Sylvia Rigardetto

No Effect of Adding Brief Dynamic Therapy to Pharmacotherapy in the Treatment of Obsessive-Compulsive Disorder with Concurrent Major Depression

Background: Until now no studies have investigated the benefits of adding brief dynamic therapy (BDT) to medication in obsessive-compulsive disorder (OCD), while a number of recent investigations have demonstrated the efficacy of supplemental BDT among patients with major depressive disorders (MDD). The objective of the present study was to explore the efficacy of BDT combined with pharmacotherapy in comparison with pharmacotherapy alone in the treatment of OCD with concurrent MDD. Methods: A 12-month randomized clinical trial compared a standard selective serotonin reuptake inhibitor treatment with (n = 27) or without (n = 30) supplemental BDT in patients with OCD and concurrent MDD. Supplemental BDT was added during the first 16-week trial; all patients continued to be treated with only pharmacotherapy in the following continuation phase. The primary efficacy assessments were the Yale-Brown Obsessive Compulsive Scale and the 17-item Hamilton Rating Scale for Depression; the secondary efficacy measures included the Clinical Global Impression scale and the Global Assessment of Functioning. The data analysis was conducted on the ‘intent-to-treat (ITT) efficacy patient sample’. Results: Fifty patients completed the study. No difference between the 2 treatment groups was found at any point by any assessment method in the ITT study sample. Conclusions: Supplemental BDT in the treatment of patients with OCD with concurrent MDD who are receiving effective medication has no significant clinical effect on both obsessive and depressive symptoms.

General Medical Conditions Are Associated With Delay to Treatment in Patients with Bipolar Disorder

BACKGROUND Bipolar disorder (BPD) is associated with worse physical health. Indeed patients with BPD more frequently suffer from medical conditions such as cardiovascular illness, hypertension, diabetes, hypothyroidism, respiratory disease, liver disease, peptic ulcer, and arthritis. Since some clinical characteristics have been associated with worse course and outcome of BPD, it is possible that they might also bring to an increased medical burden in patients with BPD. The aim of the present report is to assess the prevalence of medical conditions in patients with BPD, and to determine the clinical variables associated with the presence of a medical condition. METHODS Charts of patients with BPD I and II were reviewed: socio-demographic and clinical information were collected. Medical conditions were classified by the ICD-10 and grouped according to the Cumulative Illness Rating Scales in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic. The associations between the presence of medical conditions and demographic/clinical variables of BPD were then analyzed. RESULTS Charts of 309 patients were included in the study. 170 (55%) patients had at least one medical condition. The most common were endocrine/metabolic disease (23%), and vascular disease (21%). Having a medical condition was associated with longer duration of untreated illness and female gender. CONCLUSIONS Patients with BPD have high rates of medical conditions, especially hypertension and metabolic disorders. A longer duration of untreated illness is associated with having a medical condition, probably due to the long-lasting adoption on unhealthy lifestyles not counterbalanced by treatment and psychoeducation.

A randomized, single-blind, comparison of duloxetine with bupropion in the treatment of SSRI-resistant major depression

INTRODUCTION For patients who continue to experience depressive symptoms despite an adequate antidepressant SSRI trial, across-class switch is considered one of the best treatment options. The goal of the present work was to compare in terms of efficacy two different dual-action compounds, duloxetine and bupropion, in patients who failed to respond in two consecutive antidepressant trials with SSRIs. METHODS The patients were allocated randomly to duloxetine (120 mg daily) or bupropion extended release (300 mg daily). The intended medication period was 6 weeks. The primary measure of efficacy was depressive symptoms severity. RESULTS A total of 49 participants were randomly assigned to duloxetine 120 mg (n=27) or bupropion 300 mg (n=22). The ITT efficacy patient sample consisted of 46 patients. Relatively high response and remission rates in treatment groups were found: from 60 to 70% of patients responded to treatment, and approximately 30 to 40% were in remission by the endpoint (week 6). No statistically significant difference emerged between the two groups at any post-baseline assessment, neither on mean scores of rating scales nor on qualitative efficacy measures. LIMITS Limitations of the study are the lack of a placebo arm, difficult to include owing to ethical reasons, and the relatively small size of the sample. CONCLUSIONS These preliminary results seem to support the hypothesis that in patients unresponsive to SSRIs the administration of antidepressants with different mechanisms of action is an effective switching strategy. Further studies are needed in light of the challenge posed by resistant depression.

P-205 - Medical conditions and associated clinical features in bipolar disorder: a clinical study

Introduction Several studies demonstrate that patients with Bipolar Disorder (BD) have worse physical health in comparison with the general population, reporting higher frequency of cardiovascular disease, diabetes, hepatitis, and respiratory disease (Kilbourne et al., 2004; Casey, 2005; Perron et al., 2009). However, no studies have reported whether medical comorbidities correlate with clinical characteristics such as diagnosis, comorbidity, or other clinical variables. Methods We evaluated patients with BD diagnosed by SCID-I. Medical conditions were classified by ICD-10 and grouped according to the Cumulative Illness Rating Scales in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic. The following variables were also collected: psychiatric comorbidity, age at onset, duration of illness, duration of untreated illness (DUI), lifetime suicide attempts. Results 309 patients with BD were recruited; the 68% had type II disorder. 195 (63%) were females. Age at onset was 50.7 years. 170 patients (55%) had at least one medical condition; the most frequent were endocrine/metabolic (23%), vascular (21%), musculoskeletal (11%). Medical comorbidity was related with age and DUI. Hepatic conditions were associated with Axis-II comorbidity. Conclusions Within medical conditions, endocrine/metabolic disease is the most frequently represented in patients with BD. DUI, which has been associated with worse outcome of BD (Suominen et al., 2007; Morken et al., 2009; Dell’Osso et al., 2010), is also associated with a higher medical burden also after controlling for age. This association might be mediated by the worse lifestyles and low levels of access to care in under-recognized patients.