RESUMEN
Oral antidepressants are currently the first-line pharmacotherapy for obsessive-compulsive disorder (OCD), but response rates can often be low and with delayed onset of therapeutic action. Some reports have suggested that intravenous (i.v.) anti-obsessive agents may have faster onset of action and greater efficacy. A Medline search was conducted for all reports pertaining to the use of i.v. antidepressants for OCD. Search terms included: 'intravenous', 'clomipramine', 'selective serotonin reuptake inhibitor', 'tricyclic', 'citalopram', 'sertraline', 'paroxetine', 'fluvoxamine', 'SSRIs' and 'intravenous antidepressants'. Relevant articles mainly investigated clomipramine (CMI) with one open trial examining citalopram. Intravenous agents appear to be well-tolerated, particularly in those who have failed oral agents, and may act more rapidly to produce initial clinical response, although this advantage is often lost over time. Preliminary evidence suggests subgroups of patients with severe treatment-refractory OCD may benefit from i.v. anti-obsessive agents, CMI and citalopram. Larger, controlled trials are needed for more definitive conclusions.
Asunto(s)
Antidepresivos/administración & dosificación , Citalopram/administración & dosificación , Clomipramina/administración & dosificación , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Ensayos Clínicos como Asunto , Esquema de Medicación , Humanos , Infusiones Intravenosas/efectos adversos , Infusiones Intravenosas/métodos , Quimioterapia por Pulso/métodos , Factores de TiempoRESUMEN
The efficacy and tolerability of symptom-onset dosing with citalopram in the treatment of premenstrual dysphoric disorder (PMDD) was evaluated in an open trial. Eight outpatients, aged 18-45 years and diagnosed with PMDD, were treated with 10-20 mg of citalopram from the start of premenstrual symptoms until the onset of menses. Primary efficacy variables were the premenstrual tension scale (PMTS-O) and the clinical global impression of improvement (CGI). Treatment was associated with significant improvement in PMDD symptoms (p < 0.001).
Asunto(s)
Antidepresivos de Segunda Generación/administración & dosificación , Citalopram/administración & dosificación , Síndrome Premenstrual/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/administración & dosificación , Adulto , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Fase Luteínica/efectos de los fármacos , Persona de Mediana Edad , Satisfacción del Paciente , Síndrome Premenstrual/psicología , Escalas de Valoración Psiquiátrica , Proyectos de Investigación , Resultado del TratamientoRESUMEN
Anticipation has been suggested among the genetic mechanisms of bipolar disorder (BD), prompting the search for unstable DNA sequences. Past studies of anticipation in BD have generally relied on observed shift in the age at onset between parental and offspring generations. Such a shift, however, may be caused by a number of other factors difficult to correct for. We investigated age at onset distributions in a sample of 161 related subjects and in a sample of "pseudofamilies" consisting of 320 unrelated subjects selected from a large epidemiological cohort using Monte-Carlo simulation to mimic the family sample. Comparison of age at onset distributions in both samples shows a difference between the generations, but of a similar magnitude in each sample. This suggests that age at onset alone may not be a sufficient criterion of anticipation. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:804-807, 2000.
Asunto(s)
Anticipación Genética , Trastorno Bipolar/genética , Adulto , Edad de Inicio , Estudios de Cohortes , Salud de la Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadística como AsuntoRESUMEN
In this paper we report the results of a study of the mode of inheritance in affective disorders responsive to lithium. Earlier we described a series of 71 families in which the genetic transmission was compatible with a single-gene model. We have now carried out an independent replication study on 25 newly recruited families in a different geographical location. The autosomal recessive model from our original study could not be rejected with the new data. In a subsequent analysis of the pooled sample of 96 families, a recessive model with a common predisposing allele (q = 0.16) and sex-specific penetrance (0.35 in males, 0.66 in females) fitted the data best. On the other hand, X-chromosome and polygenic models could be rejected. The finding of a major-gene effect represents a specific hypothesis that can be tested by molecular genetic techniques.