Asunto(s)
Trastorno de Pánico/clasificación , Trastorno de Pánico/tratamiento farmacológico , Trastorno de Pánico/historia , Aniversarios y Eventos Especiales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , HumanosRESUMEN
BACKGROUND: Benzodiazepines (BZs) and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacologic treatment of panic disorder (PD). However, treatment guidelines favor SSRIs over BZs based on the belief that BZs are associated with more adverse effects than SSRIs. This belief, however, is currently supported only by opinion and anecdotes. AIM: The aim of this review and meta-analysis was to determine if there truly is evidence that BZs cause more adverse effects than SSRIs in acute PD treatment. METHODS: We systematically searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and clinical trials register databases. Short randomized clinical trials of a minimum of four weeks and a maximum of 12 weeks that studied SSRIs or BZs compared to placebo in acute PD treatment were included in a meta-analysis. The primary outcome was all-cause adverse event rate in participants who received SSRIs, BZs, or placebo. RESULTS: Overall, the meta-analysis showed that SSRIs cause more adverse events than BZs in short-term PD treatment. Specifically, SSRI treatment was a risk factor for diaphoresis, fatigue, nausea, diarrhea, and insomnia, whereas BZ treatment was a risk factor for memory problems, constipation, and dry mouth. Both classes of drugs were associated with somnolence. SSRIs were associated with abnormal ejaculation, while BZs were associated with libido reduction. BZs were protective against tachycardia, diaphoresis, fatigue, and insomnia. CONCLUSION: Randomized, blinded studies comparing SSRIs and BZs for the short-term treatment of PD should be performed. Clinical guidelines based on incontrovertible evidence are needed.
Asunto(s)
Benzodiazepinas/administración & dosificación , Trastorno de Pánico/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/administración & dosificación , Benzodiazepinas/efectos adversos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Factores de TiempoRESUMEN
Following the successful partnership of the American Society for Clinical Psychopharmacology (ASCP) with the American Association of Directors of Psychiatric Residency Training (AADPRT) on developing an interactive, multimodal training module on schizophrenia, ASCP next initiated the development of similar modules in major depression and bipolar disorder. In order to create programs that would be maximally useful to residents in essentially any training program, residents/fellows from around the United States were invited to participate, along with senior educators from ASCP and AADPRT in the development of these modules. Two (depression and bipolar) workgroups each developed a module whose content was divided into twelve mini-modules. The core of each mini-module is a PowerPoint Presentation. Problem and group-based learning and alternative teaching exercises accompany each mini- module to re-enforce didactic learning objectives and extend learning beyond the scope of the slide set. Resulting from a collaborative effort between trainees and expert educators, these modules are meant to flexibly suit the needs of individual training programs, both large and small, and teach what all residents need to know about treating bipolar and unipolar mood disorders by emphasizing multi-modal, interactive, adult centred learning activities. Efforts are being made to make these two modules available to interested training directors and teachers of psychopharmacology.
Tras la exitosa colaboración tanto de la Sociedad Americana de Psicofarmacología Clínica (ASCP) como de la Asociación Americana de Directores de Residencia de Formación de Psiquiatría (AADPRT) en el desarrollo de un módulo de capacitación multimodal e interactiva de la esquizofrenia; ASCP inició el desarrollo de módulos similares tanto en depresión mayor como en trastorno bipolar, con el fin de crear programas para los residentes; los módulos serían útiles en prácticamente cualquier programa de formación. Los residentes / becados de todo los Estados Unidos, junto con docentes de nivel superior provenientes de ASCP y AADPRT, fueron invitados a participar en el desarrollo de estos módulos. Cada uno de los dos grupos de trabajo (Depresión y Trastorno Bipolar) desarrolló un módulo, cuyo contenido se dividió en doce mini-módulos. Lo principal de cada mini-módulo es una presentación de Power Point. El aprendizaje basado en problemas y grupos, junto con la enseñanza alternativa de ejercicios, acompañan a cada mini módulo para reforzar los objetivos de aprendizaje didáctico y extenderlo más allá del alcance de las diapositivas. Como resultado de la colaboración, tanto de alumnos como de expertos educadores, estos módulos están diseñados para adaptarse con flexibilidad a las necesidades de programasindividuales de formación, tanto grandes como pequeños, y enseñar lo que todos los residentes necesitan saber sobre el tratamiento de los trastornos bipolares y unipolares destacando lo multimodal, lo interactivo y las actividades de aprendizaje centradas en adultos. Se está trabajando con el fin de que estos dos módulos estén disponibles tanto para directores de formación que estén interesados, como para profesores de psicofármacologia.