Many studies of antidepressants in the treatment of dysthymic disorder (DD) have been conducted, but none has included bupropion sustained-release (SR). The aim of this study was to provide preliminary data on the tolerability and effectiveness of bupropion SR for patients with DD. Twenty-one adult subjects meeting DSM-IV criteria for DD were enrolled in this 8-week open-label study. Bupropion SR was initiated at 150 mg/day and was increased to a maximum of 200 mg, twice daily. Response was defined as a 50% or greater decrease in score on the Hamilton Rating Scale for Depression (HAM-D). Of these 21 subjects, 15 (71.4%) responded to treatment. All paired sample t-tests were highly significant, demonstrating average improvement on all measures of symptomatology and functioning. Subject scores on the HAM-D decreased from 21.7 +/- 5.6 at baseline to 5.9 +/- 3.6 at week 8 (t[19] = 12.74, p < 0.001). The average final dosage was 364 mg/day. None of the subjects dropped out during the trial. Patients with a history of alcohol or chemical abuse were significantly less likely to respond to bupropion. Side effects were reported by eight subjects (38.1%), and the most frequently reported effects were headache, decreased appetite, insomnia, gastrointestinal problems, restlessness, and tremulousness. These findings suggest the effectiveness and high tolerability of bupropion SR for the treatment of DD. Double-blind prospective studies are needed for the comparison of bupropion SR to both placebo and other medications, assessing both initial and sustained responses to treatment.
Based on the systematic approach of evaluating results of complex clinical- psychopathological, psychodiagnostical investigation cardiac infarction and cerebral stroke patients the clinical structure features, regularities in the formation, development and course of òonpsychotic psychic disorders on these patients was determined.At patients with cardial infarction in acute period the painful syndrome was the main one, leads to severe psycho-emotional disturbances. At the background of preservation of cognitive function phobic, anxiety and depressive symptoms were prevaileted, the severity of which depends on the severity of pain. Subsequently, the primary psycho-emotional component disappeared, anxiety-depressive disorders, hypo-and anozognostical type of perception of self condition were formed.At cerebral stroke patients disorders of level of consciousness were primary with cognitive and asthenic disturbances with subsequent formation of psycho-emotional disorders, anxiety and depressive disorders with hypohondrical elements on the basis of persistent cognitive impairments.The multimodal principle based system of psychotherapeutical correction of nonpsychotic psychic disorders was developed. For myocardial infarction patients, system includes personaly - oriented, rational, and autogenic-training therapy for cerebral stroke patients - hypnosuggestive, cognitive - behavioral therapy, cognitive and autogenic-training therapy. The proposed system showed a significant improvement in 80% of myocardial infarction patients and 77% of patients cerebral stroke, a partial improvement - 10% of myocardial infarction patients and 13% of cerebral stroke patients.
On the basis of the examined 350 patients with somatoform disorders and 250 patients with chronic psychosomatic diseases we have elaborated a test that allows to evaluate quantitatively the influents of the disease on patients´ social functions. We created the integrative psychotherapy system with cognitive-oriented, suggestive and autosuggestive implementations. Elucidation of peculiarity of personal perception of the disease served as basis of elaboration of purposeful system of psychotherapy, consulting, psychological support for psychosomatic patients with high-effectiveness 1,5-3 years catamnesis in 85% patients. Psychotherapy should be used first of all as a target-oriented. Our experience showed the necessity of the use the integrativе models of psychotherapy, parted on stages. On the first stage the receptions of cognitive and suggestive psychotherapy are used. There is group therapy on second stage. On the third stage elements of the autogenic training mastered.
At the present time in Ukraine the special priority has the problem of somatoform disorders. A prevalence of clinical somatization neurotic disturbances and necessity of differential diagnostics with somatic diseases were the precondition for studying this area.At the same time, in Ukraine the diagnosis “Vegetative-vascular dystonia” which is ciphered G 90.8, according to ICD-10 instead of “Somatoform disoders” F40.0-F48 is used. It leads unreasonable treatment significant contingents of neurotic patients in neurological departments.The 60 agoraphobia patients and 40 panic disorder (PD) patients were examined. The emotional disturbances of all thease patients were investigated with the clinic and pathopsychological methods. The high level of anxiety was shown. Pathopsychologically the high level of personality anxiety and low level of neurotism and depression were indentified. The system of psychotherapy correction was established, with high efficacy in 68% cases.On that ground has been developed complex differential system of medical- psychological and psychotherapy correction of agoraphobia, PD and somatoform disorders with the - 80% high efficasy. Our experience showed the necessity of the integrative models of psychotherapy provided, parted on stage. On the first stage - sedative-adapting the receptions of cognitive and suggestive psychotherapy are used. There is groupe therapy on second-main-stage. On the third stagetupesupportive elements of the autogenic training mastered.
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