Remission rates with venlafaxine extended release in Greek outpatients with generalized anxiety disorder. A double-blind, randomized, placebo controlled study.

The primary endpoints in this study were the remission rates [final Hamilton Rating Scale for Anxiety (HAM-A) total score < or =7] and reduction from baseline in the HAM-A total score in patients with generalized anxiety disorder (GAD) and no associated depression. Patients with GAD (DSM-IV and HAM-A total score >18) were randomly assigned to treatment with venlafaxine XR or placebo for 8 weeks. A 1-week placebo run-in period preceded the double-blind phase. Patients with a >20% drop in their total HAM-A score during the run-in period, were excluded from the double-blind phase. All patients started therapy with 75 mg/day venlafaxine XR or matched placebo. Patients with less than 30% decrease in their HAM-A total score at the end of the second week, doubled their dose. Patients on the 150 mg/day dose underwent a 1-week taper period. Of the 24 patients in the venlafaxine XR group, 62.5% achieved remission versus 9.1% in the placebo group (P=0.0006). The mean decrease from baseline in HAM-A total score was 19.2 points for the venlafaxine XR group and 10.8 points for the placebo group (P<0.001). Eleven placebo-treated patients and seven venlafaxine XR treated patients doubled their dose at the end of the second week of double-blind treatment. No patient interrupted therapy because of side-effects. No changes in systolic or diastolic blood pressure were observed. Venlafaxine XR 75-150 mg/day was well tolerated. The remission rates achieved with venlafaxine 75-150 mg/day in non-depressed GAD patients were high with good tolerability.

Neurofibrillary neuronal degeneration in dialysis dementia: a feature of aluminum toxicity.

Neurofibrillary material was found in cortical neurons in two patients who died with dialysis encephalopathy. The cytoplasm of these neurons contained large amounts of aluminum and whole-brain and blood aluminum levels were high. These findings suggest that in dialysis encephalopathy aluminum has a specific effect on neuronal protein synthesis, resulting in the accumulation of neurofilaments in cortical neurons. This neurofibrillary neuronal degeneration resembles that found in experimental aluminum toxicity, but differs in several respects from the neurofibrillary tangles characteristic of Alzheimer's disease.

Priapism and psychotropic medication.

Priapism is a rare but serious adverse effect of psychotropic drugs resulting from their peripheral alpha-adrenoreceptor blocking action. Two patients developed this during treatment with oral phenothiazines: one was treated surgically with a venous shunt, and the second case resolved after intracavernosal injection of an alpha-adrenoreceptor stimulating drug.

Psychiatric symptom patterns of chronic epileptics attending a neurological clinic: a controlled investigation.

The psychiatric morbidity of chronic epileptic out-patients unknown to psychiatric agencies was assessed using two questionnaire measures of psychopathology (GHQ and CCEI). Nearly half of the epileptics were classified as probable psychiatric cases. Psychiatric morbidity was both more prevalent and more severe in this group than in a comparison group of chronic neurological out-patients. Depression, anxiety and hysterical symptomatology were the commonest characteristics of psychiatrically impaired epileptics. The type and severity of epilepsy were found to influence both the degree and pattern of psychiatric morbidity. Contrary to previous findings, age of onset had no relation to psychopathology.

Epileptic dizziness.

Clinical and electroencephalographic features and the response to treatment of 30 patients with episodic dizziness due to epilepsy were noted. The symptom consisted of a brief episode of disequilibrium, often with a sensation of rotation, without evident precipitating factors or sequelae. A history of "absences" or other features suggestive of temporal lobe epilepsy was elicited in over half the patients, and seven (almost a quarter) had had one or more generalized seizures before presentation. Electroencephalography showed a posterior temporal lobe focus in all but two patients, and there was a family history of epilepsy in six. Response to treatment with phenytoin or carbamazepine was good in most patients. Epilepsy should be considered in the differential diagnosis of episodic dizziness or vertigo, especially in young people.

Pattern sensitive epilepsy: a case report.

A child with pattern sensitive epilepsy is reported. She had both absences and generalised seizures. The latter occurred spontaneously but the former followed concentration on patterned materials. These self-induced seizures appeared to have an affective component. The EEG showed generalised atypical spike and wave discharges both in the resting state and during intermittent photic and pattern stimulation. The patient responded to sodium valproate.