Volume 7, Issue 3, September 2005
The primary aim of this review is to summarize the result of clinical trials comparing tricyclic antidepressants with first generation SSRIs, dual action (serotonergic and noradrenergic) agents like venlafaxine or mirtazapine with SSRIs and escitalopram with other SSRIs and venlafaxine. The review analizes the relationship between the clinical efficacy and tolerability data and the mode of action. The clinical data suggest that multiple mode of action can substantially improve efficacy, however the relative risk of sideeffects also increases if a drug affects multiple neurotransmitters. A new opportunity of development is the molecule of escitalopram introduced to the market some years ago. Its unique dual action on serotonergic transmission offers improved efficacy without compromising the favourable side-effect profile due to selectivity. Based on clinical trials escitalopram showes improved efficacy, faster onset of action and higher remission rates compared to first generation SSRIs. Remission rates with escitalopram are at least as high as with venlafaxine and escitalopram shows faster onset of action, earlier sustained remission and better tolerability. The good clinical efficacy data of escitalopram may be explained by its unique dual serotonergic effect on serotonin transporter protein.
KEYWORDS: TCAs, first-generation SSRIs, dual-action agents, escitalopram, mode of action, dual serotonergic effect
Emma Birkás, Krisztina Lakatos, Zsófia Nemoda, Krisztina Ney, Ildikó Tóth, Alexa Novák, Mária Sasvári-Székely, Judit Gervai
Association of the 7-repeat allele of the D4 dopamine receptor (DRD4) exon 3 polymorphism with attention deficit/hyperactivity disorder is well-established, and a link with mother-reported aggressiveness was also found in healthy preschoolers assessed by the quantitative scale of the Child Behavior Checklist. In the present study, we hypothesized that children carrying the 7-repeat allele would show more attention problems and externalizing (aggressive and delinquent) behavior at 6 years of age. Further, we hypothesized a potential mediating role of early temperament in the relationship of DRD4 gene with behavior problems. Mothers filled in the Achenbach Child Behavior Checklist for 88 sixyear-old firstborn children (51 boys, 35 girls) followed from birth. Mother-reported temperament for the same children was assessed by the Rothbart Infant Behavior Questionnaire at 12 months. Genotypes of the DRD4 repeat polymorphism were determined using buccal cells. Significant main effects of gender and DRD4 genotype were observed on 6-year behavioral problems. Boys showed more attention problems and externalizing behavior, and children lacking the 7-repeat variant showed more externalizing and internalizing behavior. These effects remained significant after controlling for 1-year temperament. Our results did not confirm the negative effect of the 7-repeat allele on attention problems and externalizing behavior measured on quantitative scales. On the contrary, we found elevated problem scores in the absence of the 7-repeat allele. Further research including environmental risk factors is needed to clarify the role of the DRD4 gene in the development of externalizing behavior.
KEYWORDS:dopamine, genetic risk factors, association study, behavior problems
Possible Connection Between Ghrelin, Resistin And Tfa- Levels And The Metabolic Syndrome Caused By Atypical Antipsychotics
Dezső Birkás Kováts, Éva Palik, Gábor Faludi, Károly Cseh
Second generation antipsychotics (SGA) are obesitogenic and diabetogenic. Role of ghrelin (RIA), resistin and TNF- (ELISA) in weight gain and insulin resistance (fasting plasma insulin, HOMA, ELISA) was studied in Hungarian psychiatryic patients (n=60) treated with SGA (clozapine, olanzapine, risperidone, quetiapine, 15 each). After 1 year, 80% of patients became overweight/obese (BMI>27/30) and 35% (n= 21/60) presented impaired glucose tolerance (13/60) or diabetes (8/60). Ghrelin (1,3±0,6 ng/ml), resistin (9,8±3,7 ng/ml), TNF- (5,8±1,7 pg/ml), insulin (10,4±7,6 U/ml, HOMA A: 2,5± 1,8, HOMA B: 133±62,5) were significantly higher in patients than in healthy matched controls. Resistin and TNF- positively correlated with each other, insulin, HOMA, and negatively with ghrelin. Ghrelin contributes to weight gain, resistin and TNF- to insulin resistance. A negative feedback regulation may exist between adipocytokines and ghrelin production. SGA drugs enhance ghrelin production despite the suppressive effect of adipocytokines. All four SGA drugs are equally obesitogenic and diabetogenic.
KEYWORDS: obesity, antipsychotic drugs, ghrelin, resistin, TNF, insulin resistance
The most effective way for the diagnosing and the treatment of psychopathological symptoms appearing in non-psychiatric hospitalized patients is the utilization of consultation-liaison psychiatry. With the increasing number of the elderly patients, number of appearing gerontopsychiatric problems in consultation work is also growing. Aim. We have studied among the patients of a consultation-liaison service the problems which led to the psychiatric consultations, the diagnoses which were set up, the concomitant somatic disorders and the treatment recommendations. Method. We have retrospectively studied the data of the patients in the consultation-liaison service of St. László Hospital. Results. 77% of the consultations were asked from internal medicine. Most frequent reason of the requests were the presence of any psychiatric symptom, but unexplained somatic complains were also common. Gerontopsychiatric problems were most frequently associated to cardiovascular disorders. Demencia and delirium were the most frequent diagnoses. The rate of affective disorders was higher than reported in the literature. Conclusions. Consultations were most frequently asked for non-compliance in patients with demencia, and for unexplained somatic complain in affective disorders. Most frequent reason of psychiatric referrals was symptoms of delirium. Authors try to explain these results in accordance with the literature.
KEYWORDS: gerontopsychiatry, consultationliaison psychiatry, general hospital
The Impact Of Antidepressive Therapy On Work Productivity And Life Satisfaction – A 1-Year Follow-Up Study
Zsolt Fábián, Zsolt Karányi, Erika Szádóczky
Aim of the study. One of the most frequent causes of temporary or permanent diminution of work productivity is depression. The complete recovery of depression means fully restored creativity, work production and life satisfaction. Antidepressive treatment is regarded effective if besides symptom remission, the original functions and roles are fully restored, i.e. life satisfaction significantly improves. The aim of this study was to assess the improvement of work productivity and life satisfaction of paroxetin treated depressives. Methods. The study was a 52 weeks lasting open, multicentric, self-controlling survey with the inclusion of 1407 paroxetin treated depressed patients. Apart from recording demographic data, comorbidities, course of the illness, and scales measuring the severity of the illness (HAMD, CGI-S, CGI-I), scales indicating the impairment of work productivity (SAS, SDS) and life satisfaction (LS) were also processed. Results. Besides the improvement of the depressive symptoms (HAMD scores decreased from 22.6 to 3.8; and CGI-S scores from 4.7 to 1.3), the scores of work productivity and life satisfaction also significantly decreased (SAS scores from 2.8 to 1.3, SDS scores from 18.2 to 2.8, and LS scores from 14.9 to 7.1, respectively). Following the acute treatment period, work productivity and life satisfaction further continuously improved till the end of the maintenance treatment phase. Conclusion. Parallel to the improvement of the depressive symptoms, the number of absence days decreased, the work performance, free time activity and family functioning significantly improved. A significant correlation was found between the improvement of depressive symptoms and the positive changes in work production and life satisfaction.
KEYWORDS: depression, antidepressive therapy, work production, life satisfaction