Chi-Un Pae

Comparison of venlafaxine extended release versus paroxetine for treatment of patients with generalized anxiety disorder

Abstract  This trial was to evaluate the efficacy and tolerability of venlafaxine extended release (XR) and paroxetine for treatment of patients with generalized anxiety disorder (GAD). Sixty patients who met DSM‐IV criteria for GAD were randomly assigned to either venlafaxine XR or paroxetine for 8 weeks. Efficacy was assessed with the Hamilton Rating Scale for Anxiety (HAM‐A) and Clinical Global Impression‐Severity of Illness (CGI‐S) scale at the baseline, week 1, week 4, and week 8. The side‐effects were collected with reported adverse events and laboratory tests throughout the study period. Repeated measures analysis of variance (anova) on the HAM‐A and CGI‐S scores showed a significant decrease over time in both treatment groups without significant group difference or time × group interaction effect. There were no serious adverse events in both groups. This open trial demonstrated that either venlafaxine XR or paroxetine would be effective and tolerable for the treatment of patients with GAD. Double blind, placebo‐controlled head‐to‐head comparison studies are needed to draw a definite conclusion.

Neuronal Dysfunction of the Frontal Lobe in Schizophrenia

Localized in vivo proton magnetic resonance spectroscopy (MRS) was performed to evaluate metabolic alterations in the right and left frontal lobe before and after antipsychotic treatment of schizophrenic patients (n = 24) and a group of healthy normal subjects (n = 20). Proton metabolic ratios obtained from the 8 cm3 voxels in the right and left frontal lobes were compared with the clinical assessment for each subject. There was no significant difference in the metabolic ratios between the right and the left frontal lobes in either the schizophrenic group or the control group, indicating no laterality. Compared with those of the normal control group, NAA/Cr ratio of the schizophrenic patients showed significantly lower value. The NAA/Cr ratio of the schizophrenic patients was not changed after antipsychotic treatment. The present study supports the ‘hypofrontality’ hypothesis of schizophrenia.

Re-administration of mirtazapine could overcome previous mirtazapine- associated restless legs syndrome?

Mirtazapine (MIR) has been proved to be effective and tolerable in the treatment of depression with its unique pharmacological profiles, by blockades of the postsynaptic 5-HT 2 and 5-HT 3 receptors and presynaptic a 2-autoreceptor, and by stimulating postsynaptic 5HT 1 receptor. 1 Recently, several reports, 2,3 including our group, 4 have presented MIR-associated restless legs syndrome (RLS) characterized by unpleasant aching sensation of both legs with creeping and crawling feelings, of which the pathophysiology is unclear but mainly supposed to be related to dysfunction of the dopamine pathway and presented mostly by serotonergic-stimulating agents. 5 Interestingly, we experienced two cases that did not show MIR-associated RLS after re-administration of MIR, though they suffered RLS at the first administration of the drug.

Amisulpride versus risperidone treatment for behavioral and psychological symptoms in patients with dementia of the Alzheimer type: a randomized, open, prospective study.

The aim of this study was to evaluate the effectiveness and tolerability of both amisulpride and risperidone for treating the behavioral and psychological symptoms of dementia in patients with dementia of the Alzheimer type (DAT). Twenty-eight patients with DAT were randomly assigned to treatment with either amisulpride or risperidone for 8 weeks. The effectiveness of the treatments was assessed with the Neuropsychiatric Inventory (NPI) and the Clinical Global Impression-Severity of Illness (CGI-S) scale. The Simpson-Angus Rating Scale, the Barnes Akathisia Rating Scale and the Abnormal Involuntary Movement Scale were used for the assessment of side effects. The NPI and CGI-S scores were significantly decreased over time in both treatment groups without any significant group difference and time by treatment group interaction effect (F = 71.85, p < 0.0001). There were no serious adverse events in both groups. This study showed that either amisulpride or risperidone would be effective and tolerable for treating patients with DAT. Adequately powered studies with a head-to-head comparison design will be mandatory to draw any definite conclusion.