Kirsten Behnke

The Brief Psychiatric Rating Scale

This study has focussed on a 10-item Brief Psychiatric Rating Scale (BPRS) subscale for the quantification of schizophrenic states. Seven psychiatrists interviewed jointly patients who all fulfilled the DSM-III criteria of schizophrenia, and in a subsequent pencil-and-paper procedure a judgment analysis was performed. The reliability analysis showed that less experienced BPRS raters made less consistent judgments implying the cautionary statement that the proper use of a scale for schizophrenia requires specialized training with the scale. The validity analysis showed that the BPRS items had an additive relationship implying that the sum of these items is a sufficient statistic for the measurement of severity of schizophrenic states. Finally, the results seem to indicate, that the underlying dimension defined by the 10-items BPRS subscale includes hierarchically the negative and positive symptoms of schizophrenia.

Randomized, Double-Blind Comparison of Venlafaxine and Sertraline in Outpatients With Major Depressive Disorder

Background: This 8-week, double-blind, randomized trial compared the efficacy and tolerability of venlafaxine and sertraline in patients with major depression. Method: Outpatients (N = 147) with DSM-IV major depressive disorder and a baseline 21-item Hamilton Rating Scale for Depression (HAM-D) score of at least 18 were randomly assigned to venlafaxine, 37.5 mg b.i.d., or sertraline, 50 mg once daily. From day 15, the doses could be increased to venlafaxine, 75 mg b.i.d., or sertraline, 50 mg b.i.d. Efficacy was assessed with the 21-item HAM-D, the Montgomery-Asberg Depression Rating Scale (MADRS), and the Clinical Global Impressions scale (CGI) using a modified intent-to-treat analysis. Results: No significant differences were noted between treatments for mean HAM-D, MADRS, or CGI scores. At week 8, the HAM-D response rate was 83% with venlafaxine (N = 75) and 68% with sertraline (N = 72) (p = .05). A HAM-D score less than 10 was recorded in 68% of venlafaxine-treated and 45% of sertraline-treated patients at week 8 (p = .008). Among patients who increased their dose, the remission rate (HAM-D score < 10) was 67% with venlafaxine and 36% with sertraline at week 8 (p <.05). The overall discontinuation rate was 21% with venlafaxine and 17% with sertraline. The most common adverse events with venlafaxine were nausea, headache, and sweating and with sertraline were nausea, headache, and diarrhea. Conclusion: Among patients who increased their dose, approximately twice as many experienced a remission with venlafaxine, which is a more clinically relevant endpoint than response and represents the proportion of patients who have recovered or are well.

Mirtazapine orally disintegrating tablet versus sertraline: a prospective onset of action study.

This multinational, randomized, double-blind study was specifically designed to prospectively compare the onset of antidepressant efficacy of mirtazapine orally disintegrating tablets and sertraline at dosages commonly used in clinical practice. A total of 345 patients with major depressive episode (DSM-IV) received mirtazapine (30–45 mg/d) or sertraline (50–150 mg/d) for 8 weeks. Mirtazapine was administered in the newly developed fast dissolving, orally disintegrating tablet formulation. Assessments were performed at baseline and on days 4, 7, 10, 14, 28, 42, and 56. The primary efficacy variable (mean absolute change from baseline in the Hamilton Depression Rating Scale [HAMD] total score [17 items]) showed that mirtazapine was significantly (P < 0.05) more effective than sertraline at all assessments during the first 2 weeks of the study. After this time, HAMD total scores were similar in both groups. These findings were supported by analysis of the HAMD response rate (ie, ≥50% reduction in HAMD total score from baseline), HAMD remission rate (HAMD total score of ≤7), and the Montgomery-Åsberg Depression Rating Scale (MADRS). Both treatments were well tolerated. In addition, mirtazapine had a greater effect than sertraline on sexual functioning. In conclusion, this first prospective onset of action study using the orally disintegrating tablet indicates that mirtazapine has a faster onset of therapeutic effect than sertraline. The orally disintegrating tablet formulation of mirtazapine used in this study is known to enhance the convenience and compliance by the patient.

A 12-week study comparing moclobemide and sertraline in the treatment of outpatients with atypical depression

One hundred and ninety-seven outpatients with atypical depression [Atypical Depression Diagnostic Scale (ADDS) score=4] were randomized to 12 weeks of double-blind treatment with sertraline or moclobemide in a multicentre, parallel-group clinical trial. Patients were started on either 50 mg/day sertraline or 300 mg/day moclobemide. If the therapeutic response was not satisfactoryafter 4 weeks, the dose could be increased to either 100 mg/day sertraline or 450 mg/day moclobemide. Primary effcacy evaluations were the 29-item Hamilton Psychiatric Rating Scale for Depression (HAM-D) and the Clinical Global Impression of Improvement (CGI I) response rate (much or very much improved) at study endpoint. Secondary effcacy evaluations included the ADDS, the Hamilton Anxiety Scale (HAMA), the Leeds Sleep Scale, and the Battelle Quality of Life Battery (BQOLB). In the analysis of the 172 patient effcacy-evaluable population, there was significant baseline to endpoint improvement in all primary and secondary effcacy assessments after treatment with either sertraline or moclobemide. At the endpoint, the proportion of responders on CGI-I, was 77.5% in the sertraline group and 67.5% in the moclobemide group (p=0.052). The baseline to endpoint mean 29-item HAM-D score decreased from 35.9 to 14.5 in the sertraline group and from 36.3 to 16.1 in the moclobemide group. Sertraline also resulted in a significantly (p50.05) greater degree of improvement at the endpoint, compared with moclobemide, in the proportion of remitters on the HAMA (total score47), ADDS Category IID (Rejection Sensitivity), Leeds Sleep Factor 4 (Integrity of Behaviour Following Awakening), and on three dimensions of the BQOLB (Energy/Vitality, Social Interaction and Life Satisfaction). There were no other significant differences between treatment groups. Overall, both medications were well tolerated. In this study, both sertraline and moclobemide improved the symptoms of atypical depression.

The Brief Psychiatric Rating Scale: Schizophrenia, Reliability and Validity Studies

In an attempt to increase uniformity and unambiguity of evaluation through rating scales of schizophrenia and schizophrenialike psychosis, the 5-step edition of the Brief Psychiatric Rating Scale (BPRS) is used. In this edition of BPRS the 18 symptoms and the symptom grading are expressed in explicit item definitions. Symptoms in the Hamilton Depression Scale and in the Beigel Mania Scale which correlate with BPRS have been incorporated as far as possible. Despite wide international application of BPRS, only few reliability and validity studies have been made, the fact notwithstanding that the scale is used as a reference when new scales are introduced.This interim statement includes weekly co-rating of in-patients on the BPRS. The studies were commenced in August 1984. The rating procedure takes place between 8.15 and 9.00 a.m. and each patient is examined only once. The maximum number of raters is six but varies between three and six per rating procedure. The evaluated patients all comply with DSM-III c...

Rolipram versus nortriptyline in gerontopsychiatric inpatients with major depression

To define the therapeutic profile of the new putative antidepressant rolipram, a double-blind (double-dummy) study with 0.5 mg rolipram versus 25 mg nortriptyline three times daily was conducted in hospitalized gerontopsychiatric inpatients with major depression. During both therapies, improvement was achieved compared with base line. However, the rate of recovery in patients treated with 3×25 mg nortriptyline was significantly greater than in those treated with 3×0.5 mg rolipram. Overall, rolipram was better tolerated than nortriptyline and produced fewer adverse effects that could be attributed to cholinergic blocking. We conclude that 3×0.5 mg rolipram presumably is too low a dosage for the treatment of major depression in gerontopsychiatric inpatients.

Bilateral angle-closure glaucoma and tricyclic antidepressives

A patient who developed bilateral angle-closure glaucoma during treatment with nortriptylene is presented. The differential diagnoses are given and precautions suggested

Recidivfrekvensen ved NCE-behandling

In the rather extensive litterature concerning electroconvulsive therapy, ECT, little attention has been paid to relapse problems. Therefore a case-referent study was done at Frederiksberg Hospital. All patients receiving ECT in 1982 were retrospectively followed for 6 months after treatment.The therapy was found effective in all 38 patients with major affective disorders but insignificant in other cases. An overall relapse rate of 45% was found. In contrast to other reports no significant effect of pharmacological continuation therapy could be demonstrated in this study.It is to be concluded that ECT is effective in producing a full remission of acute psychopathology in patients with major depressive disorder but a relapse rate of 45% after ECT is unacceptably high. To improve this, further prospective studies are needed which should include biological markers in order to analyse the pathophysiology of the disorders and to monitor the therapeutic effect of ECT and the follow-up treatment.

Tobacco-alcohol amblyopia: Not a historical curiosity

Mogensen P, Behnke K, Dithmer O. Tobacco-alcohol amblyopia - not a historical curiosity.A case is reported of a 43-year-old male, an excessive user of tobacco and alcohol, who developed the characteristic symptoms of tobacco-alcohol amblyopia. This subsequently regressed for a period of 3 months during disulfiram treatment and decreased tobacco smoking. Visual acuity improved from 0.2/0.25 to 0.6 bilateraly.Amblyopia, alcoholabuse, neuropathia, tobacco

Delirium acutum. Et vanskeligt behandleligt tilfælde i forløbet af en skizofreniform psykose

A case of delirium acutum in the course of a schizofrenic exacerbation is reported. A short review of the literature dealing with nosological and patophysiological aspects of delirium acutum is given. In this case the patient was treated with neuroleptics and diazepaminfusion for some days, but since his clinical condition rapidly deteriorated electrocovulsive therapy (ECT) was commenced, and after several treatments the patient finally improved. Possible mechanisms for the failure of diazepam in the treatment is discussed. It is concluded that ECT is the treatment of first choice in the case of threatening or fully developed delirium acutum.