Dear colleagues,
It is my great pleasure to welcome you to the second issue of 2012.
The first article I am delighted to present to you is a summary of the WFSBP guidelines for pharmacological treatment of anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) in primary care. These evidence-based guidelines were compiled by Bandelow and the members of the WFSBP task force on anxiety disorders, OCD and PTSD and they provide a short treatment manual with up-to-date treatment options and recommendations for primary care.
Veldhuis et al. sought to obtain valid estimates of incidence and prevalence of obsessive compulsive disorder (OCD) in a treatment-seeking primary-care population and to compare these estimates with those from epidemiological community studies. They concluded that the incidence and prevalence rates of OCD in treatment-seeking patients were at least three times lower than the rates provided by the most conservative epidemiological community studies. Therefore, they suggest that OCD may be under-recognised and under-treated.
Tamam and colleagues investigated the anxiety and depression levels of patients prior to myocardial perfusion scintigraphy (MPS). The Hospital Anxiety Depression Scale (HADS) and the State and Trait Anxiety Inventory (STAI) I and II were used to evaluate those levels. HADS and STAI scores were significantly higher in female than in male patients. They concluded that MPS procedures might lead to increased anxiety levels, which are associated with anticipatory anxiety experienced prior to life-threatening situations.
Charnsil et al. assessed the effect of adjunctive treatment with repetitive transcranial magnetic stimulation (rTMS) in depressed patients in partial remission. It emerged that remitted patients with major depressive disorder may benefit from adjunctive rTMS.
Köhler and colleagues evaluated the effectiveness of inpatient treatment of unipolar depressive disorders by adhering to current guidelines and assessing admission and discharge depression scores, response and remission rates. Patients treated according to guidelines showed higher remission rates than “non-guideline” patients. Adherence to guidelines can therefore be assumed to be superior to other treatment strategies.
Mazza et al. examined the clinical outcome, social functioning and quality of life in bipolar patients with pure and mixed depression during a 1-year follow-up. They concluded that mixed features remain relatively stable throughout a depressive episode having a negative impact on clinical and functional outcome, but not on social adjustment.
Thase and colleagues explored the impact of aripiprazole monotherapy vs. placebo in bipolar depression. Their results suggest that aripiprazole monotherapy may provide some improvements in the core symptoms of depression in patients with bipolar I disorder who were more severely depressed.
Chou et al. provide a comparison of the validity of the Chinese versions of the Hypomania Symptom Checklist-32 (HCL-32) and the Mood Disorders Questionnaire (MDQ) for detecting bipolar disorder in patients with major depressive disorder (MDD). It emerged that HCL-32 and MDQ are valid tools to distinguish between bipolar disorder and MDD. However due to the small sample size, the findings should be considered with caution.
Hori and colleagues addressed the question of whether excessive dosing of antipsychotics (AP) worsens cognitive functions in schizophrenia patients. They compared several cognitive functions in patients taking an AP to those taking more than two kinds of APs. They concluded that an excessive dose of AP drugs regardless of the combinations of first- plus second generation APs or second-generation APs only cause deterioration of cognitive functions in schizophrenic patients.
Lertxundi et al. investigated the use of antipsychotics (AP) in inpatients from 1998 to 2010. The daily-defined dose (DDD) values were those assigned by the WHO. The use of APs increased by 135% from 1998 to 2010 when measured in DDD values or by 108% according to consensus-based recommendations. Not only was there an increase of dosage in individual drugs, but also a rising cumulative total dosage due to polypharmacy. Whether or not these prescription patterns have been translated into concrete clinical benefits remain unclear.
Mahmoud and colleagues assessed the sexual function in patients with schizophrenia receiving first-generation (FGA) and second-generation (SGA) antipsychotics. No significant differences in measured sexual function were found in patients treated with FGAs or SGAs.
Letmaier et al. present a case report of a 39-year-old woman with schizoaffective disorder. The patient suffered from severe psychotic exacerbation during combined treatment with aripiprazole and haloperidol after prior treatment with risperidone. Clinicians should be aware of this possible serious adverse event while switching to or prescribing aripiprazole with other antipsychotics. Drugs with lower D2 receptor affinity may be more suitable for a combined treatment with aripiprazole.
Harrison and colleagues report the findings of two approaches for physical screening of psychiatric inpatients. One hospital ward modified the admissions proforma and the other developed a discharge-screening clinic. The discharge-screening clinic was more likely to detect clinically significant abnormalities than improved admission procedures.
Yours sincerely,