Coexisting Depression and Anxiety: Classification and Treatment
Despite of the fact, that comorbidity of depression and anxiety is a frequent condition in clinical practice, current psychiatric classification systems (according to WHO-ICD 10 and according to APA-DSM IV-TR) are not taking this reality into account sufficiently. The concept of anxious depression is very important for clinical practice. Recommended guidelines and algorithms of treatment based on evidence based medicine (EBM), established mainly on randomized controlled trials are designed separately for depression and separately for anxious disorders. This presents very often a significant complication in clinical practice. The aim of this article was to bring the concept of anxious depression to closer attention with highlighting of possible therapeutic approaches.
Antitussive Activity of Extracts from Fallopia Sachalinensis
Giant knotweed (Fallopia sachalinensis) and related plants are commonly used in Chinese and Japanese folk medicine. Bioactive natural products derived from them are believed to possess a variety of biologic activities. We have analyzed two polysaccharide fractions from leaves of Fallopia sachalinensis. We have focused on its activities to experimentally induced cough reflex and the changes of specific airway resistance. We have compared the observed antitussive activity with cough suppressing activity of codeine ("positive" control) and effect acquired after application of water for injection ("negative" control) using conscious male guinea pigs individually placed in a double chambers bodyplethysmograph box. Peroral administration of both polysaccharides significantly inhibited the number of coughs induced by citric acid in guinea pigs and have not significantly changed the values of specific airway resistance. Moreover, the substances in experimental animals have not provoked any notable adverse events. The biological activity observed in derivatives of Fallopia sachalinensis provides a scientific basis for the use of the plant in traditional medicines.
In the previous research at Jessenius Faculty of Medicine in Martin has been studied depression and its treatment from the aspects of the quality of life and functioning of the patients, as well as comparing the efficacy and safety of venlafaxine versus venlafaxine and olanzapine treatment. Last years have been studied the parameters of the autonomic nervous system in the context of depression. Our new work will build on these findings, during the exploration of efficacy and safety of a novel antidepressant vortioxetine in monotherapy and in combination with olanzapine. Since combination of vortixetine and olanzapine is not yet understood, it is unknown whether the effect of the treatment of depressive symptoms and associated problems will be stronger and faster compared to vortioxetine monotherapy.
Attention-Deficit/Hyperactivity Disorder (ADHD) is connected with high level of psychiatric comorbidity in paediatric population. Depressive disorder is common comorbid disorder co-existing with ADHD. Atomoxetine is worldwide approved for treatment of ADHD in paediatric population; in addition atomoxetine is effective and safe in treatment of some comorbid disorders in ADHD. Pharmacotherapy of depression is limited and residual symptoms are common. Fluoxetine is currently considered to be the gold standard of treatment of depression, but effectiveness of acute phase of treatment is not sufficient. Atomoxetine as a selective noradrenaline reuptake inhibitor or olanzapine as a multi receptors antagonist drug in combination with fluoxetine could be perspective augmented treatment strategy of depression just for their antidepressant effect. The aim of our following study is to evaluate and compare effectiveness and safety of monotherapy and combined/augmented therapy in acute phase of depression treatment in adolescence, as well as introduce complex modern research methodology of effectiveness and safety of treatment.
Depressive disorder is one of the most common and serious psychiatric diagnosis in paediatric population, often connected with suicidal risk. In recent years, fluoxetine monotherapy is the gold standard in acute phase of depression treatment in children and adolescents, but is not effective enough after an acute phase of treatment. More helpful researches concerning more effective therapeutic strategies of depression in this age are insufficient. The aim of our study is to evaluate the effectiveness and safety of fluoxetine monotherapy in comparison with combined olanzapine/fluoxetine therapy in acute 6-week treatment of depression in adolescence. We found that combined therapeutic strategy, using olanzapine augmentation is predicted to be more useful in the treatment of adolescent depression.
Vortioxetine is a novel antidepressant with two mechanisms of action – direct effect on several serotonin receptors and serotonin reuptake inhibition. Atypical antipsychotics, such as olanzapine, used in the augmentation of antidepressants causes not only a better response to treatment, but also increased number of remissions. The aim of our work was to evaluate the efficacy of vortioxetine monotherapy compared to the combined treatment vortioxetine and olanzapine in adult patients with depression during the acute phase of treatment lasting 6 weeks. Depressive symptomatology was assessed by the MADRS scale, anxiety symptoms were assessed by the HAM-A scale and global clinical impression were evaluated by the CGI-S scale. The number of patients in full-analysis set was 28. The results showed statistically significant improvement in CGI-S for both groups. Patients with vortioxetine monotherapy showed significant improvement in MADRS total score from the third week of treatment (p = 0.009) compared to patients with combined therapy that showed significant improvement since the end of first week of treatment (p = 0.036). Both groups showed significant improvement in HAM-A total score from the second week of treatment. Our results show the possibility of olanzapine in the augmentation strategy in treatment of major depressive disorder in adult patients.
Attention-deficit/hyperactivity disorder (ADHD) in childhood or adolescence is associated with a significantly higher lifetime risk of oppositional defiant disorder, anxiety disorder, conduct disorder, among others. Reports of co-morbidity rates are variable and influenced by assesment methodology and refferal bias, and may reflect lifetime rates within clinical groups. Up-to date studies revealed that as many as 85% of patients with ADHD have at least one psychiatric comorbidity and approximately 60% have at least two. Research and clinical practice has shown that having multiple co-existing psychiatric problems increase the severity of ADHD and behavioural problems, and is associated with incereased psychosocial impairment. The high rate of psychiatric problems co-occuring with ADHD has strong implications for the management of these patients. The presence of co-existing psychiatric conditions may moderate the response to treatment of ADHD and ADHD treatments may adversely affect and exacerbate the symptoms of the co-morbit condition. The aim of this article was to summarize the use of atomoxetine in the most frequent co-morbid disorders accompaining ADHD, ODD (oppositional defiant disorder) and anxiety, and to emphazise decrease of co-morbid symptoms with treatment of atomoxetine what exhort us to think about them as about possible subtypes of ADHD.
Vortioxetine is a novel antidepressant with two mechanisms of action – direct effect on several serotonin receptors and serotonin re-uptake inhibition. It shows antidepressant, anxiolytic and cognitive effects during the treatment of major depressive disorder (MDD). The aim of this article was to summarize the use of vortioxetine in clinical studies and assess the efficacy and tolerability. Most of the studies reported a statistically significant efficacy for vortioxetine versus placebo. In addition, vortioxetine showed efficacy in patients with an inadequate response to selective serotonin re-uptake inhibitors (SSRI) or serotonin-noradrenaline re-uptake inhibitors (SNRI) monotherapy and improved cognitive function in patients with MDD. In these studies, vortioxetine was well tolerated – most common observed adverse effect was nausea – and it was not associated with clinically important changes in laboratory test results or vital signs. Vortioxetine showed a relatively low incidence of sexual dysfunction.
Antitussive Effect of a Pectic Arabinogalactans Isolated from Adhatoda Vasica in Vivo Experimental Conditions
The herbal polysaccharides have been the subject of many studies for a very long time, especially because of their physical properties, chemical and physical modification and application. Adhatoda vasica has also been traditionally included in preparations for the relief of cough, asthma and bronchitis recommended by Ayurvedic physicians for the management of various types of respiratory disorders. In this study, we have focused on activities of pectic arabinogalactans isolated from Adhatoda vasica on experimentally induced cough reflex and the changes of specific airway resistance in vivo conditions. The substance from leaves of Adhatoda vasica was marked as P-601 and the substance from stem bark of this shrub as P-602. The aim of presented study was to compare the antitussive activity of isolated arabinogalactans with cough suppressive activity of codeine ("positive" control) and effect acquired after application of water for injection ("negative" control). Conscious male Trik guinea pigs (200-350g) were exposed to citric acid aerosol. Peroral administration of these substances in a dose of 50 mg.kg-1 body weight decreased the number of citric acid induced cough efforts in guinea pigs more effectively than codeine. They did not induce any significant changes in the values of specific airway resistance and did not provoke any observable adverse effects. Our test results confirmed that polysaccharides isolated from Adhatoda vasica in vivo conditions have expressive antitussive effect compared with the oldest and the most effective cough suppressive agent - the codeine. The positive thing is the studied substances, despite strong supressive activity, did not induced any adverse side effects.
Objective: ADHD (Attention deficit/hyperactivity disorder) is the most common diagnosed neurobehavioral disorder in childhood and adolescence. Core symptoms of ADHD are persistent inattention, hyperactivity and impulsivity. In Slovakia, there are two specific medication choices to treat ADHD - atomoxetine and methylphenidate. Even though methylphenidate is option number one according to guidelines, the highest amount of patients are taking atomoxetine.
Aim: Our aim was to observe atomoxetine and methylphenidate effect in 40 child and adolescent patients with ADHD to compare their efficacy in child and adolescent patients using ADHD-RS-IV scale and CGI scale.
Methods: We included 40- hospitalised patients, 20 patients were taking atomoxetine and 20 patients methylphenidate. Therapeutic effect on symptoms of inattention, hyperactivity/impulsivity and global score was measured by ADHD-rating scale IV. Global clinical condition of patients was evaluated by CGI (Clinical Global Impression Scale). Symptomatology was measured before treatment, and every 2 weeks during 8 weeks of treatment. CGI was administrated before and after treatment.
Results: We found significant therapeutic effect of atomoxetine and methylphenidate on core symptoms of ADHD after 8 weeks of treatment both with atomoxetine and methylphenidate. We found non-significant difference CGI scale scores.
Conclusion: Our study evaluated atomoxetine and methylphenidate treatment effect on ADHD. Atomoxetine and methylphenidate showed significant effect on core symptoms of ADHD, there were no significant between group differences in ADHD-RS-IV. Our study revealed non-significant difference CGI scale scores between medication groups.