Document Sample
SC_Therap_Aspects Powered By Docstoc

Therapeutic aspects in psychiatric disorders
V Golik-Gruber, D Breitenfeld, E Ničea Gruber, D Karlović (Zagreb):

                         Psychopharmacotherapy with Sulpirid of
                             patients with alcohol addiction,
                                comorbid with depression
        Depression is very often present in the early stage of treating alcohol addiction. The
alcoholic’s awareness of his problematic situation can be one of the reasons for depression.
Further, depression can be the result of depressive disorders primarily, or secondarily,
connected with alcohol addiction. Antidepressive therapy usually begins after a 2-week
detoxication procedure. Exceptionally, it can begin earlier if depressive disorders are severe.
        Application of Sulpirid in the beginning of treatment gives positive results due to its
wide range effects, especially antidepressive ones. In our study the effect of Sulpirid was
examined in 20 patients suffering from minor or medium depressive disorder. The patients
were given 50 mg Sulpirid capsules three times a day. At the same time control group of 20
patients received placebo. The patients in both groups were undergoing psychotherapeutic
procedures, usual for sociotherapeutic community. The severity of depressive disorder was
measured in both Hamilton and Becks scale before the treatment started, and then 2, 4, and 6
weeks after the beginning. The patients were clinically observed during the psychotherapeutic
procedures, with other activities usually conducted in the therapeutic community.
        Sulpirid efficiency in the treatment of depressive alcohol addiction in alcoholics is
confirmed. Sulpirid dose of 15o mg per day has a quick and efficient antidepressive effect. Its
role in psychopharmacotherapy of patients with alcohol addiction in sociotherapeutic
community in a rational use is confirmed.
Key words: psychopharmacotherapy with sulpirid, alcohol addiction, depression
References: 1. Danion J.M, Rein W, Fleurot O. Improvement of schizophrenic patients with
primary negative symptoms treated with amisulpiride. Amisulpiride Study Group. Am J
Psychiatry. 1999 Apr; 156 (4): 610-6       2. Ikarashi Y,Takahashi A., Ishimaru H, Arai T,
Maruyama Y. Supression of cholinergic activity via the dopamine D2 receptor in the rat
striatum. Neurocem Int. 1997 Feb; 30(2): 191-7 3. Rein W, Turjanski S. Clinical update on
amisulpiride in deficite schisophrenia. Int Clin Psychopharmacol. 1997 May; 12 Suppl 2:
S19-27 4. Lecrubier Y, Boyer P, Turjanski S, Rein W. Amisulpiride versus imipramine and
placebo in dysthimia and major depression. Amisulpiride Study Group. J Affect Disord. 1997
Apr; 43(2): 95-103 5. Boyer P, Lecrubier Y, Stalla-Bourdillon A, Fleurot O. Amisulpiride
versus amineptine and placebo for the treatment of dysthymia. Neuropsychobiology. 1999; 39
Vesna Golik-Gruber, Darko Breitenfeld, Ema Ničea Gruber, Dalibor Karlović, Dpt. of
Psychiatry, Referral Center for Alcoholism of the Republic of Croatia, Sestre milosrdnice
University Hospital. Vinogradska c. 29, Zagreb, Croatia
V R Paunović, M Ivković, A Damjanović, M Jasović-Gasić (Belgrade):

               Carbamazepine for acute psychosis with EEG abnormalities
        Objective of our study was to investigate the effectiveness of adjunctive
carbamazepine in acute paranoid psychosis with associated EEG abnormalities compared to
sole antipsychotic treatment. 11 medication naive subjects, diagnosed as acute paranoid
psychosis with associated EEG abnormalities, were divided into two treatment groups: sole
fluphenazine group, with flexible dosing from 5-10 mg/day (n=6), and adjunctive
carbamazepine group (n=5) with addition of 600 mg/day carbamazepine to fluphenazine
treatment. CGI, BPRS, SANS and EEG were assessed on the baseline, and after 6 weeks of
treatment. Paired t-tests and two-tailed significance were used for statistical analysis.
        All patients showed significant improvement of mental state after 6 weeks of
treatment with no significant differences in CGI, BPRS and total SANS scores in respect to
adjunction of carbamazepine. Nevertheless, after 6 weeks of treatment EEG findings were
significantly better in adjunctive carbamazepine group compared to both baseline and sole
fluphenazine group.
        Conclusions: Although carbamazepine stabilized abnormal brain electrical activity, it
seems that associated EEG abnormalities did not count for acute psychosis observed. These
preliminary results suggest that there is no convincing evidence that carbamazepine is
effective as augmentation of antipsychotic treatment for patients with both acute paranoid
psychosis and EEG abnormalities.
V R Paunović, M Ivković, A Damjanović, M Jasović-Gasić. Institute of Psychiatry, Clinical
Center of Serbia, Belgrade, Serbia

D Degmečić, N Mandić, N Blagojević-Damašek, V Pereković, Lj Radanović-Grgurić, I
Pozgain (Osijek):

                         Paroxetine in the treatment of depression
       For nearly 2500 years mood disorders have been described as the most common
diseases of mankind, but only recently have they commanded major public health interest.
The World Health Organization has ranked depression fourth in the list of the most urgent
health problems worldwide. Though activity of antidepressants is more and more specific,
treatment of depression is still a complex psychiatric task. High selectiveness of
antidepressants activity on the key transmitters responsible for etiopathogenesis of depression
provides therapeutic efficacy and less adverse effects but consequently the choice of an
antidepressant is more complicated.
       Depression is related to the alterations of the central serotonergic system, and most
antidepressants achieve their therapeutic effects by affecting serotonergic transmission, i.e.
serotonin (5-HT) reuptake, either by inhibition or by stimulation. Paroxetine is a member of
the selective serotonin reuptake inhibitor (SSRI) family. The therapeutic efficacy of
paroxetine is thought to be due to the reuptake inhibition of serotonin into the presynaptic
nerve terminal.
       The sample in our analysis consisted of 30 outpatients of both sexes from 18 to 65
years of age who met ICD-10 criteria for major depression and were treated in the Dpt. of
Psychiatry, University Hospital Osijek. All of them were treated with paroxetine alone or in
combination with other drugs (mostly used combination was with anxiolytics). During the
follow-up, applied measure scales for depression (HAMD, MADRS) showed significant
improvement. Therapeutic efficacy was noticed after the first 3 weeks of treatment. Tolerance
of paroxetine was very good, and just a few patients had mild adverse effects. Our clinical
experience in the treatment of depressed patients with paroxetine showed positive outcomes.
Key words: paroxetine, depression, antidepressants
Dunja Degmečić, Nikola Mandić, Nada Blagojević-Damašek,Vesna Pereković, Ljiljana
Radanović-Grgurić, I. Pozgain. Dpt. of Psychiatry, University Hospital Osijek, J. Huttlera 4,
Osijek, Croatia

V Gruden Jr, V Gruden, Z Gruden (Zagreb):

             Anxiolytic and antidepressant therapy in anti-stress programme
        Anxiety is a response to danger. It's a threatening danger. Danger is a threat of the
destruction of ego. The very basic of every danger is separation. Anxiety is the cornerstone of
the whole psychopathology. Stress is a response to the disturbance of homeostasis.
Disequilibrium of homeostasis is the beginning of danger. Stress could be equalized with
anxiety. So antistress therapy is in fact anxiolytic therapy. When danger is real, separation has
begun or has been done, the response is depression. Life is constant change of threat and
realization of separation. As separation leads to destruction, mechanism of self-destruction is
present, too (i.e. self-aggressiveness). This is a cumulative process.
        We observed 150 patients with diagnosis of stress reaction who were receiving
treatment at the Clinic for Psychological Medicine, Zagreb University School of Medicine.
Psychological testing showed anxiety in 60 % and depression in 70 % of the patients.
Anamnestically they all had childhood or recent traumas. They all had concurrent life
traumas. The patients were receiving anxiolytic therapy (alprazolam, Helex), 1,5-3 mg daily
divided into three doses and an antidepressant agent (fluoxetine, Fluval), 20 mg in the
morning. Having completed three months of therapy all the patients showed decreased levels
of anxiety and depression symptoms.
Vladimir Gruden Jr, Vladimir Gruden, Zdenka Gruden, Clinic for Psychological Medicine,
Zagreb University School of Medicine

S J Pokupec Gruden, V Gruden, T Peharda (Zagreb):

                Is the therapy of “burning mouth” a psychiatric problem?
        Stomatopyrrhosis, or burning mouth, is a special clinical entity. A patient feels
intensive burning or pain in the mouth without any pathological evidences. Both our and other
investigations reveal a high level of anxiety and depression. That is why we conclude that it
has a psychological origin. It has not yet been elucidated if we are dealing with conversive or
psychosomatic disorder. It is our belief that it is a psychosomatic disorder, because of
decreased salivation and higher mouth temperature. The patients mostly seek help from the
dentist. Topical therapy is usually not successful. Because of present anxiety and depression,
we decided to offer psychotherapy. 120 patients were divided into four groups: patients taking
antidepressant agent (fluoxetine, Fluval), the second group was given anxiolytic agent
(alprazolam, Helex), the third group was offered autogenous training, and a control group.
After four months of therapy all three experimental and the control group had decreased
levels of anxiety and depression. The feeling of burning mouth was decreased. Autogenous
training group experienced the best results. We therefore conclude that burning mouth is a
psychiatric problem.
Sanja Josipa Pokupec Gruden, Vladimir Gruden, Tomislav Peharda. Clinic of Psychological
Medicine, Zagreb University School of Medicine

Shared By: