The safety and tolerability of duloxetine in depressed elderly patients with and without medical comorbidity.

AIM AND METHODS: The impact of medical comorbidity on the efficacy and tolerability of duloxetine in elderly patients with major depressive disorder (MDD) was investigated in this study. Data were obtained from a multicentre, randomised, double-blind, placebo-controlled study in 311 patients with MDD aged 65-89. The primary outcome measure was a prespecified composite cognitive score based on four cognitive tests: (i) Verbal Learning and Recall Test; (ii) Symbol Digit Substitution Test; (iii) 2-Digit Cancellation Test and (iv) Letter-Number Sequencing Test. Secondary measures included the Geriatric Depression Scale (GDS), 17-Item Hamilton Depression Scale (HAMD17), Clinical Global Impression-Severity (CGI-S) Scale, Visual Analogue Scale (VAS) for pain and 36-Item Short Form Health Survey (SF-36). Tolerability measures included adverse events reported as the reason for discontinuation and treatment-emergent adverse events (TEAEs). The consistency of the effect of duloxetine vs. placebo comparing patients with and without medical comorbidity (vascular disease, diabetes, arthritis or any of these) was investigated. RESULTS: Overall, duloxetine 60 mg/day demonstrated significantly greater improvement compared with placebo for the composite cognitive score, GDS and HAMD17 total scores, CGI-Severity, HAMD17 response and remission rates, and some of the SF-36 and VAS measures. There were few significant treatment-by-comorbidity subgroup interactions for these efficacy variables, or for adverse events reported as the reason for discontinuation and common TEAEs. CONCLUSIONS: The present analyses suggested that the efficacy of duloxetine on cognition and depression in elderly patients, and its tolerability, were not largely affected by the comorbidity status. These results further support the use of duloxetine in elderly patients with MDD.

Psychometric properties of the Illness Attitudes Scale in psychiatric patients.

This study assessed the factorial structure of the 29-item Illness Attitudes Scale in a population of 82 psychiatric patients hospitalized for gastrointestinal complaints. Factor analysis yielded three factors of the Illness Attitudes Scale in these patients, which have been interpreted Health Anxiety, Illness Behavior, and Health Habits. The internal consistency of these factors, estimated by Cronbach alpha, were .86, .80, and .58, respectively. The Health Anxiety and Illness Behavior scores were significantly intercorrelated .43, but scores on Health Habits were not significantly correlated with either Health Anxiety (r = .19) or Illness Behavior (r = .14). These findings are consistent with previous reports that two factors of the Illness Attitudes Scale possess reliable psychometric properties. Cross-validation with other patient populations is required to confirm the validity of the Illness Attitudes Scale factor structure testing at least 5 participants per item of the scale.

Non-herbal nutritional supplements-the next wave: a comprehensive review of risks and benefits for the C-L psychiatrist.

The continuing popularity of complementary medicine has led to the frequent appearance of new products in the marketplace. Non-herbal supplements are now a popular choice for patients seeking relief from a variety of medical conditions. As with herbal medicines, there are concerns about the safety of these products in those with physical illness. Clearly, consultation-liaison psychiatrists will encounter patients using non-herbal products or inquiring about them. This article seeks to provide knowledge about the risks and benefits of non-herbal supplements that consultation-liaison psychiatrists are likely to encounter.

Validity and reliability of the Japanese version of the Emotional Intelligence Scale among college students and psychiatric outpatients.

We examined the validity and reliability of the Japanese version of the Emotional Intelligence Scale in two samples of 267 college students and 398 psychiatric outpatients. Suitable validity and reliability of this scale were suggested by high correlations with scores on the NEO Personality Inventory, adequate internal consistency, and relatively high test-retest correlations. The Emotional Intelligence Scale seems suitable for both clinically distressed populations as well as comparative groups such as college students.

Association of emotional intelligence with alexithymic characteristics.

We examined the association of emotional intelligence and alexithymic characteristics as the personality trait in cohorts of 267 college students and 398 psychiatric outpatients. Score on the Toronto Alexithymia Scale were significantly correlated with those on the Emotional Intelligence Scale, suggesting that alexithymic characteristics are related to lower emotional intelligence. In conclusion, these data suggest that emotional intelligence overlaps with alexithymia.

Amputee fetishism and genital mutilation: case report and literature review.

A case is presented of a 49-year-old man who amputated his penis following instructions that he had obtained from the Internet. The patient had a long-standing amputee fetish, which evolved into eroticized genital mutilation. The transformation of the preferred fetish occurred in a setting of depression due to environmental stressors. The literature about amputee fetishism, also called "apotemnophilia," is reviewed, and possible connections with the genital mutilation are discussed.

Comparison of 26-item and 20-item versions of the Toronto Alexithymia Scale for psychiatric outpatients.

This study compared the 20-item revised Toronto Alexithymia Scale with the 26-item version for 257 psychiatric outpatients. Scores on the 20-item version significantly correlated with those on the 26-item inventory even when controlled for depressed mood. Furthermore, the 20-item scale showed greater internal consistency. Factor analysis for both versions indicated three subfactors but the factors in the TAS-20 accounted for greater common variance (92%) than for the factors in the TAS-26 (78%). The total variance accounted for by these factors on the TAS-20 (45%) was also greater than for the TAS-26 (38%).

Relationship between alexithymia, dissociation and personality in psychiatric outpatients.

BACKGROUND: The relationship between alexithymia and dissociation is not known. Both mechanisms ward off overwhelming affective states; hence, this report examines the relationship between dissociation, alexithymia, depressed mood and the five-factor model of personality in a sample of psychiatric outpatients. METHODS: One hundred and sixteen outpatients were evaluated using the Toronto Alexithymia Scale (TAS), the Dissociative Experiences Scale (DES), NEO Five-Factor Inventory and visual analog scales assessing depression and anxiety. Data was analyzed using multivariate analysis of variance, logistic regression and linear regression techniques. RESULTS: Depressed mood accounted for the group differences between the global TAS and DES scores. Using DES both dimensionally and categorically with regression models, there was minimal contribution of DES or its subfactors to predict TAS. CONCLUSIONS: These data reaffirm previous findings that dissociation fundamentally differs from alexithymia. Dissociation involves a change of one's sense, of self, whereas alexithymia reflects a cognitive state of externally oriented thinking with an inability to identify and report discrete emotions.

Psychosocial side effects of sildenafil therapy for erectile dysfunction.

Sildenafil is an effective agent to restore erectile capacity in the medically ill. Two cases are presented in couples whose marital situation worsened after the husband refused to take sildenafil for erectile failure following radical prostatectomy. Treating organically based sexual dysfunctions with medication still requires understanding of the dysfunctions in a broader psychosocial context.

Executive functioning and compliance in HIV patients.

25 adult HIV patients were evaluated in a study of appointments, medication, and compliance with restrictions on sexual activity. The Executive Interview (EXIT) was useful in assessing these patients for cognitive difficulties; compliance with medication and countertransference issues were negatively correlated with EXIT scores.

Use of herbal medicines among consultation-liaison populations. A review of current information regarding risks, interactions, and efficacy.

Consultation-liaison psychiatrists evaluate a wide variety of patients who are often disillusioned with conventional medical care and are seeking to gain some measure of control over their illness. With the growing popularity of alternative health care practices, consultation-liaison psychiatrists must learn more about the implications of herbal medicine usage. This review provides an overview of herbal medicines, a vital component of the alternative medicine movement.