Background: Several studies have now examined the effects of selective serotonin reuptake inhibitor (SSRI) treatment on brain function in a variety of anxiety disorders including obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (social phobia) (SAD). Regional changes in cerebral perfusion following SSRI treatment have been shown for all three disorders. The orbitofrontal cortex (OFC) (OCD), caudate (OCD), medial pre-frontal/cingulate (OCD, SAD, PTSD), temporal (OCD, SAD, PTSD) and, thalamic regions (OCD, SAD) are some of those implicated. Some data also suggests that higher perfusion pre-treatment in the anterior cingulate (PTSD), OFC, caudate (OCD) and antero-lateral temporal region (SAD) predicts subsequent treatment response. This paper further examines the notion of overlap in the neurocircuitry of treatment and indeed treatment response across anxiety disorders with SSRI treatment.
We present a case in which the use of low dose risperidone (a potent D2 and 5-HT2 antagonist) was successful in controlling gambling behaviour secondary to dopamine agonist treatment of Parkinson's disease. Pharmacotherapeutic management of pathological gambling secondary to medical causes deserves further study.
Although the sample size may have limited power to exclude a minor role for these specific gene variants, such a small contribution would have limited clinical relevance given the strong significance of the non-genetic markers. These findings suggest that currently proactive management of violent behaviour in this schizophrenia population should continue to be based on clinical predictors of violence.
<p><strong>Objective.</strong> Clozapine is the current gold standard treatment for severe treatment-refractory schizophrenia, but even so 40 - 70% of these patients will continue to experience disabling symptoms when treated with clozapine monotherapy. Current clinical practice at Stikland Hospital holds that known clozapine-refractory schizophrenia patients who relapse due to non-compliance are treated with an initial combination of clozapine and ECT (if able to consent) when readmitted. The purpose of this study was to evaluate the validity of this practice. <strong></strong></p><p><strong>Methods.</strong> Patients were divided into an ECT (EG) and non-ECT (CG) group. Clozapine was started and ECT administered as per protocol. Demographic data, psychiatric and medication history and data concerning adverse events were collected. Positive and Negative Symptom Scale (PANSS) scores were done at baseline and at days 21 and 42.<strong> </strong></p><p><strong>Results.</strong> At discharge, although numerically the average increase in clozapine dose was lower and the reduction in length of stay was greater in the EG, none of the variables measured were statistically significantly different between groups. More concomitants were also used in the EG. <strong></strong></p><p><strong>Conclusions.</strong> This pilot study represents the first controlled trial of ECT-clozapine bitherapy in a population with clozapine- refractory schizophrenia and schizoaffective disorder reported in the literature. The validity of our choice of current clinical practice in this population was not supported by our results. However, the study did provide us with preliminary evidence for the safety and efficacy of this combination. It would therefore be reasonable to continue to use this strategy in selected cases, at least until other clozapine-refractory treatment strategies become more available in our setting.</p>
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