Primary prevention of psychiatric illness in special populations.

BACKGROUND: Some populations appear to be particularly vulnerable to the development of psychiatric symptomatology related to life events and biologic or social/cultural factors. Such groups include individuals who have experienced traumatic events, military personnel, individuals with serious medical conditions, postpartum women, and immigrants. This study reviews the literature regarding primary prevention of psychiatric disorders in special populations and identifies a variety of universal, selective, and indicated prevention measures aimed at minimizing the psychiatric sequelae in these groups. METHODS: The authors reviewed the literature regarding the prevention of psychiatric symptoms in trauma/abuse victims, individuals in the military, oncology patients, patients with diabetes, pregnant/postpartum women, and immigrants. RESULTS: The literature on primary prevention of psychiatric illness in the special populations identified is rather limited. Universal prevention may be beneficial in some instances through public awareness campaigns and disaster planning. In other instances, more specific and intensive interventions for individuals at high risk of psychiatric illness may improve outcomes, for example, crisis counseling for those who have experienced severe trauma. CONCLUSIONS: Primary prevention of psychiatric illness may be an attainable goal via implementation of specific universal, selected, and indicated primary prevention measures in special populations.

Extrapyramidal symptoms associated with antidepressants--a review of the literature and an analysis of spontaneous reports.

BACKGROUND: Antidepressant-induced extrapyramidal symptoms (EPS) represent an underrecognized but important clinical entity. We reviewed the literature on new antidepressants and conducted an analysis of cases from the FDA Adverse Event Reporting System (AERS), which has not been published before. METHODS: A literature review was conducted using PubMed, Ovid, MEDLINE, PsycINFO, and the Cochrane Database. Search terms used were extrapyramidal, antidepressants, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), miscellaneous antidepressants, and monoamine oxidase inhibitors (MAOIs). Inclusion criteria for the FDA AERS analysis were cases of EPS reported by physicians, cases where patients were on one antidepressant, and cases reported between July 2005 and March 2008. Reports of patients who were on concurrent psychotropics were excluded. RESULTS: Our literature review revealed 1 report each of EPS for duloxetine, nefazodone, and bupropion, 3 for escitalopram, and 4 for citalopram. For the FDA AERS analysis, 89 cases met our inclusion criteria: duloxetine was implicated in 66% of cases, sertraline in 10%, escitalopram in 7%, and bupropion in 6%. CONCLUSIONS: EPS have been reported with different classes of antidepressants, are not dose related, and can develop with short-term or long-term use. In view of the risk for significant morbidity and decreased quality of life, clinicians must be aware of the potential for any class of antidepressants to cause these adverse effects.