The man with the purple nostrils: a case of rhinotrichotillomania secondary to body dysmorphic disorder.

Objective: To describe a different type of self-injurious behavior that may be secondary to body dysmorphic disorder (BDD).

Method: Single case report.

Results: We reported a case of an individual who have developed the self-destructive habit of pulling and severely scraping hairs and debris out of the mucous membrane of his nasal cavities.

A breath-holding challenge in panic disorder patients, their healthy first-degree relatives, and normal controls.

Our aim was to observe the induction of panic attacks (PA) symptoms by a breath-hold test in panic disorder (PD) patients as the Diagnostic and Statistical Manual for Mental Disorders 4th edition (DSM-IV) and their healthy first-degree relatives. We randomly selected 26 PD patients, 28 healthy first-degree relatives of probands with PD and 25 normal volunteers with no family history of PD. They were induced to breath-hold for as long as possible four times with a two-min interval between them.

Partial response and nonresponse to antidepressant therapy: current approaches and treatment options.

Background: Response to antidepressant drug therapy is less than optimal for a considerable proportion of depressed patients; at present, however, few data exist to guide their rational therapeutic management. This review describes general principles for the management of such patients. This review is the result of an expert roundtable meeting convened to review published clinical data and clinical experience and provide clinicians with evidence-based principles on the management of patients who fail to respond optimally to initial antidepressant therapy.

The role of noradrenaline and selective noradrenaline reuptake inhibition in depression.

Depression is a common disorder that impacts on all aspects of a person's life. For the past 10 years, clinicians have focused on serotonin in their treatment of depression. This is largely due to the growing acceptance of the efficacy and safety of the selective serotonin reuptake inhibitors (SSRIs) in comparison with older tricyclic antidepressants (TCAs).

Reboxetine, a new noradrenaline selective antidepressant, is at least as effective as fluoxetine in the treatment of depression.

The clinical profile of reboxetine, a selective noradrenaline reuptake inhibitor, was compared with that of the selective serotonin reuptake inhibitor fluoxetine and placebo in a double-blind, multicenter, parallel-group clinical trial of patients with major depression. Among the 381 patients treated with reboxetine 8 to 10 mg/day, fluoxetine 20 to 40 mg/day, or placebo for up to 8 weeks, a statistically significant greater reduction in the mean Hamilton Rating Scale for Depression (21-item HAM-D) total score (the primary efficacy variable) was seen for both active treatment groups compared with placebo (p < 0.024).

Carbon dioxide test as an additional clinical measure of treatment response in panic disorder.

Objective: We aim to determine if a treatment with a dose of clonazepam--2 mg/day, for 6 weeks, blocks spontaneous panic attacks and the ones induced by the inhalation of 35% carbon dioxide (CO2) in panic disorder (PD) patients. The CO2 challenge-test may be a useful addition tool for measuring the pharmacological response during the initial phase (6 weeks) in the treatment of PD.

Method: Eighteen PD patients drug free for a week participated in a carbon dioxide challenge test.

Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test.

The aim of the present study was to verify the sensitivity to the carbon dioxide (CO2) challenge test of panic disorder (PD) patients with respiratory and nonrespiratory subtypes of the disorder. Our hypothesis is that the respiratory subtype is more sensitive to 35% CO2. Twenty-seven PD subjects with or without agoraphobia were classified into respiratory and nonrespiratory subtypes on the basis of the presence of respiratory symptoms during their panic attacks.

Reboxetine, a selective norepinephrine reuptake inhibitor, is an effective and well-tolerated treatment for panic disorder.

Background: Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) as well as benzodiazepines have been shown to be effective for the treatment of panic disorder. The introduction of SSRIs has enabled a greater understanding of the role of serotonin in the etiology of panic disorder; however, the role of norepinephrine has been more challenging to ascertain. The aim of this study was to determine the efficacy and tolerability of reboxetine, a novel selective norepinephrine reuptake inhibitor, in patients with panic disorder with and without agoraphobia.

Impaired set-shifting ability and therapeutic response in obsessive-compulsive disorder.

Set-shifting ability and therapeutic response to serotonin reuptake inhibitors were investigated in 20 patients with obsessive-compulsive disorder. A clear relationship was found between impaired performance on two Wisconsin Card Sorting subtests (categories completed and perseverative errors) and positive treatment response.

[Quantitative electroencephalography in obsessive-compulsive disorder: preliminary results].

The predictive value of quantitative electroencephalography (EEGq) was investigated with regard to the pharmacological treatment of 10 non-medicated obsessive-compulsive disorder (OCD) patients diagnosed according to DSM-IV criteria. The following variables were selected: bipolar relative power in alpha band for Cz-C3, Cz-C4, T3-T5, T4-T6, T3-F7 and T4-F8; bipolar relative power in theta band for Cz-C3, Cz-C4, T3-T5, T4-T6, T3-F7 and T4-F8; and monopolar relative power in theta band for Fp1, Fp2, F7, F3, Fz, F4 and F8. There was statistically significant deviations in five patients with regard to bipolar relative power in alpha band for central regions when compared to normative data bank (control group).

Neuropsychological sequelae in Kleine-Levin syndrome: case report.

Kleine-Levin syndrome is characterized by periodic hypersomnia, hyperphagia, sexual disinhibitions and behavioral disturbances. The prognosis is generally benign, with normal cognitive and social functions after the episodes. We describe a typical case of Kleine-Levin syndrome associated with apparent academic decline, neuropsychological sequelae and personality alterations after the second episode of the illness.

Social functioning in depression: a review.

Objective: This article reviews the available data on social functioning in depression and provides clinical guidelines and opinion on this important and expanding field.

Data Sources: A MEDLINE search was conducted to identify all English-language articles (1988-1999) using the search terms depression and social functioning, depression and social adjustment, depression and psychosocial functioning, and social functioning and antidepressant. Further articles were obtained from the bibliographies of relevant articles.

Double-blind, placebo-controlled study with reboxetine in inpatients with severe major depressive disorder.

The efficacy and tolerability of reboxetine, a unique selective noradrenaline reuptake inhibitor, were compared with those of placebo in a 6-week, randomized, double-blind study of hospitalized patients with a DSM-III-R diagnosis of major depressive disorder. Fifty-two patients (25 in the placebo group, 27 in the reboxetine group) were included in the efficacy analysis. Sixteen (64%) of those in the placebo group and four (15%) in the reboxetine group were withdrawn during the study because of lack of efficacy.

Reboxetine versus imipramine in the treatment of elderly patients with depressive disorders: a double-blind randomised trial.

Background: Depression in older people is often unrecognised and untreated or under-treated. Antidepressant treatment may itself exacerbate a pre-existing illness, interact with concomitant medications or produce undesirable cognitive and sedative side effects. Newer antidepressants may offer advantages in terms of a lesser burden of adverse effects.

Reboxetine, the first selective noradrenaline reuptake inhibitor antidepressant: Efficacy and tolerability in 2613 patients.

Introduction: Reboxetine is the first available selective noradrenaline re-uptake inhibitor (selective NRI). This paper gives an overview of its antidepressant efficacy and tolerability in eight randomized double-blind, multicentre clinical trials. The clinical profile of reboxetine is also compared with that of the tricyclic antidepressants (TCAs) desipramine and imipramine and the selective serotonin re-uptake inhibitor (SSRI) fluoxetine.

The selective noradrenaline re-uptake inhibitor reboxetine has an early onset of antidepressant action.

Introduction: Most antidepressants take several weeks to demonstrate a therapeutic effect. We examined the time to onset of action of reboxetine, a unique selective noradrenaline re-uptake inhibitor (selective NRI).

Methods: In a multinational, multicentre, double-blind, parallel-group study, 56 inpatients with major depression were randomized to receive placebo or reboxetine titrated to 10 mg/day for 6 weeks.

Fluoxetine versus amitriptyline in the treatment of major depression with associated anxiety (anxious depression): a double-blind comparison.

Although common in clinical settings, major depressive disorder with associated anxious symptoms ('anxious depression') has not been well studied in antidepressant clinical trials. The aim of this study was to compare the effects of fluoxetine versus amitriptyline in this group of patients. After a single-blind placebo run-in period of 2 weeks, patients were treated on a double-blind basis with fluoxetine or amitriptyline for 8 weeks.

Reboxetine, a unique selective NRI, prevents relapse and recurrence in long-term treatment of major depressive disorder.

Background: The long-term efficacy and tolerability of the antidepressant reboxetine, a unique selective norepinephrine reuptake inhibitor (selective NRI), were assessed in an international study.

Method: Two hundred eighty-three patients with recurrent DSM-III-R major depression who responded to 6 weeks of reboxetine treatment (> or =50% decrease in Hamilton Rating Scale for Depression [HAM-D] total score) were randomly assigned to receive reboxetine or placebo for 46 weeks in a double-blind phase. Relapse (> or =50% increase in HAM-D total score and/or a HAM-D total score > or =18) rate was the principal assessment criterion and included patients who experienced relapse or recurrence.

Pharmacotherapy of dysthymic and chronic depressive disorders: overview with focus on moclobemide.

Chronic depression was once considered untreatable pharmacologically. Open studies conducted around 1980 demonstrated efficacious results with tricyclics, classical MAOIs and lithium in 45% of cases. The subsequent delineation of dysthymia in DSM-III and its future editions as well as ICD.

Pharmacotherapy of dysthymia: review and new findings.

Open trials with tricyclics, classical monoamine oxidase inhibitors (MAOIs) or lithium in dysthymia yielded a response rate in 45% of subjects. A long-term treatment of dysthymia with 276 patients treated during 4 years with either moclobemide, tranylcypromine or a combination of amitryptiline plus chlordiazepoxide is described. After discontinuation there was a relapse rate of 89.

Social phobia: long-term treatment outcome and prediction of response--a moclobemide study.

In this open, prospective, structured, naturalistic study of the efficacy of long-term treatment in social phobia 93 consecutive outpatients suffering from severe generalized or circumscribed social phobia (median Liebowitz Social Anxiety Scale score 83) and a high degree of concomitant psychiatric disease were administered treatment with moclobemide (712 +/- 75 mg/day at steady state). Fifty-nine patients who responded (Clinical Global Impression for Change: very much/much improved) completed 2 years of treatment. Patients then entered a drug-free period of at least 1 month during which 88% of the patients deteriorated.