The following articles are currently In Press and will be published in the next issue of
Impact Of Gabapentin Adjunct Use With Benzodiazepines For The Treatment Of Alcohol Withdrawal In A Psychiatric Hospital
Vadiei, N., Smith T. L., Walton, A. E., and Kjome, K. L.
Introduction: Benzodiazepines are currently the gold standard for treatment of alcohol withdrawal. Gabapentin has growing evidence to support its use in the treatment of alcohol use disorder, however there is limited evidence regarding its role in the treatment of alcohol withdrawal. The purpose of this study was to determine if adjunctive gabapentin reduces the need for benzodiazepine (BZD) administration during alcohol withdrawal.
Methods: This was a retrospective single-center cohort study. Patients were included if they were 18-89 years old, had an underlying alcohol use disorder, and were initiated on the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) protocol with or without scheduled gabapentin. They were excluded if they had a BZD use disorder, were on concomitant anti-epileptics, as-needed gabapentin, or BZDs outside the CIWA-Ar protocol.
Results: A total of 129 patients met inclusion criteria (n=63 gabapentin group and 66 non-gabapentin group). There was a significant difference in as-needed BZD requirements, with the gabapentin group requiring a higher number of as-needed BZDs in the initial 72 hours of treatment (gabapentin 6 [IQR 0.5-10] non-gabapentin 2 [IQR 0-4]; p=0.01) and overall (gabapentin 6 [IQR 0.5-10] vs. non-gabapentin 2 [IQR 0-5.5]; p=0.01). The gabapentin group also had higher maximum CIWA-Ar scores in the initial 72 hours of treatment, and higher anxiety item scores in the initial 48 hours.
Paroxetine Versus Vortioxetine For Depressive Symptoms In Postmenopausal Transition: A Preliminary Study
Callegari C, Ielmini M., Caselli I., Lucca G., Isella C., Diurni M., Pettenon F., and Poloni N.
Background: The impact of menopause is a consequence of social, physical and mental changes; hormonal changes play an important role in inducing an increased risk of developing depressive symptoms. It is essential to treat mood and vasomotor symptoms and to prevent their onset to promote an improvement in the quality of life, both in terms of clinical and psychological conditions. Objective. This observational study aims to compare paroxetine and vortioxetine in a sample of patients affected by postmenopausal depression attending the Anxiety and Depression Clinic in terms of: efficacy in determining clinical remission (HDRS≤7) and tolerability; improvement of autonomic and cognitive symptoms.
Methods: 39 female outpatients with a diagnosis of Postmenopausal Depression (according to DSM-5 criteria) were evaluated as the routine clinical practice through the following scales: Hamilton Depression Rating Scale (HDRS); Menopause Rating Scale(MRS); Montreal Cognitive Assessment (MoCA); Antidepressant Side-Effect Checklist (ASEC); data from/of baseline, after 8 weeks and 12 weeks were recorded.
Results: Both antidepressants resulted to be effective in clinical remission (HDRS£7) without statistical differences between the two groups (p=0.3), although paroxetine showed a faster remission than vortioxetine (p=0.01). Autonomic symptoms showed a higher improvement in the vortioxetine group (p=0.002). Paroxetine group referred insomnia and sexual problems while patients taking vortioxetine referred diarrhoea and palpitations. Data show a superiority of cognitive performance in the Paroxetine group (p=0.005), contrary to what stated in literature. Conclusions. Data are related to a small sample retrospectively assessed trough a 6-month observation period. Thus, the preliminary results need further research to be confirmed.
An Approach to the Pharmacotherapy of Neuroleptic Malignant Syndrome
COMPLICATED CASE HISTORIES
By Roland van Rensburg and Eric H. Decloedt
Neuroleptic malignant syndrome is a rare, idiosyncratic emergency associated with exposure to dopamine antagonists, commonly antipsychotic drugs. The typical clinical picture consists of altered consciousness, muscular rigidity, fever, and autonomic instability. While the condition has generally been well described, the pathophysiology is still poorly understood. The importance of this case report is to highlight the lack of robust evidence-based treatment for this emergency. We submit an approach to the pharmacotherapy of neuroleptic malignant syndrome based on the available evidence.
Akathisia Induced by Abrupt Withdrawal of Risperidone: A Case Report
COMPLICATED CASE HISTORIES
By Gangaparameswari Soundarrajan, Bharti Chogtu Magazine, Vybhav Krishna, Avinash Kamath G, and Manisha murugesan
Akathisia is a common movement disorder that occurs as a consequence of antipsychotic therapy. However, its occurrence secondary to risperidone withdrawal has been reported rarely. Reporting of such rare adverse event gains profound importance because changing the antipsychotics is very common in long term management of affective disorders. Here, we report a 17-year-old female who on withdrawal of risperidone developed akathisia. Further, we also discuss already reported cases in literature in relation to the current case.
Exercise as a Treatment for Schizophrenia: a Review
By Steven J. Girdler, Jamie E. Confino and Mary E. Woesner
Schizophrenia is a mental disorder that is characterized by progressive cognitive impairment in areas of attention, working memory, and executive functioning. Although no clear etiology of schizophrenia has been discovered, many factors have been identified that contribute to the development of the disease, such as neurotransmitter alterations, decreased synaptic plasticity, and diminished hippocampal volume. Historically, antipsychotic medications have targeted biochemical alterations in the brains of patients with schizophrenia but have been ineffective in alleviating cognitive and hippocampal deficits. Other modalities, such as exercise therapy, have been proposed as adjuvant or primary therapy options. Exercise therapy has been shown to improve positive and negative symptoms, quality of life, cognition, and hippocampal plasticity, and to increase hippocampal volume in the brains of patients with schizophrenia. This article will briefly review the clinical signs, symptoms and proposed etiologies of schizophrenia, and describe the current understanding of exercise programs as an effective treatment in patients with the disease.
Promoting The Discussion Of The Beneficial Effects Of Ketamine To Treat Refractory Depression
Priyanka, G. and Viswanath, O.
We read a recent article published by CNN titled “Ketamine offers lifeline for people with severe depression, suicidal thoughts1” with great interest. The article traces the story of a man with a 35-year history of severe refractory depression, suicidal ideation, and recent suicide attempts who was successfully treated with ketamine as a last resort after failing dozens of other pharmacologic psychiatric medications, including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants. This incredible medical success story is not isolated to this gentleman. In fact, there has been significant data, with seven placebo controlled randomized clinical trials (RCT), that have shown the beneficial effects of ketamine infusion therapy on refractory depression2. However, ketamine therapy for refractory depression in practice is still very limited since it continues to be an off-label use of ketamine.