Asunto(s)
Afecto , Anticonvulsivantes/administración & dosificación , Antipsicóticos/administración & dosificación , Trastorno Bipolar/tratamiento farmacológico , Dibenzotiazepinas/administración & dosificación , Medicina Basada en la Evidencia , Piperazinas/administración & dosificación , Trastornos Psicóticos/tratamiento farmacológico , Quinolonas/administración & dosificación , Ácido Valproico/administración & dosificación , Enfermedad Aguda , Adulto , Afecto/efectos de los fármacos , Aripiprazol , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Hospitalización , Humanos , Masculino , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Fumarato de Quetiapina , Resultado del TratamientoRESUMEN
The authors review available controlled trials of bipolar maintenance treatment and discuss the strengths and weaknesses of various study designs. Bipolar maintenance trials are organized according to the features of their designs, such as use of responder-enriched samples; inclusion following an index manic versus an index depressive episode; outcome defined as relapse into mania, depression, or either; and use of survival analysis. Pivotal studies of lithium, divalproex, lamotrigine, olanzapine, aripiprazole, and other medications are reviewed. The directional efficacy of the different medications as maintenance treatment is discussed, with treatments differentiated in terms of whether they primarily prolong time to mania or to depression or have bidirectional effects. Also discussed are findings concerning the continuation of acute treatments, including antidepressants, into the maintenance phase; dosage adjustments for maintenance treatment; the rationale for combination treatments; and implications of comorbid substance abuse and strategies for its management. Directions for future research are suggested.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Medicina Basada en la Evidencia/métodos , Aripiprazol , Benzodiazepinas/uso terapéutico , Carbamazepina/uso terapéutico , Humanos , Lamotrigina , Carbonato de Litio/uso terapéutico , Olanzapina , Piperazinas/uso terapéutico , Quinolonas/uso terapéutico , Triazinas/uso terapéutico , Ácido Valproico/uso terapéuticoRESUMEN
OBJECTIVE: In a placebo-controlled, double-blind study, the authors investigated the efficacy and safety of olanzapine as monotherapy in relapse prevention in bipolar I disorder. METHOD: Patients achieving symptomatic remission from a manic or mixed episode of bipolar I disorder (Young Mania Rating Scale [YMRS] total score < or =12 and 21-item Hamilton Depression Rating Scale [HAM-D] score
Asunto(s)
Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Trastorno Bipolar/prevención & control , Enfermedad Aguda , Adulto , Antipsicóticos/efectos adversos , Benzodiazepinas/efectos adversos , Benzodiazepinas/uso terapéutico , Trastorno Bipolar/psicología , Método Doble Ciego , Femenino , Humanos , Masculino , Obesidad/inducido químicamente , Olanzapina , Placebos , Prevención Secundaria , Factores de Tiempo , Resultado del Tratamiento , Aumento de Peso/efectos de los fármacosRESUMEN
Cocaine craving has been implicated as a major factor underlying addiction and drug relapse. From a cognitive viewpoint, craving may reflect, in part, attentional processing biased in favor of drug-related cues and stimuli. Schizophrenic individuals (SZ), however, abuse cocaine in high numbers but typically manifest baseline cognitive deficits that impair their ability to selectively allocate their attentional resources. In this study, we examined the relationship between attentional bias and craving in patients with cocaine dependence (COC; n=20), schizophrenic patients comorbid for cocaine dependence (COC+SZ; n=23), as well as two other comparison groups using a modified version of the Stroop test to include cocaine-relevant words. Results revealed that only the COC patients demonstrated Stroop interference on the cocaine-related words. Moreover, COC patients' attentional processing biases were significantly associated with their cocaine craving severity ratings. COC+SZ patients, in contrast, did not demonstrate Stroop interference and manifested significantly fewer craving symptoms than their COC counterparts. These results suggest that COC+SZ patients' inability to selectively encode their drug-use experience may limit and shape their subjective experience of craving cocaine and motivation for cocaine use.
Asunto(s)
Atención , Trastornos Relacionados con Cocaína/psicología , Percepción de Color , Conflicto Psicológico , Lectura , Esquizofrenia/rehabilitación , Psicología del Esquizofrénico , Semántica , Síndrome de Abstinencia a Sustancias/psicología , Adulto , Trastornos Relacionados con Cocaína/rehabilitación , Comorbilidad , Aprendizaje Discriminativo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tiempo de Reacción , Síndrome de Abstinencia a Sustancias/rehabilitaciónRESUMEN
BACKGROUND: Standard treatment for acute psychotic agitation often involves intramuscular administration of the benzodiazepine lorazepam and the antipsychotic haloperidol. This study compared the efficacy and safety of oral treatment with the atypical antipsychotic risperidone plus lorazepam with those of standard intramuscular treatment. We hypothesized that the efficacy and speed of action of both treatments would be similar. METHOD: In a prospective, parallel-group, randomized, rater-blinded noninferiority study conducted at 24 sites in the United States, 162 patients exhibiting agitation associated with active psychosis were randomly assigned to receive either oral treatment with 2 mg of risperidone plus 2 mg of lorazepam (N = 83) or intramuscular treatment with 5 mg of haloperidol plus 2 mg of lorazepam (N = 79). The change scores on a 5-item acute-agitation cluster from the Positive and Negative Syndrome Scale (hallucinatory behavior, excitement, hostility, uncooperativeness, and poor impulse control) were the main outcome measure. The study was conducted from January 8 to August 8, 2001. RESULTS: Mean acute-agitation cluster scores were similar in the 2 groups at baseline. Mean score improvements at 30, 60, and 120 minutes after dosing were significant at each timepoint in both groups (p <.0001) and were similar in both groups (p >.05). Both treatments were well tolerated. CONCLUSION: A single oral dose of risperidone plus lorazepam was as effective as parenterally administered haloperidol plus lorazepam for the rapid control of agitation and psychosis. These findings suggest that this oral regimen is an acceptable alternative to the current intramuscular treatment for acute psychotic agitation.
Asunto(s)
Antipsicóticos/uso terapéutico , Haloperidol/uso terapéutico , Lorazepam/uso terapéutico , Agitación Psicomotora/tratamiento farmacológico , Risperidona/uso terapéutico , Enfermedad Aguda , Administración Oral , Adolescente , Adulto , Anciano , Antipsicóticos/administración & dosificación , Análisis por Conglomerados , Quimioterapia Combinada , Femenino , Haloperidol/administración & dosificación , Humanos , Inyecciones Intramusculares , Lorazepam/administración & dosificación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Agitación Psicomotora/diagnóstico , Risperidona/administración & dosificación , Índice de Severidad de la Enfermedad , Método Simple CiegoRESUMEN
BACKGROUND: The InterSePT Scale for Suicidal Thinking (ISST) is a 12-item instrument for the assessment of current suicidal ideation in patients with schizophrenia and schizoaffective disorders. We report the psychometric characteristics of this new scale based on two studies. METHOD: In Study 1, 22 inpatients with schizophrenia and schizoaffective disorders, who had recently attempted suicide or engaged in suicidal ideation, were rated by three trained independent raters to examine interrater reliability. In Study 2, a total of 980 patients with schizophrenia or schizoaffective disorder with a history of suicidal ideation in the past 36 months were enrolled in a 2-year industry-sponsored suicide prevention study. At baseline, these patients were administered the ISST and the Clinical Global Impression Scale for Severity of Suicidality (CGI-SS) by the Principal Investigator (PI) and by a blinded rater (BR), who also administered the Positive and Negative Symptom Scale (PANSS), the Calgary Depression Scale (CDS), and the Scale of Functioning (SOF). Indices of internal reliability, construct and discriminant validity were examined. RESULTS: The intraclass correlation coefficient (ICC) for the total ISST score for the 22 subjects in Study 1 was 0.90 and mean weighted item kappa coefficients ranged from 0.66 to 0.92. In Study 2, internal reliability (Cronbach alpha) was high, ranging from 0.86 to 0.89 for the individual items, and the overall Cronbach alpha coefficient for all items was 0.88. The ISST (PI) total score was highly correlated with the CGI-SS by the blind rater (r = 0.61, p < 0.0001). ISST total scores significantly differentiated the different levels of CGI-SS (F = 519.2; p < 0.0001). Results of construct and discriminant validity analyses are also presented. CONCLUSION: The ISST is a reliable and valid instrument for the assessment of current suicidal thinking in patients with schizophrenia and schizoaffective disorder by both clinicians and researchers.
Asunto(s)
Intento de Suicidio/estadística & datos numéricos , Encuestas y Cuestionarios , Pensamiento , Adolescente , Adulto , Afecto , Depresión/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Reproducibilidad de los Resultados , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Índice de Severidad de la Enfermedad , Intento de Suicidio/prevención & controlRESUMEN
Breakthrough depression is a common problem in the treatment of bipolar disorder. Only one, recently published, double-blind, placebo-controlled trial has examined the efficacy of divalproex in the prevention of depressive episodes in bipolar patients. This report describes, in further detail, the findings from that trial of the effect of divalproex on multiple dimensions of depressive morbidity in bipolar disorder. A randomized, double-blind, parallel-group, multicenter study was conducted over a 52-week maintenance period. Bipolar I patients, who may have been treated with open-label lithium or divalproex and who met recovery criteria within 3 months of onset of an index manic episode, were randomized to maintenance treatment with divalproex, lithium, or placebo in a 2 : 1 : 1 ratio. Adjunctive paroxetine or sertraline for breakthrough depression was allowed in maintenance phase. Outcome measures were the rate of early discontinuation for depression, time to depressive relapse, proportion of patients with depressive relapse, mean change in Depressive Syndrome Scale score, proportion of patients receiving antidepressants, and time in the study. Among patients taking an antidepressant, a higher percentage of patients on placebo than divalproex discontinued early for depression. Patients who were previously hospitalized for affective episodes or took divalproex in the open period relapsed later on divalproex than on lithium during the maintenance period. Divalproex-treated patients had less worsening of depressive symptoms than lithium-treated patients during maintenance. Indices of severity of prestudy illness course predicted worse outcome in all treatment groups. Divalproex improved several dimensions of depressive morbidity and reduced the probability of depressive relapse in bipolar disorder, particularly in patients who had responded to divalproex when manic, and among patients with a more severe course of illness.