Defne Eraslan

Obsessive‐compulsive symptoms in schizophrenia: Prevalance and clinical correlates

Abstract  Obsessive‐compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this study, the rate of occurrence of OCS and obsessive‐compulsive disorder (OCD) in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms and depressive symptoms were assessed. A total of 100 subjects with a diagnosis of schizophrenia from the 4th edition of the Diagnostic and Statistical Manual (DSM‐IV) were evaluated by the structured and clinical interview for axis‐1 DSM‐IV disorders – patient edition (SCID‐P), the Positive and Negative Syndrome Scale (PANSS), Yale‐Brown Obsessive‐Compulsive Scale (Y‐BOCS), and the Calgary Depression Rating Scale for Schizophrenia. The prevalance of OCS in individuals meeting criteria for schizophrenia was 64%. A total of 30 of these patients (Y‐BOCS total score ≥7) also met the DSM‐IV criteria for OCD. The total score on Y‐BOCS was significantly correlated with total score on PANSS, Positive‐PANSS score, General‐PANSS score and total score on Calgary Depression Rating Scale for Schizophrenia. OCS and OCD relatively frequent in schizophrenic patients and OCS are significantly correlated with the severity of psychosis, positive symptoms, and depressive symptoms in schizophrenic patients. These findings provide further evidence for the importance of OCS in schizophrenia.

Safety of electroconvulsive therapy-duloxetine combination.

To the Editor: Despite the emergence of new pharmacological treatments for major depression, electroconvulsive therapy (ECT) remains an invaluable short-term treatment in a group of patients. However, 40% of patients with medication-resistant major depressive episodes are nonresponsive to ECT, so combining ECT with antidepressants may improve the response rate. Furthermore, using the ECT-antidepressant combination during the immediate phase of major depression makes it easier to continue the same antidepressant during the maintenance period. Duloxetine, a novel inhibitor of the reuptake of serotonin and noradrenaline, has shown efficacy in alleviating symptoms of major depressive disorder (MDD).3 It has been studied for the treatment of MDD at doses of 40 to 120 mg/d and is shown to reduce physical symptoms associated with depression.4,5 Duloxetine lacks significant affinity for muscarinic, histamine H1, >1-adrenergic, dopamine D2, 5-hydroxytryptamine (5-HT) 1A, 5-HT1B, 5-HT1D, 5-HT2C, F-aminobutyric acid, glutamate, and opioid receptors.6,7 We report the combined use of ECT and duloxetine in 2 patients who had suicidal major depression with psychotic features.

Paroxetine augmentation to tianeptine treatment causes exacerbation of depressive symptoms: presentation of two cases

We present two cases whose depressive symptoms partially remitted with tianeptine treatment but exacerbated after paroxetine augmentation to tianeptine. Although tianeptine has structural similarities with tricyclic antidepressants, unlike tricyclic agents or selective serotonin- reuptake inhibitors(SSRIs), it enhances 5-HT reuptake in brain, leading to decreased availability of the transmitter in the synaptic cleft. Thus, efficacy of tianeptine as an antidepressant agent caused a challenge to the concept of serotonergic deficit theory in depression. Both paroxetine and tianeptine are found equivalently effective in treatment of major depression, but no data are available for combined use of these two agents.