion criteria were high risk of suicide or another axis I disorder concomitant. At beginning of treatment, subjects were evaluated on sociodemographic features, clinical characteristics with Symptoms Check-List 90-R, Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale and STAI, and personality factors with Eysenck Personality Questionnaire (EPQ), 16 Personality Factors questionnaire and Structured Clinical Interview for DSM-III-R for axis II. At six monahs of development, tests were reapplied. The efficacy were evaluated by HDRS and Clinical Global Impression. A descriptive study of the different variables was conducted. After this, in the case of the quantitative variables, the t-test was used if they followed a normal distribution, and the Wilcoxon test was used for unpaired samples that did not. For the qualitative variables, a comparison by means of the Chi squared test was used. A comparison between two groups was made, according to whether or not they improved (moderate or more in scoring of CGI) in the treatment after six months. With those variables which in the bivariant analysis showed a significant association of p < 0.1, a non-conditional logistic regression model was established, with a predictive objective. The analysis was conducted with the SPSS statistical packet. Results: Eleven subjects doesn't stayed at six months. 66% of sample fulfill criteria of major depression and 34% of dysthymia. 64.3% of initial sample improvement (moderate or more). A personality disorders was diagnosed in 60% of this sample. The best prediction model of favourable retention by logistic regression consisted of a low score in global subscale of SCL-90-R, a high one in extroversion factor of EPQ and a diagnosis of major depression. Conclusion: Personality factors and psychopathological severity are relevant factors in response to SSRI. Personality dimensions appears more important that personality disorders in outcome.
Purpose: The aim of our study was to set up a self rating scale assessing separation anxiety in adults (< 18 years) as a dimension. Methods: A self questionnaire including 24 items was created according to DSM III-R criteria of SAD (Separation Anxiety Disorder). It was submitted to 54 healthy volunteers and 55 anxious and/or depressive outpatients. Results: Factor analysis showed good internal consistency of the questionnaire and gathering of items in two factors: ~ne could refer tofeeled anxiety, the other to represented anxiety. The average score in patients (M = 11.3; SD = 4.2) is significatly higher than in healthy volunteers. Subjects suffering of anxious disorders have an average score at the questionnaire very close to the score found in the depressive subjects. Finally a second step of our work is proposed with a 17 items version of the separation anxiety self questionnaire.
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Trazodone and priapism
R. A~lon, N. Kaya, A.S. ~illi. Medical Faculty of Sel¢uk University,
Department of Psychiatry, 42080, Konya, Turkey Objective: Trazodone is the only antidepressant that has been associated with priapism, which may be irreversible and require surgical intervention. Here we described two cases of priapism associated with use of trazodone. The patients was informed of possible sexual dysfunction. Cases: First patient a 14-year-old male was on trazodone for one week. Prolonged painful erections occurred. The erections removed when the drug was discontinued. The second patient is a 44-year-old male and was on a regimen of trazodone, 200 mg/day, for 4 weeks, two years after a 1-year treatment period with trazodone without any sexual side effects. Standard treatment was initiated but was unsuccessful. Penile pain and swelling slowly resolved with surgical intervention over the next week without return of erectile function. Conclusions: The presented cases demonstrate that men being prescribed trazodone should be warned of this rare but serious side effect. Early identification is important, and treatment should be sought immediately.
References [1] Thompson JW Jr, Ware MR, Blashfield RK (1990) Psychotropic medication and priapism: a comprehensive review. J Clin Psychiatry 51,430-33 [2] Segraves RT (1989) Effects of psychotropic drugs on human erection and ejaculation. Arch Gen Psychiatry 46, 275-284
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Analysis of the utilization of anxiolytics and sedative-hypnotics prior to and post initiation of an SSRI for the treatment of depression
R.M. Baldridge
1, T.R. Hylan 1, L. Meneades 2, W.H. Crown 2. 1Eli Lilly
and Company, Indianapolis, Indiana; 2 The MEDSTAT Group, Cambridge, Massachusetts, USA A review of the literature regarding the concomitant use of SSRIs and anxiolytics or sedative-hypnotics reveals limited information about the timing of receipt of the anxiolytics or sedative-hypnotics in the period surrounding the initiation of SSRI therapy. Symptoms of anxiety and sleep disturbances often precede and coexist with depression (Coplan and Gorman, 1990; Neylan, 1995). Many physicians initiate treatment with anxiolytics and/or sedative-hypnotics both prior to, at and following the initiation of the SSRI. They are prescribed to provide ,;ymptomatic relief and to relieve the burden of side effects (Coplan and Gorman, 1990). A study of anxiolytic and sedative-hypnotic prescribing prior to and post initiation of the treatment for depression with SSRIs may provide important insights into understanding differences in the use of these products among the three leading SSRIs in the United States. Patient-level episodes of SSRI treatment covering a twelve-month period (6 months prior and 6 months post initiation of fluoxetine, sertraline and paroxetine) were constructed from an insurance claims database for a privately insured population in the United States. The results indicated that l) the rate of prescribing of anxiolytics and/or sedative-hypnotics was greatest in the months immediately preceding and following the initiation of the SSRI; 2) paroxetine patients had the highest peak use in the prior period (17.5% in month - 1 vs. 12.1% for se~araline and 10.3% for fluoxetine, p < 0.01) and in the post period (17.5% in month +2 vs. 14.0% for sertraline and 12.6% for fluoxetine, p <0.04); 3) after a drop in concomitant use in month +1 for paroxetine, the rate of concomitant use increased to the pre-treatment peak and continued to remain at levels higher than those of either sertraline or fluoxetine for the remainder of the post period; 4) the rate of concomitant use increased among sertraline patients in the later months of the study. Higher prescribing of concomitant anxiolytics anti/or sedative-hypnotics among paroxetine and sertraline patients may be reflective of patients with more anxiety symptoms or sleep disturbances. However, the decrease and subsequent increase in use among paroxetine patients indicated a pattern incongruous with a lower incidence of side effects suggested in clinical research (DeWilde et al., 1992). Broadly considered, the rates of decline in concomitant prescribing of anxiolytics and/or sedative-hypnotics differ across the SSRI class with the rate of decline being greatest for fluoxetine patients.
References [1] Coplan, J.D. and Gorman, J.M. (1990) Treatment of Anxiety Disorder in Patients With Mood Disorders. J. Clin. Psych. 51 (10, suppl.), 9-13. [2] DeWilde, J., Spiers, R., Mertens, C., Bartholome, E, Schone, G. and Leyman.
S136
•
Predictors of outcome in depression in treatment with selective serotonin reuptake inhibitors
•
Dimensional study of separation anxiety in adults
F. Arias, J.J. Padin, J. Cabo, C. Alv~irez, M.B. Mateos, M.T. Gallego.
F. Atger, P. Aloupis, S. Kentin, M. Fouillet, M-H. Dao-.Castellana, D. Verot, S. Consoli, A. Braconnier. Service du DrA. Braconnier, Centre
Mental Health Unit, Santa Elena, Zamora, Spain
Philippe Paumelle, 11 rue Albert Bayer, 75013 Paris, France
The main purpose of this research was determining predictors of favourable outcome in mood disorders in treatment with SSRI. Methods: The sample consisted of 70 outpatients with DSM-III-R criteria of major depression or dysthymia, consecutively admitted in a Mental Health Unit from Zamora (Spain), without antidepressant treatment in the last month. Exclussion criteria were high risk of suicide or another axis I disorder concomitant. At beginning of treatment, subjects were evaluated on sociodemographic features, clinical characteristics with Symptoms Check-List 90-R, Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale and STAI, and personality factors with Eysenck Personality Questionnaire (EPQ), 16 Personality Factors questionnaire and Structured Clinical Interview for DSM-III-R for axis II. At six monahs of development, tests were reapplied. The efficacy were evaluated by HDRS and Clinical Global Impression. A descriptive study of the different variables was conducted. After this, in the case of the quantitative variables, the t-test was used if they followed a normal distribution, and the Wilcoxon test was used for unpaired samples that did not. For the qualitative variables, a comparison by means of the Chi squared test was used. A comparison between two groups was made, according to whether or not they improved (moderate or more in scoring of CGI) in the treatment after six months. With those variables which in the bivariant analysis showed a significant association of p < 0.1, a non-conditional logistic regression model was established, with a predictive objective. The analysis was conducted with the SPSS statistical packet. Results: Eleven subjects doesn't stayed at six months. 66% of sample fulfill criteria of major depression and 34% of dysthymia. 64.3% of initial sample improvement (moderate or more). A personality disorders was diagnosed in 60% of this sample. The best prediction model of favourable retention by logistic regression consisted of a low score in global subscale of SCL-90-R, a high one in extroversion factor of EPQ and a diagnosis of major depression. Conclusion: Personality factors and psychopathological severity are relevant factors in response to SSRI. Personality dimensions appears more important that personality disorders in outcome.
Purpose: The aim of our study was to set up a self rating scale assessing separation anxiety in adults (< 18 years) as a dimension. Methods: A self questionnaire including 24 items was created according to DSM III-R criteria of SAD (Separation Anxiety Disorder). It was submitted to 54 healthy volunteers and 55 anxious and/or depressive outpatients. Results: Factor analysis showed good internal consistency of the questionnaire and gathering of items in two factors: ~ne could refer tofeeled anxiety, the other to represented anxiety. The average score in patients (M = 11.3; SD = 4.2) is significatly higher than in healthy volunteers. Subjects suffering of anxious disorders have an average score at the questionnaire very close to the score found in the depressive subjects. Finally a second step of our work is proposed with a 17 items version of the separation anxiety self questionnaire.
•
Trazodone and priapism
R. A~lon, N. Kaya, A.S. ~illi. Medical Faculty of Sel¢uk University,
Department of Psychiatry, 42080, Konya, Turkey Objective: Trazodone is the only antidepressant that has been associated with priapism, which may be irreversible and require surgical intervention. Here we described two cases of priapism associated with use of trazodone. The patients was informed of possible sexual dysfunction. Cases: First patient a 14-year-old male was on trazodone for one week. Prolonged painful erections occurred. The erections removed when the drug was discontinued. The second patient is a 44-year-old male and was on a regimen of trazodone, 200 mg/day, for 4 weeks, two years after a 1-year treatment period with trazodone without any sexual side effects. Standard treatment was initiated but was unsuccessful. Penile pain and swelling slowly resolved with surgical intervention over the next week without return of erectile function. Conclusions: The presented cases demonstrate that men being prescribed trazodone should be warned of this rare but serious side effect. Early identification is important, and treatment should be sought immediately.
References [1] Thompson JW Jr, Ware MR, Blashfield RK (1990) Psychotropic medication and priapism: a comprehensive review. J Clin Psychiatry 51,430-33 [2] Segraves RT (1989) Effects of psychotropic drugs on human erection and ejaculation. Arch Gen Psychiatry 46, 275-284
•
Analysis of the utilization of anxiolytics and sedative-hypnotics prior to and post initiation of an SSRI for the treatment of depression
R.M. Baldridge
1, T.R. Hylan 1, L. Meneades 2, W.H. Crown 2. 1Eli Lilly
and Company, Indianapolis, Indiana; 2 The MEDSTAT Group, Cambridge, Massachusetts, USA A review of the literature regarding the concomitant use of SSRIs and anxiolytics or sedative-hypnotics reveals limited information about the timing of receipt of the anxiolytics or sedative-hypnotics in the period surrounding the initiation of SSRI therapy. Symptoms of anxiety and sleep disturbances often precede and coexist with depression (Coplan and Gorman, 1990; Neylan, 1995). Many physicians initiate treatment with anxiolytics and/or sedative-hypnotics both prior to, at and following the initiation of the SSRI. They are prescribed to provide ,;ymptomatic relief and to relieve the burden of side effects (Coplan and Gorman, 1990). A study of anxiolytic and sedative-hypnotic prescribing prior to and post initiation of the treatment for depression with SSRIs may provide important insights into understanding differences in the use of these products among the three leading SSRIs in the United States. Patient-level episodes of SSRI treatment covering a twelve-month period (6 months prior and 6 months post initiation of fluoxetine, sertraline and paroxetine) were constructed from an insurance claims database for a privately insured population in the United States. The results indicated that l) the rate of prescribing of anxiolytics and/or sedative-hypnotics was greatest in the months immediately preceding and following the initiation of the SSRI; 2) paroxetine patients had the highest peak use in the prior period (17.5% in month - 1 vs. 12.1% for se~araline and 10.3% for fluoxetine, p < 0.01) and in the post period (17.5% in month +2 vs. 14.0% for sertraline and 12.6% for fluoxetine, p <0.04); 3) after a drop in concomitant use in month +1 for paroxetine, the rate of concomitant use increased to the pre-treatment peak and continued to remain at levels higher than those of either sertraline or fluoxetine for the remainder of the post period; 4) the rate of concomitant use increased among sertraline patients in the later months of the study. Higher prescribing of concomitant anxiolytics anti/or sedative-hypnotics among paroxetine and sertraline patients may be reflective of patients with more anxiety symptoms or sleep disturbances. However, the decrease and subsequent increase in use among paroxetine patients indicated a pattern incongruous with a lower incidence of side effects suggested in clinical research (DeWilde et al., 1992). Broadly considered, the rates of decline in concomitant prescribing of anxiolytics and/or sedative-hypnotics differ across the SSRI class with the rate of decline being greatest for fluoxetine patients.
References [1] Coplan, J.D. and Gorman, J.M. (1990) Treatment of Anxiety Disorder in Patients With Mood Disorders. J. Clin. Psych. 51 (10, suppl.), 9-13. [2] DeWilde, J., Spiers, R., Mertens, C., Bartholome, E, Schone, G. and Leyman.