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Biomedical subjects

I Varia

Publications and source records attributed to I Varia.

7 recordsLinked to original sources
PubMed2002

Treatment of generalized anxiety disorder with citalopram.

Serotonin reuptake inhibitors (SSRI), such as venalafaxine and paroxetine, are used in the treatment of generalized anxiety disorder (GAD). Patients with GAD frequently have comorbid psychiatric disorders, such as depression. SSRIs are effective in the treatment of a variety of anxiety disorders and depression. Citalopram, a newer SSRI used in the treatment of depression, has not been studied for GAD. This is the first report of the use of citalopram, the most selective SSRI, for the treatment of GAD in a retrospective case observation study. Thirteen patients diagnosed with GAD were treated with citalopram at an academic outpatient clinic. The main outcome measures were the Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Depression Rating Scale (HAM-D) and Clinical Global Impressions of Severity (CGI-S; at baseline) and Improvement (CGI-I). The mean age of the patients was 38 years. The mean dose of citalopram at endpoint was 33 mg/day (range 10-60 mg/day). After 12 weeks of treatment with citalopram, all 13 patients experienced full or partial improvement in GAD and depressive symptoms leading to meaningful improvement in social and occupational functioning. Mean baseline HAM-A scores (mean+/-SEM) decreased from 22.2+/-1.3 to 6.2+/-0.9 after citalopram treatment. The mean CGI-I score was 1.8+/-0.2 with 11 of the 13 patients responding (CGI-I of 1 or 2). These data suggest that citalopram may be an effective treatment for GAD. Several patients who had failed previous treatment with other SSRIs responded to citalopram, suggesting that a second SSRI, such as citalopram, may be beneficial in this population. A larger placebo-controlled study of citalopram is warranted in GAD.

Adolescent↗
PubMed2000

Randomized trial of sertraline in patients with unexplained chest pain of noncardiac origin.

BACKGROUND: Between 10% and 30% of patients with symptoms similar to angina and sufficient to justify cardiac catheterization are found to have normal coronary angiograms. Treatment of patients with chest pain with no apparent cardiac cause is a major clinical problem. Our hypothesis was that sertraline would reduce the severity of pain in patients with chest pain of noncardiac origin. METHODS AND RESULTS: This was a single-site, double-blind, placebo-controlled study of the efficacy, tolerability, and safety of sertraline in the treatment of noncardiac chest pain in outpatients. Thirty patients were enrolled in the study. After 1 week of single-blind placebo washout, patients were randomly assigned in a double-blind fashion either to drug or placebo. The Beck Depression Inventory was administered at baseline and at completion of study. Daily pain diaries (visual analogue scale, rating pain on a scale of 1 to 10) were selfadministered and evaluated at baseline and at follow-up visits. Statistical measures were performed with an intention-to-treat approach. Patients who received sertraline over the course of the study showed a statistically significant reduction in pain compared with those who were receiving placebo. CONCLUSIONS: The use of sertraline in patients with noncardiac chest pain produced clinically significant reduction of daily pain. These results suggest the need for further studies of the efficacy and tolerability of sertraline and other selective serotonin reuptake inhibitors in the long-term management of noncardiac chest pain.

Adolescent↗
PubMed1992

Medically unexplained syncope: relationship to psychiatric illness.

The purpose of this article is to review the literature and present new data concerning the relationship between psychiatric disorders and unexplained syncope. Several case series are presented of patients with syncope in whom psychiatric structured interviews were undertaken, tilt-table (physiologic) testing was performed, and health-related quality of life was measured. Patients seen in a syncope specialty clinic underwent structured psychiatric interviews in addition to in-depth medical evaluations. Tilt-table testing was performed on a separate series of patients to determine susceptibility to syncope during the orthostatic challenge of head-up tilt; in some cases, tilt studies included simultaneous electroencephalographic (EEG) monitoring and cerebral blood flow measurements. Formal functional status assessment was carried out using the Sickness Impact Profile, the Symptom Check List 90, and the Medical Outcomes Study Short-Form 36. Psychiatric disorders (in particular, panic disorders and major depression) were a common cause of syncope (24-31% of syncope patients). Tilt table studies showed several physiologic profiles in syncope: (a) a typical vasovagal (hypotension-bradycardia) response, (b) a "psychosomatic" response (fainting with normal vital signs), and (c) a gradual decline in blood pressure (dysautonomic response). EEG and cerebral blood flow measurements in three patients with the psychosomatic response to tilt were normal during fainting. Functional status measurements showed serious impairment in two series of syncope patients. Conclusions were as follows: (a) Psychiatric disorders are common in syncope. (b) Tilt-table methodology may elucidate underlying mechanisms of syncope in these subjects. (c) Syncope can seriously disrupt a patient's life and result in important psychosocial sequelae. (d) There is an intimate relationship between unexplained syncope and psychiatric illness, mandating a combined medical and psychiatric approach to such patients.

Humans↗
PubMed1990

Psychiatric syncope: a new look at an old disease.

Psychiatric disorders in patients with unexplained syncope or presyncope have received little attention in the recent medical literature. Seventy-two patients with unexplained syncope and presyncope referred to the Duke Syncope Clinic received a standardized evaluation. Symptoms appeared to be explained by a psychiatric diagnosis in 17 (24%) patients (panic disorder in 13%, and major depression in 11%). These patients were younger than other patients with syncope and presyncope (p less than .001) and had more disability due to their syncope and presyncope (p less than .01). They also had more frequent episodes of syncope (p less than .005) and more symptoms as a part of their prodrome (p less than .0001). Treatment aimed at the psychiatric diagnosis resulted in a remission from syncopal or presyncopal symptoms in 90% of patients who complied with therapy. The authors conclude that psychiatric disorders are common in patients with syncope and presyncope, that certain characteristics of the patient and prodrome may alert physicians to a psychiatric diagnosis, and that directed treatment may result in relief from symptoms.

Anxiety Disorders↗