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P.1.165 Management of suicidality in old age depression by family physicians in Germany
P.1 Affective disorders and antidepressants [3] de Boer, T., Ruigt, G.S.E (1995) The selective (2)-adrenoceptor antagonist mirtacapine (Org 3770) enhances noradrenergic and 5-HT 1A-mediated serotonergic neurotransmission. CNS Drugs 4 (Suppl 1), 29-38.
•
Efficacy of paroxetine in the treatment of patient disability in social phobia M. Stein 1, C.D. Pitts 2, R. Oakes 2, I. Gergel 2.1 Department of Psychiatr); University of California San Diego, La Jolia, California; 2SmithKline Beecham Pharmaceuticals, Collegeville, Pennsylvania, USA
Social phobia is a common disorder, with a lifetime prevalence of 13.3% (US) (Kessler et al., 1994). More than half of all social phobic patients report at least moderate impairment at some time in their lives, due to social anxiety and avoidance, affecting education and employment as well as social and family relationships (Schneier et al., 1994). Thus, a burden is placed on the individual and on society unless there is accurate diagnosis of the disorder followed by prompt and effective treatment. However, the problem may be underestimated as the nature of the disorder means that patients avoid consulting their doctor for perhaps many years. Delayed presentation may complicate the clinical picture even further by allowing the development of comorbid conditions such as anxiety disorders, alcohol dependence and major depressive disorder. Such comorbidity may reflect a more severe psychopathology with increased disability and impaired functioning than seen with social phobia alone. Once diagnosed, treatment should ideally alleviate social phobia while significantly contributing to the remission of comorbid disorders and improvement in the patient's overall quality of life. There are no precise clinical guidelines for the management of social phobia, but there is growing support for the use of some members of the selective serotonin reuptake inhibitor (SSRI) class of antidepressant. The efficacy of the SSRI paroxetine has recently been demonstrated in a placebo-controlled study in patients with social phobia. Patients (n = 187) meeting DSM-IV criteria of generalised social phobia were randomised to receive either paroxetine (20-50 mg per day) or placebo in a double-blind manner over 12 weeks. The primary efficacy parameter, patients responding at endpoint using the Clinical Global Impression global improvement score, demonstrated significantly greater improvement for paroxetine over placebo (55% vs 24%, p < 0.001). Paroxetine's statistical advantage was observed from week four onward. In addition, relative to baseline, the endpoint Liebowitz Social Anxiety Scale total scores were improved significantly more by paroxetine than by placebo (p < 0.001). This clinical benefit was continuous from week two onwards. Significant differences in favour of paroxetine were also noted on the Social Anxiety and Distress Scale (p < 0.001) and Sheehan Disability Inventory work (p < 0.05) and social life items (p < 0.00l) at endpoint. These data indicate that paroxetine is an effective agent for the treatment of generalised social phobia and that aspects of quality of life may be positively improved. In addition, comorbid disorders may be effectively managed since paroxetine has previously demonstrated efficacy in the treatment of depression and anxiety disorders, both of which commonly co-exist with social phobia.
References [1] Kessler, R.C., McGonagle, K.A., Zhao, S., et al. (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch. Gen. Psychiatry 5t, 8-19. [2] Schneier, ER., Heckelman, L.R., Garfinkel, R., et al. (1994) Functional impairment in social phobia. J. Clin. Psychiatry 55,322-331.
~
A
randomized trial of the effectiveness of sertraline vs interpersonal therapy (IPT) alone or in combination, for people with dysthymia
G. Browne, M. Steiner, J. Roberts, A. Gafni, C. Byrne, B. Bell, M. Webb, E. Jamieson. Department of Psychiatry, St Joseph's Hospital,
and System-Linked Research Unit, McMaster University Hamilton, ON. Canada Rostered patients in a Health Service Organization in southern Ontario Canada, as well as persons recruited from the region, were screened by phone for 9 psychiatric disorders (major depressive disorder, dys-
S 187
thymia, generalized anxiety disorder, panic, social phobia, simple phobia, agoraphobia, alcohol and drug dependence) using the UM-CIDI short :form. Those who scored positive on any disorder were invited to see a tlealth care provider; those who consented to the visit were screened for dysthymia and/or major depressive disorder using a modified SCID-NP. ']?hose who were positive for dysthymia and consento:l to participate were randomized to one of three groups: sertraline alone, IPT alone, or sertraline in combination with IPT. This is an ongoing study. Patients have follow-up clinic visits at 3 weeks, 6 weeks, and 3, 6, 9, 12, 15, 18, 21, and 24 months. Blind assessment of outcome are made by trained interviewers at baseline, 6 months, 12, and 24 months using the Monlgomery-Asherg Depression Rating Scale (MADRS). Results: 5872 persons were screened; of these, 2535 were positive on at least one of the 9 disorders, of those positive, 1544 consented to the visit; 736 persons were positive for dysthymia; and of those, 29 refused to participate. Altogether, 707 dysthymic patients were randomized; 229 to sertraline alone, 247 to sertraline and IPT, and 231 to the IPT alone group. Sertraline is prescribed by the attending physician at an initial dose of 25 mg with the option to be increased gradually up to a maximum of 200 mg per day. Sertraline plasma levels are measured both at regular as well as random visits. IPT is provided by trained staff, a total of up to 16 sessions are provided within the first three months of the study. Preliminary results comparing the responses in the sertraline, sertraline and IPT, and IPT alone groups at the six month follow-up visit, will be presented. [Supported by a grant from the Medical Research Council of Canada Pharmaceutical Manufacturers Association of Canada and Pfizer Canada Inc.]
of suicidality in old age depression IP' 1. 165 I Management by family physicians in Germany G. Stoppe, H. Sandholzer 1, p. Aksari, C. Muder, H. Duwe, J. Staedt.
University c~fGtttingen, Department of Psychiatr).,; i Department of General Practice, GOttingen, Germany With a prevalence of about 20% depression is the most common disorder in old age with a strong impact on quality of life and also on physical health (1)+ The rate of suicides is considerably high especially in this age group with a predominance in the male patients (5:1 compared to the females). Since most of the elderly are treated exclusively by their family physicians (FP), the following study was designed to investigate the influence of various factors (gender, severity, comorbidity) on disease management. We designed two written case histories describing mild depression (case l, Hamilton Depression Rating Scale (HDRS): 9) and moderate to severe (delusionary) depression (case 2, HDRS: 23). For each case different versions were used: in case 1 the gender of the: patients varied, in case 2 both the gender and the previous history (stroke/hypothyreosis). The different combinations of case lafo and case 2a-d were randomly assigned and a pair of case l and 2 presented to FP by trained investigators in a face to face interview. A standardised interview was performed concerning different aspects of disease management. After asking the physicians for informations and diagnostics they would like to get in the respective cases, at the end we also asked directly (cued) whether they would ask the patient for a potential suicidality, and if not, why not. 170 (77.6%) of all FPs in Kassel and rural surroundings were interviewed during summer 1995. The data may be regarded as representative. In both cases nearly no physician considered suicidality uncued (case 1: 2.4%, case 2: 5.9%). Following the direct question, 66.5% of all physicians said that they would ask the patient, and another 10% would do this "later". 22.6% would not ask the patient. There were no significant differences with regard to patient's and physicians' gender anti between the answers to case 1 and 2. Those who would not ask the patient argued, that they would not see a "reason" for this and/or would wait for the patient's initiative and/or feared to "make the patient suicidal" by asking. The signficant differences between cued and uncued answers point into the direction, that the problem of suicidality in depression is generally known to FE As far as the results are comparable to the actual situation
S188
P1 Affective disorders and antidepressants
in primary care however, they point to major problems in dealing with suicidality.
References ill NIH consensus Development Panel on Depressionin Late Life. Diagnosis and treatment of depression in late life. J Am Med Assoc 1992: 168:1018-1024
•
Diagnosis of depression in the elderly by family physicians in Germany
G. Stoppe, H. Sandholzer 1, p. Aksari, C. Muder, H. Duwe, J. Staedt.
University of GOttingen, Department of Psychiatry" 1Department of General Practice, Gtttingen, Germany With a prevalence of about 20% depression is the most common disorder in old age with a strong impact on quality of life and also on physical health. Previous studies revealed a striking underdiagnosis and undertreatment of depression in primary care. The following study was designed to investigate the influence of various factors (gender, severity, comorbidity) on disease recognition and treatment. We designed two written case histories describing mild depression (case l, Hamilton Depression Rating Scale (HDRS): 9) and moderate to severe (delusionary) depression (case 2, HDRS: 23). For each case different versions were used: in case 1 the gender of the patients varied, in case 2 both the gender and the previous history (stroke/hypothyreosis). The different combinations of case la/b and case 2a~,t were randomly assigned and a pair of case 1 and 2 presented to family physicians (FP) by trained investigators in a face to face interview. A standardised interview was performed concerning different aspects of disease management. At the end we also asked the physicians to estimate their own competence in diagnosis and treatment of depression. 170 (77.6%) of all FPs in Kassel and rural surroundings were interviewed during summer 1995. The data may be regarded as representative. In case 1 significantly more physicians considered depression for primary diagnosis than in case 2 (71.8% versus 41.8%). In both cases, about 17% of all physicians would not make a diagnosis. The diagnosis did not correlate to the perception of own competence, with about 60% of the FPs regarding the diagnosis of depression as simple and less than 5% who found it difficult. There was a trend in both cases to diagnose depression more often in a female than in a male patient (case 1: 78.8% versus 63.8%). Correspondingly, more physicians would not "give" a diagnosis to the male patient (case 1: 26.3% versus 10%). For differential diagnosis, a variety of disorders was discussed, mostly cancer, organic brain disorder, anemia, diabetes, and myocardial insufficiency. In conclusion, in contrast to other studies (e.g. 2), primary care physicians seem to think of depression quite often and significantly more in those cases, which are the most frequent in ambulatory care. Women are diagnosed more often. With regard to the treatment data however, depression recognition is not followed by adequate treatment. Different reasons may be discussed: lack of competence, doubts in a "disease concept" of depression e. g..
References [1] NIH consensus Development Panel on Depression in Late Life. Diagnosis and treatment of depression in late life. J Am Med Assoc 1992; 168:1018-1024 [2] Mullan E, Katona E D'Ath, Katona C. Screening, detection and management of depression in elderly primary care attenders. It: Detection and fitness for treatment: a case record study. Faro Pract 1994; 11:267-270
•
Citalopram in the treatment of depression in patients suffering from simultaneous serious somatic disorders
H. Tondlova 1, j. Bagtecky 2. 1Psychiatric Outpatient Unit, Railway Hospital with Outpatient Clinic, Italskd 37, 120 O0 Prague 2; 2Dept. of Psychiatry Postgraduate Medical School, Psychiatric Hospital, Ustavn{ 91, 181 02 Prague 8, Czech Republic Citalopram is one of serotonine selective reuptake inhibitors/SSRI/. With regard to its pharmacological properties it seems to be suitable for the treatment of depressive syndromes in patients suffering from serious
somatic disorders. Lipavsk~ proved efficacy of citalopram in 65 per cent of depressive patients with concommitant serious somatic disorders, e.g. cardiovascular, and did not observe deterioration of basic somatic disease / 1997/. The aim of our study has been to prove efficacy of citalopram/SEROPRAM Lundbeck/in depressive syndromes in patients with simultaneous serious somatic disorders. Design: 19 female outpatients/with age ranging fl'om 47 to 70 years/ and one male outpatient were included into the study. They suffered from cancer of different sites, malignant hypertension, diabetes mellitus, osteoporosis and other diseases. Their mental state was evaluated by an interview and the SCL - 90 rating scale/Symptom Check List according to Derogatis et al. 1973; Czech version - Bolelouck~ 1985/. The SCL 90 was administered before and after the treatment. It contains 90 questions /items/. 10 symptom constructs /dimensions/ corresponding with some psychopathological syndromes can be constructed from respones to the questions: somatisation, obsessions - compulsions, interpersonal sensitivity, depression, anger - hostility, phobic anxiety, paranoidity, psychoticism and items not included/reflecting mostly sleep and eating distortions/. Basic somatic examination and laboratory screeing/including ECG/were performed before the beginning of the treatment, after 6 weeks and at the discontinuation of the treatment. The patients were given 20 mgms of citalopram dally for a period of 3 to 4 months. The T test was used for a statistical evaluation of results. Results: Mean values of psychopathology in the most important dimensions of the SCL - 90/e.g. depression, anxiety/exceeded so called borderline values of the psychopathology/derived from control persons/ in our patients. Their depression was evaluated mostly as moderately hard/F 32.1/before the treatment. The mean values of psychopathology decreased significantly in the course of the treatment. Only minimal and transient side effects were observed. Nor worsening of basic somatic disorder nor serious changes in laboratory findings were checked.
References ill Lipavsk~, P. /1997/Citalopram/Seropram/v 16~b~depresivn~o syndromu u pacientt~ se sou~asn3~mz,'tvaZn~jgfmsomatick~m onemocn~nfm/Citalopramin the treatment of depressive syndrome in patients with concommitant serious somatic disorder/C.S. Psychiat./1997 - press/.
P.1~-6.168--~ Nitric oxide and depression: Voltametric detection of blood nitric oxide on depressed patients P. Vandel 1, S. Burlet 2, R. Cespuglio 2, j. Dalery 3.1 Service de psychiatric, CHU 25030 Besan9on; 2D~partement de M~decine Exp~rimentale, 69373 Lyon; 3Service de psychiatric, CHS Le Vinatier, 69500 Bron, France Nitric oxJLde(NO), a potentially toxic molecule, has been implicated in a wide range of physiological functions and is considered as a new messenger in the brain. NO may also play a role in a large number of pathologies such as depression. Indeed NO is colocalized with serotonin in the brain which role in depression has been largely discussed. NO is also involved in immune responses which are often disturbed in depressive illness. The aim of this study was to determine if blood NO concentration in major depressed patients showed any difference from a control population and if this concentration varied during the antidepressant treatment. Direcl determination of blood NO was conducted through voltametric detection using an original biosensor recently developped in "Dtpartement de Mtdecine Exptrimentale, Lyon". The patients suffered from major depressive illness, were hospitalized and received antidepressants. The evaluation consisted on both clinical and biological statements. Clinical evaluation used MADRS and COVI anxiety rating scales. Biological evaluation measured blood NO and also other factors (hemoglobin, methemogiobin, blood cortisol and blood intefleukin-l/3) which modifications could explain NO variations. The evaluation was conducted 3 times over a 21 day period. The results are preliminary and concern 14 patients and 16 control subjects. Before treatment, there was no difference between the two subject groups. A significant increase of blood NO was noted in depressed patients compared to control after 3 weeks of antidepressant treatment.
•
Efficacy of paroxetine in the treatment of patient disability in social phobia M. Stein 1, C.D. Pitts 2, R. Oakes 2, I. Gergel 2.1 Department of Psychiatr); University of California San Diego, La Jolia, California; 2SmithKline Beecham Pharmaceuticals, Collegeville, Pennsylvania, USA
Social phobia is a common disorder, with a lifetime prevalence of 13.3% (US) (Kessler et al., 1994). More than half of all social phobic patients report at least moderate impairment at some time in their lives, due to social anxiety and avoidance, affecting education and employment as well as social and family relationships (Schneier et al., 1994). Thus, a burden is placed on the individual and on society unless there is accurate diagnosis of the disorder followed by prompt and effective treatment. However, the problem may be underestimated as the nature of the disorder means that patients avoid consulting their doctor for perhaps many years. Delayed presentation may complicate the clinical picture even further by allowing the development of comorbid conditions such as anxiety disorders, alcohol dependence and major depressive disorder. Such comorbidity may reflect a more severe psychopathology with increased disability and impaired functioning than seen with social phobia alone. Once diagnosed, treatment should ideally alleviate social phobia while significantly contributing to the remission of comorbid disorders and improvement in the patient's overall quality of life. There are no precise clinical guidelines for the management of social phobia, but there is growing support for the use of some members of the selective serotonin reuptake inhibitor (SSRI) class of antidepressant. The efficacy of the SSRI paroxetine has recently been demonstrated in a placebo-controlled study in patients with social phobia. Patients (n = 187) meeting DSM-IV criteria of generalised social phobia were randomised to receive either paroxetine (20-50 mg per day) or placebo in a double-blind manner over 12 weeks. The primary efficacy parameter, patients responding at endpoint using the Clinical Global Impression global improvement score, demonstrated significantly greater improvement for paroxetine over placebo (55% vs 24%, p < 0.001). Paroxetine's statistical advantage was observed from week four onward. In addition, relative to baseline, the endpoint Liebowitz Social Anxiety Scale total scores were improved significantly more by paroxetine than by placebo (p < 0.001). This clinical benefit was continuous from week two onwards. Significant differences in favour of paroxetine were also noted on the Social Anxiety and Distress Scale (p < 0.001) and Sheehan Disability Inventory work (p < 0.05) and social life items (p < 0.00l) at endpoint. These data indicate that paroxetine is an effective agent for the treatment of generalised social phobia and that aspects of quality of life may be positively improved. In addition, comorbid disorders may be effectively managed since paroxetine has previously demonstrated efficacy in the treatment of depression and anxiety disorders, both of which commonly co-exist with social phobia.
References [1] Kessler, R.C., McGonagle, K.A., Zhao, S., et al. (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch. Gen. Psychiatry 5t, 8-19. [2] Schneier, ER., Heckelman, L.R., Garfinkel, R., et al. (1994) Functional impairment in social phobia. J. Clin. Psychiatry 55,322-331.
~
A
randomized trial of the effectiveness of sertraline vs interpersonal therapy (IPT) alone or in combination, for people with dysthymia
G. Browne, M. Steiner, J. Roberts, A. Gafni, C. Byrne, B. Bell, M. Webb, E. Jamieson. Department of Psychiatry, St Joseph's Hospital,
and System-Linked Research Unit, McMaster University Hamilton, ON. Canada Rostered patients in a Health Service Organization in southern Ontario Canada, as well as persons recruited from the region, were screened by phone for 9 psychiatric disorders (major depressive disorder, dys-
S 187
thymia, generalized anxiety disorder, panic, social phobia, simple phobia, agoraphobia, alcohol and drug dependence) using the UM-CIDI short :form. Those who scored positive on any disorder were invited to see a tlealth care provider; those who consented to the visit were screened for dysthymia and/or major depressive disorder using a modified SCID-NP. ']?hose who were positive for dysthymia and consento:l to participate were randomized to one of three groups: sertraline alone, IPT alone, or sertraline in combination with IPT. This is an ongoing study. Patients have follow-up clinic visits at 3 weeks, 6 weeks, and 3, 6, 9, 12, 15, 18, 21, and 24 months. Blind assessment of outcome are made by trained interviewers at baseline, 6 months, 12, and 24 months using the Monlgomery-Asherg Depression Rating Scale (MADRS). Results: 5872 persons were screened; of these, 2535 were positive on at least one of the 9 disorders, of those positive, 1544 consented to the visit; 736 persons were positive for dysthymia; and of those, 29 refused to participate. Altogether, 707 dysthymic patients were randomized; 229 to sertraline alone, 247 to sertraline and IPT, and 231 to the IPT alone group. Sertraline is prescribed by the attending physician at an initial dose of 25 mg with the option to be increased gradually up to a maximum of 200 mg per day. Sertraline plasma levels are measured both at regular as well as random visits. IPT is provided by trained staff, a total of up to 16 sessions are provided within the first three months of the study. Preliminary results comparing the responses in the sertraline, sertraline and IPT, and IPT alone groups at the six month follow-up visit, will be presented. [Supported by a grant from the Medical Research Council of Canada Pharmaceutical Manufacturers Association of Canada and Pfizer Canada Inc.]
of suicidality in old age depression IP' 1. 165 I Management by family physicians in Germany G. Stoppe, H. Sandholzer 1, p. Aksari, C. Muder, H. Duwe, J. Staedt.
University c~fGtttingen, Department of Psychiatr).,; i Department of General Practice, GOttingen, Germany With a prevalence of about 20% depression is the most common disorder in old age with a strong impact on quality of life and also on physical health (1)+ The rate of suicides is considerably high especially in this age group with a predominance in the male patients (5:1 compared to the females). Since most of the elderly are treated exclusively by their family physicians (FP), the following study was designed to investigate the influence of various factors (gender, severity, comorbidity) on disease management. We designed two written case histories describing mild depression (case l, Hamilton Depression Rating Scale (HDRS): 9) and moderate to severe (delusionary) depression (case 2, HDRS: 23). For each case different versions were used: in case 1 the gender of the: patients varied, in case 2 both the gender and the previous history (stroke/hypothyreosis). The different combinations of case lafo and case 2a-d were randomly assigned and a pair of case l and 2 presented to FP by trained investigators in a face to face interview. A standardised interview was performed concerning different aspects of disease management. After asking the physicians for informations and diagnostics they would like to get in the respective cases, at the end we also asked directly (cued) whether they would ask the patient for a potential suicidality, and if not, why not. 170 (77.6%) of all FPs in Kassel and rural surroundings were interviewed during summer 1995. The data may be regarded as representative. In both cases nearly no physician considered suicidality uncued (case 1: 2.4%, case 2: 5.9%). Following the direct question, 66.5% of all physicians said that they would ask the patient, and another 10% would do this "later". 22.6% would not ask the patient. There were no significant differences with regard to patient's and physicians' gender anti between the answers to case 1 and 2. Those who would not ask the patient argued, that they would not see a "reason" for this and/or would wait for the patient's initiative and/or feared to "make the patient suicidal" by asking. The signficant differences between cued and uncued answers point into the direction, that the problem of suicidality in depression is generally known to FE As far as the results are comparable to the actual situation
S188
P1 Affective disorders and antidepressants
in primary care however, they point to major problems in dealing with suicidality.
References ill NIH consensus Development Panel on Depressionin Late Life. Diagnosis and treatment of depression in late life. J Am Med Assoc 1992: 168:1018-1024
•
Diagnosis of depression in the elderly by family physicians in Germany
G. Stoppe, H. Sandholzer 1, p. Aksari, C. Muder, H. Duwe, J. Staedt.
University of GOttingen, Department of Psychiatry" 1Department of General Practice, Gtttingen, Germany With a prevalence of about 20% depression is the most common disorder in old age with a strong impact on quality of life and also on physical health. Previous studies revealed a striking underdiagnosis and undertreatment of depression in primary care. The following study was designed to investigate the influence of various factors (gender, severity, comorbidity) on disease recognition and treatment. We designed two written case histories describing mild depression (case l, Hamilton Depression Rating Scale (HDRS): 9) and moderate to severe (delusionary) depression (case 2, HDRS: 23). For each case different versions were used: in case 1 the gender of the patients varied, in case 2 both the gender and the previous history (stroke/hypothyreosis). The different combinations of case la/b and case 2a~,t were randomly assigned and a pair of case 1 and 2 presented to family physicians (FP) by trained investigators in a face to face interview. A standardised interview was performed concerning different aspects of disease management. At the end we also asked the physicians to estimate their own competence in diagnosis and treatment of depression. 170 (77.6%) of all FPs in Kassel and rural surroundings were interviewed during summer 1995. The data may be regarded as representative. In case 1 significantly more physicians considered depression for primary diagnosis than in case 2 (71.8% versus 41.8%). In both cases, about 17% of all physicians would not make a diagnosis. The diagnosis did not correlate to the perception of own competence, with about 60% of the FPs regarding the diagnosis of depression as simple and less than 5% who found it difficult. There was a trend in both cases to diagnose depression more often in a female than in a male patient (case 1: 78.8% versus 63.8%). Correspondingly, more physicians would not "give" a diagnosis to the male patient (case 1: 26.3% versus 10%). For differential diagnosis, a variety of disorders was discussed, mostly cancer, organic brain disorder, anemia, diabetes, and myocardial insufficiency. In conclusion, in contrast to other studies (e.g. 2), primary care physicians seem to think of depression quite often and significantly more in those cases, which are the most frequent in ambulatory care. Women are diagnosed more often. With regard to the treatment data however, depression recognition is not followed by adequate treatment. Different reasons may be discussed: lack of competence, doubts in a "disease concept" of depression e. g..
References [1] NIH consensus Development Panel on Depression in Late Life. Diagnosis and treatment of depression in late life. J Am Med Assoc 1992; 168:1018-1024 [2] Mullan E, Katona E D'Ath, Katona C. Screening, detection and management of depression in elderly primary care attenders. It: Detection and fitness for treatment: a case record study. Faro Pract 1994; 11:267-270
•
Citalopram in the treatment of depression in patients suffering from simultaneous serious somatic disorders
H. Tondlova 1, j. Bagtecky 2. 1Psychiatric Outpatient Unit, Railway Hospital with Outpatient Clinic, Italskd 37, 120 O0 Prague 2; 2Dept. of Psychiatry Postgraduate Medical School, Psychiatric Hospital, Ustavn{ 91, 181 02 Prague 8, Czech Republic Citalopram is one of serotonine selective reuptake inhibitors/SSRI/. With regard to its pharmacological properties it seems to be suitable for the treatment of depressive syndromes in patients suffering from serious
somatic disorders. Lipavsk~ proved efficacy of citalopram in 65 per cent of depressive patients with concommitant serious somatic disorders, e.g. cardiovascular, and did not observe deterioration of basic somatic disease / 1997/. The aim of our study has been to prove efficacy of citalopram/SEROPRAM Lundbeck/in depressive syndromes in patients with simultaneous serious somatic disorders. Design: 19 female outpatients/with age ranging fl'om 47 to 70 years/ and one male outpatient were included into the study. They suffered from cancer of different sites, malignant hypertension, diabetes mellitus, osteoporosis and other diseases. Their mental state was evaluated by an interview and the SCL - 90 rating scale/Symptom Check List according to Derogatis et al. 1973; Czech version - Bolelouck~ 1985/. The SCL 90 was administered before and after the treatment. It contains 90 questions /items/. 10 symptom constructs /dimensions/ corresponding with some psychopathological syndromes can be constructed from respones to the questions: somatisation, obsessions - compulsions, interpersonal sensitivity, depression, anger - hostility, phobic anxiety, paranoidity, psychoticism and items not included/reflecting mostly sleep and eating distortions/. Basic somatic examination and laboratory screeing/including ECG/were performed before the beginning of the treatment, after 6 weeks and at the discontinuation of the treatment. The patients were given 20 mgms of citalopram dally for a period of 3 to 4 months. The T test was used for a statistical evaluation of results. Results: Mean values of psychopathology in the most important dimensions of the SCL - 90/e.g. depression, anxiety/exceeded so called borderline values of the psychopathology/derived from control persons/ in our patients. Their depression was evaluated mostly as moderately hard/F 32.1/before the treatment. The mean values of psychopathology decreased significantly in the course of the treatment. Only minimal and transient side effects were observed. Nor worsening of basic somatic disorder nor serious changes in laboratory findings were checked.
References ill Lipavsk~, P. /1997/Citalopram/Seropram/v 16~b~depresivn~o syndromu u pacientt~ se sou~asn3~mz,'tvaZn~jgfmsomatick~m onemocn~nfm/Citalopramin the treatment of depressive syndrome in patients with concommitant serious somatic disorder/C.S. Psychiat./1997 - press/.
P.1~-6.168--~ Nitric oxide and depression: Voltametric detection of blood nitric oxide on depressed patients P. Vandel 1, S. Burlet 2, R. Cespuglio 2, j. Dalery 3.1 Service de psychiatric, CHU 25030 Besan9on; 2D~partement de M~decine Exp~rimentale, 69373 Lyon; 3Service de psychiatric, CHS Le Vinatier, 69500 Bron, France Nitric oxJLde(NO), a potentially toxic molecule, has been implicated in a wide range of physiological functions and is considered as a new messenger in the brain. NO may also play a role in a large number of pathologies such as depression. Indeed NO is colocalized with serotonin in the brain which role in depression has been largely discussed. NO is also involved in immune responses which are often disturbed in depressive illness. The aim of this study was to determine if blood NO concentration in major depressed patients showed any difference from a control population and if this concentration varied during the antidepressant treatment. Direcl determination of blood NO was conducted through voltametric detection using an original biosensor recently developped in "Dtpartement de Mtdecine Exptrimentale, Lyon". The patients suffered from major depressive illness, were hospitalized and received antidepressants. The evaluation consisted on both clinical and biological statements. Clinical evaluation used MADRS and COVI anxiety rating scales. Biological evaluation measured blood NO and also other factors (hemoglobin, methemogiobin, blood cortisol and blood intefleukin-l/3) which modifications could explain NO variations. The evaluation was conducted 3 times over a 21 day period. The results are preliminary and concern 14 patients and 16 control subjects. Before treatment, there was no difference between the two subject groups. A significant increase of blood NO was noted in depressed patients compared to control after 3 weeks of antidepressant treatment.