Prednisone augmentation in treatment-resistant depression with fatigue and hypocortisolaemia: a case series.

Abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis have long been implicated in major depression with hypercortisolaemia reported in typical depression and hypocortisolaemia in some studies of atypical depression. We report on the use of prednisone in treatment-resistant depressed patients with reduced plasma cortisol concentrations. Six patients with treatment-resistant major depression were found to complain of severe fatigue, consistent with major depression, atypical subtype, and to demonstrate low plasma cortisol levels.

Neuropharmacology of paradoxic weight gain with selective serotonin reuptake inhibitors.

It has been suggested that weight gain associated with tricyclic antidepressants (TCA) reflect actions on dopamine (DA) and histamine receptors. However, a definitive cause is purely assumptive given the nonselective pharmacology of these agents. The selective serotonin reuptake inhibitors (SSRIs), as well as agents like dexfenfluramine (DFF), have emphasized the pivotal role of serotonin (5HT) in reducing carbohydrate (CHO) intake, and have provided a more selective tool with which to study appetite regulation.

Moclobemide and fluoxetine for panic disorder. International Panic Disorder Study Group.

An international, multicentre, double blind parallel group study compared the tolerability and efficacy of moclobemide with the selective serotonin reuptake inhibitor (SSRI) fluoxetine for panic disorder. SSRIs have been shown effective for panic. The target dose of moclobemide was 450 mg and of fluoxetine was 20 mg.

Panic disorder following torture by suffocation is associated with predominantly respiratory symptoms.

Background: We previously reported that in panic disorder a history of near-suffocation is associated with predominantly respiratory panic attacks. It might be hypothesized that the near-suffocation experienced in certain kinds of torture is also associated with the development of predominantly respiratory panic attacks.

Methods: A sample of patients who had experienced torture (N = 14) was drawn from an Anxiety Disorders Clinic in South Africa.

Hyperresponsivity to nicotinic acid challenge in generalized social phobia: a pilot study.

Although blushing is an almost pathognomonic feature of social phobia, little is known about the neurobiology of blushing in this disorder. Nicotinic acid (100 mg), a vasodilator that may induce flushing, was administered to six male patients with generalized social phobia and to six healthy male controls. Compared with controls, patients demonstrated increased flushing, anxiety, autonomic activity, and temperature after nicotinic acid administration.

Trichobezoars in trichotillomania: case report and literature overview.

Objective: Although trichobezoars are well described in the surgical literature, there is relatively little in the psychiatric literature on them. This study aims to focus the attention of readers on trichobezoars by means of a case report and an overview of the literature.

Method: We present a case of a patient with trichotillomania and a trichobezoar, including psychiatric management.

Use of the selective serotonin reuptake inhibitor citalopram in the treatment of generalized social phobia.

Background: There is increasing evidence that social phobia responds to treatment with selective serotonin reuptake inhibitors (SSRIs). However, the efficacy of citalopram, the most selective of the SSRIs, in social phobia has not been well documented.

Methods: Citalopram was used on an open-label naturalistic basis in 22 social phobia patients presenting for treatment (40 mg daily for 12 weeks).

Is olfactory reference syndrome an obsessive-compulsive spectrum disorder?: two cases and a discussion.

A number of disorders characterized by intrusive repetitive symptoms and varying degrees of insight may overlap phenomenologically and neurobiologically with obsessive-compulsive disorder (OCD). There is a question as to whether olfactory reference syndrome, a disorder characterized by persistent preoccupations about body odor accompanied by shame and embarrassment, is also an OCD spectrum disorder. Two cases of olfactory reference syndrome, with accompanying phenomenological and neurobiological data, are presented in order to discuss the possible overlap with OCD.

Moclobemide for anxiety disorders: a focus on moclobemide for panic disorder.

Moclobemide is a reversible selective inhibitor of monoamine oxidase A. It has proven efficacy in a wide range of depressive disorders, including agitated anxious depression. In an international, multicentre, double-blind parallel-group study, the tolerability and efficacy of moclobemide were compared with that of the selective serotonin reuptake inhibitor fluoxetine.

Association of panic disorder with a history of traumatic suffocation.

Objective: An important recent hypothesis suggests that panic disorder results from a false suffocation alarm. However, the association of panic disorder with a history of traumatic suffocation experiences (e.g.

Magnetic resonance brain imaging in women with obsessive-compulsive disorder and trichotillomania.

Magnetic resonance imaging of the brain was undertaken in women with obsessive-compulsive disorder (n = 13), trichotillomania (n = 17), and healthy controls (n = 12). Caudate volume and ventricular-brain ratio (VBR) (variables that have previously been highlighted as abnormal in studies of OCD) were compared in the three subject groups and were correlated with neuropsychological and neurological soft sign findings. No significant differences were found between women with OCD, trichotillomania and normal controls on caudate volume or VBR.

A neuro-evolutionary approach to the anxiety disorders.

Background: Advances in our understanding of the anxiety disorders and in the application of evolutionary principles to medicine provide the possible basis for a neuro-evolutionary approach to these conditions. In this paper, initial steps taken towards such an approach are described.

Methods: Neuro-evolutionary accounts of each of the anxiety disorders have been offered.

Blushing and social phobia: a neuroethological speculation.

Blushing is a well-known but relatively poorly understood phenomenon. This paper reviews the phenomenology, neurobiology, and psychology of blushing. We argue that a neuroethological understanding of blushing provides a useful explanation of many aspects of normal blushing, and leads to a useful account of social phobia.

Buspirone is an effective augmenting agent of serotonin selective re-uptake inhibitors in severe treatment-refractory depression.

Background: Buspirone has previously been reported to be effective in the augmentation of the antidepressant effect of serotonin selective re-uptake inhibitors (SSRIs) in depressed outpatients. We report on buspirone augmentation of SSRIs in severe treatment-refractory depression in inpatients.

Methods: A retrospective chart review was undertaken of patients diagnosed with DSM-III-R major depression and treated at our inpatient unit.

Risperidone augmentation of serotonin reuptake inhibitors in obsessive-compulsive and related disorders.

Background: While serotonin is the neurotransmitter most commonly implicated in obsessive-compulsive and related disorders, there is also evidence for dopaminergic mediation of these conditions. Indeed, augmentation of serotonin reuptake inhibitors with the atypical neuroleptic risperidone has been suggested to be useful in obsessive-compulsive disorder (OCD).

Method: Charts of all patients treated in our OCD clinic with the combination of a serotonin reuptake inhibitor and risperidone were reviewed.

Use of the selective serotonin reuptake inhibitor citalopram in treatment of trichotillomania.

Previous trials of selective serotonin reuptake inhibitors (SSRIs) in the treatment of trichotillomania have provided conflicting data. Furthermore, the efficacy of citalopram, the most selective of the SSRIs, in trichotillomania has not previously been documented. Citalopram was used on an open-label naturalistic basis in 14 (1 male and 13 females) patients who presented with chronic hair-pulling and met DSM-IV criteria for trichotillomania.

Pica and the obsessive-compulsive spectrum disorders.

Background: The concept of a spectrum of obsessive-compulsive related disorders may have clinical and research heuristic value in the approach to disorders similar to obsessive-compulsive disorder (OCD) in respect of phenomenology and psychobiology. Like other repetitive and ritualistic behaviours, pica may be postulated to fall at times on this spectrum.

Methods: Five cases of pica seen at our clinics are presented here in order to test this hypothesis.

Phasic craving for carbohydrate observed with citalopram.

The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients.