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Background The objective of this study was to compare the incidence and prevalence of depressive symptoms in atypical parkinsonian ( APD) syndromes versus Parkinson disease ( PD). Methods In a large, retrospective patient cohort, the authors analyzed the incidence and prevalence of depressive symptoms using the Beck Depression Inventory and evaluated patients longitudinally on subsequent visits. For individuals who were followed at subsequent visits, incidence rates were calculated in person-years as a measure of incidence. Results In total, 361 patients were identified who had APD syndromes, including progressive supranuclear palsy, corticobasal degeneration, multiple system atrophy, and dementia with Lewy bodies; and 2352 patients with PD were used as a control group. The mean Beck Depression Inventory values were significantly higher in patients with APD (F = 14.19; P < 0.001). A significantly higher proportion of those with APD screened positive for depressive symptoms both at the initial visit and on subsequent visits ( P < 0.001), and depressive symptoms appeared to be more severe in the APD subgroups. Unified Parkinson's Disease Rating Scale motor scores and disease duration were correlated with depressive symptoms. Conclusions The current results suggest that the incidence and prevalence of depressive symptoms are higher in patients with APD syndromes and also appear to be more severe than those in patients with PD. Depressive symptoms in APD are common and affect patients regardless of disease duration or motor severity. [ABSTRACT FROM AUTHOR]

Objective: Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) region has shown promise as a neurosurgical intervention for adults with severe treatment-refractory obsessive-compulsive disorder (OCD). Pilot studies have revealed improvement in obsessive-compulsive symptoms and secondary outcomes following DBS. We sought to establish the long-term safety and effectiveness of DBS of the VC/VS for adults with OCD. Materials and Methods: A long term follow-up study (73–112 months) was conducted on the six patients who were enrolled in the original National Institute of Mental Health pilot study of DBS for OCD. Qualitative and quantitative data were collected. Results: Reduction in OCD symptoms mirrored the one-year follow-up data. The same four participants who were treatment responders after one year of treatment showed a consistent OCD response (greater than 35% reduction in Yale Brown Obsessive Compulsive Scale (YBOCS)). Another subject, classified as a non-responder, achieved a 26% reduction in YBOCS score at long term follow-up. The only patient who did not achieve a 25% or greater reduction in YBOCS was no longer receiving active DBS treatment. Secondary outcomes generally matched the one-year follow-up with the exception of depressive symptoms, which significantly increased over the follow-up period. Qualitative feedback indicated that DBS was well tolerated by the subjects. Discussion: These data indicate that DBS was safe and conferred a long-term benefit in reduction of obsessive-compulsive symptoms. DBS of the VC/VS region did not reveal a sustained response for comorbid depressive symptoms in patients with a primary diagnosis of OCD. [ABSTRACT FROM AUTHOR]

Stemming from its use in movement disorders, deep brain stimulation (DBS) has emerged as an experimental therapy for treatment-resistant cases of major depressive disorder, obsessive-compulsive disorder, and Tourette's syndrome. Early, positive results from case studies have led to controlled trials evaluating the use of DBS in each of these conditions. Results have been varied but suggest moderate benefit in many cases and remain encouraging. As the relative safety and potential efficacy of DBS has become more widely accepted, its use has expanded to include the treatment of other psychiatric disorders and symptoms including anorexia nervosa, substance use disorder, aggression, and Alzheimer's disease. Case studies using DBS for each of these have reported benefits. [ABSTRACT FROM AUTHOR]

Abstract: Deep brain stimulation (DBS) has proven a powerful treatment for medication refractory movement disorders. Success in this group of patients has allowed preliminary studies of DBS to proceed in severe and medication resistant cases of depression, obsessive-compulsive disorder (OCD) and Tourette''s syndrome (TS). Pathophysiological and imaging studies along with attempts at lesioning the basal ganglia, have offered clues as to nodes in the circuitry that may be amenable to neuromodulation. DBS in neuropsychiatric illness has offered hope, but at this time rigorous screening by interdisciplinary and ethical teams should be employed when establishing treatment candidacy. A cautious approach to these disorders utilizing institutional review board approved research protocols will hopefully shed light onto patient selection and brain target(s) for each disorder. We need to keep an open mind as we move forward and especially that rational therapy may need to be patient and symptom specific. This review will summarize each disorder (depression, OCD and TS), review pathophysiology (both known and speculated), and update the current observations on DBS in each neuropsychiatric condition. [Copyright &y& Elsevier]

The article focuses on prevalence and the treatability of anxiety disorders particularly keeping in mind the significant impact these common conditions have on quality of life, health and general well being. There has continued to be increasing attention paid to the presentation of different symptoms with anxiety disorders including somatic anxiety, as well as psychic anxiety symptoms. They also result in the presentation of suffering patients to treatment in primary care, through emergency department services and in a consultation-liaison setting.

Objective: Various classes of antidepressant medications generally induce remission of major depressive disorder in only about one-third of patients. In a previous study using mirtazapine or paroxetine alone or in combination from treatment initiation, the rate of patients who remitted within a 6-week period was twice that of patients using either drug alone. In this double-blind study, the authors sought to produce evidence for the superiority of different combinations of antidepressant drugs from treatment initiation. Method: Patients (N=105) meeting DSM-IV criteria for major depressive disorder were randomly assigned to receive, from treatment initiation, either fluoxetine monotherapy (20 mg/day) or mirtazapine (30 mg/day) in combination with fluoxetine (20 mg/day), venlafaxine (225 mg/day titrated in 14 days), or bupropion (150 mg/day) for 6 weeks. The primary outcome measure was the Hamilton Depression Rating Scale (HAM-D) score. Results: The overall dropout rate was 15%, without notable differences among the four groups. Compared with fluoxetine monotherapy, all three combination groups had significantly greater improvements on the HAM-D. Remission rates (defined as a HAM-D score of 7 or less) were 25% for fluoxetine, 52% for mirtazapine plus fluoxetine, 58% for mirtazapine plus venlafaxine, and 46% for mirtazapine plus bupropion. Among patients who had a marked response, double-blind discontinuation of one agent produced a relapse in about 40% of cases. Conclusions: The combination treatments were as well tolerated as fluoxetine monotherapy and more clinically effective. The study results, which add to a growing body of evidence, suggest that use of antidepressant combinations from treatment initiation may double the likelihood of remission compared with use of a single medication. [ABSTRACT FROM AUTHOR]

Abstract: We conducted a prospective, randomized, sham-controlled, double blind, parallel group study of right or left pre-frontal rTMS in 48 subjects with medication-resistant depression. Two thousand (50×8-s trains of 5Hz) stimuli at MEP threshold were delivered each weekday for 2weeks. We employed a sham coil and simultaneous electrical stimulation of the scalp to simulate rTMS. Mean (±S.D.) reductions in the HAMD-24 from baseline to 3-months were not significantly different between rTMS and sham treatment groups. However, right cranial stimulation (sham or rTMS) was significantly more effective than left cranial stimulation (sham or rTMS) (P =0.012). Mean (±S.D.) reductions in the HAMD from baseline to 3months were: left: 28.1 (±5.36) to 19.2 (±11.2); and right 27.2 (±4.2) to 11.5 (±9.4). Left rTMS achieved a reduction in HAMD 9.5 points greater than that achieved by left sham, a benefit greater than that reported in a recent multi-center Phase III trial of rTMS (O''Reardon et al., 2007), albeit not statistically significant. These results suggest that somatosensory stimuli that repeatedly engage the left hemisphere may be important to the achievement of therapeutic effect. [Copyright &y& Elsevier]

Background: Prior promising results have been reported with deep brain stimulation (DBS) of the anterior limb of the internal capsule in cases with severe obsessive compulsive disorder (OCD) who had exhausted conventional therapies. Methods: In this pilot study, six adult patients (2 male; 4 female) meeting stringent criteria for severe (minimum Yale-Brown Obsessive Compulsive Scale [Y-BOCS] of 28) and treatment-refractory OCD had DBS electrode arrays placed bilaterally in an area spanning the ventral anterior limb of the internal capsule and adjacent ventral striatum referred to as the ventral capsule/ventral striatum. Using a randomized, staggered-onset design, patients were stimulated at either 30 or 60 days following surgery under blinded conditions. Results: After 12 months of stimulation, four (66.7%) of six patients met a stringent criterion as “responders” (≥35% improvement in the Y-BOCS and end point Y-BOCS severity ≤16). Patients did not improve during sham stimulation. Depressive symptoms improved significantly in the group as a whole; global functioning improved in the four responders. Adverse events associated with chronic DBS were generally mild and modifiable with setting changes. Stimulation interruption led to rapid but reversible induction of depressive symptoms in two cases. Conclusions: This pilot study suggests that DBS of the ventral capsule/ventral striatum region is a promising therapy of last resort for carefully selected cases of severe and intractable OCD. Future research should attend to subject selection, lead location, DBS programming, and mechanisms underpinning therapeutic benefits. [Copyright &y& Elsevier]