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Biomedical subjects

S C Sonne

Publications and source records attributed to S C Sonne.

17 recordsLinked to original sources
PubMed2001

Paroxetine for social anxiety and alcohol use in dual-diagnosed patients.

The objective of this study was to compare the efficacy and tolerability of paroxetine to matched placebo in adults with co-occurring social anxiety disorder and alcohol use disorder. Outcome measures included standardized indices of social anxiety and alcohol use. Fifteen individuals meeting DSM-IV criteria for both social anxiety disorder and alcohol use disorder were randomized to treatment. Paroxetine (n = 6) or placebo (n = 9) was given in a double-blind format for 8 weeks using a flexible dosing schedule. Dosing began at 20 mg/d and increased to a target dose of 60 mg/d. There was a significant effect of treatment group on social anxiety symptoms, where patients treated with paroxetine improved more than those treated with placebo on both the Clinical Global Index (CGI) and the Liebowitz Social Anxiety Scale (Ps < or = 0.05). On alcohol use, there was not a significant effect of treatment on quantity/frequency measures of drinking, but there was for the CGI ratings (50% paroxetine patients versus 11% placebo patients were improvers on drinking, P < or = 0.05). This pilot study suggests that paroxetine is an effective treatment for social anxiety disorder in individuals with comorbid alcohol problems, and positive treatment effects can be seen in as little as 8 weeks. Further study is warranted to investigate its utility in helping affected individuals reduce alcohol use.

Adolescent↗
PubMed2001

Alcohol and substance abuse.

Substance abuse and dependence is a public health problem with far-reaching societal implications. The acute toxicity of substances of abuse and medical consequences of chronic use are substantial. On a more optimistic note, a great deal of progress has been made in understanding and treating substance use disorders. Expanding knowledge concerning the neurobiology of substances of abuse and substance use disorders has led to a growth in pharmacotherapeutic treatment options. A growth in understanding of behavioral processes, motivational issues, and processes of behavioral change has been important in designing new and increasingly more effective psychosocial treatments. A growing body of evidence indicates that the treatment of substance use disorders can be effective, making early diagnosis and treatment or referral increasingly important.

Chronic Disease↗
PubMed2000

Oral nutritional supplementation for the alcoholic patient: a brief overview.

Approximately 1.5 million Americans seek treatment for alcoholism annually. Malnutrition is frequently observed in the alcoholic population due to several factors, including poor dietary intake, alcohol-associated gastrointestinal problems, decreased nutrient absorption and enhanced excretion of trace elements. The administration of multivitamins with minerals and folic acid is commonplace. The present paper reviews basic nutrient deficits commonly encountered in alcoholic individuals and describes the rationale and basic guidelines for oral replacement therapy.

Administration, Oral↗
PubMed1999

Substance abuse and bipolar comorbidity.

Bipolar disorder and substance abuse commonly co-occur. In fact, as many as 50% of individuals with bipolar disorder have been found to have a lifetime history of substance abuse or dependence. This article discusses the very important comorbidity of bipolar disorder as it is complicated by substance abuse, focusing on the prevalence, course, diagnostic considerations and treatment.

Anti-Anxiety Agents↗
PubMed1999

The role of stress in alcohol use, alcoholism treatment, and relapse.

Addiction to alcohol or other drugs (AODs) is a complex problem determined by multiple factors, including psychological and physiological components. Stress is considered a major contributor to the initiation and continuation of AOD use as well as to relapse. Many studies that have demonstrated an association between AOD use and stress have been unable to establish a causal relationship between the two. However, stress and the body's response to it most likely play a role in the vulnerability to initial AOD use, initiation of AOD abuse treatment, and relapse in recovering AOD users. This relationship probably is mediated, at least in part, by common neurochemical systems, such as the serotonin, dopamine, and opiate peptide systems, as well as the hypothalamic-pituitary-adrenal (HPA) axis. Further exploration of these connections should lead to important pharmacological developments in the prevention and treatment of AOD abuse. Studies indicate that treatment techniques which foster coping skills, problem-solving skills, and social support play a pivotal role in successful treatment. In the future, individualized treatment approaches that emphasize stress management strategies in those patients in whom a clear connection between stress and relapse exists will become particularly important.

Alcoholism↗
PubMed1998

Diagnosis of personality disorders in cocaine-dependent individuals.

The authors explored the relationship between personality disorder (PD) and cocaine use. Diagnostic interviews for PD were performed at baseline and 12 weeks (study termination) in 47 cocaine-dependent individuals entering a pharmacologic treatment trial; 68% met criteria for a PD at baseline, 51% at study termination. In comparing baseline and termination PD, 22 individuals had no change in the number of PDs, 6 had more, and 17 had fewer. The group with an increase in the number of PD diagnoses had more positive urine drug screens than either of the other groups and more cocaine use by self-report. Personality disorders appear to be common in cocaine-dependent individuals but may be affected by cocaine use and withdrawal.

Adult↗
PubMed1998

Posttraumatic stress disorder and cocaine dependence. Order of onset.

To investigate differences between patients whose posttraumatic stress disorder (PTSD) preceded their cocaine dependence and vice versa, 33 patients with comorbid PTSD and cocaine dependence were divided into two groups: one in which the traum and PTSD occurred before onset of cocaine dependence (primary PTSD) and one in which the PTSD occurred after cocaine dependence was established (primary cocaine). In the primary-PTSD group, the trauma was generally childhood abuse. In the primary-cocaine group, the trauma was generally associated with the procurement and use of cocaine. In the primary PTSD group, there were significantly more women, more other Axis I diagnoses, more Cluster B and C Axis II diagnoses, and more benzodiazepine and opiate use. In the primary-cocaine group, there was a trend toward more cocaine use in the previous month. Significant clinical differences between these two groups may warrant different types of treatment or differing treatment emphasis.

Adult↗
PubMed1995

Venlafaxine: a structurally unique and novel antidepressant.

OBJECTIVE: To introduce the new antidepressant venlafaxine. Basic pharmacokinetic data and clinical trials are reviewed, as well as adverse reactions, drug interactions, dosing guidelines, and therapeutic considerations. The article also discusses several pharmacotherapy issues and how venlafaxine compares with other available antidepressants. DATA SOURCES: A MEDLINE search was used to identify pertinent literature, including reviews. STUDY SELECTION: As this is a relatively new agent, all available clinical trials were reviewed. DATA EXTRACTION: All clinical trials that were available prior to submission for publication were reviewed. Preliminary trials and unpublished reports were not reviewed. DATA SYNTHESIS: Venlafaxine hydrochloride is a structurally novel agent that has recently been approved in the US for the treatment of depression. This unique antidepressant blocks neuronal reuptake of norepinephrine, serotonin, and, to a lesser extent, dopamine. Venlafaxine and its major active metabolite, O-desmethylvenlafaxine, exhibit linear kinetics with an elimination half-life of 5 and 11 hours, respectively. Venlafaxine has been evaluated in 7 clinical trials for the treatment of depression. These have consisted of 2 open trials, 3 double-blind, placebo-controlled trials, and 2 double-blind trials where venlafaxine was compared with trazodone and imipramine. All 7 trials have established efficacy for venlafaxine using standard psychiatric rating scales to measure change of depressive symptoms. The usual daily dosage ranges from 75 to 225 mg/d in 2 to 3 divided doses, with a maximum daily dosage of 375 mg/d. The drug's adverse effect profile differs somewhat from other more specific serotonin reuptake inhibitors in that it appears to cause dry mouth, somnolence, and elevated blood pressure as well as nausea, headache, and dizziness. CONCLUSIONS: Although venlafaxine has recently become available for use as an antidepressant in the US, few clinical trials have been conducted to help the practitioner evaluate its place in the treatment of depression. There are no comparative trials of venlafaxine with the serotonin specific reuptake inhibitor antidepressants, which are rapidly becoming the newest comparative standard. The clinical place for venlafaxine in the treatment of depression has yet to be determined.

Absorption↗
PubMed1995

Sertraline treatment of comorbid posttraumatic stress disorder and alcohol dependence.

BACKGROUND: Posttraumatic stress disorder (PTSD) often co-occurs with alcohol dependence, yet little is known about treatment of this comorbidity. The serotonin selective reuptake inhibitors have been shown preliminarily to be effective in decreasing symptoms of PTSD but have not been studied in individuals with comorbid alcohol dependence. This is of particular interest as the SSRIs also have a modest effect in decreasing alcohol consumption. METHOD: In this preliminary trial, nine subjects with comorbid PTSD and alcohol dependence were treated in an open-label trial with sertraline for a 12-week period. Symptoms of PTSD and depression were monitored monthly with the Impact of Event Scale and the Hamilton Rating Scale for Depression (HAM-D). Alcohol consumption was monitored by a self-report instrument (Time-Line Follow-Back). RESULTS: There were significant decreases in all three symptom clusters of PTSD measured by overall PTSD symptom scores (p < or = .001) and in HAM-D scores (p < or = .001) during the follow-up period. Days of abstinence increased and average number of drinks decreased during the follow-up period. Four subjects claimed total abstinence during the follow-up period. CONCLUSION: While limited by small sample size and the open-label, nonblinded study design, this study suggests that sertraline may be useful in the treatment of PTSD complicated by alcoholism. The medication was well tolerated and subjects showed improvement in PTSD symptoms as well as decreased alcohol consumption. A controlled trial of sertraline in this population would be of interest.

1-Naphthylamine↗
PubMed1995

Valproate in the treatment of acute bipolar affective episodes complicated by substance abuse: a pilot study.

BACKGROUND: Bipolar disorder is commonly complicated by comorbid substance dependence. Little is known about treatment of this important subpopulation of patients with bipolar disorder. The following study was designed to preliminary explore the use of valproate in a group of patients with comorbid bipolar disorder and substance dependence. METHOD: Nine patients with bipolar disorder, as defined by DSM-III-R, and concurrent substance dependence (five alcohol, three polysubstance abuse, one cocaine) were treated with valproate in an open-label, nonblinded trial. Subjects were followed for a mean of 16 weeks. Ratings included measures of affective state (Young Mania Rating Scale, Hamilton Rating Scale for Depression [HAM-D]) as well as substance use (Time-Line Follow-Back). RESULTS: Patients tolerated valproate well with minimal reports of side effects and no liver toxicity or increase in liver function tests noted. The mean +/- SD maintenance dose of valproate was 1583 +/- 204 mg/day. Subjects evidenced significant decreases in both depression (HAM-D score 17.8 vs. 10.4, p < or = .005) and mania (Young Mania Rating Scale score 12.0 vs. 4.9, p < or = .001) ratings by Week 4, which were sustained throughout the study period. There was a significant decrease in number of days of substance use (t = 4.7, p < or = .005) as well as the amount of substances used during the follow-up period as compared with the month before valproate treatment. CONCLUSION: While limited by the open-label, nonblinded nature of the design, this study provides preliminary evidence for the efficacy of valproate in the acute treatment of bipolar episodes complicated by concomitant substance dependence. The medication was well tolerated, and no unacceptable elevations in liver function tests were seen.

Acute Disease↗
PubMed1995

The relationship between substance abuse and bipolar disorder.

The significant prevalence of substance use disorders among patients with psychiatric illnesses has attracted increasing interest. One large epidemiologic study indicates that, of all Axis I disorders, bipolar disorder is the most likely to co-occur with alcohol or drug abuse. Evidence is emerging that shows that bipolar patients who also abuse drugs or alcohol have an earlier onset and worse course of illness compared with those who do not. They are more likely to experience irritable and dysphoric mood states, increased treatment resistance, and a greater need for hospitalization. Caution about diagnosing bipolar disorder in the presence of substance abuse is advised because of overlapping symptomatology. A rationale for the pharmacologic approach to treatment is explored. Data from several studies indicate that the presence of a substance use disorder may be a predictor of poor response to lithium. While it is possible that the anticonvulsants divalproex sodium and carbamazepine may be more useful in this population, a direct comparison of lithium with the anticonvulsants in a substance-abusing population of individuals with bipolar disorder has not yet been performed. Further investigation of diagnostic and treatment issues in this important population of patients with bipolar disorder is needed.

Alcoholism↗
PubMed1994

Substance abuse and bipolar affective disorder.

This interview study was conducted to explore the onset, course, and features of bipolar affective disorder complicated by substance abuse. Forty-four patients with a diagnosis of bipolar affective disorder were interviewed using the Structured Clinical Interview for DSM-III-R, Hamilton Rating Scale for Depression, Young Mania Rating Scale, and a questionnaire concerning psychiatric history. Current substance users averaged twice as many hospitalizations for mood problems. The age of onset of mood problems for substance users was significantly earlier than that of the nonusers (p < or = .05). Substance users were four times as likely to have other comorbid axis I disorders (p < or = .05) and twice as likely to have dysphoric mania at time of interview. This preliminary study suggests that individuals with bipolar affective disorder complicated by substance abuse may have more hospitalizations, a higher incidence of dysphoric mania, earlier onset of mood problems, and more comorbid axis I disorders.

Adult↗
PubMed1993

Lithium side effects in the medically ill.

OBJECTIVE: This review will include the general pharmacology of lithium and discuss its effects on various organ systems, with emphasis on the medically ill patient as well as the geriatric patient with multiple medical problems. METHODS: A full literature review on the side effects of lithium was performed. Attention is focused on the medically ill and possible drug interactions. RESULTS: This review points to the numerous problems which can result in toxicity in the medically ill or the geriatric patient. CONCLUSION: Serious side effects can be avoided with proper drug monitoring and knowledge of potential drug interactions.

Bipolar Disorder↗