Background and aims:Impulsive behaviours (impulse control deficit) and compulsive behaviours (over control) have been considered at the core of different disorders, but patients often present with mixed features of impulsive and compulsive behaviours (i.e. patients with OCD and borderline personality disorder). Therefore, a clinical spectrum from impulsivity to compulsivity could exist, in which obsessive compulsive disorder (OCD) and impulsive personality disorders (borderline personality disorder, antisocial personality disorder…) would be the endpoints.Regarding treatment, SSRI have demonstrated high efficacy in the treatment of both impulsive and obsessive-compulsive symptoms. On the other hand, topiramate has been described as an effective agent in treating impulsive behavior.The aim of this study is to test the hypothesis that coadjuvant treatment with SSRI and topiramate would improve the outcome of patients with comorbid OCD and impulsive behaviour disorders.Methods:We will describe two clinical cases admitted to our Psychiatric Hospitalization Unit. Case 1 is a 39 years old female diagnosed with OCD, borderline personality disorder and alcohol dependence and case 2 is a 38 years old male with OCD, mixed personality disorder and cocaine abuse.Results:Treatment with topiramate (range dosage: 250-400 mg/daily) as well as SSRI (paroxetine 40 mg/daily- case 1; sertraline 200 mg/daily-case 2) improved affective instability and impulsive symptoms in both patients. Topiramate was well tolerated without important side effects.Conclusions:Topiramate could be an interesting alternative in the coadjuvant treatment of OCD with impulsive features.
hypertension, and 18% other cardiovascular disease. Similarly, 29% of patients with bipolar disorder reported obesity, 14% diabetes, 21% hypertension, and 8% other cardiovascular disease. A BMI >30 kg/m2 was reported in 71% of subjects with schizophrenia and 51% of subjects with bipolar disorder. Health care providers discussed potential long-term consequences of weight gain with 61% of subjects with schizophrenia and 42% of subjects with bipolar disorder, and they discussed the impact of psychotropic medication on comorbidities with 60% of subjects with schizophrenia and 40% of subjects with bipolar disorder. However, only 20% of subjects with schizophrenia and 24% of subjects with bipolar disorder reported receiving a physical examination, 35% and 42% respectively reported being weighed, and 28% and 36% respectively reported having a blood test. These results suggest that subjects in this sample are suboptimally informed about issues surrounding comorbidity and its long-term consequences despite high rates of medical comorbidity.
depression in the UK patients' population providing an insight into these conditions. Method: A case-control design was used to assess the incidence of sexual dysfunction every year in the five year period pre-and post depression diagnosis. Depressed patients (8,221 in UK ffGPRD database) were matched by age, sex and time in the database to nondepressed patients. Significance tests were carried and risk ratios were calculated at each time-point in the 10 year follow-up. Results: The incidence rate of sexual dysfunction for cases (4.9 events/1000 person-years) and for controls (2.66 events/1000 personyears) were found to be significantly different (p 0.001). The incidence rate for the individuals sexual disorders (erectile dysfunction, premature ejaculation, and low libido were also significantly different.In addition, the risk ratios for the above conditions calculated by year in the five year period pre-and post diagnosis of depression were statistically significant from the date of diagnosis of depression. Further analysis was also undertaken to explore the observed patterns in the data. Conclusions: Sexual dysfunction diagnosis differs significantly between cases and controls, particularly after diagnosis of depression. This raises questions regarding management of depression and its effect on sexual dysfunction.
By the other hand, taking drugs and links between violence and disease are considered as a less important problem by the schizophrenic patients.
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