Biomedical subjects

Erica Sood

Publications and source records attributed to Erica Sood.

7 recordsLinked to original sources

PubMed2006

Positron emission tomography imaging of risperidone augmentation in serotonin reuptake inhibitor-refractory patients.

We studied 15 nondepressed patients with obsessive-compulsive disorder (OCD) who were nonresponders to serotonin reuptake inhibitors with an additive trial of risperidone. Positron emission tomography with (18)F-deoxyglucose and magnetic resonance imaging was obtained at baseline and following 8 weeks of either risperidone or placebo in a double-blind parallel group design. Risperidone treatment was associated with significant increases in relative metabolic rate in the striatum, cingulate gyrus, the prefrontal cortex, especially in the orbital region, and the thalamus. Four of 9 patients who received risperidone showed clinical improvement (CGI score of 1 or 2 at 8 weeks) while none of the 6 patients who received placebo showed improvement. Patients with low relative metabolic rates in the striatum and high relative metabolic rates in the anterior cingulate gyrus were more likely to show a clinical response. These metabolic predictors of clinical response are consistent with earlier PET studies showing similar prediction when either neuroleptics or serotonin reuptake inhibitor treatments are administered individually. Our results are consistent with a frontostriatal circuit change related to both dopaminergic and serotonergic systems and with the presence of psychopharmacological subtypes within OCD.

Adult↗

PubMed2005

Pharmacological treatments of pathological gambling.

Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.

Antidepressive Agents, Second-Generation↗

PubMed2005

Imaging monetary reward in pathological gamblers.

We acquired two 18F-deoxyglucose positron emisssion tomography (PET) scans on seven unmedicated pathological gamblers, at least 7 days apart. Following an injection of 5 mCi FDG, subjects carried out a computer blackjack task for 35 min under two different reward conditions: monetary reward and computer game points only. Relative FDG metabolic rate was obtained from regions of interest in the prefrontal cortex, cingulate, striatum and visual cortex. Monetary reward blackjack was associated with significantly higher relative metabolic rate in the primary visual cortex (Brodmann area 17), the cingulate gryus (Brodmann area 24), the putamen and prefrontal areas 47 and 10, compared to blackjack playing for points only. No area tested showed a significant decrease. This pattern suggests heightened limbic and sensory activation in the gambling for money condition with increased emotional valence and greater risk and reward, and confirms the salience of monetary reward in the development of pathological gambling.

Adult↗

PubMed2005

Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders?

OBJECTIVE: Selective serotonin reuptake inhibitors may be effective for some patients with pathological gambling, but those with comorbid conditions, such as bipolar spectrum disorders, may relapse during treatment. To the authors' knowledge, this is the first placebo-controlled treatment study in pathological gamblers with bipolar spectrum disorders; it compares sustained-release lithium carbonate to placebo. METHOD: Forty pathological gambling patients with bipolar spectrum disorders entered a 10-week randomized, double-blind, placebo-controlled treatment study of sustained-release lithium carbonate. Outcome measures included gambling severity, mood, anxiety, and impulsivity scales. RESULTS: Pathological gambling patients with bipolar spectrum disorders significantly improved while taking sustained-release lithium carbonate compared to placebo on total pathological gambling scores on the Yale-Brown Obsessive Compulsive Scale, including both thoughts/urges and behavior, as well as on the Clinical Global Impression severity of pathological gambling scale. Affective instability (the Clinician-Administered Rating Scale for Mania score) was also lower in the group treated with sustained-release lithium carbonate compared to placebo. Ten (83%) of 12 completers were rated as responders in the sustained-release lithium group versus five (29%) of 17 in the placebo group. Of note, improvement in gambling severity was significantly correlated with improvement in mania ratings. CONCLUSIONS: Sustained-released lithium may be an effective treatment in reducing both gambling behavior and affective instability in pathological gamblers with bipolar spectrum disorder. This study highlights the need to identify subgroups of pathological gambling patients with bipolar spectrum conditions because this may have important treatment implications.

Adult↗

PubMed2003

Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study.

This double-blind, placebo-controlled trial was performed to determine the efficacy and tolerability of 8 wk of risperidone augmentation of serotonin reuptake inhibitor (SRI) treatment in adult subjects with treatment-resistant obsessive-compulsive disorder (OCD) (failure of at least two SRI trials). Sixteen adult treatment-resistant OCD patients were randomly assigned to augmentation with 8 wk of either risperidone (n=10) (0.5-3.0 mg/d) or placebo (n=6) following at least 12 wk of SRI treatment. Four patients on risperidone (40%) and none (0%) on placebo were responders with both a Clinical Global Impression - Improvement (CGI-I) score of 1 or 2 and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decrease >/=25%. Risperidone was generally well tolerated: there were 3 dropouts, 1 on risperidone and 2 on placebo. Better Y-BOCS insight score at baseline significantly correlated with a greater CGI-I score at endpoint on risperidone augmentation. Risperidone may be an effective and well-tolerated augmentation strategy in treatment-resistant OCD subjects, but larger sample size studies are required to demonstrate this.

Adult↗

PubMed2002

Lithium and valproate treatment of pathological gambling: a randomized single-blind study.

OBJECTIVE: The aim of the present study was to evaluate the efficacy and safety of lithium and valproate in nonbipolar pathological gamblers. METHOD: Forty-two subjects with DSM-IV-defined pathological gambling entered a 14-week single-blind trial with lithium (N = 23) or valproate (N = 19). A total of 15 subjects on lithium treatment and 16 patients on valproate treatment completed the 14-week protocol. RESULTS: At the end of the 14-week treatment period, both the lithium and the valproate groups showed significant (p <.01) improvement in mean score on the Yale-Brown Obsessive Compulsive Scale modified for pathological gambling. This improvement did not significantly differ between groups. Fourteen (60.9%) of the 23 patients taking lithium and 13 (68.4%) of the 19 patients taking valproate were responders based on a Clinical Global Impressions-Improvement score of much or very much improved. CONCLUSION: Findings from the present study suggest the efficacy of both lithium carbonate and valproate in the treatment of pathological gambling. This is the first controlled trial of the efficacy of mood stabilizers in pathological gambling. A double-blind, placebo-controlled trial is required to confirm these findings.

Anticonvulsants↗

PubMed2002

Nefazodone treatment of pathological gambling: a prospective open-label controlled trial.

BACKGROUND: Pathological gambling is a disabling and highly prevalent impulse-control disorder not otherwise specified (NOS). According to the hypothesis of abnormal serotonin function in the pathophysiology of poor impulse control and pathological gambling, we assessed the efficacy and tolerability of nefazodone, a 5-HT antagonist reported to be effective in other impulse-control disorders NOS, in the treatment of pathological gambling. METHOD: Fourteen outpatients who met DSM-IV criteria for pathological gambling were enrolled in a prospective 8-week open-label oral nefazodone trial. Nefazodone was initiated at 50 mg/day and titrated upward to a maximum of 500 mg/day based on patient's response and side effects, with a minimum daily dose of 100 mg. Improvement in gambling was assessed via the pathological gambling modifications of the Yale-Brown Obsessive Compulsive Scale (PG-YBOCS), the Clinical Global Impressions-Improvement scale (PG-CGI-I), and self-rated gambling scales. Response was defined a priori as both a 25% reduction in PG-YBOCS score and a score of 1 (very much improved) or 2 (much improved) on the PG-CGI-I scale. RESULTS: Twelve subjects completed the study, and 2 subjects were early dropouts who did not receive the minimum required dose. Significant improvements were noted in all gambling outcome measures, as well as in depression and anxiety ratings (which did not significantly correlate with gambling reduction). Nine (75%) of 12 patients were rated as responders according to a priori criteria. Side effects (dry mouth and sedation) of moderate severity occurred in 4 subjects. CONCLUSION: These preliminary results suggest that nefazodone may be effective in reducing symptoms of pathological gambling and is well tolerated.

Adult↗