Relationships between treatments received in the Nottingham Study of Neurotic Disorder over 30 years and personality status.

We compared the drug treatments and health service contacts of anxious and depressed patients separated by personality disturbance in 200 patients over 30 years. Contact details with health professionals at 5, 12 and 30 years were recorded and analysed by multilevel models at all time points. Over 30 years, patients with dependent and anankastic personality disturbance and cothymia (the general neurotic syndrome) were 2.27 times more likely to receive selective serotonin reuptake inhibitors (SSRIs) and new antidepressants (95% confidence interval [CI]: 1.22-4.24), particularly paroxetine, and were 1.6 weeks (95% CI: 1.2-2.3) longer on the drug than those without the syndrome. Similar results with SSRIs and new antidepressants in patients with personality disorder fell short of significance after adjusting for age, sex and DSM status. Most patients had a DSM diagnosis at follow-up points, and these had increased psychological treatment, psychiatric admissions, multiple drugs, SSRIs and new antidepressants. At later follow-up, most drug treatments decreased apart from psychological treatment, SSRIs and new antidepressants, and baseline personality disorder had little impact on treatment histories compared with others. We conclude that the (Galenic) general neurotic syndrome is associated with greater use of treatments in the long term, showing that combined personality and symptomatic pathology overcomes that of personality disorder alone.

[Neurotic disorders as a problem of modern gerontopsihiatry]. / Nevroticheskie rasstroistva kak problema sovremennoi gerontopsikhiatrii.

The relevance of the problem is determined by the growth of elderly population in the world and in Russia and by the increase in the frequency of non-psychotic mental disorders (non-PMD) in the structure of psychiatric diseases. The authors consider the current state of research in the field of non-PMD of old age, including neurotic disorders (ND). An analysis of the literature has shown that there is no convergent view on the ND of old age. As a consequence, there are contradictory views from researchers or psychiatric schools on the ND prevalence and morbidity. Attention is drawn to the insufficient diagnosis of non-PMD in the primary link of health care, difficulties of distinguishing ND from neurotic-like states, necessity in the clarification of the epidemiology of neuroses and efficiency of psychotherapeutic help. The use of resources of able-bodied people is important for the socio-economic development of the country.

[Treatment of asthenoneurotic disorders in children]. / Korrektsiya astenonevroticheskikh rasstroistv u detei.

AIM: To evaluate the efficacy of cogitum in the treatment of asthenoneurotic disorders in children after bacterial meningitis (BM) or brain injury (BI). MATERIAL AND METHODS: Twenty-four patients were examined. Group 1 included 14 patients with BM, 8 boys and 6 girls, aged 7 - 12 years, mean age 9,91 ± 1,71 years; group 2 consisted of 10 patients with BI, 6 boys and 4 girls, aged 7-12 years, mean age 10,4 ± 2,36 years. All patients received cogitum in dose of 250- 500 mg daily during 8 weeks. Neurological and neuropsychological (Bourdon's test, Luria's tests) examinations, EEG, MRI were performed before and after treatment. RESULTS AND CONCLUSION: The study of cognitive functions showed a decrease in the accuracy and speed during performance of Bourdon's and Luria's tests. After the beginning of treatment with cogitum, 80% of the patients in both groups demonstrated a significant improvement in the accuracy of Bourdon's test (р<0,01) and verbal retention (р<0,001). Repeated EEG (3-6 months after treatment) showed the distinct theta- , alpha-, beta- rhythms and clear zonal differences. Given a spectrum of clinical effects of cogitum, the authors recommend it for active use in pediatric practice.

A population-based study of antipsychotic prescription trends in children and adolescents in British Columbia, from 1996 to 2011.

OBJECTIVES: To establish prevalence rates of antipsychotic (AP) prescriptions for children 18 years of age or younger in British Columbia (BC) from 1996 to 2011 by age, sex, AP type, and primary diagnosis; and to identify the predominant AP prescribers for children by specialty training. METHODS: BC Ministry of Health administrative data were used to describe AP prescriptions for youth aged 18 years or younger. Comparisons were made using population prevalence based on sex; age group; AP; International Classification of Diseases, Ninth Revision, diagnosis; and prescriber specialty. RESULTS: From 1996 to 2011, overall AP (both first and second generation) prescription prevalence rate increased 3.8-fold (1.66 to 6.37 per 1000 population); second-generation AP (SGA) prescriptions increased 18.1-fold (0.33 to 5.98 per 1000 population). The highest increase in all AP prescriptions occurred in males aged 13 to 18 years (3.3 to 14.4 per 1000 population; 4.4-fold), followed by similar increases in males aged 6 to 12 years (2.3 to 8.6 per 1000 population; 3.7-fold) and in females aged 13 to 18 years (2.8 to 10.7 per 1000 population; 3.8-fold). Overall, the 3 most common diagnoses associated with all AP prescriptions were depressive disorders (12.8%), hyperkinetic syndrome of childhood (11.7%), and neurotic disorders (11.1%); however, variation was observed by prescriber specialty training. Among all new AP prescriptions in 2010/11, 38.6%, 34.3%, and 15.6% were provided by psychiatrists, family physicians, and pediatricians, respectively. CONCLUSIONS: There has been an exponential rise in SGA prescriptions in BC secondary to extensive off-label use, not only by psychiatrists but also by family physicians and pediatricians. Knowledge translation initiatives promoting evidence-based prescribing and monitoring practices related to SGA treatment need to target all 3 prescriber groups and be tailored for age subgroups.

Objectifs : Établir les taux de prévalence des prescriptions d'antipsychotiques (AP) à des enfants et des adolescents de 18 ans et moins en Colombie-Britannique (C.-B.) de 1996 à 2011 selon l'âge, le sexe, le type d'AP, et le diagnostic primaire; et identifier les prescripteurs d'AP prédominants pour les enfants par formation de spécialité. Méthodes : Les données administratives du ministère de la Santé de la C.-B. ont servi à décrire les prescriptions d'AP à des adolescents de 18 ans ou moins. Des comparaisons ont été effectuées au moyen de la prévalence de la population selon le sexe, le groupe d'âge, les AP, la 9e édition de la Classification internationale des maladies, le diagnostic, et la spécialité du prescripteur. Résultats : De 1996 à 2011, le taux global de prévalence des prescriptions d'AP (de la première et de la deuxième génération) a augmenté 3,8 fois (1,66 à 6,37 par 1000 de population); les prescriptions d'AP de deuxième génération (ADG) ont augmenté 18,1 fois (0,33 à 5,98 par 1000 de population). L'augmentation la plus élevée de toutes les prescriptions d'AP a touché les jeunes hommes de 13 à 18 ans (3,3 à 14,4 par 1000 de population; soit 4,4 fois plus), suivie par des augmentations semblables chez les garçons de 6 à 12 ans (2,3 à 8,6 par 1000 de population; soit 3,7 fois plus) et chez les filles de 13 à 18 ans (2,8 à 10,7 par 1000 de population; soit 3,8 fois plus). En général, les 3 diagnostics les plus communs associés à toutes les prescriptions d'AP étaient les troubles dépressifs (12,8 %), l'instabilité de l'enfance (11,7 %), et les troubles névrotiques (11,1 %); toutefois, une variation a été observée dans la formation de spécialité du prescripteur. Parmi toutes les nouvelles prescriptions d'AP en 2010-2011, 38,6 %, 34,3 %, et 15,6 % ont été fournies par des psychiatres, des médecins de famille, et des pédiatres, respectivement. Conclusions : Il y a eu une hausse exponentielle des prescriptions d'ADG en C.-B., consécutive à une vaste utilisation non indiquée sur l'étiquette, non seulement par les psychiatres mais aussi les médecins de famille et les pédiatres. Les initiatives de transmission des connaissances qui prônent des pratiques de prescription et de surveillance fondées sur les données probantes et reliées au traitement par ADG doivent cibler les 3 groupes de prescripteurs et être adaptées aux sous-groupes d'âge.

[Comorbid neurotic disorders in opioid-dependent patients].

Necessity of distinguishing between psychopathology of opioid dependence itself and co-occurred neurotic (ICD-10 item F4) disorders is caused by the need to choose an adequate therapy. The prevalence and types of comorbid neurotic disorders among opioid-dependent patients in sustained full and partial remission are described.

[Fenibut and its citrate prevent psychoneurological disorders caused by chronic stress (paradoxical sleep deprivation)].

The antistress protective action of two structural analogs of GABA, fenibut and its salt with citric acid (fenibut citrate, citrocard, RGPU-147), has been studied using a model of chronic stress caused by seven-fold 24-h deprivation of paradoxical sleep phase at an interval of 24 h between the deprivations. It is established that fenibut and fenibut citrate produce a protective action by (i) reducing the intensity of emotional disorders in the open-field test and elevated plus maze test, (ii) decreasing cognitive disorders in the tests for conditioned avoidance response and extrapolatory deliverance; and (iii) limiting stress reaction due to a decrease in the intensity of adrenal hypertrophy, thymus involution, and stomach mucous membrane ulceration. Fenibut citrate surpasses fenibut in the intensity of antistress protective action.

Effect of chronic escitalopram versus placebo on personality traits in healthy first-degree relatives of patients with depression: a randomized trial.

INTRODUCTION: The serotonergic neurotransmitter system is closely linked to depression and personality traits. It is not known if selective serotonin reuptake inhibitors (SSRI) have an effect on neuroticism that is independent of their effect on depression. Healthy individuals with a genetic liability for depression represent a group of particular interest when investigating if intervention with SSRIs affects personality. The present trial is the first to test the hypothesis that escitalopram may reduce neuroticism in healthy first-degree relatives of patients with major depressive disorder (MD). METHODS: The trial used a randomized, blinded, placebo-controlled parallel-group design. We examined the effect of four weeks escitalopram 10 mg daily versus matching placebo on personality in 80 people who had a biological parent or sibling with a history of MD. The outcome measure on personality traits was change in self-reported neuroticism scores on the Revised Neuroticism-Extroversion-Openness-Personality Inventory (NEO-PI-R) and the Eysenck Personality Inventory (EPQ) from entry until end of four weeks of intervention. RESULTS: When compared with placebo, escitalopram did not significantly affect self-reported NEO-PI-R and EPQ neuroticism and extroversion, EPQ psychoticism, NEO-PI-R openness, or NEO-PI-R conscientiousness (p all above 0.05). However, escitalopram increased NEO-PI-R agreeableness scores significantly compared with placebo (mean; SD) (2.38; 8.09) versus (-1.32; 7.94), p = 0.046), but not following correction for multiplicity. A trend was shown for increased conscientiousness (p = 0.07). There was no significant effect on subclinical depressive symptoms (p = 0.6). CONCLUSION: In healthy first-degree relatives of patients with MD, there is no effect of escitalopram on neuroticism, but it is possible that escitalopram may increase the personality traits of agreeableness and conscientiousness. TRIAL REGISTRATION: Clinicaltrials.gov NCT00386841.

Effects of personality on use of medications, alcohol, and cigarettes during pregnancy.

PURPOSE: The aim of the study was to examine the role of personality in a pregnant woman's consumption of medications, cigarettes, and alcohol. METHODS: The study included 835 pregnant women in Norway who responded to an electronic questionnaire posted on websites for pregnant women. On the questionnaire, the women reported their use of medications, cigarettes, and alcohol during pregnancy. They also filled out a personality assessment questionnaire, the Big Five Inventory. RESULTS: Use of medications, alcohol, and cigarettes was significantly associated with different personality traits. Women with high scores for conscientiousness were less likely to use an over-the-counter medication such as paracetamol than other women (odds ratio (OR) 0.74; 95% confidence interval (CI) 0.55-0.99). Women who scored high for neuroticism were four- to sixfold more likely to use prescription medications such as sedatives/anxiolytics (OR 4.07; 95% CI 1.48-11.20) or antidepressants (OR 5.73, 95% CI 2.33-14.09). Women with high scores for openness to experience were more likely to use herbal remedies (OR 1.59; 95% CI 1.00-2.52). Women who continued consuming alcohol during pregnancy were more likely to score high on extraversion and low on conscientiousness than women who quit alcohol use. Scoring high on neuroticism increased the likelihood of quitting smoking during pregnancy. CONCLUSIONS: This study shows that a woman's personality traits are associated with use of medications, cigarettes, and alcohol during pregnancy. This knowledge could be of clinical importance to health care personnel providing prenatal care.

Personality predictors of antiaggressive response to fluoxetine: inverse association with neuroticism and harm avoidance.

Although selective serotonin reuptake inhibitors (SSRI) are generally effective in reducing impulsive aggression in individuals with intermittent explosive disorder, a large proportion of intermittent explosive disorder patients fail to achieve full remission despite adequate dosage and duration of treatment. Temperament, specifically those associated with negative emotionality (neuroticism, harm avoidance) may predict response to SSRI treatment. The objective of this study was to determine whether baseline neuroticism and harm avoidance scores would be associated with reduced aggression (as measured by the Overt Aggression Scale-Modified [OAS-M] aggression scores) after SSRI treatment. Participants participating in a randomized, placebo-controlled clinical trial of fluoxetine completed the Eysenck Personality Questionnaire (n=57) and the Tridimensional Personality Questionnaire (n=38) before entering the treatment trial. Multiple regression analyses (accounting for baseline OAS-M aggression scores) revealed that pretreatment eysenck personality questionnaire neuroticism and tridimensional personality questionnaire harm avoidance independently and uniquely predicted OAS-M aggression scores at endpoint in the fluoxetine, but not placebo, treated group. These preliminary findings are the first from a placebo-controlled clinical trial to suggest that temperamental factors such as neuroticism and harm avoidance can partly explain the observed variability in treatment response in SSRI treated individuals with impulsive aggression and prompt future prospective studies examining personality dimensions as predictors of outcomes in clinical trials.

Serotonin receptors of type 6 (5-HT6): what can we expect from them?

The serotonin (5-HT) receptors of type 6 (5-HT6) are relatively new. They are quite different from all other 5-HT receptors, as they are characterized by a short third cytoplasmatic loop and a long C-terminal tail, and contain one intron located in the middle of the third cytoplasmatic loop. After some initial controversies, the available findings are now apparently more congruent. Nevertheless, discrepancies still exist, such as those in binding affinity, effects of 5-HT6 ligands on brain catecholamines and behavioral syndromes mediated by them. Much interest in 5-HT6 receptors was triggered by the evidence that some antipsychotics could bind to them. Subsequently, despite the lack of complete information on metabolic patterns of the various compounds, some of 5-HT6 receptor ligands entered the clinical development as potential anti-dementia, antipsychotic and anti-obese drugs. In any case, the available information on both the pharmacology of 5-HT6 receptors is still quite scant. Therefore, with the present paper we aimed at reporting a comprehensive review on the status of art of the 5-HT6 receptors, while highlighting the potential clinical applications of 5-HT6 receptor agonists/antagonists.

Possible role of BDNF-induced microglial intracellular Ca(2+) elevation in the pathophysiology of neuropsychiatric disorders.

Microglia are intrinsic immune cells that release factors, including proinflammatory cytokines, nitric oxide (NO) and neurotrophins, following activation after disturbance in the brain. Elevation of intracellular Ca(2+) concentration ([Ca(2+)]i) is important for microglial functions, such as the release of cytokines and NO from activated microglia. There is increasing evidence suggesting that pathophysiology of neuropsychiatric disorders is related to the inflammatory responses mediated by microglia. Brain-derived neurotrophic factor (BDNF) is a neurotrophin well known for its roles in the activation of microglia as well as in pathophysiology and/or treatment of neuropsychiatric disorders. We have recently reported that BDNF induces a sustained increase in [Ca(2+)]i through binding with the truncated TrkB receptor, resulting in activation of the PLC pathway and store-operated calcium entry (SOCE) in rodent microglial cells. Sustained activation of SOCE, possibly mediated by TRP channels, occurred after brief BDNF application and contributed to the maintenance of sustained [Ca(2+)]i elevation. Pretreatment with BDNF significantly suppressed the release of NO from activated microglia. Additionally, selective serotonin reuptake inhibitors (SSRIs), including paroxetine or sertraline, potentiated the BDNF-induced increase in [Ca(2+)]i in rodent microglial cells This article provides a review of recent findings on the role of BDNF in the pathophysiology of neuropsychiatric disorders, especially by focusing on its effect on intracellular Ca(2+) signaling in microglial cells.

[The use of the antidepressant citalopran for the treatment of chronic pharyngitis and pharyngeal neurosis].

The analysis of the efficacy of citalopran for the treatment of chronic pharyngitis and pharyngeal neurosis was carried out. The positive outcome of the treatment was documented in 95% of the patients.

Neuroticism but not omega-3 fatty acid levels correlate with early responsiveness to escitalopram.

BACKGROUND: Omega-3 fatty acid (O3FA) levels and dimensional personality measures have been associated with major depression and the course of depressive illness. We sought to study the utility of O3FA levels and dimensional personality measures as predictors of early improvement with escitalopram. METHODS: Twenty-four participants were enrolled in an open-label trial of escitalopram 10 mg/d for 4 weeks. Baseline erythrocyte O3 levels and dimensional personality assessments were obtained. RESULTS: Using a conservative, intention-to-treat analysis, baseline neuroticism (r = -0.57; P = .007), as measured by the Revised NEO Personality Inventory but not erythrocyte O3 levels, was correlated with improvements on escitalopram. A facet analysis of the neuroticism domain showed the relationship with antidepressant response to be focused on trait anxiety (r = -0.65; P = .002). CONCLUSIONS: Anxiety may have important prognostic implications on subsequent response to selective serotonin reuptake inhibitors, such as escitalopram.

Major depression: the importance of clinical characteristics and treatment response to prognosis.

BACKGROUND: This article analyzed data from the intervention arm of a large treatment trial to demonstrate the importance of clinical severity, course, comorbidity, and treatment response in patient prognosis. METHODS: This is a secondary analysis of data from a large primary care-based geriatric depression treatment trial that analyzes outcomes from the measurement-based stepped-care intervention arm (N=871 patients) to determine: whether increasing severity levels of depression at baseline were linked with other factors associated with poor depression outcomes such as double depression, anxiety, medical disorders, and high levels of neuroticism and pain; and whether patients with increasing levels of depressive severity would have more intervention visits and treatment trials based on a stepped-care algorithm, but would be less likely to reach remission and have a greater likelihood of re-emerging depression in the year after intervention. RESULTS: Increasing levels of depression severity were a robust predictor of lack of remission and were associated with other clinical variables that have been associated with lack of remission in earlier studies such as double depression, anxiety, medical comorbidity, high neuroticism levels, and chronic pain. Patients with higher levels of severity received significantly more intervention visits, more months of antidepressant treatment and more antidepressant trials, but had fewer depression-free days during the 12-month intervention and in the postintervention year. CONCLUSION: Patients with higher levels of depression severity had worse clinical outcomes despite receiving greater intensity of treatment. A new classification of depression is proposed based on clinical severity, course of illness and treatment experience.

Forty meals for a drop of blood ...

Increasing migration flow to Western countries poses formidable challenges from the epidemiological, clinical, and cultural standpoints. A case of Dhat syndrome is presented in a young Pakistani male migrant living in Italy, which required integrated medical and cultural approach to be solved after a through diagnostic workout that did not yield any result.

[Peptic ulcer in patients with neurotic and affective disorders: comorbidity, clinicoendoscopic and psychopathological features, approaches to therapy].

AIM: to study clinicoendoscopic and psychopathological relationships and the course of peptic ulcer (PU) in patients with neurotic and affective disorders and to evaluate the efficiency of psychopharmacotherapy, by applying a comprehensive approach to the treatment of comorbidies. SUBJECTS AND METHODS: The study covered 245 patients aged 43.3 +/- 8.8 years from the Department of Borderline Conditions who had been diagnosed as having duodenal PU and gastric PU with a prevalence of stress-associated neurotic disorders, as well as affective and other ones. Clinical psychopathological and experimental psychological tests and rating psychometric scales were used to evaluate the patients' mental status. Somatic diseases were verified by endoscopic, morphological, and ultrasound diagnostic techniques. RESULTS: Multivariate analysis has revealed a relationship of the phase of an ulcerative process and age to the first manifestations of psychopathology, its duration, and gender. Assessment of psychopharmacotherapy in patients with PU has shown the high efficacy of the antidepressant of coaxil in the treatment of the comorbidity. CONCLUSION: The polymorphism of psychopathological disorders and their trend are determined by the clinical changes in the course of an ulcerative or erosive process. The inclusion of coaxil into the combined treatment regimen for PU in patients with neurotic and affective disorders is expedient and pathogenetically founded at all stages of a follow-up.

Dispensing of psychotropic drugs to adults in community pharmacies in Latvia.

OBJECTIVE: To estimate outpatient utilization of psychotropic drugs before and after pharmaceutical reform in Latvia. SETTING: Data concerning prescribing and dispensing of psychotropic drugs were collected in six community pharmacies in the region of Latgale of Latvia. METHOD: An exploratory analysis of prescription data provided by six community pharmacies from 2004 to 2007. Drugs included in the study were classified according to an Anatomical-Therapeutic-Chemical (ATC) drug classification system, and ATC data were used to calculate defined daily doses (DDD) per 1,000 inhabitants. The National SSK-10 classification was used for analysis of codes of disease diagnosis. MAIN OUTCOME MEASURES: Identification of the most often prescribed psychotropic drug and prescribing physician, patient characterization by age and gender, and analysis of codes of diseases. RESULTS: Benzodiazepines and benzodiazepine-related drugs were mainly prescribed in outpatient practice. Diazepam was the most frequently prescribed benzodiazepine-12 DDD/1,000/day. The drugs were prescribed mainly by family physicians (in 66% of cases). Female residents bought more psychotropic drugs than males. In addition, residents of cities bought little more drugs than those living outside urban areas. Accordingly to the recorded disease codes, the codes for neurotic and behavioral disorders dominated. CONCLUSION: The introduction of new norms neither increased nor decreased the number of psychotropic drug prescriptions filled. The most often prescribed psychotropic drugs over 4-year period were benzodiazepines and their derivates. Disease codes on the prescriptions fully justified a reason for psychotropic drug use.

Neuroticism as a mediator of treatment response to SSRIs in major depressive disorder.

BACKGROUND: Serotonin function has been implicated in both major depressive disorder and neuroticism. In the current investigation, we examined the hypothesis that any change in depression severity is mediated through the reduction of neuroticism, but only for those compounds which target serotonin receptors. METHODS: Ninety-three outpatients in the midst of a major depressive episode received one of three antidepressant medications, classified into two broad types: selective serotonin reuptake inhibitors (SSRIs) and non-SSRIs (i.e. reversible monoamine oxidase inhibitors [RIMAs] and noradrenergic and dopaminergic reuptake blockers [NDMs]). Patients completed the Hamilton Rating Scale for Depression, Beck Depression Inventory II and Revised NEO Personality Inventory prior to and following approximately 16 weeks of treatment. Structural equation modeling was used to test two models: a mediation model, in which neuroticism change is the mechanism by which SSRIs exert a therapeutic effect upon depressive symptoms, and a complication model, in which neuroticism change is a mere epiphenomenon of depression reduction in response to SSRIs. RESULTS: The mediation model provided a good fit to the data; the complication model did not. Patients treated with SSRIs demonstrated greater neuroticism change than those treated with non-SSRIs, and greater neuroticism change was associated with greater depressive symptom change. These effects held for both self-reported and clinician-rated depressive symptom severity. LIMITATIONS: Replication within a randomized control trial with multiple assessment periods is required. CONCLUSION: Neuroticism mediates changes in depression in response to treatment with SSRIs, such that any treatment effect of SSRIs occurs through neuroticism reduction.