Anxiety Disorders: Han C

Marks DM, Park MH, Ham BJ, Han C, Patkar AA, Masand PS, Pae CU. · Duke University Medical Center, Department of Psychiatry and Behavioural Sciences, 2218 Elder Street, Durham 27705, USA. · Expert Opin Drug Saf. · Pubmed #18983224 No free full text.

Abstract: Paroxetine is a selective serotonin re-uptake inhibitor (SSRI) available in immediate release and controlled release (CR) formulations. Paroxetine is the most potent inhibitor of serotonin re-uptake among the now available SSRIs. Paroxetine has been approved for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder, panic disorder (PD), generalised anxiety disorder, post traumatic stress disorder (PTSD), and social anxiety disorder (SAD) in adults, whereas paroxetine CR is approved for the treatment of MDD, SAD, PD and premenstrual dysphoric disorder in adults. The overall efficacy of paroxetine seems to be comparable to other SSRIs in the treatment of approved indications, although paroxetine treatment induces more sedation, constipation, sexual dysfunction, discontinuation syndrome and weight gain than other SSRIs. Recent data suggest that paroxetine treatment leads to increased rates of congenital malformations, although this evidence is not conclusive. Paroxetine and paroxetine CR are not indicated for use in the paediatric population and are categorised as Pregnancy Class D. In conclusion, whether the tolerability profile of paroxetine differs substantially from other new antidepressants (including other SSRIs) needs to be determined in adequately powered well-designed randomised controlled comparative clinical trials.

Marks DM, Han C, Krulewicz S, Pae CU, Peindl K, Patkar AA, Masand PS. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. ; and GlaxoSmithKline, King of Prussia, Pa. · Prim Care Companion J Clin Psychiatry. · Pubmed #19158975 links to  free full text

Abstract: OBJECTIVE: Although irritable bowel syndrome (IBS) is highly comorbid with depressive and anxiety disorders, information on the clinical implications of this comorbidity is limited. We investigated whether a history of depressive and/or anxiety disorders was associated with response to treatment in a double-blind, randomized, placebo-controlled trial of paroxetine controlled release (CR) in IBS. METHOD: Seventy-two IBS subjects (diagnosed using Rome II criteria) were recruited from August 2003 to November 2005 and randomly assigned to receive flexibly dosed paroxetine CR (dose, 12.5-50 mg/day) or placebo for 12 weeks. The Mini-International Neuropsychiatric Interview (MINI-Plus version) was used to ascertain current (exclusionary) or past diagnoses of depressive and anxiety disorders. Subjective depression, anxiety, and stress were assessed at entry and throughout the trial using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Perceived Stress Scale (PSS). Severity of IBS symptoms was determined by the Composite Pain Score (CPS), administered via Interactive Voice Response System, and the Clinical Global Impressions scale (CGI). The primary outcome was treatment response defined as >/= 25% reduction in CPS from randomization to end of treatment. A post hoc analysis (multivariate logistic regression) was done to evaluate whether a history of depressive and/or anxiety disorder was associated with response to medication. RESULTS: Baseline demographic and clinical characteristics (CPS, BDI, BAI, PSS, CGI scores) were similar between groups (history of depressive/anxiety disorder vs. no history). In multivariate logistic regression analysis, treatment response was not predicted by history of depressive and/or anxiety disorder (OR = 0.58, CI = 0.29 to 1.68, p = .32) or drug status (paroxetine CR vs. placebo) (OR = 1.26, CI = 0.68 to 3.21, p = .19). Drug status was significantly associated with the secondary outcome variable of treatment response as defined by a CGI improvement score of 1 to 2 (OR = 12.14, CI = 2.9 to 48.4, p < .001). Paroxetine CR was safe and well tolerated during the study. CONCLUSIONS: History of depressive and/or anxiety disorder was not associated with response of IBS symptoms to paroxetine CR. Conclusions are limited due to insufficient statistical power. Further research is needed to clarify the role of selective serotonin reuptake inhibitors in the treatment of IBS and to elucidate the treatment ramifications of comorbid psychiatric disorders. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00610909.

Pae CU, Marks DM, Han C, Masand PS, Patkar AA. · Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, South Korea. · Int Clin Psychopharmacol. · Pubmed #19060720 No free full text.

Abstract: This study evaluated the efficacy of pregabalin augmentation of antidepressant treatment in patients with posttraumatic stress disorder (PTSD). Nine patients meeting Diagnostic and Statistical Manual, fourth edition criteria for PTSD who were on stable doses of antidepressants were treated open label with flexibly dosed pregabalin for 6 weeks. All patients were assessed with the Short PTSD Rating Interview, Montgomery-Asberg Depression Rating Scale, Patient Global Impression-severity, Visual Analog Scale-pain, and Sheehan Disability Scale at baseline and weeks 2, 4, and 6. Significant reductions were observed in all effectiveness measures from week 4 to the end of the study. In particular, the numerical improvement of the Visual Analog Scale-pain score was most robust (-53.4%, P=0.007). Pregabalin augmentation was effective and well tolerated during the study. Our findings warrant adequately powered, placebo-controlled clinical trials to confirm the usefulness of pregabalin augmentation of antidepressants in patients with PTSD.

Dankert ME, Brensinger CM, Metzger KL, Li C, Koleva SG, Mesén A, Laprade B, Wiguna T, Han C, Farooq S, Severus WE, Gayares JG, Langosch JM, Lallart X, Tateno M, Mihai A, Nair SR, Belmaker R, Rybakowski J, Owe-Larsson B, Kane JM, Johnstone EC, MacIntyre DJ, Malhotra S, González-Pinto A, Mosquera F, Babb SM, Habib pour E, Fatemi SS, Swanson C, Adler C, Young A, Hoeft F, Sivakumar K, Radoeva PD, Lallart EA, Bilker WB, Siegel SJ. · Stanley Center for Experimental Therapeutics in Psychiatry, Division of Neuropsychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States. · Schizophr Res. · Pubmed #18571376 No free full text.

Abstract: INTRODUCTION: Medication is a necessary part of treatment for severe psychiatric illnesses such as schizophrenia and nonadherence to prescribed medication is one of the most important public health issues in psychiatry today. The devastating consequences of nonadherence have motivated the development of novel therapeutic strategies, including a new long-term implantable medication delivery system. METHODS: The current study assesses attitudes towards implantable medication in psychiatric patients and their family members. Patients included in the study had diagnoses of Schizophrenia, Schizoaffective Disorder, Mood or Anxiety related disorders. RESULTS: 49.62% of patients and 74.47% of family members endorse support for implantable medication. CONCLUSIONS: This study demonstrates that implants may be an acceptable alternative to oral and injectable medication for a subset of psychiatric patients and their families.

Han C. · Department of Anthropology, Harvard University, Boston, MA 02115, USA. · Cult Med Psychiatry. · Pubmed #15470947 No free full text.

Abstract: In political and biomedical discourses, "posttraumatic stress disorder" has become a set of organizing concepts for trauma and traumatic memory. These concepts, however, are predicated on an understanding of traumatic memory as a discrete etiological event that, when reexperienced, is productive of symptoms. In this essay, I explore alternative framings of trauma that arise out of historical changes in political economic language and from experiences of monetary, historical, and affective indebtedness in Santiago, Chile. This ethnographic research is based in an historically leftist población (poor urban sector) and follows the interwoven narratives of a formerly exiled communist militant and her adopted daughter. Throughout this essay, I describe the mother's attempts to inhabit an untimely language of socialist politics and the daughter's rejection of both this language and her mother's pain. I elaborate on how these attempts are products of and productive of monetary and intersubjective indebtedness in a neoliberal present. By describing the differing historical languages inhabited by these subjects, I attempt to evoke an understanding of trauma not as an individual possession or etiological event, but rather as a referential dissonance in the neoliberal context. This referential dissonance emerges from the gap between the historical languages that inform subjectivities. I explore how such a gap can create contexts in which the everyday itself both threatens the disarticulation of the subject and produces injurious affective relationships. In this way, I interrogate relationships between trauma, recovery, and the everyday.