Anxiety Disorders: Mamo DC

Mamo DC. · Centre for Addiction and Mental Health, Assisstant Professor of Psychiatry, University of Toronto, Ontario. · Can J Psychiatry. · Pubmed #17824353 No free full text.

Abstract: OBJECTIVE: The primary objective of this review article is to provide a coherent, systematic synthesis of the literature on the management of suicidality in schizophrenia that is relevant to the front-line clinician. METHOD: Literature searches were conducted on MEDLINE (1996 to 2007) and PubMed (1993 to 2007), using the key words "schizophrenia" and "suicide," as well as references from the resulting articles. I used my own clinical experience to create fictional case examples to illustrate the applicability of the literature discussed in this paper. RESULTS: Suicidality in schizophrenia is high, and early detection relies on the appreciation and evaluation of the clinical manifestations of depression, despair, and hopelessness, as well as on the nature and severity of the psychotic experience itself, particularly in recent-onset patients with higher cognitive function and educational background. Clinical management includes ensuring immediate safety, the use of psychosocial techniques to address depression and psychosocial stressors, targeted pharmacotherapy for depression and psychosis, and adequate discharge planning. Clozapine is the only antipsychotic with good evidence for efficacy in decreasing suicidal behaviour in schizophrenia. CONCLUSIONS: The optimal management of suicidality in schizophrenia involves the incorporation of traditional bedside clinical skills, selection of psychosocial modalities based on individual needs, and selective pharmacotherapy directed primarily at psychotic and depressive symptoms.

Uchida H, Suzuki T, Mamo DC, Mulsant BH, Tsunoda K, Takeuchi H, Kikuchi T, Nakajima S, Nomura K, Tomita M, Watanabe K, Kashima H. · Keio University, School of Medicine, Department of Neuropsychiatry, Tokyo, Japan. · Psychiatry Clin Neurosci. · Pubmed #19175759 No free full text.

Abstract: Data on benzodiazepine use in mood disorders are still limited, especially among seniors. A cross-sectional review of psychotropic prescriptions in 948 outpatients with mood disorders (405 male; mean +/- SD age, 52 +/- 17 years; age range, 16- 91 years) was conducted in Japan. The use of benzodiazepine-derivative anxiolytics was approximately 60% in all decades, including older patients, without a group difference. The frequent use of benzodiazepines is a cause for concern because they are not preferred treatment, given their well-known adverse effects especially in the elderly.

Uchida H, Suzuki T, Mamo DC, Mulsant BH, Kikuchi T, Takeuchi H, Tomita M, Watanabe K, Yagi G, Kashima H. · Keio University, School of Medicine, Department of Neuropsychiatry, Tokyo, Japan. · J Anxiety Disord. · Pubmed #19010641 No free full text.

Abstract: Since the literature on benzodiazepine use in elderly patients with anxiety disorders is limited, a large cross-sectional review of psychotropic prescriptions in 796 patients with neurotic disorders (ICD-10) (age range=11-91 years) was conducted across 30 sites in Japan. Use of benzodiazepine-derivative anxiolytics was approximately 70% in all decades without a group difference. The proportion of subjects who received prescriptions for benzodiazepine-derivative anxiolytics in the absence of antidepressants was higher in older age groups (e.g., 27.7% and 43.2% in the third and sixth decades, respectively). On the other hand, antidepressants were less frequently prescribed in older age groups (e.g., 59.8% and 41.5% in the third and sixth decades, respectively). The very high use of anxiolytics in the elderly, especially in the absence of concomitant antidepressant use, is a cause for concern since they are not a preferred long-term treatment strategy given their adverse effects in the elderly.