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This perspective paper explores the choice of psychotherapy for psilocybin‐assisted psychotherapy for treatment‐resistant depression. There is evidence to support the use of some psychotherapies in treating 'treatment‐resistant' depression, and emerging evidence for the efficacy of psilocybin. The next step which is the focus of this paper is to identify psychotherapies that are both effective and congruent with the psilocybin experience. The evidence for the efficacy of the psychotherapies is drawn from a Cochrane review and the analysis of their congruence with the psilocybin experience is drawn from a qualitative meta‐synthesis of the experience of psilocybin. The paper will examine whether three one‐to‐one psychotherapies identified as effective in the treatment of treatment‐resistant depression are compatible with the psilocybin experience. Each psychotherapy will be examined in relation to its congruence with the qualitative evidence that suggests the choice of psychotherapy needs to give priority to the subjective experience, facilitate emotional processing, support connectedness with others, acceptance of the self as emotional and support change based on the person's insights into their relationships with others and the world in which they live. We conclude that interpersonal psychotherapy and intensive short‐term dynamic psychotherapy align with that experience, although others are currently being trialled. [ABSTRACT FROM AUTHOR]

Objectives To examine the acceptability of fluoxetine in elderly depressed patients with chronic obstructive pulmonary disease (COPD). Setting A university teaching hospital. Method Single-blinded (open) study. One hundred and thirty-seven outpatients (69 male) with symptomatic irreversible, moderate to severe COPD were recruited. Major depression was diagnosed using the Geriatric Mental State Schedule. Quality of life was assessed by the Breathing Problems Questionnaire, physical disability by the Manchester Respiratory Activities of Daily Living Questionnaire and severity of depression using the Montgomery Asberg Depression Rating Scale. Exclusion criteria were: use of oral steroids within 6 weeks, acute or chronic confusion, known cancer and known psychosis. Results Fifty-seven patients (42%) (25 males) with a mean age of 72 years (range 60–89 years) were depressed. Fourteen (six male) agreed to undergo therapy with fluoxetine 20 mg/day for 6 months, while 36 (72%) refused antidepressant drug therapy. Only seven subjects completed the trial; of these, four (57%) responded to fluoxetine therapy. Five subjects withdrew because of side-effects. Twenty-two of those who refused treatment (61%) agreed to be interviewed, and of these 19 (86%) were still depressed. Conclusion Patient acceptance of fluoxetine was poor. The reasons for refusing treatment varied but were largely due to misapprehension by the patient. Untreated depression became chronic. Offering antidepressants to COPD patients with depression is not an effective strategy. Why this might be so is discussed. Copyright © 2001 John Wiley & Sons, Ltd [ABSTRACT FROM AUTHOR]

This article built on previous results of the author's experience in the treatment of elderly people with depression admitted under his care in 1949 and 1951. The article presents a followup investigation of a further consecutive series over the age of 60 receiving care in 1966 and 1967. The progress of 92 depressives over the age of 60 after discharge from hospital was compared with that of 81 subjects of an earlier follow up study. On account mainly of earlier and presumably often successful treatment in the community, the recent sample or hospital patients turned out to be more seriously and persistently ill. In spite of this, long-term results were similar to those obtained during an earlier period, possibly because of more effective aftercare and maintenance therapy with antidepressant drugs, which had in the meantime been introduced.

In recent decades, the phenomenon of grief, when you lose a loved one, has been the subject of exploration and discussion among researchers. Because of this, prolonged grief is now recognized as a possible mental disorder as the latest version of the diagnosis manual; 'International Classification of Diseases' (ICD‐11) being published in 2018 is featuring a new diagnosis called 'prolonged grief disorder'. The commencement of this new disorder indicates a shift in the way grief is being articulated why the notion of rupture from the French philosopher Michel Foucault is applied as a philosophical approach in this paper. A Foucault‐inspired discourse analysis has been prepared and by considering the issue historically and tracing how the concept of grief has been articulated in different time periods throughout history, the aim is to map out the discursive transformation that has taken place and to gain insight into how the societal context has supported and enabled this transformation. This paper takes a historical look back from the 1800s to present and identifies when changes can be observed in the way grief is being articulated. These changes or ruptures are identified in the work of Søren Aabye Kierkegaard, Sigmund Freud and Margaret Stroebe & Henk Schut who all must be assumed to have contributed significantly to how grief is perceived in various historical time periods. The discourse analysis identifies how prominent thinkers have articulated grief in each period and how today's perception of grief, as a possible mental disorder, both relates to these prominent thinkers but also reflects dominant societal values and ideologies. [ABSTRACT FROM AUTHOR]

Aim: Research has shown that preventative intervention in individuals at ultra‐high risk of psychosis (UHR) improves symptomatic and functional outcomes. The staged treatment in early psychosis (STEP) trial aims to determine the most effective type, timing and sequence of interventions in the UHR population by sequentially studying the effectiveness of (1) support and problem solving, (2) cognitive‐behavioural case management and (3) antidepressant medication with an embedded fast‐fail option of (4) omega‐3 fatty acids or low‐dose antipsychotic medication. This paper presents the recruitment flow and baseline clinical characteristics of the sample. Methods: STEP is a sequential multiple assignment randomized trial. We present the baseline demographics, clinical characteristics and acceptability and feasibility of this treatment approach as indicated by the flow of participants from first contact up until enrolment into the trial. Recruitment took place between April 2016 and January 2019. Results: Of 1343, help‐seeking young people who were considered for participation, 402 participants were not eligible and 599 declined/disengaged, resulting in a total of 342 participants enrolled in the study. The most common reason for exclusion was an active prescription of antidepressant medication. Eighty‐five percent of the enrolled sample had a non‐psychotic DSM‐5 diagnosis and symptomatic/functional measures showed a moderate level of clinical severity and functional impairment. Discussion: The present study demonstrates the acceptability and participant's general positive appraisal of sequential treatment. It also shows, in line with other trials in UHR individuals, a significant level of psychiatric morbidity and impairment, demonstrating the clear need for care in this group and that treatment is appropriate. [ABSTRACT FROM AUTHOR]

Quinazoline‐2,4(1H,3H)‐dione is a significant class of N‐fused heterocyclic with a wide range of biological functions, including anti‐HIV, anticancer, antifungal, antibacterial, antimutagenic, anticoccidial, anticonvulsant, anti‐inflammatory, antidepressant, antimalarial, antioxidant, antileukemic, and antileishmanial activities, and other activities, and has attracted great attention in organic and medicinal chemistry. As a result, all chemists and pharmaceutical chemists must be aware of many methods to make quinazoline‐2,4(1H,3H)‐dione. This review paper focuses on various methods for producing quinazoline‐2,4(1H,3H)‐diones, such as green methods and homogeneous or heterogeneous catalysts from various precursors under varied conditions. [ABSTRACT FROM AUTHOR]

The article cites a paper on the use of antidepressants by adults, written by Joanna Moncrieff and Irving Kirsch, published in the "British Medical Journal." According to the authors of the paper, prescribing of antidepressants has increased 253 percent over the last ten years. They suggest that review data from the U.S. National Institute for Health and Clinical Excellence indicate that SSRIs show no clinically meaningful advantage over placebo, consistent with some recent metaanalyses. Furthermore, they assert that claims that antidepressants are more effective for treating severe conditions lack supporting evidence.

Depression is a common mental disorder that may lead to major mental health problems, and antidepressant drugs have been used as a treatment of choice to mitigate symptoms of major depressive disorders by ameliorating the chemical imbalances of neurotransmitters in brain. Since abusing antidepressant drugs such as selective serotonin reuptake inhibitors and tricyclic antidepressant drugs can cause severe adverse effects, continuous toxicological monitoring of the parent compounds as well as their metabolites using numerous analytical methods appears pertinent. Among them, capillary electrophoresis has been popularly utilized since the method has a lot of advantages viz. using small amounts of sample and solvents, ease of operation, and rapid analysis. This review paper brings a survey of more than 30 papers on capillary electrophoresis of antidepressant drugs published approximately from 1999 until 2018. It focuses on the reported capillary electrophoresis techniques and their applications and challenges for determining antidepressant drugs and their metabolites. It is organized according to the commonly used capillary zone electrophoresis method, followed by non‐aqueous capillary electrophoresis and micellar electrokinetic chromatography, with details on breakthrough findings. Where available, information is given about the background electrolyte used, detector utilized, and sensitivity obtained. [ABSTRACT FROM AUTHOR]

Context In patients with cancer, pain is one of the most feared and burdensome symptoms. Adjuvant analgesics are an important cornerstone on which treatment of pain in patients with cancer is based. Objectives To update our guidelines for the treatment of pain in patients with cancer, we performed a systematic review on the use of adjuvant analgesics in pain in cancer. Methods A systematic search of the literature was performed searching for articles that studied the effect of (1) antidepressants, (2) anti-epileptics, (3) N-methyl- d-aspartate ( NMDA) receptor antagonists, and (4) other adjuvant analgesics in patients with cancer pain and described their effects on pain intensity and/or side effects. Results Based on the keywords and after reading the full papers, we could include 12 papers on anticonvulsants, 10 papers on antidepressants, four on NMDA receptor antagonists, and 10 papers on other adjuvant analgesics. The methodological quality of the included papers was graded as low to very low. Overall, there was a low quality of evidence that gabapentin, pregabalin, amitriptyline, and venlafaxine were effective in reducing pain intensity in patients with cancer pain. There was insufficient evidence on the effectiveness of lamotrigine, levetiracetam, NMDA antagonists, cannabinoids, corticosteroids, and local anesthetics on reducing pain intensity in patients with cancer pain. Conclusion The quality of currently available evidence on the effectiveness of adjuvant analgesics in the treatment of cancer pain is low. The treatment of pain associated with cancer should be tailored to the patient's personal preferences. [ABSTRACT FROM AUTHOR]

A simple, eco‐friendly, accurate and inexpensive pencil graphite electrode (PGE) was utilized for the quantitative determination of Vilazodone hydrochloride (VLZ) by Square wave voltammetric (SWV) method. Optimum electrochemical performance of the electrode was achieved by optimizing the pH of the measuring solution, the rate of potential scan and the time of accumulation onto the electrode surface. The SWV showed linearity over the concentration range of 9.99×10−9 to 9.78×10−7 M, with LOD of 6.4×10−9 M. This method was applied to evaluate VLZ in pharmaceutical preparation and spiked plasma with %recovery± RSD of 99.99±0.41 and 99.40±1.36, respectively. [ABSTRACT FROM AUTHOR]

Medicinal chemistry is a science applied to the search and discovery of new therapeutic agents for the treatment of various diseases. Therefore, promising structures have been identified; one of these structures is the piperazine moiety, a cyclic molecule containing two nitrogen atoms in positions 1 and 4 as well as four carbon atoms. Many piperazine derivatives have central pharmacological activity that mainly involves the activation of the monoamine pathway. Thus, piperazine derivatives have been the subject of research for many central therapeutic applications, including antipsychotic, antidepressant and anxiolytic applications. Benzylpiperazine is the prototype of piperazine derivatives; this substance is the main component of recreational drugs, partly due to its stimulant and euphoric effects. This paper describes some piperazine derivatives used therapeutically as antipsychotic (clozapine), antidepressant (vortioxetine) and anxiolytic (buspirone) drugs. [ABSTRACT FROM AUTHOR]

This paper describes current non‐antibody pharmacologic approaches to the prevention of migraine in adults. Preventive therapy should be considered for patients with migraine who routinely have more than 6 headache days per month or in other special circumstances. Choices for preventive therapy are based on patient preferences about side effects and evidence of efficacy. The evidence level and commonly used doses for selected categories of migraine preventive medication are reviewed, including antiepileptic drugs, antihypertensive drugs, and antidepressants. Propranolol, timolol, topiramate, and divalproex sodium are approved for migraine prevention by the US FDA. OnabotulinumtoxinA is approved for prevention of chronic migraine. Several off‐label drugs, especially lisinopril, candesartan, and amitriptyline also have good evidence of benefit. The spectrum of response to preventive therapy varies; in general, complete cessation of headaches is uncommon, although there are "super‐responders" to every therapy, as illustrated by patient reports of dramatic responses to treatment. Preventive treatment should be started at a low dose and doses increased slowly until therapeutic benefit is achieved or side effects preclude continued use. [ABSTRACT FROM AUTHOR]

Background People with intellectual disabilities have very high rates of mental ill health. Standard psychosocial interventions designed for the general population may not be accessible for people with mild intellectual disabilities, and drug usage tends to be modified - 'start low and go slow'. This systematic review aims to synthesise the evidence on psychological, pharmacological and electroconvulsive therapy (ECT) interventions for adults with mild intellectual disabilities and mental ill health. Method PRISMA guidelines were followed. Medline, Embase, PsycINFO and CINAHL were searched, as was grey literature and reference lists of selected papers. Papers were selected based on pre-defined inclusion and exclusion criteria. A proportion of papers were double reviewed. Data was extracted using a structured table. Study registration: PROSPERO 2015:CRD42015015218. Results Initially, 18 949 records were identified. Sixteen studies were finally selected for inclusion; seven on psychological therapies, two on group exercise, five on antipsychotics and two on antidepressants. They do not provide definitive evidence for effectiveness of psychosocial interventions, nor address whether starting low and going slow is wise, or causes sub-optimum therapy. Conclusions There are few evidence-based interventions for people with mild intellectual disabilities and mental ill-health; existing literature is limited in quantity and quality. Group cognitive-behavioural therapies have some supporting evidence - however, further randomised control trials are required, with longer-term follow-up, and larger sample sizes. [ABSTRACT FROM AUTHOR]

Objective: The six items of the clinician-administrated Hamilton Depression Scale (HAM-D6) cover the core items of depressive states reflecting the antidepressive effect of medication. In this study, the two self-reported versions of the HAM-D6 have been psychometrically validated to ensure the unidimensionality of this administration form in patients with mild-to-moderate depression. Method: The item response theory analysis of Mokken was used to test the unidimensionality of both the Interactive Voice Recording System (IVRS) version of the HAM-D6 and a paper-and-pencil self-reported version (S-HAM-D6). Patients with typical major depression and with seasonal affective disorder were included. Results: The Mokken analysis showed that the two self-reported versions of the HAM-D6 obtained coefficients of homogeneity above 0.40, similar to the clinician-rated HAM-D6 and thus implying unidimensionality. By contrast, the full HAM-D17 versions (self-reported as well as clinician-rated) obtained coefficients of homogeneity below 0.40, implying that the HAM-D17 is a multidimensional scale. Conclusion: The analysis show that both the IVRS version and the S-HAM-D6 version are unidimensional self-rating scales for the measurement of depressive states. [ABSTRACT FROM AUTHOR]

Figures from the Editors selected issue highlights will be displayed each month in the journal image carousel on the BJCP homepage http://bpspubs.onlinelibrary.wiley.com/hub/journal/10.1111/(ISSN)1365-2125/. Treatment regimens for tuberculosis are lengthy and require a high number of combination drugs and unfortunately antitubercular drug development to date has not been very successful. In their paper, Morris Muliaditan M. and Oscar della Pasqua (London, UK), showed that drug-disease modelling may provide rationale for dose selection and companion drugs to treat tuberculosis. [Extracted from the article]

Abstract: A paper considering the role of antidepressants for adults with major depression was recently published in the Lancet, a world leading medical journal (Cipriani et al. 2018). The review was the largest ever on this topic based on 28,552 citations including 522 trials comprising 116,477 participants. The authors note that, in adults with major depression, all antidepressants were more efficacious than placebo. In head‐to‐head studies, the authors also note that agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious. The authors report that the standardised mean difference was 0.3 a moderate effect size for any antidepressant over placebo, this is confirmatory of past reviews noting rather similar magnitudes of effect. In clinical terms the results suggest a choice for practitioners in regard to their individual patients. For many adult depressed patients however, there is also the implication that antidepressants may not work. The old adage ‘what works for whom’ remains unanswered. What does seem reasonable to conclude is that we have learnt that these medications are clinically effective and the questions for research now must be who is likely to benefit and who is not, how do these medicines work, and what is the best long‐term management of responders as the majority of studies have focused on acute response only. [ABSTRACT FROM AUTHOR]

Aim: Previous research indicates that preventive intervention is likely to benefit patients “at risk” of psychosis, in terms of functional improvement, symptom reduction and delay or prevention of onset of threshold psychotic disorder. The primary aim of the current study is to test outcomes of ultra high risk (UHR) patients, primarily functional outcome, in response to a sequential intervention strategy consisting of support and problem solving (SPS), cognitive‐behavioural case management and antidepressant medication. A secondary aim is to test biological and psychological variables that moderate and mediate response to this sequential treatment strategy. Methods: This is a sequential multiple assignment randomised trial (SMART) consisting of three steps: Step 1: SPS (1.5 months); Step 2: SPS vs Cognitive Behavioural Case Management (4.5 months); Step 3: Cognitive Behavioural Case Management + Antidepressant Medication vs Cognitive Behavioural Case Management + Placebo (6 months). The intervention is of 12 months duration in total and participants will be followed up at 18 months and 24 months post baseline. Conclusion: This paper reports on the rationale and protocol of the Staged Treatment in Early Psychosis (STEP) study. With a large sample of 500 UHR participants this study will investigate the most effective type and sequence of treatments for improving functioning and reducing the risk of developing psychotic disorder in this clinical population. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to clarify the inconsistent findings in the association between antidepressant use and the risk of epithelial ovarian cancer (EOC). Methods: This study is a meta‐analysis of observational studies retrieved from the PubMed, EMBASE, and Web of Science databases prior to August 15, 2017. Two researchers independently screened studies and extracted study characteristics and risk estimates. The odds ratios (OR) and 95% confidence intervals (CI) of EOC risk were summarized using an inverse variance weighted random‐effects model. Heterogeneity between studies was assessed with the I2 statistic. Results: Eight case–control studies involving 7878 EOC cases and 73 913 controls were identified. Compared with non‐use, use of antidepressants was not significantly associated with EOC risk (summarized OR = 1.10, 95% CI: 0.91–1.32, I2 = 74.4%). Similar null results were also observed in the use of selective serotonin reuptake inhibitors (OR = 1.04, 95% CI = 0.80–1.35), tricyclic antidepressants (OR = 1.01, 95% CI = 0.79–1.30), and other antidepressant drugs (OR = 0.91, 95% CI = 0.74–1.12). Subgroup analyses of study characteristics, stratified by the type of control subjects, geographic location, exposure assessment, number of cases, and adjustment for potential confounders, showed that the ORs were broadly consistent across strata. The OR per 1 year‐increment of duration was 0.99 (95% CI = 0.94–1.05, I2 = 40.0%, P = 0.154). Additionally, the OR for the greatest intensity of antidepressant use compared with never use was 0.82 (95% CI = 0.70–0.98, I2 = 0%, P = 0.489). Furthermore, no evidence of publication bias was detected through Funnel plots as well as Egger's and Begg's tests. Conclusions: There is no association between antidepressant use and EOC risk. Further prospective studies are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Despite advances in clinical trial design, failure rates near 80% in phase 2 and 50% in phase 3 have recently been reported. The challenges to successful drug development are particularly acute in central nervous system trials such as for pain, schizophrenia, mania, and depression because high‐placebo response rates lessen assay sensitivity, diminish estimated treatment effect sizes, and thereby decrease statistical power. This paper addresses the importance of rigorous patient selection in major depressive disorder trials through an enhanced enrichment paradigm. This approach led to a redefinition of an ongoing, blinded phase 3 trial algorithm for patient inclusion (1) to eliminate further randomization of transient placebo responders and (2) to exclude previously randomized transient responders from the primary analysis of the double blind phase of the trial. It is illustrated for a case study for the comparison between brexpiprazole + antidepressant therapy and placebo + antidepressant therapy. Analysis of the primary endpoint showed that efficacy of brexpiprazole versus placebo could not be established statistically if the original algorithm for identification of placebo responders was used, but the enhanced enrichment approach did statistically demonstrate efficacy. Additionally, the enhanced enrichment approach identified a target population with a clinically meaningful treatment effect. Through its successful identification of a target population, the innovative enhanced enrichment approach enabled the demonstration of a positive treatment effect in a very challenging area of depression research. [ABSTRACT FROM AUTHOR]

Objective To review the DSM-5 proposed criteria for mixed depression in light of robust and consistent historical and scientific evidence. Method An extensive historical search, a systematic review of the papers used by DSM-5 as reference papers, and a PubMed search were performed. Results As Hippocrates, depressive mixed states have been described as conditions of intense psychic suffering, consisting of depressed mood, inner tension, restlessness, and aimless psychomotor agitation. In DSM-5, new criteria are proposed for a mixed features specifier, as part of depression either in major depressive disorder ( MDD) or bipolar disorder. Those criteria require, as diagnostically specific, manic/hypomanic symptoms that are the least common kinds of symptoms that actually arise in depressive mixed states. The DSM-5 proposal is based, almost entirely, on a speculative wish to avoid 'overlapping' manic and depressive symptoms. Mixed states are, in fact, nothing but overlapping manic and depressive symptoms. Conclusion In this article, we review the psychopathology and research on mixed depressive states, and try to demonstrate that the DSM-5 proposal has weak scientific basis and does not identify a large number of mixed depressive states. This may be harmful because of the different treatment required by these conditions. [ABSTRACT FROM AUTHOR]

Background The on-the-road driving test in normal traffic is used to examine the impact of drugs on driving performance. This paper compares the sensitivity of standard deviation of lateral position (SDLP) and SD speed in detecting driving impairment. Methods A literature search was conducted to identify studies applying the on-the-road driving test, examining the effects of anxiolytics, antidepressants, antihistamines, and hypnotics. The proportion of comparisons (treatment versus placebo) where a significant impairment was detected with SDLP and SD speed was compared. Results About 40% of 53 relevant papers did not report data on SD speed and/or SDLP. After placebo administration, the correlation between SDLP and SD speed was significant but did not explain much variance ( r = 0.253, p = 0.0001). A significant correlation was found between ΔSDLP and ΔSD speed (treatment-placebo), explaining 48% of variance. When using SDLP as outcome measure, 67 significant treatment-placebo comparisons were found. Only 17 (25.4%) were significant when SD speed was used as outcome measure. Alternatively, for five treatment-placebo comparisons, a significant difference was found for SD speed but not for SDLP. Conclusions Standard deviation of lateral position is a more sensitive outcome measure to detect driving impairment than speed variability. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper deals with a comprehensive study of the mixed micellization and adsorption behavior of mixed systems enclosing an amphiphilic antidepressant drug nortriptyline hydrochloride (NOT) and Triton X-114 (TX-114) (nonionic surfactant) in aqueous/urea (500 mmol·kg−1 and 1000 mmol·kg−1) solutions by tensiometric method. The NOT is used for the cure of depression. For comparison purpose cmc value of pure drug NOT was also evaluated by conductimetric technique. Different theoretical models like Clint, Rubingh, and Rosen were used to get information about the nature of interaction between the components in bulk and at the interface. Because of the occurrence of urea increase in the surface charge of the micelles was obtained resulting a delay of the micelles formation. The cmc values of the mixed systems of NOT and TX-114 were found to be in between the cmc values of pure components, which signify nonideal mixed system having attractive interactions in the absence and presence of urea. Various parameters such as micellar mole fractions of TX-114 ( X1m, X1σ) in solution and at interface, interaction parameter ( βm/ βσ) in solution and at interface, and activity coefficient in solution and at interface were evaluated and discussed using Rubingh's and Rosen's models. Surface excess ( Γmax) increases that means minimum area per head group ( Amin) decreases as mole fraction ( α1) of TX-114 increases in the absence/presence of urea. Different thermodynamic parameters have been calculated and discussed. The ∆ G0m values achieved are all negative both in the absence and occurrence of urea. [ABSTRACT FROM AUTHOR]

Objective We aimed to explore whether the prevalence of manic switch was underestimated in randomized controlled trials ( RCTs) compared to observational studies ( OSs). Method Meta-analyses and simple and systematic reviews were identified by two reviewers in a blinded, standardized manner. All relevant references were extracted to include RCTs and OSs that provided data about manic switch prevalence after antidepressant treatment for a major depressive episode. The primary outcome was manic switch prevalence in the different arms of each study. A meta-regression was conducted to quantify the impact of certain variables on manic switch prevalence. Results A total of 57 papers (35 RCTs and 22 OSs) were included in the main analysis. RCTs underestimated the rate of manic switch [0.53 (0.32-0.87)]. Overestimated prevalence was related to imipraminics [1.85 (1.22-2.79)]; to serotonin-norepinephrine reuptake inhibitors [1.74 (1.06-2.86)]; and to other classes of drugs [1.58 (1.08-2.31)], compared to placebo treatment. The prevalence of manic switch was lower among adults than among children [0.2 (0.07-0.59)]; and higher [20.58 (8.41-50.31)] in case of bipolar disorder. Conclusion Our results highlight an underestimation of the rates of manic switch under antidepressants in RCTs compared to the rates observed in observational studies. [ABSTRACT FROM AUTHOR]

Objectives: This paper reviews the literature to examine the DSM-IV diagnostic criteria for rapid cycling in bipolar disorder. Methods: Studies on the clinical characteristics of rapid cycling bipolar disorder were reviewed. To identify relevant papers, literature searches using PubMed and MEDLINE were undertaken. Results: First observed in the prepharmacologic era, rapid cycling subsequently has been associated with a relatively poor response to pharmacologic treatment. Rapid cycling can be conceptualized as either a high frequency of episodes of any polarity or as a temporal sequence of episodes of opposite polarity. The DSM-IV defines rapid cycling as a course specifier, signifying at least four episodes of major depression, mania, mixed mania, or hypomania in the past year, occurring in any combination or order. It is estimated that rapid cycling is present in about 12–24% of patients at specialized mood disorder clinics. However, apart from episode frequency, studies over the past 30 years have been unable to determine clinical characteristics that define patients with rapid cycling as a specific subgroup. Furthermore, rapid cycling is a transient phenomenon in many patients. Conclusions: While a dimensional approach to episode frequency as a continuum between the extremes of no cycling and continuous cycling may be more appropriate and provide a framework to include ultra-rapid and ultradian cycling, the evidence does not exist today to refine the DSM-IV definition in a less arbitrary manner. Continued use of the DSM-IV definition also enables comparisons between past and future studies, and it should be included in the next release of the ICD. Further scientific investigation into rapid cycling is needed. In addition to improving the diagnostic criteria, insight into neurophysiologic mechanisms of mood switching and episode frequency may have important implications for clinical care. [ABSTRACT FROM AUTHOR]

In recent years a growing body of evidence has highlighted the impact of neuroleptics and antidepressants on sexual function. Research from a service user’s perspective suggested that service users are dissatisfied with the information that they received on drugs, and would like more education, in particular, on the side effects of medication that impact on sexual function. This paper reports some of the findings of a grounded theory study that explored how psychiatric nurses responded to issues of sexuality in practice. Emphasis within the paper is given to how nursing staff addressed the side effects of drugs that impact on sexual function. Findings suggested that nurse addressed the issue of prescribed medication and sexual function in practice, using a ‘Veiling Sexualities Cycle’, which had three subcategories: ‘ Hanging the Veil’, ‘Lifting the Veil’ and ‘Re-veiling’. In the light of contemporary mental health policy, findings from the study are discussed and recommendations for practice and education made. [ABSTRACT FROM AUTHOR]

AbstractThis paper provides an updated review of the use of antidepressant drugs in dermatology. Some of the psychiatric disorders that are usually comorbid with dermatological disorders and respond to antidepressants include major depressive disorder, obsessive compulsive disorder, body dysmorphic disorder, social phobia and post-traumatic stress disorder usually secondary to trauma and abuse during early life. Cutaneous symptoms may be the feature of a primary psychiatric disorder, e.g. cutaneous body image problems, dermatitis artefacta, neurotic excoriations and trichotillomania, or psychiatric syndromes may be comorbid with a primary dermatological disorder such as the association of major depressive disorder or social phobia with psoriasis and obsessive compulsive disorder with acne excoriee. Some of the salient pharmacological properties of the tricyclic antidepressants (TCAs) and the selective serotonin reuptake inhibitor (SSRI) antidepressants are reviewed. The review indicates that the SSRI antidepressants are potentially beneficial in the management of all the major psychiatric syndromes that are encountered in dermatological disorders. The generally more favourable side-effect profile of the SSRIs, such as lower cardiotoxicity in contrast to the TCAs, has made them the first-line agents for the treatment of depression. Furthermore, some of the pharmacological properties of the antidepressant agents that are not related to their antidepressant activity, such as the histamine H1 blocking effect of TCAs, such as doxepin, amitriptyline and trimipramine, are of benefit in dermatological conditions such as urticaria and pruritus. This paper reviews the general guidelines for use of antidepressants and salient drug–drug interactions resulting mainly from the inhibition of the cytochrome P450 (CYP) 2D6 and 3A3/4 isoenzymes by some of the SSRI antidepressants. Before prescribing an antidepressant agent, the specific guidelines, side-effect profile,... [ABSTRACT FROM AUTHOR]

Introduction and Aims: In recent years there has been growing concern about new psychoactive substances (NPS) designed to mimic the effects of established illicit drugs. This paper explores the patterns and correlates of NPS use in a sample of Australian students.Design and Methods: A cross-sectional survey was conducted in Australia in 2014. Data were collected from 1126 students (mean age: 14.9 years) from 11 secondary schools. Students completed a self-report questionnaire assessing NPS use and knowledge, beliefs and intentions to use these substances. NPS users were compared with non-users and illicit drug users, who had not used NPS, in terms of gender, binge drinking, tobacco use, psychological distress and self-efficacy to resist peer pressure.Results: Of the 1126 students, 3% reported having ever tried NPS, 2.4% had used synthetic cannabis and 0.4% had used a synthetic stimulant. Analyses revealed that NPS users were more likely to have had an episode of binge drinking in the past 6 months, tried tobacco and had higher levels of psychological distress and lower perceived self-efficacy to resist peer pressure than non-users, but did not significantly differ from users of other illicit drugs.Discussion and Conclusions: NPS use appears to be uncommon among Australian school students. Although adolescents that do use these substances did not differ from students that had used traditional illicit drugs, both appear to be higher-risk groups of students than non-users. Our findings suggest that universal education about NPS be incorporated into existing drug prevention programmes, and that targeted NPS prevention may also be warranted among high-risk adolescents. [Champion KE, Teesson M, Newton NC. Patterns and correlates of new psychoactive substance use in a sample of Australian high school students. Drug Alcohol Rev 2016;35:338-344]. [ABSTRACT FROM AUTHOR]

Currently, it has been demonstrated that psychotropic drugs, particularly antidepressants, are frequently prescribed for patients who seek bariatric surgery. Many bariatric surgery patients have a history of a mood disorder. Unlike medications for diabetes, hypertension or hyperlipidemia, which are generally reduced and at times discontinued, postsurgery antidepressants use is only slightly reduced. The Roux-en-Y procedure is most frequently associated with alteration in drug exposure. Medication disintegration, dissolution, absorption, metabolism and excretion have been found to be altered in postbariatric patients, although data are sparse at this time. This paper will review the current evidence regarding the effect of bariatric surgery on drug treatment including mechanism of interference as well as the extent of changes identified to date. Data will be presented as controlled trials followed by case series and reports. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Within the bipolar world, there is a chronic gnashing of teeth among experts, decrying clinicians' poor ability to diagnose bipolar disorder early in the course of the disorder. The feared consequence of this delayed diagnosis is risking a greater number of episodes early in adult life and increasing the likelihood of prescriptions of antide-pressants without mood stabilizers with their attendant risks when taken by those diagnosed as having unipolar depression but who are latently bipolar. These papers typically point to the long time frame from initial depressive symptoms to the proper bipolar diagnosis, usually measured in many years if not a decade or more. Clinicians are then usually urged to be more vigilant in ferreting out subtle hypomanic symptoms and looking for predictors of bipolar outcome. The treatment implication of making this earlier, accurate diagnosis of bipolar disorder would be to institute mood stabilizers and (presumably) to avoid antidepressants. Of course, in order to follow these recommendations, predictors of bipolar outcome among depressed patients must be established and validated across studies. [ABSTRACT FROM AUTHOR]

In this paper we extend and test with long-term follow-up the results of a previous paper on the usefulness of a sequential treatment protocol with risperidone and clozapine in resistant schizophrenia. Twenty-four patients diagnosed as resistant schizophrenics according to DSM III R and Kane et al .'s (1988) criteria were treated with risperidone for 3 months. Eight patients responded (according to a priori criteria: improvement of basal BPRS, SAPS and SANS total scores over 20 per cent at 3 months observation), while of the remaining 16 patients two dropped out and nine responded to clozapine treatment within the next month. Five patients had partial or no response to clozapine. Follow-up lasting up to 37 months (mean 22·4 months for risperidone responders and 18·3 months for clozapine responders) showed good stability of response, no significant differences in relapses and re-hospitalizations between risperidone and clozapine responders and no tardive responses. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The development of new antidepressants has had mixed results over the past decade, with several notable failures. This paper reviews a number of major initiatives in the development of new antidepressant agents. Traditional strategies to build on agents that have monoaminergic effects at the synapse (e.g., vilazodone and ketamine) have been complemented with efforts that have emphasized devices and brain circuits (e.g., deep brain stimulation and transcranial magnetic stimulation) or chemical agents that modulate neuroendocrine systems (e.g., glucocorticoid antagonists, mixed melatonin agonists/serotonin type-2 receptor antagonists). Interestingly, chemical agents, such as onabotulinumtoxin A, may affect brain circuits as well. We present data from recent studies in drug and device development--reviewing progress made, stumbling blocks encountered, and issues that need to be addressed in future studies. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) is one of the most disabling diseases worldwide and is becoming a significant public health threat. Current treatments forMDDprimarily consist of monoamine-targeting agents and have limited efficacy. However, the glutamate neurotransmitter system has recently come into focus as a promising alternative for novel antidepressant treatments. We review the current data on the glutamate NMDA receptor antagonist ketamine, which has been shown in clinical trials to act as a rapid antidepressant inMDD.We also examine ketamine efficacy on dimensions of psychopathology, including anhedonia, cognition, and suicidality, consistent with theNIMH Research Domain Criteria initiative. Other aspects of ketamine reviewed in this paper include safety and efficacy, different administration methods, and the risks of misuse of ketamine outside of medical settings. Finally, we conclude with a discussion of glutamatergic agents other than ketamine currently being tested as novel antidepressants. [ABSTRACT FROM AUTHOR]

The recent trend toward health care consumerism is largely the product of market practices, which have instilled the notion of health care as a product to be purchased by informed, empowered consumers, rather than a service bestowed upon a patient by a paternalistic provider. In recent years, health care consumerism has been facilitated by direct-to-consumer advertising (DTCA) of pharmaceutical products. In this paper, we use the case of DTCA for antidepressant medications to examine medicalization techniques used to promote consumerism and establish and expand the antidepressant market. We used content analysis of DTCA from the 1997-2006 issues of a broad sample of women's, men's, and common readership magazines to identify techniques of medicalization, and we analyzed in-depth interviews with magazine readers and antidepressant users to examine how such messages are received. Findings are presented within a framework of economic sociology, which allowed us to unveil the links between emotions and social action that undergird responses to medicalization techniques and consumption of advertised products. [ABSTRACT FROM AUTHOR]

Previous reviews of antidepressant treatment for children and adolescents that found minimal or no positive effects failed to account for critical methodological differences in studies, a new review concludes. The author of the review, published March 3 in the American Journal of Psychiatry, states that earlier reviews have drawn questionable conclusions because they categorized many flawed pharmaceutical industry-sponsored trials that found no benefits from antidepressants as negative trials, rather than as failed trials. Accounting for this distinction leads the author of the present paper to conclude that evidence for beneficial effects of antidepressants in children and adolescents is actually strong. [ABSTRACT FROM AUTHOR]

The use of antidepressants (AD) in major depressive disorders (MDD) Keywords: antidepressants; depression; meta-analyses EN antidepressants depression meta-analyses 862 863 2 12/29/20 20201201 NES 201201 The often mud-throwing long-standing debate on the use of antidepressant was rebooted by a meta-analyses1 from a Danish group in 2017. In that paper, the authors successfully distorted the overall primary outcome (that selective serotonin reuptake inhibitors (SSRI) had a statistically significant effect in comparison with placebo). [Extracted from the article]

This paper presents commentaries on how endoluminal antireflux procedures compare to laparoscopic fundoplication; new endoscopic procedures being studied to treat refractory gastroesophageal reflux disease (GERD); the new Stretta; the relationship between obesity and proton pump inhibitor (PPI) resistance; data concerning acid hypersensitivity and sensory receptors (vallinoid, TRPV1) causing refractory GERD; whether microscopic esophagitis is relevant in determining symptoms of non-erosive reflux disease (NERD); how concomitant functional gastrointestinal disorders affect the PPI response in NERD; the evidence that a functional esophagus is associated with inflammatory bowel syndrome (IBS); the role of GABA agonists in the treatment of refractory GERD; the role of biofeedback and antidepressants in refractory GERD; and endoluminal fundoplication using the EsophyX device. [ABSTRACT FROM AUTHOR]

Objective As part of a series of papers examining chronobiology ['Getting depression clinical guidelines right: time for change?' Kuiper et al. Acta Psychiatr Scand 2013; 128(Suppl. 444):24-30; and 'Manipulating melatonin in managing mood' Boyce & Hopwood. ActaPsychiatrScand 2013; 128(Suppl. 444):16-23], in this article, we review and synthesise the extant literature pertaining to the chronobiology of depression and provide a preliminary model for understanding the neural systems involved. Method A selective literature search was conducted using search engines such as MEDLINE/ Pub Med, combining terms associated with chronobiology and mood disorders. Results We propose that understanding of sleep-wake function and mood can be enhanced by simultaneously considering the circadian system, the sleep homoeostat and the core stress system, all of which are likely to be simultaneously disrupted in major mood disorders. This integrative approach is likely to allow flexible modelling of a much broader range of mood disorder presentations and phenomenology. Conclusion A preliminary multifaceted model is presented, which will require further development and testing. Future depression research should aim to examine multiple systems concurrently in order to derive a more sophisticated understanding of the underlying neurobiology. [ABSTRACT FROM AUTHOR]

Background During the last 10 years, the use of psychotropic medications in youth with psychiatric disorders, including eating disorders, has significantly increased, but their role in the treatment of adolescent anorexia nervosa is still controversial. Objective This paper aims to review the literature on the use of antidepressants and antipsychotics in adolescents with anorexia nervosa, comparing the efficacy and tolerability in this population with those reported in trials with patients not selected by age. Method A systematic review of the available literature published so far. Results Only few studies met the selection criteria. No strong evidence of beneficial effects was found in using antidepressants and antipsychotics neither in adults nor in adolescents. Side effects were more frequently reported in studies including adolescent population. Among psychotropic drugs, the majority of studies focused on olanzapine, which seems to have, in some studies, only positive effects on body mass index, eating disorder symptoms and functional impairment in both age groups. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

There is a high incidence of psychiatric comorbidity in people with epilepsy ( PWE), particularly depression. The manifold adverse consequences of comorbid depression have been more clearly mapped in recent years. Accordingly, considerable efforts have been made to improve detection and diagnosis, with the result that many PWE are treated with antidepressant drugs, medications with the potential to influence both epilepsy and depression. Exposure to older generations of antidepressants (notably tricyclic antidepressants and bupropion) can increase seizure frequency. However, a growing body of evidence suggests that newer ('second generation') antidepressants, such as selective serotonin reuptake inhibitors or serotonin-noradrenaline reuptake inhibitors, have markedly less effect on excitability and may lead to improvements in epilepsy severity. Although a great deal is known about how antidepressants affect excitability on short time scales in experimental models, little is known about the effects of chronic antidepressant exposure on the underlying processes subsumed under the term 'epileptogenesis': the progressive neurobiological processes by which the non-epileptic brain changes so that it generates spontaneous, recurrent seizures. This paper reviews the literature concerning the influences of antidepressants in PWE and in animal models. The second section describes neurobiological mechanisms implicated in both antidepressant actions and in epileptogenesis, highlighting potential substrates that may mediate any effects of antidepressants on the development and progression of epilepsy. Although much indirect evidence suggests the overall clinical effects of antidepressants on epilepsy itself are beneficial, there are reasons for caution and the need for further research, discussed in the concluding section. [ABSTRACT FROM AUTHOR]

Sienaert P, Lambrichts L, Dols A, De Fruyt J. Evidence-based treatment strategies for treatment-resistant bipolar depression: a systematic review. Bipolar Disord 2012: 00: 000-000. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd. Objectives: Treatment resistance in bipolar depression is a common clinical problem that constitutes a major challenge for the treating clinician as there is a paucity of treatment options. The objective of this paper was to review the evidence for treatment options in treatment-resistant bipolar depression, as found in randomized controlled trials and with special attention to the definition and assessment of treatment resistance. Methods: A Medline search (from database inception to May 2012) was performed using the search terms treatment resistance or treatment refractory, and bipolar depression or bipolar disorder, supplemented with 43 separate searches using the various pharmacologic agents or technical interventions as search terms. Results: Only seven studies met our inclusion criteria. These studies examined the effects of ketamine (n = 1), (ar)modafinil (n = 2), pramipexole (n = 1), lamotrigine (n = 1), inositol (n = 1), risperidone (n = 1), and electroconvulsive therapy (ECT) (n = 2). Conclusions: The available level I evidence for treatment strategies in resistant bipolar depression is extremely scarce, and although the response rates reported are reassuring, most of the strategies remain experimental. There is an urgent need for further study in homogeneous patient samples using a clear concept of treatment resistance. [ABSTRACT FROM AUTHOR]

Purpose. Child and family education regarding management of pediatric migraine is essential to reduce acute pain, prevent chronic daily migraine, and minimize the total number of headache attacks. This paper summarizes current evidence and provides a foundation for family teaching. Conclusions. Effective management of pediatric migraine can be achieved with a combination of individually tailored biobehavioral strategies, lifestyle modifications, and optimal scheduling of rescue and preventative pharmacologic treatment. Practice Implications. Included are goal setting recommendations, common triggers, key comorbidities, lifestyle modifications, principles of pharmacologic management, commonly used naturopathic compounds, and a link to an online downloadable teaching handout. [ABSTRACT FROM AUTHOR]

In perinatal psychiatry, randomized controlled trials are often not feasible on ethical grounds. Many studies are observational in nature, while others employ large databases not designed primarily for research purposes. Quality assessment of the resulting research is complicated by a lack of standardized tools specifically for this purpose. The aim of this paper is to describe the Systematic Assessment of Quality in Observational Research (SAQOR), a quality assessment tool our team devised for a series of systematic reviews and meta-analyses of evidence-based literature regarding risks and benefits of antidepressant medication during pregnancy. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Parker G, Brotchie H. Mood effects of the amino acids tryptophan and tyrosine. Objective: Reflecting increased scientific interest in any nutritional contribution to the onset and treatment of mood disorders, we overview research into two neurotransmitter precursors - the amino acids tryptophan and tyrosine - particularly examining whether any deficiency increases risk to depression and whether those amino acids have any antidepressant properties. Method: The theoretical relevance of the two amino acids was overviewed by considering published risk and intervention studies, technical papers and reviews. Results: There is some limited evidence, suggesting that depressed patients, especially those with a melancholic depression, have decreased tryptophan levels. Whether such findings reflect a causal contribution or are a consequence of a depressed state remains an open question. There is a small database supporting tryptophan preparations as benefitting depressed mood states. There is no clear evidence as to whether tyrosine deficiency contributes to depression, while the only randomized double-blind study examining tyrosine supplementation did not show antidepressant benefit. Conclusion: Acute tryptophan depletion continues to provide a research tool for investigating the relevance of serotonin to depression onset. There is limited evidence that tryptophan loading is effective as a treatment for depression through its action of increasing serotonin production. Most clinical studies are dated, involve small sample sizes and/or were not placebo controlled. The development of the new serotonin reuptake inhibitor drugs seemingly signalled an end to pursuing such means of promoting increased serotonin as a treatment for depression. The evidence for tyrosine loading promoting catecholamine production as a possible treatment for depression appears even less promising, and depletion studies less informative. [ABSTRACT FROM AUTHOR]

Background Selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor antidepressants are associated with high rates of treatment-emergent sexual dysfunction (TESD) due to stimulation of serotonin receptors. Objective The objective is to evaluate the effect of agomelatine on sexual function in depressed patients. Methods This paper reviews published and unpublished data on sexual function with agomelatine in depressed patients and healthy volunteers. Results Agomelatine, an agonist of melatonergic MT1 and MT2 receptors and antagonist of 5-HT2 receptors, is associated with similar rates of sexual dysfunction compared with placebo and lower rates compared with other antidepressants. Twice as many sexually active depressed patients ( n = 193) reported a deterioration of sexual function during 12 weeks of treatment with venlafaxine compared with agomelatine (15.2% vs. 8.2%, p < 0.0001); however, no differences were found with respect to arousal. Using the Arizona Sexual Experience Scale in depressed patients ( n = 399), the incidence of treatment-emergent sexual dysfunction (TESD) with agomelatine (3%) was significantly lower than placebo (8.6%) and selective serotonin reuptake inhibitors (10.1%). Among healthy male volunteers ( n = 92), TESD was not increased compared with placebo in either agomelatine (25 and 50 mg/day) group over 8 weeks, and both were significantly lower than TESD with paroxetine ( p < 0.0001). Moderate or severe TESD occurred in less than 5% of subjects receiving agomelatine versus 62% who received paroxetine ( p < 0.001). Conclusion Agomelatine demonstrates favorable sexual acceptability. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: A large body of research has focused on "mediating mechanisms" and predisposing brain abnormalities to geriatric depression, but little is known about its etiology. This paper examines whether age-related and comorbid disease-related immune deregulation is an etiologic contributor to geriatric depression.Methods: This article reviews findings on neuroinflammation during the aging process and depression as well as studies of anti-inflammatory actions of classical antidepressants and antidepressant actions of anti-inflammatory agents.Results: Aging results in increased peripheral immune responses, impaired peripheral-CNS immune communication, and a shift of the CNS into a pro-inflammatory state. These exaggerated and prolonged immune responses may lead to changes in the function of emotional and cognitive networks pertinent to geriatric depression and to behavioral changes reminiscent of the depressive and cognitive symptoms of geriatric depression. Some antidepressants may reduce the expression of inflammation markers. Limited data suggest that some anti-inflammatory agents may have antidepressant properties.Conclusions: A synthesis of available findings suggests that aging-related and comorbid disease-related inflammatory processes may promote changes in the neural systems predisposing to geriatric depression or facilitating metabolic changes that mediate depressive syndromes. The "inflammation hypothesis" in geriatric depression cannot be tested in its entirety, but it can lead to testable hypotheses and data on mechanisms by which inflammatory processes promote geriatric depression. The significance of such an effort is that it may lead to a novel treatment development model bringing to bear recent advances of anti-inflammatory pharmacology to the treatment of depressed elderly patients. [ABSTRACT FROM AUTHOR]

Parker G, Brotchie H. 'D' for depression: any role for vitamin D?. Objective: While there has long been interest in any nutritional contribution to the onset and treatment of mood disorders, there has been increasing scientific evaluation of several candidate nutritional and dietary factors in recent years. In this paper, we overview research into any vitamin D insufficiency and deficiency contribution to depression. Method: The relevant literature was reviewed. Results: Cross-sectional studies have identified associations between depression and low vitamin D levels, but studies have failed to clarify whether vitamin D deficiency is an antecedent cause, correlate or consequence of depression. While vitamin D deficiency and insufficiency have been linked with seasonal affective disorder, suggested associations have not been rigorously tested. There has been insufficient research to establish whether and when vitamin D supplementation should be considered as an augmentation strategy with antidepressant drugs. Conclusion: There is currently insufficient evidence to argue strongly for vitamin D supplementation in patients with depression, but such a strategy is worthy of consideration in depressed patients whose lifestyle and geographical residence may indicate a risk of vitamin D insufficiency - or where low vitamin D levels have been quantified. [ABSTRACT FROM AUTHOR]

Depression and dementia, among the most common conditions in clinical practice, sometimes coexist, sometimes succeed each other, and often confuse clinicians. In the present paper, the clinical concept of 'depression-dementia medius' (which includes pseudodementia and depression in Alzheimer's disease as exemplars) is proposed, in reference to Janet's concept of psychological tension. Because psychosomatically complex human lives are always in a state of dynamic equilibrium, it seems sensible to propose that pseudodementia and depression in Alzheimer's disease are located within a spectrum extending from depression without dementia symptoms to dementia without depression. From the Janetian viewpoint, pseudodementia is regarded as uncovered latent dementia as a result of reduced psychological tension. Dementia is more than a fixed progressive condition under this view, and is a manifestation of dynamic mental activities. Characterizing these entities through perspectives such as psychological tension may yield deep insights in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To determine the validity of electronic hospital pharmacy dispensing records as an indicator of late gestation exposure to antidepressants using medical records as the gold standard. Method:Medical records (gold standard) were reviewed for a consecutive sample of 400 women who delivered at a large maternity hospital during 2005. Data on antidepressants used in pregnancy from the medical records were compared with the electronic pharmacy dispensing records to ascertain sensitivity and specificity. Results: According to the medical records, 12 (3%) women were identified as taking antidepressants during late gestation. The electronic pharmacy dispensing records correctly identified 9 women as exposed to antidepressants (sensitivity score 75%; 95%CI 43-95). No women were classified as exposed according to pharmacy dispensing records and classified as not exposed according to the medical records (specificity score 100%; 95%CI 99-100). 7 (1.8%) women were identified in the medical records as taking antidepressants but had either stopped prior to pregnancy or on finding out that they were pregnant. These patients were not identified in the pharmacy dispensing records. Conclusion: Electronic hospital pharmacy dispensing records may provide an efficient alternative to paper records for identifying late gestation exposure to antidepressants, but will underestimate the exposure by 25%. [ABSTRACT FROM AUTHOR]

I Sir, i We are grateful to Drs Braillon and Bewley for their interest in our recent paper in I BJOG i 1 and would like to elaborate on some of the important points they raise. GRAPH: Supplementary Material GRAPH: Supplementary Material GRAPH: Supplementary Material GRAPH: Supplementary Material GRAPH: Supplementary Material GRAPH: Supplementary Material GRAPH: Supplementary Material References 1 Kolding L, Ehrenstein V, Pedersen L, Sandager P, Petersen OB, Uldbjerg N, et al. [Extracted from the article]