Anxiety Disorders: Alda M

Yatham LN, Kennedy SH, O'Donovan C, Parikh S, MacQueen G, McIntyre R, Sharma V, Silverstone P, Alda M, Baruch P, Beaulieu S, Daigneault A, Milev R, Young LT, Ravindran A, Schaffer A, Connolly M, Gorman CP, Anonymous00076. · Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. · Bipolar Disord. · Pubmed #15952957 No free full text.

Abstract: Since the previous publication of Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines in 1997, there has been a substantial increase in evidence-based treatment options for bipolar disorder. The present guidelines review the new evidence and use criteria to rate strength of evidence and incorporate effectiveness, safety, and tolerability data to determine global clinical recommendations for treatment of various phases of bipolar disorder. The guidelines suggest that although pharmacotherapy forms the cornerstone of management, utilization of adjunctive psychosocial treatments and incorporation of chronic disease management model involving a healthcare team are required in providing optimal management for patients with bipolar disorder. Lithium, valproate and several atypical antipsychotics are first-line treatments for acute mania. Bipolar depression and mixed states are frequently associated with suicidal acts; therefore assessment for suicide should always be an integral part of managing any bipolar patient. Lithium, lamotrigine or various combinations of antidepressant and mood-stabilizing agents are first-line treatments for bipolar depression. First-line options in the maintenance treatment of bipolar disorder are lithium, lamotrigine, valproate and olanzapine. Historical and symptom profiles help with treatment selection. With the growing recognition of bipolar II disorders, it is anticipated that a larger body of evidence will become available to guide treatment of this common and disabling condition. These guidelines also discuss issues related to bipolar disorder in women and those with comorbidity and include a section on safety and monitoring.

Yatham LN, Kennedy SH, Schaffer A, Parikh SV, Beaulieu S, O'Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Young AH, Alda M, Milev R, Vieta E, Calabrese JR, Berk M, Ha K, Kapczinski F. · Department of Psychiatry, University of British Columbia,2255 Wesbrook Mall, Vancouver, BC V6T 2A1, , Canada. · Bipolar Disord. · Pubmed #19419382 No free full text.

Abstract: The Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder in 2005, with a 2007 update. This second update, in conjunction with the International Society for Bipolar Disorders (ISBD), reviews new evidence and is designed to be used in conjunction with the previous publications. The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate, and several atypical antipsychotics continue to be first-line treatments for acute mania. Tamoxifen is now suggested as a third-line augmentation option. The combination of olanzapine and carbamazepine is not recommended. For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. New data support the use of adjunctive modafinil as a second-line option, but also indicate that aripiprazole should not be used as monotherapy for bipolar depression. Lithium, lamotrigine, valproate, and olanzapine continue to be first-line options for maintenance treatment of bipolar disorder. New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events. Bipolar II disorder is frequently overlooked in treatment guidelines, but has an important clinical impact on patients' lives. This update provides an expanded look at bipolar II disorder.

García-Campayo J, Serrano-Blanco A, Rodero B, Magallón R, Alda M, Andrés E, Luciano JV, del Hoyo YL. · Servicio de Psiquiatría, Hospital Miguel Servet y Universidad de Zaragoza, Spain. · Trials. · Pubmed #19389246 links to  free full text

Abstract: BACKGROUND: Fibromyalgia is a prevalent and disabling disorder characterized by widespread pain and other symptoms such as insomnia, fatigue or depression. Catastrophization is considered a key clinical symptom in fibromyalgia; however, there are no studies on the pharmacological or psychological treatment of catastrophizing. The general aim of this study is to assess the effectiveness of cognitive-behaviour therapy and recommended pharmacological treatment for fibromyalgia (pregabalin, with duloxetine added where there is a comorbid depression), compared with usual treatment at primary care level. METHOD/DESIGN: DESIGN: A multi-centre, randomized controlled trial involving three groups: the control group, consisting of usual treatment at primary care level, and two intervention groups, one consisting of cognitive-behaviour therapy, and the other consisting of the recommended pharmacological treatment for fibromyalgia. SETTING: 29 primary care health centres in the city of Zaragoza, Spain. SAMPLE: 180 patients, aged 18-65 years, able to understand and read Spanish, who fulfil criteria for primary fibromyalgia, with no previous psychological treatment, and no pharmacological treatment or their acceptance to discontinue it two weeks before the onset of the study. INTERVENTION: Psychological treatment is based on the manualized protocol developed by Prof. Escobar et al, from the University of New Jersey, for the treatment of somatoform disorders, which has been adapted by our group for the treatment of fibromyalgia. It includes 10 weekly sessions of cognitive-behaviour therapy. Pharmacological therapy consists of the recommended pharmacological treatment for fibromyalgia: pregabalin (300-600 mg/day), with duloxetine (60-120 mg/day) added where there is a comorbid depression). MEASUREMENTS: The following socio-demographic data will be collected: sex, age, marital status, education, occupation and social class. The diagnosis of psychiatric disorders will be made with the Structured Polyvalent Psychiatric Interview. Other instruments to be administered are the Pain Catastrophizing Scale, the Hamilton tests for Anxiety and for Depression, the Fibromyalgia Impact Questionnaire (FIQ), the EuroQuol-5 domains (EQ-5D), and the use of health and social services (CSRI). Assessments will be carried out at baseline, 1, 3, and 6 months. MAIN VARIABLE: Pain catastrophizing. ANALYSIS: The analysis will be per intent to treat. We will use the general linear models of the SPSS version 15 statistical package, to analyse the effect of the treatment on the result variable (pain catastrophizing). DISCUSSION: It is necessary to assess the effectiveness of pharmacological and psychological treatments for pain catastrophizing in fibromyalgia. This randomized clinical trial will determine whether both treatments are effective for this important prognostic variable in patients with fibromyalgia. TRIAL REGISTRATION: Current Controlled Trials ISRCTN10804772.

Etches SM, Schmidt M, Alda M, Hajek T, Kahn DA. · Columbia University Department of Psychiatry, New York, NY, USA. · J Psychiatr Pract. · Pubmed #19339849 No free full text.

Abstract: Cerebral infarction producing psychiatric disorders such as depression and mania is a recognized phenomenon. However, resolution of affective disorders following stroke has not been previously reported. We describe the case of a 53-year-old woman with a 25-year history of treatment-resistant bipolar II and panic disorders. At the age of 46, she experienced a subarachnoid hemorrhage with secondary vasospasm that resulted in a stroke. Shortly following the hemorrhage, the patient experienced a complete remission of both psychiatric illnesses that has been sustained for 7 years. Initial computed tomography (CT) and angiography studies revealed subarachnoid hemorrhage with intraventricular extension, communicating hydrocephalus, and aneurysms of the left posterior communicating artery and the right anterior cerebral artery. Following clipping of the left internal posterior communicating artery aneurysm, the patient developed vasospasm with further stroke symptoms. A subsequent CT scan showed a fully developed ischemic infarct in the left temporoparietal region that was confirmed by follow-up magnetic resonance imaging (MRI). We present a 7-year follow-up with complete psychiatric interview, chart review, and MRI. The present case demonstrates the importance of continued efforts to localize neural circuits involved in the pathogenesis and maintenance of affective disorders.

Duffy A, Alda M, Crawford L, Milin R, Grof P. · Department of Psychiatry, McGill University, Montreal, QC, Canada. · Bipolar Disord. · Pubmed #18076532 No free full text.

Abstract: OBJECTIVE: A major aim of this longitudinal high-risk study is to identify reliable early indicators of emerging bipolar disorder (BD) among offspring from well-characterized parents. METHODS: High-risk offspring were recruited from families in which one parent had BD diagnosed on the basis of the Schedule for Affective Disorders and Schizophrenia - Lifetime version (SADS-L) interviews and DSM-IV diagnostic criteria and the other parent was well. Bipolar parents were further subdivided on the basis of response or non-response to long-term lithium. A comparison group of offspring was recruited from well parents diagnosed on the basis of either SADS-L interviews or the family history method. All consenting offspring from high-risk and control families were assessed longitudinally with the Schedule for Affective Disorders and Schizophrenia for School-aged Children - Present and Lifetime version (KSADS-PL) interviews and DSM-IV diagnoses were made on a blind consensus review. The offspring were reassessed on average annually, as well as at any time symptoms developed. RESULTS: Antecedent conditions to BD in both high-risk groups included sleep and anxiety disorders, while attention-deficit hyperactivity disorder and pre-psychotic conditions were antecedents among the offspring of lithium non-responders only. Among those offspring developing BD, the index mood episode was almost always depressive. CONCLUSIONS: Despite a specific genetic risk, BD began with non-specific psychopathology and/or depressive disorders in a majority of offspring. Therefore, diagnosis based only on cross-sectional assessment of symptoms appears to be insufficient for the accurate early detection of emerging BD. Other parameters such as family history and associated antecedents should be taken into account.

Garcia-Campayo J, Alda M, Sobradiel N, Olivan B, Pascual A. · Miguel Servet University Hospital, Zaragoza, Spain. · J Psychosom Res. · Pubmed #17540225 No free full text.

Abstract: OBJECTIVE: The aim of this paper is to assess personality disorder (PD) comorbidity in somatization disorder (SD) patients compared with psychiatric controls in a Spanish sample. METHODS: This is a case-control study. Selection of 70 consecutive SD patients was made, and an age-, sex-, and ethnic-group-matched control group of 70 mood and/or anxiety disorder patients recruited in psychiatric outpatient clinics was selected. PDs were measured using the International Personality Disorder Examination, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I morbidity was measured by means of the Standardized Polyvalent Psychiatric Interview. RESULTS: PD comorbidity in SD patients was 62.9%, compared to 28.2% in controls [odds ratio (OR)=3.7; 95% confidence interval (95% CI)=1.8-7.6]. The highest ORs of PD in SD patients, compared with controls, were for paranoid (OR=9.2; 95% CI=1.9-43), obsessive-compulsive (OR=6.2; 95% CI=1.2-53.6), and histrionic (OR=3.6; 95% CI=0.9-13.9) PDs. CONCLUSIONS: This is a controlled study with the largest sample of SD patients. The prevalence of PD comorbidity is similar to that of a previously published controlled study but is different from those of the most frequent PD subtypes.

McGirr A, Séguin M, Renaud J, Benkelfat C, Alda M, Turecki G. · McGill Group for Suicide Studies, Douglas Hospital Research Center, McGill University, Montreal, QC, Canada. · J Clin Psychiatry. · Pubmed #17107255 No free full text.

Abstract: OBJECTIVE: It is unclear whether clinical and behavioral suicide risk factors, identified primarily among men, can be extended to women. We therefore explored sex differences in psychopathology and personality variants among suicide completers. METHOD: Using the psychological autopsy method, we compared personality variants and the prevalence of psychopathology as a function of sex among 351 consecutive suicides in a large, urban community. Psychiatric diagnoses were obtained using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and measures of impulsive aggression, temperament, and character were administered. Subsequently, we carried out secondary analyses between male and female suicides matched 2:1 for age, current depression, and number of lifetime depressive episodes. The study was conducted from late 2000 to 2005. RESULTS: Females were less likely to meet criteria for current and lifetime alcohol abuse, but those who did were less likely than males to have concurrent depression. On average, females were less impulsive, yet similar proportions of males and females were highly impulsive and impulsivity was associated with alcohol abuse irrespective of gender. Females were more likely to meet criteria for lifetime anxiety disorders; these were associated with nonviolent suicide methods, irrespective of gender. CONCLUSIONS: Despite a lower prevalence among females, high levels of impulsivity and alcohol abuse appear to be valid risk factors for both sexes. Researchers should focus on females for the identification of other suicide mediators.