Metabolic syndrome and risk of death in older adults with major psychiatric disorders: Results from a 5-year prospective multicenter study.

OBJECTIVES: No study has explored the association of individual components of metabolic syndrome with mortality in older patients with psychiatric disorders. In this report, we examined whether metabolic syndrome or any of its components predicted mortality in a cohort of older adults with psychiatric disorders. METHODS: We used data from a multicenter 5-year prospective cohort, including 634 in- and out-patients with schizophrenia, bipolar or major depressive disorder. Metabolic syndrome was assessed at baseline following NCEP-ATPIII criteria. Cause of death was categorized as cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality (e.g., infections), suicide and accident. RESULTS: 122 participants (44.0%) were diagnosed with metabolic syndrome at baseline. In the full sample, there was no significant association between metabolic syndrome or any of its components with all-cause, CVD and non-CVD mortality. However, for the subpopulation of older adults with major depressive disorder, metabolic syndrome was significantly associated with increased all-cause and disease-related mortality after adjustment for age, sex and smoking status (p = 0.032 and p = 0.036, respectively). There was a significant interaction between metabolic syndrome and psychiatric diagnoses indicating that in participants with major depressive disorder, metabolic syndrome had a significantly greater effect on all-cause mortality (p = 0.025) and on disease-related mortality (p = 0.008) than in participants with either bipolar disorder or schizophrenia. CONCLUSIONS: Our findings do not support an association between metabolic syndrome and increased mortality in older patients with major psychiatric disorders. Several explanations are discussed, including a survival bias, a lack of sensitivity of the used cut-offs and a ceiling effect of metabolic syndrome on mortality in this very high-risk population. The latter hypothesis could also explain the significant association between metabolic syndrome and mortality in the depressive subgroup, where a ceiling effect is yet to be reached, given the less marked premature mortality in depressive patients compared to those with bipolar disorder or schizophrenia.

Non-Antidepressant Treatment of Social Anxiety Disorder: A Review.

Social anxiety disorder is a debilitating mental illness with eventually serious comorbidities such as major depression and alcohol or substance abuse and dependence. Those comorbidities are much more common when social phobia is left neglected and untreated. It is characterized by excessive fears to one or most social situations (circumscribed versus generalized type). Social phobia has its onset typically in childhood or early adolescence and it is associated with significant functional impairment. Although cognitive behavioral therapy and the selective serotonin reuptake inhibitors are considered the mainstay treatment of this disorder, other psychotropic agents can be of value in the management of this condition. This review discusses the efficacy of beta-bockers, benzodiazepines, anticonvulsants, D-cycloserine, buspirone and atypical antipsychotics in the treatment of social anxiety disorder.

Pregabalin dependence: a case report.

INTRODUCTION: Pregabalin is a gamma-aminobutyric acid (GABA) analogue approved for the treatment of neuropathic pain, partial seizure and generalized anxiety disorder. As a GABA analogue, there is a raising concern regarding the abuse potential of this drug. CASE: We present a first case of pregabalin dependence in a 26-year-old woman without a previous history of illicit drug abuse. DISCUSSION: Physician should be aware about the addictive potential of pregabalin even in patients without a previous history of substance abuse.

Hyperammonemia induced by interaction of valproate and quetiapine.

INTRODUCTION: Hyperammonemia is one of the rare nevertheless serious side effects associated with valproic acid treatment. Two cases of valproic acid induced hyperammonemia are detailed in this article. CASES: Case one describes an adult male who developed hyperammonemia after acute exposure to valproic acid as a treatment for his bipolar disorder-manic episode. Case two developed a similar pattern of toxicity but after chronic exposure to valproic acid. Both patients were receiving a combination of valproic acid and quetiapine. DISCUSSION: Measurement of the ammonium level should be considered where there is a decreased level of consciousness in patients receiving valproic acid irrespective of the diagnosis and even after a long term exposure. A possible risk of hyperammonemia can result from a combination of valproic acid and quetiapine, however further studies are yet needed to confirm this hypothesis.