Buspirone: a worldwide update.

Buspirone is an anxiolytic drug from the azapirone family of molecules. It differs chemically and pharmacologically from the benzodiazepines. Although its profile of efficacy is comparable with that of benzodiazepines, it produces less drowsiness, less psychomotor impairment, less alcohol potentiation, and has less potential for addiction or abuse. Buspirone also appears to have efficacy in major depressive disorders, in comparison with placebo, but its activity in panic disorders is less impressive. It may diminish alcohol dependence both in animals and in chronic alcoholics. Clinical studies in the elderly show no important difference from younger patients in safety and efficacy profile, pharmacokinetics, and dosage requirement. The drug appears to be well tolerated in primary care settings and to be free of adverse clinical interactions with many drugs that might be used concomitantly. However, because its pharmacology differs from that of conventional anxiolytics, patients need to be informed about both its gradual onset of action and absence of euphoria and immediate sedation.

The safety and usefulness of buspirone as an anxiolytic drug in elderly versus young patients.

Buspirone, the prototype of the new azaspirodecanedione series of antianxiety drugs, was studied in over 6,000 patients in an open, multicenter trial to confirm its safety and usefulness for anxiety in a typical medical practice setting. Non-psychotic patients with clinically manifest anxiety that required anxiolytic drug therapy were enrolled to receive four weeks of treatment with a fixed dose of buspirone (15 mg/day). Patient data were analyzed according to age: the elderly group comprised 605 patients aged 65 years or older, and the younger group included 5,969 patients less than 65 years old. Both the elderly and younger patients achieved similar relief of anxiety within four weeks based on the Hamilton Anxiety Scale and global assessments of improvement. Most patients (80%) in both groups reported no side effects. Further, the side effect profile in the elderly differed little from that in the younger patients. Overall, the data indicate that buspirone may be administered to patients aged 65 years or older without any special adjustment in dose, does not cause unusual adverse age-related phenomena, and relieves moderate-to-severe symptoms of anxiety in elderly patients.

A study of buspirone coprescribed with histamine H2-receptor antagonists in anxious outpatients.

In a study of a large cohort of patients suffering from anxiety symptoms and treated with the new anxiolytic, buspirone, 0.5% were found to be receiving concomitant histamine H2-receptor antagonist therapy. A study of this subgroup showed that no drug interaction occurred.

Vigabatrin for refractory complex partial seizures: multicenter single-blind study with long-term follow-up.

The irreversible GABA transaminase inhibitor vigabatrin (VGB) was given in a single-blind fashion to 89 patients with complex partial seizures (CPS) refractory to conventional drugs. The median number of CPS per month decreased from 11.0 to 5.0 after addition of VGB, and 51% of patients had a 50% or greater decrease in CPS frequency (p less than 0.001). Side effects (principally drowsiness, ataxia, and headache) occurred mainly during the initiation of therapy and decreased during therapy. After 12 weeks on VGB, side effects significantly interfered with functioning in only 13% of patients, and the efficacy:toxicity ratio warranted continued administration in 74% of patients. Coadministration of VGB resulted in a mean decrease of 20% in phenytoin serum concentration (p less than 0.001). Sixty-six patients with a favorable response to VGB during the single-blind study have been followed for a median of 16.7 months on VGB. No serious systemic or neurologic toxicity has been detected, and most patients have retained their initial favorable CPS control.

Review of the side-effect profile of buspirone.

In 984 patients with generalized anxiety disorder who received buspirone in double-blind studies, the incidence of drowsiness (9 percent) did not differ significantly from that (10 percent) reported in 334 patients who received placebo. A probability value of p less than or equal to 0.10 was the criterion for significance. The incidence of drowsiness in buspirone-treated patients was significantly less than that in each of the groups receiving diazepam (32 percent), clorazepate (26 percent), lorazepam (58 percent), or alprazolam (43 percent). The side effects that did occur significantly more frequently in the buspirone group than in the placebo group were dizziness (9 percent versus 2 percent), headache (7 percent versus 2 percent), nervousness (4 percent versus 1 percent), light-headedness (4 percent versus less than 1 percent), diarrhea (3 percent versus less than 1 percent), paresthesia (2 percent versus less than 1 percent), excitation (2 percent versus less than 1 percent), and sweating/clamminess (1 percent versus 0 percent). The severities of these effects were predominantly rated as only mild or moderate. Fatigue occurred less frequently in buspirone-treated patients than in those receiving any of the benzodiazepines, and weakness occurred more frequently in diazepam-treated patients. Depression occurred less frequently in buspirone-treated patients than in those receiving clorazepate, diazepam, or lorazepam. Impotence occurred only in clorazepate- and lorazepam-treated patients. Decreased libido occurred more frequently in diazepam-treated patients, whereas increased libido was more frequent in clorazepate-treated patients. Nausea was reported more frequently in buspirone-treated patients than in those receiving clorazepate, diazepam, or alprazolam; diarrhea occurred more frequently in the buspirone group than in the diazepam group. The mean daily doses of the various treatments were buspirone, 20 mg; diazepam, 20 mg; clorazepate, 24 mg; lorazepam, 3 mg; and alprazolam, 1.5 mg. In an open-field study in West Germany involving 5,414 patients, gastrointestinal-related complaints were the most frequently reported side effects.

Gamma-vinyl-GABA treatment of tardive dyskinesia and other movement disorders.

We conducted a single-blind trial of gamma-vinyl-GABA (GVG) in nine patients: seven with tardive dyskinesia, one with Meige syndrome, and one with Tourette syndrome. Five tardive dyskinesia patients completed the entire 11-week study and, as a group, demonstrated significant decreases in dyskinesia scores. Four of these five tardive dyskinesia patients showed clinically evident improvement, with approximately 30% reduction in dyskinetic symptoms. Other patients had no clinical benefit from GVG. Three patients had transient exacerbation of psychiatric symptoms after sudden withdrawal of GVG, and one patient experienced dose-related confusional episodes. Our results suggest that GABAergic drugs may have a role in treating patients with tardive dyskinesia.

Obsessions: source of inefficiency in the workplace.

Obsessions are persistent, intrusive, unwanted ideas that are unproductive and anxiety-arousing. Although the magnitude of their importance in the workplace has not been established by acceptable scientific research criteria, they are in all probability a major source of inefficiency in jobs involving a high percentage of intellectual effort. The current body of knowledge of clinical psychiatry and behavioral psychology can provide rudimentary insights and hypotheses. The need is emphasized for further research to elucidate more precisely the extent of the problem.

From board candidate to rookie examiner.

The author describes his experience as a candidate for the American Board of Psychiatry and Neurology, Inc., examinations one year and as an oral examiner the next. He discusses the oral examination process, listing the errors most frequently made by candidates.