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2.
Front Psychiatry ; 10: 261, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31057446

RESUMEN

Aim: The following work aims to investigate the putative correlation between early trauma and cognitive functions, as well as psychotic symptoms and cognitive functions, in individuals diagnosed with schizophrenia. Methods: A quantitative assessment was performed with 20 individuals diagnosed with schizophrenia according to the 5th edition of the Diagnostic and Statistical Manual (DSM-5) criteria and who were in ongoing outpatient treatment in Psychosocial Care Centres in Brazil. Clinical measurements comprised a semistructured clinical interview, a screening questionnaire for common mental disorders, the Positive and Negative Syndrome Scale (PANSS), and the Early Trauma Inventory Self-Report-Short Form (ETISR-SF). Cognitive assessment included Beta III test, Concentrated Attention (CA) test, Color Trails Test (CTT), and Visual Face Memory (VFM) test. Results: Age-adjusted analysis showed a negative correlation between early trauma and visual memory performance (r = -0.585, p = 0.007) and negative symptoms and attention performance (r = -0.715, p = 0.000). Conclusion: Although a cause-effect relationship cannot be firmly stated, an association between early trauma experience and cognitive impairment such as visual memory, as well as a relationship between negative symptoms and attention domains, is suggested by our preliminary findings. Future studies with larger sample sizes and prospective design will clarify the long-term effects of early exposure to trauma and its clinical meaning in terms of developing psychotic-related illness.

3.
Rev. Psicol. Saúde ; 11(1): 89-98, jan.-abr. 2019.
Artículo en Portugués | LILACS-Express | ID: biblio-990426

RESUMEN

O Transtorno do Espectro Autista (TEA) é uma desordem do neurodesenvolvimento, caracterizada por déficits na comunicação social e presença de padrões de comportamento repetitivos. Como uma condição usualmente crônica, o TEA normalmente requer atenção de equipes interdisciplinares por afetar o desenvolvimento de forma global. Recentemente, o Ministério da Saúde publicou dois documentos que estabelecem a linha de cuidado e as diretrizes para sua reabilitação na rede pública de saúde brasileira. O presente artigo caracteriza e analisa a linha de cuidado proposta e as abordagens terapêuticas recomendadas. A análise permitiu verificar que os documentos reafirmam que pessoas com TEA são indivíduos com os mesmos direitos de pessoas com deficiência, seu cuidado deve ocorrer de maneira multidisciplinar pela Rede de Atenção Psicossocial, mas faltou clareza quanto aos critérios de escolha das abordagens terapêuticas e o local em que estas seriam oferecidas. Algumas implicações para o tratamento do TEA são discutidas.


Autism Spectrum Disorder (TEA) is a neurodevelopmental disorder, characterized by deficits in social communication and by the presence of repetitive patterns of behavior. As a chronic condition, TEAD usually requires attention from interdisciplinary teams as it affects development in many areas. Recently, the Brazilian Ministry of Health (MS) published two documents establishing the guidelines for attention and rehabilitation of people with TEA in the national public health system. This article aims to characterize and analyze these guidelines and the recommended therapeutic approaches. The analysis showed the recognition of the TEA as a condition with the same rights as people with disabilities. The care approach is essentially multidisciplinary and supported by the Psychosocial Attention Network, but the criteria for recommending the therapeutic approaches and the place where therapies would be offered are not clear. Some implications for TEA treatment are discussed.


El Trastorno del Espectro Autista (TEA) es un desorden del neurodesarrollo, caracterizado por déficits en la comunicación social y presencia de patrones de comportamiento repetitivo. Como una condición usualmente crónica, el TEA normalmente requiere atención de equipos interdisciplinares pues afecta el desarrollo de manera global. Recientemente, el Ministerio de Salud publicó dos documentos que establecen la línea de cuidado y las directrices para su rehabilitación en la red pública de salud brasileña. El presente artículo caracteriza y analiza la línea de cuidado propuesta y las intervenciones terapéuticas recomendadas. El análisis permitió verificar que los documentos reafirman que personas con TEA son individuos con los mismos derechos que personas con discapacidad, y su cuidado debe realizarse de manera multidisciplinar por la Red de Atención Psicosocial, pero faltó aclarar en lo que se refiere a los criterios de elección de las intervenciones terapéuticas y el local donde dichos tratamientos serían ofrecidos. También se discuten algunas implicaciones para el tratamiento del TEA.

4.
Psychiatry Res ; 271: 111-113, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30472504

RESUMEN

The association of early trauma exposure with current cognition was examined in a research series of 56 schizophrenia cases with respect to the BDNF Val66Met polymorphism (rs6265, Val66Val, Val66Met, Met66Met), as met allele carriers have reduced neurotrophic activity. The Perceptual Organization Index had a significant negative correlation with trauma exposures only in met carriers, including early physical abuse, general trauma after age 18 years, and physical abuse. Within the Val66Val subgroup, there were no significant correlations between WAIS indices and traumatic experiences.


Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Alelos , Factor Neurotrófico Derivado del Encéfalo/genética , Cognición , Polimorfismo de Nucleótido Simple/genética , Esquizofrenia/genética , Psicología del Esquizofrénico , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
6.
Trends psychiatry psychother. (Impr.) ; 40(3): 179-184, July-Sept. 2018. tab
Artículo en Inglés | LILACS | ID: biblio-963104

RESUMEN

Abstract Objective To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. Methods Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. Results Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. Conclusion Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.


Resumo Objetivos Avaliar o padrão de apego em portadores de esquizofrenia e discutir a relação que tais padrões apresentam com a sintomatologia psicótica e as comorbidades dos pacientes investigados. Métodos Vinte pacientes diagnosticados com esquizofrenia de acordo com os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 5ª edição (DSM-5) foram submetidos a avaliação de sintomas retrospectivos e avaliação cuidadosa do número e modo de mudança de cuidador da infância. A Entrevista Diagnóstica para Psicoses e Transtornos Afetivos (DI-PAD) foi utilizada para avaliar sintomas relacionados à esquizofrenia (sintomas positivos e negativos), depressão e mania. As comorbidades de transtorno de ansiedade foram avaliadas pela Escala de Ansiedade Social de Liebowitz (LSAS), Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e Entrevista de Pânico e Esquizofrenia (PaSI). Os instrumentos Questionário das Experiências nas Relações Próximas-Estruturas Relacionais (ECR-RS) e Inventário de Autorrelato de Trauma Precoce - Forma Curta (ETISR-SF) foram utilizados para avaliar padrões de apego e histórico traumático, respectivamente. Resultados Foram identificadas correlações significativas entre a ocorrência de traumas precoces e o apego do tipo ansioso. Também foi verificada a relação entre traumas gerais e sintomas de pânico, constatando-se que as crises de pânico antecipam surtos quando predominam sintomas ansiosos, somáticos, alucinações e ideias delirantes. Foi observado que a ocorrência de traumas precoces contribui para o pânico, elevando o risco de episódios psicóticos. Conclusão . Os resultados indicam que as adversidades ambientais na infância estão associadas com o risco de desenvolvimento de esquizofrenia e de outras psicoses mais tarde na vida.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Apego a Objetos , Escalas de Valoración Psiquiátrica , Trastorno Bipolar/complicaciones , Trastorno Bipolar/epidemiología , Comorbilidad , Factores de Riesgo , Trastorno de Pánico/complicaciones , Trastorno de Pánico/epidemiología , Depresión/complicaciones , Depresión/epidemiología , Alucinaciones/complicaciones , Alucinaciones/epidemiología
7.
Trends Psychiatry Psychother ; 40(3): 179-184, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29641648

RESUMEN

OBJECTIVE: To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. METHODS: Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. RESULTS: Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. CONCLUSION: Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.


Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Apego a Objetos , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Adulto , Trastorno Bipolar/complicaciones , Trastorno Bipolar/epidemiología , Comorbilidad , Depresión/complicaciones , Depresión/epidemiología , Femenino , Alucinaciones/complicaciones , Alucinaciones/epidemiología , Humanos , Masculino , Trastorno de Pánico/complicaciones , Trastorno de Pánico/epidemiología , Escalas de Valoración Psiquiátrica , Factores de Riesgo
9.
J Psychiatr Res ; 97: 58-64, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29190530

RESUMEN

BACKGROUND: Oxytocin is a peptide hormone that influences the integration of social cognition with behavior and affect regulation. Oxytocin also prominently directs the transition of neuronal GABA neurotransmission from excitatory to inhibitory after birth. The oxytocin receptor (OXTR) is linked to schizophrenia, a heterogeneous syndrome. Relationships of OXTR polymorphisms with specific clinical features could aid in evaluating any role of oxytocin in the pathogenesis of schizophrenia. METHOD: Schizophrenia cases with rare missense coding OXTR single nucleotide variants (SNVs) were identified from a well-characterized sample of cases and controls who were assessed for symptoms, cognition and early life trauma. RESULTS: Five of 48 cases showed rare OXTR variants. Compared to the other cases they had less severe negative symptoms (deficits in emotional expression and motivation) and less severe general psychopathology scores (depression and anxiety). They demonstrated lower nonverbal (performance) than verbal intelligence due to deficient perceptual organization and slow processing speed. They also reported greater early trauma exposure (physical and sexual abuse and emotional trauma). CONCLUSION: Cases carrying rare OXTR SNVs had less negative and affective symptoms than other cases, but similar psychotic symptoms, along with specific cognitive deficits. The clinical characterization of these cases occurred in association with environmental exposure to early trauma, especially sexual abuse, which may have influenced the expression of schizophrenia in subjects harboring specific SNVs in the OXTR.


Asunto(s)
Experiencias Adversas de la Infancia , Síntomas Afectivos , Disfunción Cognitiva , Trauma Psicológico , Trastornos Psicóticos , Receptores de Oxitocina/genética , Esquizofrenia , Delitos Sexuales , Adulto , Síntomas Afectivos/etiología , Síntomas Afectivos/genética , Síntomas Afectivos/fisiopatología , Estudios de Casos y Controles , Disfunción Cognitiva/etiología , Disfunción Cognitiva/genética , Disfunción Cognitiva/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mutación Missense , Polimorfismo de Nucleótido Simple , Trauma Psicológico/complicaciones , Trauma Psicológico/genética , Trauma Psicológico/fisiopatología , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/etiología , Trastornos Psicóticos/genética , Trastornos Psicóticos/fisiopatología , Esquizofrenia/complicaciones , Esquizofrenia/etiología , Esquizofrenia/genética , Esquizofrenia/fisiopatología , Adulto Joven
10.
Psychiatry Res ; 257: 172-178, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28763736

RESUMEN

Twenty patients with DSM5 schizophrenia were comprehensively and formally assessed by an experienced psychiatrist. All subjects were assessed for: positive and negative psychotic symptoms; social anxiety; panic anxiety; obsessive compulsive disorder, atypical depression; major depression; suicide risk; and global assessment of functioning. Different profiles of clinical presentation and symptom evolution emerged for patients with schizophrenia who had co-morbid depression (15%), OCD (15%), panic or limited symptom attacks (55%) and social anxiety (5%). At least eighty percent of the sample had one or more of these co-morbidities. Summing up, the data support our previous finding that panic is highly prevalent in Schizophrenia with Auditory Hallucinations (>73% here, versus 100% before), and panic was paroxysmally concurrent with voice onset. Moreover, characteristic clinical findings may help point clinicians to five specific co-morbidity psychosis subtypes. Moreover, co-morbidity dissection of psychotic diagnoses recalls and parallels the historical psychopharmacologic dissection of non-psychotic anxiety and depressive subtypes diagnoses. Larger studies should further test and explore these preliminary findings.


Asunto(s)
Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Adulto , Trastornos de Ansiedad/psicología , Comorbilidad , Trastorno Depresivo Mayor/psicología , Femenino , Alucinaciones/diagnóstico , Alucinaciones/epidemiología , Alucinaciones/psicología , Humanos , Masculino , Persona de Mediana Edad , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/epidemiología , Trastorno Obsesivo Compulsivo/psicología , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/epidemiología , Trastorno de Pánico/psicología , Proyectos Piloto , Prevalencia , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Estudios Retrospectivos , Psicología del Esquizofrénico
11.
Front Mol Neurosci ; 10: 152, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28611585

RESUMEN

The endocannabinoid system comprises several molecular entities such as endogenous ligands [anandamide (AEA) and 2-arachidonoylglycerol (2-AG)], receptors (CB1 and CB2), enzymes such as [fatty acid amide hydrolase (FAHH) and monoacylglycerol lipase (MAGL)], as well as the anandamide membrane transporter. Although the role of this complex neurobiological system in the sleep-wake cycle modulation has been studied, the contribution of the blocker of FAAH/transient receptor potential cation channel subfamily V member 1 (TRPV1), N-arachidonoyl-serotonin (AA-5-HT) in sleep has not been investigated. Thus, in the present study, varying doses of AA-5-HT (5, 10, or 20 mg/Kg, i.p.) injected at the beginning of the lights-on period of rats, caused no statistical changes in sleep patterns. However, similar pharmacological treatment given to animals at the beginning of the dark period decreased wakefulness (W) and increased slow wave sleep (SWS) as well as rapid eye movement sleep (REMS). Power spectra analysis of states of vigilance showed that injection of AA-5-HT during the lights-off period diminished alpha spectrum across alertness in a dose-dependent fashion. In opposition, delta power spectra was enhanced as well as theta spectrum, during SWS and REMS, respectively. Moreover, the highest dose of AA-5-HT decreased wake-related contents of neurotransmitters such as dopamine (DA), norepinephrine (NE), epinephrine (EP), serotonin (5-HT) whereas the levels of adenosine (AD) were enhanced. In addition, the sleep-inducing properties of AA-5-HT were confirmed since this compound blocked the increase in W caused by stimulants such as cannabidiol (CBD) or modafinil (MOD) during the lights-on period. Additionally, administration of AA-5-HT also prevented the enhancement in contents of DA, NE, EP, 5-HT and AD after CBD of MOD injection. Lastly, the role of AA-5-HT in sleep homeostasis was tested in animals that received either CBD or MOD after total sleep deprivation (TSD). The injection of CBD or MOD increased alertness during sleep rebound period after TSD. However, AA-5-HT blocked this effect by allowing animals to display an enhancement in sleep across sleep rebound period. Overall, our findings provide evidence that AA-5-HT is an important modulator of sleep, sleep homeostasis and neurotransmitter contents.

12.
Curr Clin Pharmacol ; 12(2): 106-112, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28637417

RESUMEN

BACKGROUND: Effect of Heteropterys aphrodisiaca (dog-node) on anxiety and function of adult female wistar mice. The project is an experiment with the use of H. aphrodisiac root extract, in order to observe the frequency of sexual exposure of females exposed to the extract, quantify the effect of the extract on the concentration of total testosterone and observe the anxiety levels of the animals exposed. Results will be measured with the laboratory testosterone test and LCE and CA tests. METHODS: In preparation of the extract, the root was oven dried at 40°C and diluted in alcohol extract (100g of root for 1 liter of alcohol) and lyophilized. 40 adult female mice were enrolled, separated in control group (placebo) and treatment group (50 mg/kg/day) for 15, 30, 45 and 60 days. At each period, hormonal testosterone and anxiety levels by the Elevated-Cross Labyrinth (ECL) tests and Open Camp (CA) were measured in 10 animals that were later euthanized (SBNeC). RESULTS: The results showed an improvement in the decrease of anxiety, as shown in the variables of number of open arm entries, time on the same side of the field, less avoidance and leakage. However, it appears that the time of exposure to the extract does not result in increased benefit, with possible decline of effect after 45 days of use. CONCLUSION: With this performed experiment with the "no-de-cachorro" extract, it was possible to understand a little more how this root can act in relation to anxiety, as predicted by the pharmacology that validates the animal models; anxiolytic components decrease anxiety-related behaviors, as shown in the variables of entry numbers in the open arm, time on the same side of the field, less avoidance and escape. However, it seems that the time of exposure to the extract does not modify the performance in the tests, observing until an apparent exhaustion of the anxiolytic action, which evidences the need for more specific studies on the possible effects of the extract.


Asunto(s)
Ansiolíticos/farmacología , Ansiedad/tratamiento farmacológico , Malpighiaceae/química , Extractos Vegetales/farmacología , Envejecimiento , Animales , Ansiolíticos/administración & dosificación , Ansiolíticos/aislamiento & purificación , Reacción de Prevención/efectos de los fármacos , Conducta Animal/efectos de los fármacos , Modelos Animales de Enfermedad , Reacción de Fuga/efectos de los fármacos , Femenino , Masculino , Ratones , Extractos Vegetales/administración & dosificación , Testosterona/metabolismo , Factores de Tiempo
15.
J Nerv Ment Dis ; 203(6): 477-9, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26034873

RESUMEN

Social anxiety disorder (SAD) patients may have self-referential ideas and share other cognitive processes with paranoid delusional disorder (PDD) patients. From an evolutionary perspective, SAD may derive from biologically instinctive social hierarchy ranking, thus causing an assumption of inferior social rank, and thus prompting concerns about mistreatment from those of perceived higher rank. This naturalistic longitudinal study followed four patients with initial SAD and later onset of PDD. These four patients show the same sequence of diagnosed SAD followed by diagnosed PDD, as is often retrospectively described by other PDD patients. Although antipsychotic medication improved psychotic symptoms in all patients, those who also had adjunctive serotonin-specific reuptake inhibitors for SAD had much more improvement in both psychosis and social functioning. From an evolutionary perspective, it can be conjectured that when conscious modulation of the SAD social rank instinct is diminished due to hypofrontality (common to many psychotic disorders), then unmodulated SAD can lead to paranoid delusional disorder, with prominent ideas of reference. Non-psychotic SAD may be prodromal or causal for PDD.


Asunto(s)
Jerarquia Social , Trastornos Fóbicos/psicología , Esquizofrenia Paranoide/psicología , Adulto , Edad de Inicio , Antipsicóticos/uso terapéutico , Evolución Biológica , Humanos , Estudios Longitudinales , Masculino , Trastornos Fóbicos/tratamiento farmacológico , Trastornos Fóbicos/etiología , Esquizofrenia Paranoide/tratamiento farmacológico , Esquizofrenia Paranoide/etiología , Inhibidores de la Captación de Serotonina/uso terapéutico , Resultado del Tratamiento , Adulto Joven
16.
Med Hypotheses ; 81(5): 792-6, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24053978

RESUMEN

INTRODUCTION: Attachment theory offers an evolutionary explanation for the occurrence of panic states. The distance between a mother and child causes the sensation of fear. The experience of feared annihilation, an intense fear reaction (panic), is presented as a threat to the individual's cohesiveness, disrupting the mental representation of self-consciousness, specifically self-unity. Alterations in self-consciousness in schizophrenia are so important that they are mostly included among Kurt Schneider's first-ranked symptoms. HYPOTHESES: Based on clinical trials, case reports, and brain imaging and pharmacological studies, a paradigm is proposed to explain the relationship between panic anxiety and psychosis. CONCLUSION: The psychosis-anxiety pathophysiology explanation needs further investigation into the brain areas that integrate self-monitoring with fear areas, but it seems possible to note the importance of the anterior cingulate cortex.


Asunto(s)
Modelos Psicológicos , Relaciones Madre-Hijo/psicología , Pánico/fisiología , Esquizofrenia/fisiopatología , Autoimagen , Humanos
17.
J Clin Psychopharmacol ; 32(1): 120-6, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22198456

RESUMEN

This long-term extension of an 8-week randomized, naturalistic study in patients with panic disorder with or without agoraphobia compared the efficacy and safety of clonazepam (n = 47) and paroxetine (n = 37) over a 3-year total treatment duration. Target doses for all patients were 2 mg/d clonazepam and 40 mg/d paroxetine (both taken at bedtime). This study reports data from the long-term period (34 months), following the initial 8-week treatment phase. Thus, total treatment duration was 36 months. Patients with a good primary outcome during acute treatment continued monotherapy with clonazepam or paroxetine, but patients with partial primary treatment success were switched to the combination therapy. At initiation of the long-term study, the mean doses of clonazepam and paroxetine were 1.9 (SD, 0.30) and 38.4 (SD, 3.74) mg/d, respectively. These doses were maintained until month 36 (clonazepam 1.9 [SD, 0.29] mg/d and paroxetine 38.2 [SD, 3.87] mg/d). Long-term treatment with clonazepam led to a small but significantly better Clinical Global Impression (CGI)-Improvement rating than treatment with paroxetine (mean difference: CGI-Severity scale -3.48 vs -3.24, respectively, P = 0.02; CGI-Improvement scale 1.06 vs 1.11, respectively, P = 0.04). Both treatments similarly reduced the number of panic attacks and severity of anxiety. Patients treated with clonazepam had significantly fewer adverse events than those treated with paroxetine (28.9% vs 70.6%, P < 0.001). The efficacy of clonazepam and paroxetine for the treatment of panic disorder was maintained over the long-term course. There was a significant advantage with clonazepam over paroxetine with respect to the frequency and nature of adverse events.


Asunto(s)
Anticonvulsivantes/administración & dosificación , Clonazepam/administración & dosificación , Trastorno de Pánico/tratamiento farmacológico , Paroxetina/administración & dosificación , Inhibidores de la Captación de Serotonina/administración & dosificación , Adolescente , Adulto , Anticonvulsivantes/efectos adversos , Brasil , Clonazepam/efectos adversos , Quimioterapia Combinada , Femenino , Humanos , Entrevista Psicológica , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/psicología , Paroxetina/efectos adversos , Inventario de Personalidad , Estudios Prospectivos , Retratamiento , Inhibidores de la Captación de Serotonina/efectos adversos , Adulto Joven
18.
Int Arch Med ; 4(1): 12, 2011 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-21477366

RESUMEN

BACKGROUND: Social Anxiety Disorder (SAD) is mainly characterized by an individual's intense concern about other people's opinion of the individual. Notably, among those with severe anxious symptoms, we can often observe self-referential feelings. OBJECTIVE: Faced with little research directed toward the exploration of psychotic symptoms in SAD patients, we will approach the topic by describing three cases. DISCUSSION: Three explanations seem possible for the psychotic manifestations in SAD. The first one depends on the individual's ability or inability to challenge the impression of being criticized by people. A second possibility would be the stressor and perpetuating role of SAD, which would make individuals more likely to present with more severe mental disorders such as delusional disorder (DD). The third explanation would be the possibility that SA is caused by a primary thought abnormality (psychotic self-reference) in some cases, instead of an affective disturbance (anxious insecurity), which led to intense concern about others' opinions. We also observed that antipsychotics did not produce significant improvement in any of the three cases. This result may be related to dopaminergic circuits and the D2 receptor hypoactivity. CONCLUSION: The differentiation between delusion and anxious concern may be inaccurate and may change throughout the disorder's evolution. New diagnostic subcategories or the enlargement of the social anxiety diagnostic is proposed to overcome the current diagnostic imprecision. There seems to be a symptomatic spectrum between SAD and DDs.

20.
J Clin Psychopharmacol ; 30(3): 290-3, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20473065

RESUMEN

High-potency benzodiazepines, such as clonazepam, are frequently used in the treatment of panic disorder (PD) because of their rapid onset of action and good tolerability. However, there is concern about their potential to cause withdrawal symptoms. We aimed to develop a protocol for safely tapering off clonazepam in patients with PD who had been receiving treatment for at least 3 years. A specific scale for judging withdrawal was also developed, the Composite Benzodiazepine Discontinuation Symptom Scale. We selected 73 patients with PD who had been asymptomatic for at least 1 year and who wished to discontinue the medication. The trial consisted of a 4-month period of tapering and an 8-month follow-up period. The dosage of clonazepam was decreased by 0.5 mg per 2-week period until 1 mg per day was reached, followed by a decrease of 0.25 mg per week. The mean dosage at the start of tapering was 2.7 +/- 1.2 mg/d. In total, 51 (68.9%) of the patients were free of the medication after the 4 months of tapering according to the protocol, and 19 (26.0%) of the patients needed another 3 months to be free of medication. Clonazepam discontinuation symptoms were mostly mild and included mainly: anxiety, shaking/trembling/tremor, nausea/vomiting, insomnia/nightmares, excessive sweating, tachycardia/palpitations, headache, weakness, and muscle aches. The improvement in PD and general well-being was maintained during both the taper and follow-up phases. Clonazepam can be successfully discontinued without any major withdrawal symptoms if the dose is reduced gradually. We recommend reducing the dosage of clonazepam after intermediate-term use by 0.25 mg/wk.


Asunto(s)
Clonazepam/administración & dosificación , Trastorno de Pánico/tratamiento farmacológico , Trastorno de Pánico/psicología , Síndrome de Abstinencia a Sustancias/prevención & control , Síndrome de Abstinencia a Sustancias/psicología , Adolescente , Adulto , Anciano , Clonazepam/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica/normas , Síndrome de Abstinencia a Sustancias/etiología , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
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