Headache centers have to deal with patients suffering from headache induced by chronic substance use which is a well-recognized complication of migraine treatment. The objective of this study was to compare psychiatric comorbidity between migraineurs with and without chronic substance use: 34 migrainous inpatients with chronic substance use were compared with 34 sex-matched noncomplicated migraineurs in a case-control study. The results showed a significantly higher prevalence of major depressive disorder, panic disorder, and social phobia in the patients with a history of chronic substance use. Consistently, anxious and depressive dimensions were significantly higher in these patients. Therefore, psychiatric morbidity may be linked to chronic substance use in migraineurs.This stresses the importance of psychiatric assessment and the need for appropriate treatment in such patients.
Objective: To assess, in depressed patients, the clinical benefit of mianserin augmentation of fluoxetine or the the benefit of switching treatment from fluoxetine to mianserin. Method:
In a 6‐week double‐blind study we compared the therapeutic efficiency and tolerance of mianserin 60 mg/day (N=34), mianserin 60 mg/day plus fluoxetine 20 mg/day (N=32) and continuing fluoxetine 20 mg/day (N=38) in patients with major depression who did not respond to previous fluoxetine treatment. Results:
Intent‐to‐treat analysis showed that at week 6 the decrease in the Hamilton Depression rating scale score was significantly (P0.03) greater in the mianserin plus fluoxetine group when compared to the fluoxetine group (effect size 0.665). Switching from fluoxetine to mianserin gave intermediate results. Mianserin augmentation of fluoxetine was well tolerated. Conclusion: Mianserin augmentation of fluoxetine in patients non‐responders to fluoxetine 20 mg/day increases response to treatment and is well tolerated.
It is not clear whether patient's psycho-education enhances compliance to antipsychotic treatments and reduces the number of relapses. Here we investigated the impact of a new psycho-educational program (SOLEDUC) on the one- and two-years rate of relapse (primary outcome measure) and a number of clinical assessments (secondary outcome measures). This was a multicentric French clinical trial (51 centers) of Phase IV, open, controlled, randomized, consisting in two parallel groups: the Soleduc group (N=111) and the control group (N=109). All subjects received a variable dose over the 2-year period of the same antipsychotic drug (amisulpride). Soleduc consisted of a 7-session program (1h per session), presented three times (at baseline, 6-months and 12-months). Patients in the control group received a non-specific psychosocial training for an equivalent period of time. The models of Andersen-Gill (AG) and Prentice, Williams and Peterson (PWP) were used to analyze relapses. Patients in the Soleduc group attended 14.8+/-6.1 sessions (mean+/-SD), including 17 patients who never attended a session. Intent to treat analysis showed less patients relapsing in the Soleduc group as compared to the control group (21.6% versus 28.4% after 1 year and 84.4% versus 90.8% after 2years), but the differences were not statistically significant. Relapse risk was significantly reduced for patients who followed at least 7 modules (p=0.015 AG-test; p<0.001 PWP-test). In conclusion, no significant differences in relapse rates were found between patients attending the Soleduc program and the control group. Attendance of at least 7 out of 21 program sessions was required to see a modest, but significant two-year relapse prevention in schizophrenia. Other well designed studies are required to evaluate the medical impact of patient's education programs.
The efficacy of hydroxyzine was investigated in 110 patients suffering from generalized anxiety, in a double-blind placebo controlled multicentre study. Oral hydroxyzine 50mg/day for four weeks significantly improved standard measurements of anxiety compared with placebo control. These improvements were seen from the end of the first week of treatment and were maintained throughout the study; there was no rebound effect after cessation of therapy. The most commonly reported adverse effect in both active and placebo treatment groups was a transient sleepiness. We conclude that hydroxyzine is an effective and well-tolerated treatment for generalized anxiety.
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