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P.2.g.005 The application of antidepressants and anxiolytics in the outpatients psychiatric practise
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P.2.g. Affective disorders and antidepressants − Other (clinical)
body scanner equipped with an 8-channel phased-array head coil (Verio, Siemens, Erlangen, Germany). For surface and volumetric segmentation of the whole brain, we used the Freesurfer image analysis suite (version 5.1.) [3]. Volumes of the bilateral hippocampi were obtained in Freesurfer from an automated procedure for volumetric measures of brain structures. Automated segmentation of the hippocampus to its respective subfields was performed using Bayesian inference and a statistical model of the medial temporal lobe. Summary: The total volumes of the left (F = 12.8; p = 0.001) and the right (F = 13.5; p = 0.001) hippocampi of the LLD group were significantly smaller than those of the controls. In the left hippocampus, the presubiculum (F = 8.4; p = 0.005), subiculum (F = 6.8; p = 0.012), CA2−3 (F = 6.4; p = 0.015), CA4-DG (F = 6.8; p = 0.012), and fimbria (F = 8.9;p = 0.004) areas showed tendencies of volume reduction in the LLD group compared to the controls. In the right hippocampus, the subiculum (F = 11.5; p = 0.001) and CA2−3 (F = 11.7; p = 0.001) areas were significantly reduced in the LLD group compared to the controls. In addition, the presubiculum (F = 7.7; p = 0.008), CA1 (F = 4.1; p = 0.049), CA4-DG (F = 6.4; p = 0.015), and fimbria (F = 5.1; p = 0.029) areas showed tendencies of volume reduction in the LLD group compared to the controls. Conclusions: This is the first study to elaborate on the subfields volume differences of both hippocampi between controls and drug na¨ıve LLD patients. In this study, we observed a significant volume reduction in the total hippocampus, subiculum, and CA2−3 areas in the LLD group, which is in line with previous studies using 3D hippocampal surface mapping. In addition, presubiculum, CA1, CA4-DG, and fimbria areas showed a trend of volume reductions in LLD. However, we could not observe volume reductions in the CA1 area in LLD compared to controls, and did not show a correlation pattern between duration of illness and hippocampal subfields volumes. References [1] Small, S.A., Schobel, S.A., Buxton, R.B., Witter, M.P., Barnes, C.A., 2011. A pathophysiological framework of hippocampal dysfunction in ageing and disease. Nature reviews. Neuroscience 12, 585–601. [2] Van Leemput, K., Bakkour, A., Benner, T., Wiggins, G., Wald, L., Augustinack, J., Dickerson, B.C., Golland, P., Fischl, B., 2009. Automated segmentation of hippocampal subfields from ultra-high resolution in vivo MRI. Hippocampus 19, 549–557. [3] Fischl, B., Dale, A.M., 2000. Measuring the thickness of the human cerebral cortex from magnetic resonance images. Proceedings of the National Academy of Sciences of the United States of America 97, 11050–11055.
P.2.g.005 The application of antidepressants and anxiolytics in the outpatients psychiatric practise S. Kuzmanovic1 ° , V. Kostic1 1 Primary Health Center “Stari grad”, Neuropsychiatry, Belgrade, Serbia Introduction: Psychiatric illnesses and behavioural disorders not only cause suffering and affect the quality of life of patients and their environment but also represent an economic burden in relation to the wider community. Therefore, the promotion of mental health is important, as are prevention, recognition and treatment of these mental disorders, and the involvement in community life. The economic burden consists of the incapacity due to illness, but also the costs of treatment, especially if it is irrational, as in
some examples of prescribing anxiolytics (benzodiazepine). For the destigmatization of psychiatric patients, as well as for adequate treatment, it is necessary to have psychiatric services available in primary healthcare, where the psychiatric diagnosis of depression is frequently made. Purpose of the study: To present the incidence of depressive disorders among the patients who come to the outpatient psychiatric practice of a state institution, and the use of antidepressants and anxiolytics in this group of patients. Methods used: Of the patients who were referred by a general practitioner to the outpatient psychiatric practice of a state institution, we examined those who were diagnosed with depression and depressive disorder and were prescribed drug therapy by antidepressants and anxiolytics. Diagnosis was made according to the ICD-10 Classification of Mental and Behavioral Disorders, with depressive disorder including codes F32 (Depressive episode) and F33 (Recurrent depressive disorder) and anxious depression code F41.2 (Mixed anxiety and depressive disorder). Statistical processing of the application and the estimated dose of anxiolytics is combined with antidepressants. Summary of the results and Statistical assessment: Fortytwo patients (27.5%) out of 153 parients examined were diagnosed with depressive disorders; 35 patients had depressive (F32, F33) and 7 patients had mixed anxious–depressive disorder (F41.2). Four groups were identified: the first group consisted of depressive patients treated with antidepressants only; the second group, depressive patients treated with a combination of antidepressants and anxiolytics; the third group, patients with anxious–depressive disorder who received a combination of antidepressants and anxiolytics; the fourth group, anxious–depressive patients treated with anxiolytics only. All 35 depressive patients (100%) received antidepressants, 10 of them (28.6%) receiving antidepressants only, and 25 (71.4%) receiving a combination of antidepressants and anxiolytics. Anxiolytic doses varied from low, evening doses with 11 patients in the beginning of treatment, up to 3 doses a day with 14 patients which were reduced during treatment. Of the patients with anxious–depressive disorder, all 7 received anxiolytics; 6 patients (85.7%) additionally received antidepressants, and 1 (14.3%) anxiolytics only. The doses prescribed were in the low to medium range of recommended doses; 4 patients received evening doses only, and 3 patients received 2 or 3 daily doses. Conclusions: In the therapy of depressed and anxious– depressed patients, the psychopharmacological approach depends on the clinical picture and is strongly individualistic; templates or pre-determined rules cannot be used. Antidepressants are combined with anxiolytics according to determined anxiety symptoms. Frequent psychiatric examination is in order to monitor the clinical effects of treatment. Dosing of anxiolytics should be tailored individually to the lowest possible level and limited in time, to benefit from the effectiveness of low doses of anxiolytics and to prevent addiction. References [1] ICD-10 Classification of Mental and Behavioural Disorders, Clinical Descriptions and Diagnostic Guidelines, 1992, Geneva, World Health Organization. [2] International Statistical Classification of Diseases and Related Problems, Tenth Revision 1992, ICD-10, Geneva, World Health Organization. [3] Mental Health: New Understanding, New Hope, World Health Report 2001, World Health Organization.
P.2.g. Affective disorders and antidepressants − Other (clinical)
body scanner equipped with an 8-channel phased-array head coil (Verio, Siemens, Erlangen, Germany). For surface and volumetric segmentation of the whole brain, we used the Freesurfer image analysis suite (version 5.1.) [3]. Volumes of the bilateral hippocampi were obtained in Freesurfer from an automated procedure for volumetric measures of brain structures. Automated segmentation of the hippocampus to its respective subfields was performed using Bayesian inference and a statistical model of the medial temporal lobe. Summary: The total volumes of the left (F = 12.8; p = 0.001) and the right (F = 13.5; p = 0.001) hippocampi of the LLD group were significantly smaller than those of the controls. In the left hippocampus, the presubiculum (F = 8.4; p = 0.005), subiculum (F = 6.8; p = 0.012), CA2−3 (F = 6.4; p = 0.015), CA4-DG (F = 6.8; p = 0.012), and fimbria (F = 8.9;p = 0.004) areas showed tendencies of volume reduction in the LLD group compared to the controls. In the right hippocampus, the subiculum (F = 11.5; p = 0.001) and CA2−3 (F = 11.7; p = 0.001) areas were significantly reduced in the LLD group compared to the controls. In addition, the presubiculum (F = 7.7; p = 0.008), CA1 (F = 4.1; p = 0.049), CA4-DG (F = 6.4; p = 0.015), and fimbria (F = 5.1; p = 0.029) areas showed tendencies of volume reduction in the LLD group compared to the controls. Conclusions: This is the first study to elaborate on the subfields volume differences of both hippocampi between controls and drug na¨ıve LLD patients. In this study, we observed a significant volume reduction in the total hippocampus, subiculum, and CA2−3 areas in the LLD group, which is in line with previous studies using 3D hippocampal surface mapping. In addition, presubiculum, CA1, CA4-DG, and fimbria areas showed a trend of volume reductions in LLD. However, we could not observe volume reductions in the CA1 area in LLD compared to controls, and did not show a correlation pattern between duration of illness and hippocampal subfields volumes. References [1] Small, S.A., Schobel, S.A., Buxton, R.B., Witter, M.P., Barnes, C.A., 2011. A pathophysiological framework of hippocampal dysfunction in ageing and disease. Nature reviews. Neuroscience 12, 585–601. [2] Van Leemput, K., Bakkour, A., Benner, T., Wiggins, G., Wald, L., Augustinack, J., Dickerson, B.C., Golland, P., Fischl, B., 2009. Automated segmentation of hippocampal subfields from ultra-high resolution in vivo MRI. Hippocampus 19, 549–557. [3] Fischl, B., Dale, A.M., 2000. Measuring the thickness of the human cerebral cortex from magnetic resonance images. Proceedings of the National Academy of Sciences of the United States of America 97, 11050–11055.
P.2.g.005 The application of antidepressants and anxiolytics in the outpatients psychiatric practise S. Kuzmanovic1 ° , V. Kostic1 1 Primary Health Center “Stari grad”, Neuropsychiatry, Belgrade, Serbia Introduction: Psychiatric illnesses and behavioural disorders not only cause suffering and affect the quality of life of patients and their environment but also represent an economic burden in relation to the wider community. Therefore, the promotion of mental health is important, as are prevention, recognition and treatment of these mental disorders, and the involvement in community life. The economic burden consists of the incapacity due to illness, but also the costs of treatment, especially if it is irrational, as in
some examples of prescribing anxiolytics (benzodiazepine). For the destigmatization of psychiatric patients, as well as for adequate treatment, it is necessary to have psychiatric services available in primary healthcare, where the psychiatric diagnosis of depression is frequently made. Purpose of the study: To present the incidence of depressive disorders among the patients who come to the outpatient psychiatric practice of a state institution, and the use of antidepressants and anxiolytics in this group of patients. Methods used: Of the patients who were referred by a general practitioner to the outpatient psychiatric practice of a state institution, we examined those who were diagnosed with depression and depressive disorder and were prescribed drug therapy by antidepressants and anxiolytics. Diagnosis was made according to the ICD-10 Classification of Mental and Behavioral Disorders, with depressive disorder including codes F32 (Depressive episode) and F33 (Recurrent depressive disorder) and anxious depression code F41.2 (Mixed anxiety and depressive disorder). Statistical processing of the application and the estimated dose of anxiolytics is combined with antidepressants. Summary of the results and Statistical assessment: Fortytwo patients (27.5%) out of 153 parients examined were diagnosed with depressive disorders; 35 patients had depressive (F32, F33) and 7 patients had mixed anxious–depressive disorder (F41.2). Four groups were identified: the first group consisted of depressive patients treated with antidepressants only; the second group, depressive patients treated with a combination of antidepressants and anxiolytics; the third group, patients with anxious–depressive disorder who received a combination of antidepressants and anxiolytics; the fourth group, anxious–depressive patients treated with anxiolytics only. All 35 depressive patients (100%) received antidepressants, 10 of them (28.6%) receiving antidepressants only, and 25 (71.4%) receiving a combination of antidepressants and anxiolytics. Anxiolytic doses varied from low, evening doses with 11 patients in the beginning of treatment, up to 3 doses a day with 14 patients which were reduced during treatment. Of the patients with anxious–depressive disorder, all 7 received anxiolytics; 6 patients (85.7%) additionally received antidepressants, and 1 (14.3%) anxiolytics only. The doses prescribed were in the low to medium range of recommended doses; 4 patients received evening doses only, and 3 patients received 2 or 3 daily doses. Conclusions: In the therapy of depressed and anxious– depressed patients, the psychopharmacological approach depends on the clinical picture and is strongly individualistic; templates or pre-determined rules cannot be used. Antidepressants are combined with anxiolytics according to determined anxiety symptoms. Frequent psychiatric examination is in order to monitor the clinical effects of treatment. Dosing of anxiolytics should be tailored individually to the lowest possible level and limited in time, to benefit from the effectiveness of low doses of anxiolytics and to prevent addiction. References [1] ICD-10 Classification of Mental and Behavioural Disorders, Clinical Descriptions and Diagnostic Guidelines, 1992, Geneva, World Health Organization. [2] International Statistical Classification of Diseases and Related Problems, Tenth Revision 1992, ICD-10, Geneva, World Health Organization. [3] Mental Health: New Understanding, New Hope, World Health Report 2001, World Health Organization.