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SSRIs in the treatment of delusional depression
278S
Antidepressant: Clinical II
BIOL. PSYCHIATRY 1991;42:15-2915
Orals 99. Antidepressant: Clinical II
199-1 I
SSRls In the treatment of delusional depression
R. lanardi, L. Franchini, M. Gasperini, J. Perez, E. Smeraldi. Department
of Neuropsychiatric Sciences HSR, University of Milan, Italy
The efficacy of selective serotonin reuptake inhibitors (SSRls) in the treat• ment of depression is well established. The aim of the present study was to evaluate the efficacy and the safety of these compounds In the treat• ment of delusional depression. The study group Included 105 inpatients who met DSM IV criteria for major depression with psychotic features. The depressive and the delusional symptoms were assessed at baseline and weekly using Hamilton Rating Scale for Depression (HRSD) and the Di· mension for Delusional Experience Rating Scale (DOERS), respectively. 59 inpatients were treated with fluvoxamlne 300 mglday, 24 with sertraline. 150 mglday and 22 with paroxetlne 50 mglday for six weeks. 2 bipolar patle~ts treated with fluvoxamine switched polarity; 9 patients treated With paroxellne dropped oUl for unpleasant side-effects (anXiety, agitation and Insomnia). Thus, 94 patients (895%) completed the study. 72 of them (76.6%) met the response criterion: HRSD score lower than 8 and DDERS score of O. The response rate of SSRls Is similar to the most efficacious treatments for delusional depression including antidepressants plus antipsychotics and electroconvulsive therapy.
199-21
The serotonin syndrome scale: First results on validity
U. Hegerl, R. Bottlender, J. Gallinat, H.J. Kuss, M. Ackenheil, H.J. MOiler. Department of Psychiatry, Ludwig-Maxlmllians·UniversiUlt Manchen, Germany, Laboratory of Clinical Neurophysiology, Manchen, Germany As a modification of the diagnostic criteria of the serotonin syndrome proposed by Stemberg, the Serotonin Syndrome Scale was developed for the operationalised assessment of both the presence and the severity of the core symptoms of the serotonin syndrome. Methods: In a first study on the validity of this scale, the relationships between the serotonin syndrome score (SSS) and paroxetine plasma levels (n .. 42) as well as the loudness dependence of the auditory evoked potentials (LDAEP, n .. 24) were investigated In depressed patients treated with paroxetine. A strong LDAEP is supposed to indicate low central serotonerglc neurolransmisslon and vice versa (Hegerl and JuckeI1993). Results: The SSS was positively related to paroxetine plasma levels and negatively to the LDAEP. Both results support the validity of the serotonin syndrome scale. Using a SSS greater six as diagnostic criterion, mild serotonin syndromes were diagnosed In five of our 42 patients. The serotonin syndrome scale may become a useful tool for clinicians and scientists dealing with the serotonin syndrome. Reference
neuroleptics were excluded, one patient group (n • 13) was treated with biperidene (2-4 mglday), and the other patient group (n • 12) with both biperldene (2-4 mglday) and moclobemlde (300-450 mglday). The Hamilton Depression Rating Scale and the Scale for assessment of M. Parkinsonl (KJawans) were used for evaluation of antidepressant and antlparcinsonian effect of the applied therapy-at the beginning of the study and after 7, 14 and 28 days of therapy application. Four patients in both treatment groups dlscontinuated the study. Statistical comparison of the results, obtained from this study was performed using Student t test (P ~ 0.05). Conclusion: Concomitant therapy (moclobemide + biperldene) showed better antidepressant effect, without significance and slightly better an• tlparkinsonlan effect In comparison with monotherapy (blperldene), In the treatment of parkinsonismus with depression in patients previously treated with neuroleptics.
199-41
Six-month controlled efficacity study of f1uoxetine the treatment of dysthymia
In
J.M. Vanelle, D. Attar-Levy, M.F. Poirier, M. Bouhasslra, S. Coussinoux, P. Blin, J.P. Olle. SIs Anns Hospllal S.H.U., Paris, Francs Background: This study was designed to confirm whether (as suggested In a number of open or relatively short-term and small controlled trials) a SRRI like fluoxetine Is effective In the treatment of dysthymia. Method: This multicenter randomized study, Including 140 patients com• pared fluoxetlne (91 patients) and placebo (49 patients) on a double-blind basis Into 2 distinct phases: a short-term endpoint (3 months with 20 mgld dose of fluoxetine) and a medium-term endpoints (6 months) where the Initial responders continued double-blind treatment unchanged and nonre• sponders received an additional treatment of 20 mgld f1uoxetine. The response to treatment was defined as greater than 50% decrease In HDRS score and a score of 1 or 2 on the CGI. Remission was defined by a HDRS score <7. The changes were also evaluated at different times In psychopathological state and social functioning by measures of Eysenck personality inventory scores and GAF scores respectively. Results: After 3 months of treatment, response was seen more frequently In patients taking fluoxetlne (42/72) than In those receiving placebo (14139). The clinical improvement was confirmed by the CGI scores. The patients ImproVed at 3 months were still Improved at 6 months. Furthermore 50% of the nonresponders at 3 months were Improved at 6 months after fluoxetlne was increased to 40 mg daily. The percentage of patients in remission was statistically greater In the fluoxetlne group (29/42) than In the placebo group (4113, p .. 0.01). The Increase In GAF between Day 0 and Day Month 3 was significantly greater in the f1uoxetine group compared to the placebo group (p .. 0.02). After 3 months of treatment, the neurosis score measured by the Eysenck Inventory showed a change which paralleled the change In depressive symptomatology. No differences In the safety were observed between fluoxetlne and placebo groups. Conclusions: This study confirmed the significant and persistent action of an antidepressant like fluoxetine on dysthymia. Moreover the finding that 50% of the nonresponders to active therapy at 3 months were Improved at 6 months after fluoxetine dosage was increased to 40 mg daily argues In favor of treating dysthymic patients for sufficiently long, at least 6 months, at increasing dosage If the Initial doses are Ineffective.
III Hegert and Juckel (1993): Bioi Psychiatry 33: 173-187.
199-31
The efficacy of RIMA In treatment of Iatrogenic parkinsonism with depression
Z.B. Stankovic. Institute for Psychiatry, Pasterova 2, 11000 Beograd, Yugoslavia The objective of this study was to examine therapeutic efficacy of moclobe• mide in treatment of iatrogenic parkinsonism accompanied by depression in psychotic patients. Method: 25 female in- and outpatients with various forms of psychotic disorders, previously treated with neuroleptlcs (haloperidol or phluphenazlne) participated in this open trial of 4 weeks duration. All of them developed parkinsonism and depressive symptoms during neuroleptic therapy. Aftef
199-51
The nuclear affects and antidepressant treatment response
D. Yu. Veltischev, J.M. Gurevich, a.F. Seravlna. Stats Researoh centre of Psychiatry, Moscow. Russia The concept Is based on the supposition of correspondence of nuclear depressive affects (anxietlve, melancholic and apathetic) In personality and depression manifesting In characterological affective traits, psychopathology of depression and psychobiological reactivity. Methods: The type of nuclear and masking affects have been stud• Ied in 125 patients with moderate depressive episode. The pesonalltie's nuclear affects were valued by the associative test ·Pictogrammes"; the ·Skln-Wlndow" test was adapted to determine the variant of non-specific
Antidepressant: Clinical II
BIOL. PSYCHIATRY 1991;42:15-2915
Orals 99. Antidepressant: Clinical II
199-1 I
SSRls In the treatment of delusional depression
R. lanardi, L. Franchini, M. Gasperini, J. Perez, E. Smeraldi. Department
of Neuropsychiatric Sciences HSR, University of Milan, Italy
The efficacy of selective serotonin reuptake inhibitors (SSRls) in the treat• ment of depression is well established. The aim of the present study was to evaluate the efficacy and the safety of these compounds In the treat• ment of delusional depression. The study group Included 105 inpatients who met DSM IV criteria for major depression with psychotic features. The depressive and the delusional symptoms were assessed at baseline and weekly using Hamilton Rating Scale for Depression (HRSD) and the Di· mension for Delusional Experience Rating Scale (DOERS), respectively. 59 inpatients were treated with fluvoxamlne 300 mglday, 24 with sertraline. 150 mglday and 22 with paroxetlne 50 mglday for six weeks. 2 bipolar patle~ts treated with fluvoxamine switched polarity; 9 patients treated With paroxellne dropped oUl for unpleasant side-effects (anXiety, agitation and Insomnia). Thus, 94 patients (895%) completed the study. 72 of them (76.6%) met the response criterion: HRSD score lower than 8 and DDERS score of O. The response rate of SSRls Is similar to the most efficacious treatments for delusional depression including antidepressants plus antipsychotics and electroconvulsive therapy.
199-21
The serotonin syndrome scale: First results on validity
U. Hegerl, R. Bottlender, J. Gallinat, H.J. Kuss, M. Ackenheil, H.J. MOiler. Department of Psychiatry, Ludwig-Maxlmllians·UniversiUlt Manchen, Germany, Laboratory of Clinical Neurophysiology, Manchen, Germany As a modification of the diagnostic criteria of the serotonin syndrome proposed by Stemberg, the Serotonin Syndrome Scale was developed for the operationalised assessment of both the presence and the severity of the core symptoms of the serotonin syndrome. Methods: In a first study on the validity of this scale, the relationships between the serotonin syndrome score (SSS) and paroxetine plasma levels (n .. 42) as well as the loudness dependence of the auditory evoked potentials (LDAEP, n .. 24) were investigated In depressed patients treated with paroxetine. A strong LDAEP is supposed to indicate low central serotonerglc neurolransmisslon and vice versa (Hegerl and JuckeI1993). Results: The SSS was positively related to paroxetine plasma levels and negatively to the LDAEP. Both results support the validity of the serotonin syndrome scale. Using a SSS greater six as diagnostic criterion, mild serotonin syndromes were diagnosed In five of our 42 patients. The serotonin syndrome scale may become a useful tool for clinicians and scientists dealing with the serotonin syndrome. Reference
neuroleptics were excluded, one patient group (n • 13) was treated with biperidene (2-4 mglday), and the other patient group (n • 12) with both biperldene (2-4 mglday) and moclobemlde (300-450 mglday). The Hamilton Depression Rating Scale and the Scale for assessment of M. Parkinsonl (KJawans) were used for evaluation of antidepressant and antlparcinsonian effect of the applied therapy-at the beginning of the study and after 7, 14 and 28 days of therapy application. Four patients in both treatment groups dlscontinuated the study. Statistical comparison of the results, obtained from this study was performed using Student t test (P ~ 0.05). Conclusion: Concomitant therapy (moclobemide + biperldene) showed better antidepressant effect, without significance and slightly better an• tlparkinsonlan effect In comparison with monotherapy (blperldene), In the treatment of parkinsonismus with depression in patients previously treated with neuroleptics.
199-41
Six-month controlled efficacity study of f1uoxetine the treatment of dysthymia
In
J.M. Vanelle, D. Attar-Levy, M.F. Poirier, M. Bouhasslra, S. Coussinoux, P. Blin, J.P. Olle. SIs Anns Hospllal S.H.U., Paris, Francs Background: This study was designed to confirm whether (as suggested In a number of open or relatively short-term and small controlled trials) a SRRI like fluoxetine Is effective In the treatment of dysthymia. Method: This multicenter randomized study, Including 140 patients com• pared fluoxetlne (91 patients) and placebo (49 patients) on a double-blind basis Into 2 distinct phases: a short-term endpoint (3 months with 20 mgld dose of fluoxetine) and a medium-term endpoints (6 months) where the Initial responders continued double-blind treatment unchanged and nonre• sponders received an additional treatment of 20 mgld f1uoxetine. The response to treatment was defined as greater than 50% decrease In HDRS score and a score of 1 or 2 on the CGI. Remission was defined by a HDRS score <7. The changes were also evaluated at different times In psychopathological state and social functioning by measures of Eysenck personality inventory scores and GAF scores respectively. Results: After 3 months of treatment, response was seen more frequently In patients taking fluoxetlne (42/72) than In those receiving placebo (14139). The clinical improvement was confirmed by the CGI scores. The patients ImproVed at 3 months were still Improved at 6 months. Furthermore 50% of the nonresponders at 3 months were Improved at 6 months after fluoxetlne was increased to 40 mg daily. The percentage of patients in remission was statistically greater In the fluoxetlne group (29/42) than In the placebo group (4113, p .. 0.01). The Increase In GAF between Day 0 and Day Month 3 was significantly greater in the f1uoxetine group compared to the placebo group (p .. 0.02). After 3 months of treatment, the neurosis score measured by the Eysenck Inventory showed a change which paralleled the change In depressive symptomatology. No differences In the safety were observed between fluoxetlne and placebo groups. Conclusions: This study confirmed the significant and persistent action of an antidepressant like fluoxetine on dysthymia. Moreover the finding that 50% of the nonresponders to active therapy at 3 months were Improved at 6 months after fluoxetine dosage was increased to 40 mg daily argues In favor of treating dysthymic patients for sufficiently long, at least 6 months, at increasing dosage If the Initial doses are Ineffective.
III Hegert and Juckel (1993): Bioi Psychiatry 33: 173-187.
199-31
The efficacy of RIMA In treatment of Iatrogenic parkinsonism with depression
Z.B. Stankovic. Institute for Psychiatry, Pasterova 2, 11000 Beograd, Yugoslavia The objective of this study was to examine therapeutic efficacy of moclobe• mide in treatment of iatrogenic parkinsonism accompanied by depression in psychotic patients. Method: 25 female in- and outpatients with various forms of psychotic disorders, previously treated with neuroleptlcs (haloperidol or phluphenazlne) participated in this open trial of 4 weeks duration. All of them developed parkinsonism and depressive symptoms during neuroleptic therapy. Aftef
199-51
The nuclear affects and antidepressant treatment response
D. Yu. Veltischev, J.M. Gurevich, a.F. Seravlna. Stats Researoh centre of Psychiatry, Moscow. Russia The concept Is based on the supposition of correspondence of nuclear depressive affects (anxietlve, melancholic and apathetic) In personality and depression manifesting In characterological affective traits, psychopathology of depression and psychobiological reactivity. Methods: The type of nuclear and masking affects have been stud• Ied in 125 patients with moderate depressive episode. The pesonalltie's nuclear affects were valued by the associative test ·Pictogrammes"; the ·Skln-Wlndow" test was adapted to determine the variant of non-specific