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P.3.040 Relapse in social anxiety disorder (SAD): Costs and quality of life
s370
P3.
Anxiety
disorders
of relapse but further cost-effectiveness studies are required2. This study evaluated the cost-effectiveness of escitalopram in comparison with placebo in relapse preveutiou of SAD. Use of medical services aud days of sick leave were recorded in parallel with a double-blind, placebo-controlled, 6-mouth relapse preveutiou clinical study. Patient reported outcomes (PROS) were assessed at Baseline, aud at Weeks 12 aud 24 of treatment using the SF-363. The study was conducted from a societal perspective. Patients treated with escitalopram experienced better patient reported outcomes compared to placebo-treated patients aud scored better 011 all the meutal health-related subscales: social fuuctiouiug (p=O.OOl), meutal health (p i O.OOl), role emotional aud vitality (p i 0.05). Total costs were lower for patients treated with escitalopram compared to placebo (#335 versus #390). The multivariate analysis confirmed that escitalopram significantly decreases total costs (p i 0.01). Thus, coutiuuatiou of escitalopram treatment is effective in the preveutiou of relapse in SAD patients. Escitalopram is more cost-effective thau placebo aud the drug purchase costs are more thau offset by a decrease in total costs. References [l] [2]
[3]
Pate1 A., Knapp M., Henderson J. and Baldwin D. (2002). The economic consequences of social phobia. J. Affect. Disord. 68:221&33. Pollack M.H., Bose A., Zheng H. (2002). Efficacy and tolerability of escitalopram in the treatment of anxiety disorders. Eur. Neuropsychophannacology, 12 (suppl 3):S344. Jenkinson C. (1998). The SF-36 physical and mental health summary measures: an example of how to intqret scores. J. Health Serv. Res. Policy; 3 (2):92-96
m P3
039
B.A. Nit M. Bourin
The implication of 5-HT2 the anxiolvtic-like effects mouse fair plate test
receptor subtypes in of paroxetine in the ’
Dhouuchadha, N. Ripoll, M. Hascoet, Faculte’ de Mkdecine, Pharmacology,
P Jolliet, Nantes, France
and
m P3
040
Relapse in social anxiety and quality of life
disorder
(SAD):
Costs
D. Servant’ , S.A. Moutgomery2, C. Fraucois3. ’ University Hospital, Stress and Anxiety Unit, Lille, Cedex, France; 21mperial College, London, United Kingdom; 3LundDeck SA, Paris, France Social anxiety disorder (SAD) is a chrouic disabling psychiatric disorder’. SSRIs are effective first-line treatment for this couditiou but relapse rates as high as 60% have beeu reported wheu treatment is discoutiuued2~3. This study compared costs aud patient reported outcomes (PRO) of SAD-relapsed patients with a control group of non-relapsed patients. Au economic evaluation, conducted alongside a double-blind, 6-mouth, relapsepreveutiou clinical study, was used to compare the PRO aud costs for relapsed aud non-relapsed patients treated with either escitalopram or placebo. PRO assessments were made at Baseline aud at Weeks 12 aud 24 using the SF-36. Costs related to medical resource use aud days of sick leave were calculated from a societal perspective. Total costs at study eudpoiut were higher for relapsed patients thau non-relapsed patients (#38 1 versus #35 1; difference uot statistically significant at the 5% co&deuce level). Fewer escitalopram-treated patients relapsed compared to the placebo group (22% versus 50%; p i 0.001). Relapsed patients had poorer patient reported outcomes compared to non-relapsed patients (lower scores for all the meutal health-related subscales: social fuuctiouiug, role emotional, meutal health aud vitality; p i 0.001). Relapsed patients have poorer patient reported outcomes aud iucur higher costs. These results highlight the ueed for pharmacological therapies that are effective in preveutiug relapse in SAD patients. References [l]
[2] [3]
The effects of the selective serotouiu reuptake iuhibitor (SSRI), paroxetiue were evaluated in the mouse four plate test (FPT). Paroxetiue (0.2558 mgkg) administered iutraperitoueally (i.p.) potently augmented the munber of punished passages accepted by mice in this paradigm for the doses of 2 to 8 mgkg. The maguitude of iucrease was comparable to that seeu after alprazolam (0.25 mgkg) administration The effects of paroxetiue (8 mgkg) were uot reversed by the selective 5-HT2C receptor autagouist, RS lo-2221 (0.1 aud 1 mgkg) or the selective 5-HT2Bi2C receptor autagouist SB 206553 (0.1 aud 1 mgkg), at doses which lack au effect wheu administered alone. In contrast, the selective 5-HT2A receptor amagonist, SR 46349B (0.1 aud 1 mgikg) completely abolished the paroxetiue-induced iucrease in punished passages. It is thus postulated that 5-HT2A receptors play a role in the effects of paroxetiue in this model of anxiety. The co-administration of selective 5-HT2A, 2B, 2C receptor agonists (DO1 0.06 aud 0.25 mgkg; BW 723C86 0.5 aud 2 mgkg aud RO 60-0175 0.25 aud 1 mgkg) respectively, was subsequently investigated. The effects of sub-active doses ofparoxetiue (0.25 aud 1 mgkg) were poteutiated by 5-HT2 receptor agonists challenge. These results indicate that the co-administration of 5-HT2 receptor agonists with paroxetiue may provide a powerful tool for euhauciug the clinical efficacy of this SSRI.
anxiolytics
Weissman MM, Blanc RC, Cmino GJ, Greenwald S, Lee CK, Newman SC, Rubio-Stipec M, Wickramaratne.J (1996). Cross-national epidemiology of social phobia: a preliminary report. Int. Clin. Psychophamacol.l1:9-14. Pate1 A., Knapp M., Henderson J., Baldwin D. (2002). The economic consequences of social phobia. J. Affect. Disord. (68): 221-233. Davidson JR (1998). Pharmacology of social anxiety disorder. J. Clin. Psychiatry 59 (suppl. 17): 47751.
Ip.3.0411 Effects
of SKF 10047, a sigma selective agonist, on anxiety tested in the elevated maze in male mice
D. Belt&, University Spain
M. Cavas, of MLilaga,
J.F. Navarro. Department
plus
Faculty of Psychology. of Psychobiology, Mcilaga,
It is uow well established that sigma receptors represent au unique biudiug site in brain, distinct from auy other known proteins. From a behavioural point of view, these receptors have beeu implicated in cocaine‘s rewardiug effects aud the motivational actions of ethanol. Furthermore, sigma receptor ligauds exhibit auti-stress, auti-amnesic, autidepressaut aud ueuroprotective effects. Sigma-l receptors are widely distributed iuto the brain, being mainly observed in the granular layer of the olfactory bulb, various hypothalamic nuclei, the dentate gyrus of the hippocampus, motor nucleus of the hiudbraiu aud the dorsal horu of the spiual cord. Likewise, these are present in the pyramidal cells of the hippocampal layers CAl-CA3, the superficial layers II-IV of the cerebral cortex, the lateral septum, the nucleus ceutralis of the
P3.
Anxiety
disorders
of relapse but further cost-effectiveness studies are required2. This study evaluated the cost-effectiveness of escitalopram in comparison with placebo in relapse preveutiou of SAD. Use of medical services aud days of sick leave were recorded in parallel with a double-blind, placebo-controlled, 6-mouth relapse preveutiou clinical study. Patient reported outcomes (PROS) were assessed at Baseline, aud at Weeks 12 aud 24 of treatment using the SF-363. The study was conducted from a societal perspective. Patients treated with escitalopram experienced better patient reported outcomes compared to placebo-treated patients aud scored better 011 all the meutal health-related subscales: social fuuctiouiug (p=O.OOl), meutal health (p i O.OOl), role emotional aud vitality (p i 0.05). Total costs were lower for patients treated with escitalopram compared to placebo (#335 versus #390). The multivariate analysis confirmed that escitalopram significantly decreases total costs (p i 0.01). Thus, coutiuuatiou of escitalopram treatment is effective in the preveutiou of relapse in SAD patients. Escitalopram is more cost-effective thau placebo aud the drug purchase costs are more thau offset by a decrease in total costs. References [l] [2]
[3]
Pate1 A., Knapp M., Henderson J. and Baldwin D. (2002). The economic consequences of social phobia. J. Affect. Disord. 68:221&33. Pollack M.H., Bose A., Zheng H. (2002). Efficacy and tolerability of escitalopram in the treatment of anxiety disorders. Eur. Neuropsychophannacology, 12 (suppl 3):S344. Jenkinson C. (1998). The SF-36 physical and mental health summary measures: an example of how to intqret scores. J. Health Serv. Res. Policy; 3 (2):92-96
m P3
039
B.A. Nit M. Bourin
The implication of 5-HT2 the anxiolvtic-like effects mouse fair plate test
receptor subtypes in of paroxetine in the ’
Dhouuchadha, N. Ripoll, M. Hascoet, Faculte’ de Mkdecine, Pharmacology,
P Jolliet, Nantes, France
and
m P3
040
Relapse in social anxiety and quality of life
disorder
(SAD):
Costs
D. Servant’ , S.A. Moutgomery2, C. Fraucois3. ’ University Hospital, Stress and Anxiety Unit, Lille, Cedex, France; 21mperial College, London, United Kingdom; 3LundDeck SA, Paris, France Social anxiety disorder (SAD) is a chrouic disabling psychiatric disorder’. SSRIs are effective first-line treatment for this couditiou but relapse rates as high as 60% have beeu reported wheu treatment is discoutiuued2~3. This study compared costs aud patient reported outcomes (PRO) of SAD-relapsed patients with a control group of non-relapsed patients. Au economic evaluation, conducted alongside a double-blind, 6-mouth, relapsepreveutiou clinical study, was used to compare the PRO aud costs for relapsed aud non-relapsed patients treated with either escitalopram or placebo. PRO assessments were made at Baseline aud at Weeks 12 aud 24 using the SF-36. Costs related to medical resource use aud days of sick leave were calculated from a societal perspective. Total costs at study eudpoiut were higher for relapsed patients thau non-relapsed patients (#38 1 versus #35 1; difference uot statistically significant at the 5% co&deuce level). Fewer escitalopram-treated patients relapsed compared to the placebo group (22% versus 50%; p i 0.001). Relapsed patients had poorer patient reported outcomes compared to non-relapsed patients (lower scores for all the meutal health-related subscales: social fuuctiouiug, role emotional, meutal health aud vitality; p i 0.001). Relapsed patients have poorer patient reported outcomes aud iucur higher costs. These results highlight the ueed for pharmacological therapies that are effective in preveutiug relapse in SAD patients. References [l]
[2] [3]
The effects of the selective serotouiu reuptake iuhibitor (SSRI), paroxetiue were evaluated in the mouse four plate test (FPT). Paroxetiue (0.2558 mgkg) administered iutraperitoueally (i.p.) potently augmented the munber of punished passages accepted by mice in this paradigm for the doses of 2 to 8 mgkg. The maguitude of iucrease was comparable to that seeu after alprazolam (0.25 mgkg) administration The effects of paroxetiue (8 mgkg) were uot reversed by the selective 5-HT2C receptor autagouist, RS lo-2221 (0.1 aud 1 mgkg) or the selective 5-HT2Bi2C receptor autagouist SB 206553 (0.1 aud 1 mgkg), at doses which lack au effect wheu administered alone. In contrast, the selective 5-HT2A receptor amagonist, SR 46349B (0.1 aud 1 mgikg) completely abolished the paroxetiue-induced iucrease in punished passages. It is thus postulated that 5-HT2A receptors play a role in the effects of paroxetiue in this model of anxiety. The co-administration of selective 5-HT2A, 2B, 2C receptor agonists (DO1 0.06 aud 0.25 mgkg; BW 723C86 0.5 aud 2 mgkg aud RO 60-0175 0.25 aud 1 mgkg) respectively, was subsequently investigated. The effects of sub-active doses ofparoxetiue (0.25 aud 1 mgkg) were poteutiated by 5-HT2 receptor agonists challenge. These results indicate that the co-administration of 5-HT2 receptor agonists with paroxetiue may provide a powerful tool for euhauciug the clinical efficacy of this SSRI.
anxiolytics
Weissman MM, Blanc RC, Cmino GJ, Greenwald S, Lee CK, Newman SC, Rubio-Stipec M, Wickramaratne.J (1996). Cross-national epidemiology of social phobia: a preliminary report. Int. Clin. Psychophamacol.l1:9-14. Pate1 A., Knapp M., Henderson J., Baldwin D. (2002). The economic consequences of social phobia. J. Affect. Disord. (68): 221-233. Davidson JR (1998). Pharmacology of social anxiety disorder. J. Clin. Psychiatry 59 (suppl. 17): 47751.
Ip.3.0411 Effects
of SKF 10047, a sigma selective agonist, on anxiety tested in the elevated maze in male mice
D. Belt&, University Spain
M. Cavas, of MLilaga,
J.F. Navarro. Department
plus
Faculty of Psychology. of Psychobiology, Mcilaga,
It is uow well established that sigma receptors represent au unique biudiug site in brain, distinct from auy other known proteins. From a behavioural point of view, these receptors have beeu implicated in cocaine‘s rewardiug effects aud the motivational actions of ethanol. Furthermore, sigma receptor ligauds exhibit auti-stress, auti-amnesic, autidepressaut aud ueuroprotective effects. Sigma-l receptors are widely distributed iuto the brain, being mainly observed in the granular layer of the olfactory bulb, various hypothalamic nuclei, the dentate gyrus of the hippocampus, motor nucleus of the hiudbraiu aud the dorsal horu of the spiual cord. Likewise, these are present in the pyramidal cells of the hippocampal layers CAl-CA3, the superficial layers II-IV of the cerebral cortex, the lateral septum, the nucleus ceutralis of the