Dimitris Karaiskos

Treatment of alcohol dependence with low-dose topiramate: an open-label controlled study

BackgroundGABAergic anticonvulsants have been recommended for the treatment of alcohol dependence and the prevention of relapse. Several studies have demonstrated topiramates efficacy in improving drinking behaviour and maintaining abstinence. The objective of the present open-label controlled study was to assess efficacy and tolerability of low-dose topiramate as adjunctive treatment in alcohol dependence during the immediate post-detoxification period and during a 16-week follow-up period after alcohol withdrawal.MethodsFollowing a 7-10 day inpatient alcohol detoxification protocol, 90 patients were assigned to receive either topiramate (up to 75 mg per day) in addition to psychotherapeutic treatment (n = 30) or psychotherapy alone (n = 60). Symptoms of depression and anxiety, as well as craving, were monitored for 4-6 weeks immediately following detoxification on an inpatient basis. Thereafter, both groups were followed as outpatients at a weekly basis for another 4 months in order to monitor their course and abstinence from alcohol.ResultsA marked improvement in depressive (p < 0.01), anxiety (p < 0.01), and obsessive-compulsive drinking symptoms (p < 0.01) was observed over the consecutive assessments in both study groups. However, individuals on topiramate fared better than controls (p < 0.01) during inpatient treatment. Moreover, during the 4-month follow up period, relapse rate was lower among patients who received topiramate (66.7%) compared to those who received no adjunctive treatment (85.5%), (p = 0.043). Time to relapse in the topiramate augmentation group was significantly longer compared to the control group (log rank test, p = 0.008). Thus, median duration of abstinence was 4 weeks for the non-medicated group whereas it reached 10 weeks for the topiramate group. No serious side effects of topiramate were recorded throughout the study.ConclusionsLow-dose topiramate as an adjunct to psychotherapeutic treatment is well tolerated and effective in reducing alcohol craving, as well as symptoms of depression and anxiety, present during the early phase of alcohol withdrawal. Furthermore, topiramate considerably helps to abstain from drinking during the first 16-week post-detoxification period.

An open pilot study of tiagabine in alcohol dependence: tolerability and clinical effects

There is evidence that GABAergic anticonvulsants can be efficacious in the treatment of alcohol dependence and in the prevention of alcohol relapse because these agents act on the substrate that is involved in alcoholism. Tiagabine, a selective GABA transporter1 reuptake inhibitor, may be a promising candidate for the treatment of alcohol-dependent individuals. In this randomized, open pilot study, we aimed to investigate the efficacy and tolerability of tiagabine as adjunctive treatment of alcohol-dependent individuals (N = 60) during the immediate post-detoxification period and during a 6-month follow-up period following alcohol withdrawal. A control non-medicated group of alcohol-dependent individuals (N = 60) was used for comparisons in terms of anxiety and depressive symptoms, craving and drinking outcome. Although a steady improvement in terms of psychopathology, craving and global functioning was observed in both groups throughout the study, subjects on tiagabine improved significantly more compared to the control subjects (P < 0.001). Furthermore, the relapse rate in the tiagabine group was lower than in the control group (7 vs 14.3%). Tiagabine was well tolerated and only a minority of the participants reported some adverse effects in the beginning of tiagabine treatment. Results from this study suggest that tiagabine is a safe and effective medication for the management of alcohol dependence when given adjunctively to a standard psychotherapy treatment. Further studies are warranted before definite conclusions can be reached.

Agomelatine and sertraline for the treatment of depression in type 2 diabetes mellitus

The present study compared the efficacy of agomelatine and sertraline in the treatment of symptoms of depression/anxiety, diabetes self‐care and metabolic control in a sample of depressed patients with non‐optimally controlled type 2 diabetes mellitus (DM).

Left parieto-occipital lesion with epilepsy mimicking panic disorder.

Panic attacks, the cardinal manifestation of panic disorder, can occur in the context of cerebral disorders, especially epilepsy with simple and complexpartial seizures (Sazgar et al., 2003; Trimble and Schmitz, 2002; Vazquez and Devinsky, 2003). Similarities between psychogenic and epileptic panic attacks can be misleading, especially when the presence of comorbid psychiatric conditions and the absence of other epileptic manifestations fail to raise the index of suspicion that will lead to a complete workup. We present the case of a woman misdiagnosed with panic disorder before being diagnosed and successfully treated for epilepsy. This is also the first published case of a left parieto-occipital lesion generating panic attacks as manifestations of seizures.

Should impaired liver function be held responsible for cognitive impairment and poor health‐related quality of life in alcoholic cirrhosis?

colonic lactulose fermentation recorded by a new extensometer. Neurogastroenterol Motil 2003;15:427-433. 8. Conn H, Bircher J. Adverse reactions and side effects of lactulose and related agents. In: Conn H, Bircher J, eds. Hepatic Encephalopathy: Syndromes and Therapies. Bloomington, IL: Medi-Ed Press, 1994:299-310. 9. Orlandi F, Freddara U, Candelaresi MT, Morettini A, Corazza GR, Di Simone A, et al. Comparison between neomycin and lactulose in 173 patients with hepatic encephalopathy: a randomized clinical study. Dig Dis Sci 1981;26:498-506. 10. Als-Nielsen B, Gluud LL, Gluud C. Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials. BMJ 2004;328:1046-1051.

Cotard's syndrome in the context of psychotic depression can be successfully treated with electroconvulsive therapy (ECT): A case report

Introduction Cotards syndrome is the delusional belief that one is dead or missing organs. Cotards syndrome has been observed in mentally ill persons with psychotic disorders (such as schizophrenia and psychotic depression). Electroconvulsive therapy (ECT) was originally used for the treatment of catatonic schizophrenia. Additionally, case reports have suggested a possible role for ECT in two specific atypical psychotic disorders: Cotards syndrome and cycloid psychosis. Aim The aim of our study was the evaluation of ECT in situation such as Cotards syndrome. Methods-results We report a case of Cotards syndrome associated with depressive symptoms. A 57-year-old man was admitted to our department with the diagnosis of psychotic depression. His presenting symptoms, which had started eight months before hospital admission, were somatic delusions of gastrointestinal and cardiovascular malfunction and the absence of brain. Head Magnetic Resonance Imaging had been occurred. The patient did not respond to antipsychotic therapies, so he started with elecroconvulsive therapy. After two months (ECT three times per week), the patient was successfully treated. Conclusion This report emphasizes that electroconvulsive therapy could be the first-line therapy in such patients with psychotic disorders.

EPA-1332 – Family burden in cerebrovascular accident (CVA)

Objective The CVA is one of the most serious medical problems. It represents the third most common cause of death in North Amerika and in most countries of Europe. In Japan and in China is the most frequent cause of death. We present a 18-month follow-up data on the burden of families of stroke individuals. The purpose of this study is to investigate the degree of family burden in families of patients with chronic CVA. Methods-subjects The sample comprised 110 patients with CVA aged 40–90 years old and their caregivers. The form-questionnaire consisting essentially of the Family Burden Scale (MG Madianos and M. Oikonomou). Descriptive statistics are used for the presentation of the results Results The caregivers were in the majority the spouse (50%), and the children (39%). The results show that the increased burden was related more to leisure of the caregivers and less to their daily activities. The type of CVA Is not associated with caregivers burden. Family burden is strongly dependent on the initial inability of the patients as well their age and the time elapsed from the start of the disease. The age of the caregiver does not play any role in family burden, Furthermore the financial burden is related only with the disability. Conclusion The factors that have been implicated for the family burden were mainly the severity of disability, the duration of the illness and the age of the chronically ill, factors which can influence severe the caregivers.

EPA-1240 – Sexual dysfunction and antidepressant medications in male depressed patients

Introduction Sexual dysfunction, such as low libido, erectile dysfunction and anorgasmia, is very common in patients taking serotoninergic antidepressants (SSRIs). These adverse effects persist throughout the treatment period, are not self-limited, and drive many male patients to treatment discontinuation in order to recuperate normal sexual functioning. Objectives - Aims The purpose of the present study was to investigate the sexual function of male patients treated with antidepressants for major depression, before initiation of treatment, during treatment and two months following withdrawal of SSRIs. Methods This observational study comprised 25 male patients (age: 30–50 years) followed-up on an outpatient basis for major depression. Sexual functioning was assessed with the Arizona Sexual Experience Scale (ASEX) and depressive symptoms with the Hamilton Rating Scale for Depression (HDRS) at three time points: baseline (period free of medication), three months after starting treatment with SSRIs, and two months following antidepressant discontinuation. Paired samples t-tests were used for comparisons between numeric variables at the three time points and Spearmans correlation coefficients were calculated between factors associated with sexual dysfunction. Results Mean values ??(± SD) of ASEX and HDRS scores at the initial, second and final assessment are shown in Table 1. Initial assessment Second assessment Final assessment ASEX 17.8± 5.4 25.6±7.9* 12.9±5.8** HDRS 22.3±4.2 4.2±3.4* 7.3±5.2** Correlation coefficients between ASEX, HDRS and age at the three points of evaluation are presented in Table 2. ASEX 1 Spearmans rho Sig. (2-tailed) ASEX 2 Spearmans rho Sig. (2-tailed) ASEX 3 Spearmans rho Sig. (2-tailed) HDRS 1 0.775 HDRS 2 0.318 0.340 HDRS 3 0,719 Age 0.842 Age 0.554 0.062 Age 0.856 Conclusions Antidepressants (SSRIs) have a negative impact on sexual functioning of male depressed patients. Quality of sexual functioning is negatively associated with age and the severity of depressive symptoms before the administration of antidepressant treatment. Sexual functioning significantly improves after discontinuation of antidepressants; this improvement is even superior to the pre-treatment period of sexual functioning.

1373 – Agomelatine and sertraline for the treatment of depression in type 2 diabetes mellitus

Introduction Fifteen percent of patients with diabetes mellitus (DM) meet the criteria for comorbid major depression. To maximize response of both depression and diabetic disorder, one should consider antidepressant treatment. Objective The present study compared the efficacy of agomelatine and sertraline in the treatment of symptoms of depression/anxiety, diabetes self-care, and metabolic control in a sample of depressed patients with non-optimally controlled type 2 DM. Method This was an observational study of 40 depressed patients with DM who were randomly assigned to receive either agomelatine or sertraline, and were assessed over a 4-month period for depression, anxiety, self care, fasting plasma glucose, haemoglobin A1c and body weight. Results HDRS scores fell at the end of the study for both treatment groups; significantly lower HARS scores were noted at the last assessment for the agomelatine group. Body weight increased slightly in the sertraline group. Although an improvement in fasting plasma glucose was observed in the final assessment in both treatment groups glycated hemoglobin showed a tendency towards lower values in the agomelatine group. Both groups had better SCI scores at the end of the study; the changes in the agomelatine group were higher. Both antidepressants were well tolerated and none of the patients dropped-out of the study. Conclusion The main finding of the present study was that agomelatine had a more positive effect than sertraline on symptoms of depression and anxiety, as well as metabolic parameters and health-related behaviors, in depressed patients with type 2 DM.

2148 – Agomelatine augmentation in obsessive compulsive disorder

Introduction Augmentation treatment has been the subject of several studies in treatment-resistant obsessive compulsive disorder (OCD). We hypothesized that medications with a dual action on the melatoninergic and serotoninergic systems may be of use in treatment-resistant OCD. Objectives/aims In this open label study we investigated the efficacy and safety of agomelatine augmentation in treatmentresistant OCD. Methods Twelve patients, aged 18–50, fulfilling OCD criteria, with no response to a 16-week or longer treatment with a selective serotonine reuptake inhibitor (SSRI) at the indicated dose, were assigned to receive agomelatine augmentation. Subjects were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and were screened for treatmentemergent side effects at baseline, week 8 and week 12 of treatment. Results The overall Y-BOCS score fell during the duration of the study (all comparisons among baseline, 8 th week and 16 th week were statistically significant, p th week of the study (p th week of the study (p Conclusion Agomelatine could be efficacious and well tolerated as an augmenting agent in refractory to treatment OCD. Further controlled studies are warranted to explore the efficacy of agomelatine, as well as the potential role of circadian rhythm modulation both in the pathophysiology and treatment of OCD.