David Lloyd Ginsberg, M.D.

Ciprofloxacin-induced mania
Ginsberg DL
2007 ;14(2):27-28, Primary Psychiatry
The fluoroquinolone ciprofloxacin is among the most frequently prescribed antibiotics. As a class, the fluoroquinolones are an under-recognized cause of drug-induced neuropsychiatric effects, with cases reported of psychotic reactions to ciprofloxacin both orally and topically in the form of eye drops. A newer fluoroquinolone, gatifloxacin, has also been associated with delirium and psychosis. The following is the first published report of ciprofloxacin-induced mania
— id: 71154, year: 2007, vol: 14, page: 27, stat: Journal Article,

Clozapine-induced restless legs syndrome
Ginsberg DL
2007 ;14(4):33-34, Primary Psychiatry
— id: 72663, year: 2007, vol: 14, page: 33, stat: Journal Article,

Duloxetine-induced hyponatremia
Ginsberg DL
2007 ;14(2):29-30, Primary Psychiatry
— id: 71152, year: 2007, vol: 14, page: 29, stat: Journal Article,

Topiramate-induced hyperthyroidism
Ginsberg DL
2007 ;14(2):28-29, Primary Psychiatry
— id: 71153, year: 2007, vol: 14, page: 28, stat: Journal Article,

Worsened renal functioning after switch from lithium to gabapentin
Ginsberg DL
2007 ;14(4):32-33, Primary Psychiatry
— id: 72664, year: 2007, vol: 14, page: 32, stat: Journal Article,

Abacavir sulfate-lnduced mania [Column/Opinion]
Ginsberg, David L
2007 ;14(7):39-, Primary Psychiatry
Non-nucleoside reverse transcriptase inhibitors such as zidovudine, didanosine, lamivudine, and stavudine have all been associated with precipitating mania. Presents a case report of abacavir sulfate-induced mania in a 47-year-old man infected with human immunodeficiency virus (HIV).
— id: 139594, year: 2007, vol: 14, page: 39, stat: Journal Article,

Acute porphyria triggered by duloxetine
Ginsberg, David L
2007 ;14(4):31-31 Apr, Primary Psychiatry
The porphyries are a group of bullous disorders caused by abnormalities in the synthesis of heme. Various enzyme deficiencies lead to accumulation of porphyrin precursors. Clinically there are three main categories of which the variegate subtype is characterized by acute episodes and skin changes. Acute cases are characterized by abdominal pain and neuropsychiatric disturbances. Skin changes include acute flares with erythema, edema with pain, and burning. A second pattern has skin fragility with blisters, erosions, and scars. According to the American Porphyria Foundation, drugs considered unsafe for use in porphyria include anticonvulsants, such as phenytoin, carbamazepine, and valproic acid; barbiturates, oral contraceptives, calcium channel blockers, clonazepam, and sulfonamide-antibiotics. (journal abstract)
— id: 73995, year: 2007, vol: 14, page: 31, stat: Journal Article,

Add-on aripiprazole to treat olanzapine-induced metabollic syndrome
Ginsberg, David L
2007 ;14(11):21-23, Primary Psychiatry
Aripiprazole is an atypical neuroleptic indicated for the treatment of schizophrenia and acute manic and mixed episodes associated with bipolar disorder. A potent dopamine partial agonist, aripiprazole acts as an antagonist at dopamine (D)2 receptors under hyperdopaminergic conditions and as a D2 agonist under hypodopaminergic conditions. It has been theorized that dopamine partial agonists may be able to stabilize the dopaminergic system without inducing a hypodopaminergic state, thereby reducing the risk of side effects associated with pure blockade of 'dopamine receptors. In addition to these effects, aripiprazole also acts as a partial agonist at serotonin (5-HT)-sub(1A) and as an antagonist at 5-HT-sub(2A) receptors. Aripiprazole has a low incidence of clinically significant weight gain and hyperlipidemia.
— id: 92738, year: 2007, vol: 14, page: 21, stat: Journal Article,

Alopecia associated with quetiapine
Ginsberg, David L
2007 ;14(6):21-22 Jun, Primary Psychiatry
Presents a case study, of 34-year-old woman with a history of psychotic depression commenced citalopram 20 mg/day and quetiapine 25 mg/day, with the latter titrated up to 100 mg/day. Approximately 6 weeks later, she noticed significant hair loss, involving whole strands. One week after onset, quetiapine was withdrawn. The hair loss resolved. At last follow-up, the patient remained on citalopram. In the second report, another 34-year-old woman with a history of bipolar disorder was taking quetiapine 300 mg/day, zopiclone 7.5-15 mg/day, clonazepam 1 mg as needed, and salbutamol inhaler as needed. There are two main mechanisms presumed to underlie druginduced alopecia. Typically, medication-induced alopecia is reversible upon dosage reduction or discontinuation of the offending drug. Other options for managing this side effect include waiting for accomodation to occur or the use of zinc and selenium.
— id: 93521, year: 2007, vol: 14, page: 21, stat: Journal Article,

Aripiprazole augmentation of clomipramine-refractory obsessive-compulsive disorder
Ginsberg, David L
2007 ;14(8):19-20 Aug, Primary Psychiatry
While currently available treatments, such as selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT), are efficacious in obsessive-compulsive disorder (OCD), only approximately 40% to 60% of patients experience significant reduction of symptoms, with many others demonstrating either partial or no response. Little practical advice is available to clinicians on next-step treatment strategies for patients who have not responded to >=2 trials of SSRIs. Augmentation with various agents, including dopamine antagonists, typically are recommended. In severe, resistant cases, neurosurgery may even be used. The following is a report on the successful use of the atypical antipsychotic aripiprazole in combination with the serotonergic tricyclic antidepressant clomipramine in a patient with severe, refractory OCD.
— id: 92727, year: 2007, vol: 14, page: 19, stat: Journal Article,

Aripiprazole-induced hyponatremia
Ginsberg, David L
2007 ;14(6):19-20 Jun, Primary Psychiatry
Previous Psychopharmacology Reviews have discussed the association between serotonin reuptake inhibitors (SRIs) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is characterized by the sustained release of antidiuretic hormone (ADH) from the posterior pituitary gland. The norepinephrine reuptake inhibitor reboxetine, approved in Europe for the treatment of depression, has also been associated with SIADH. Other medications associated with SIADH include tricyclic antidepressants (TCAs), bupropion, neuroleptics, carbarnazepine, sodium divalproex, vincristine, and cyclophosphamide.
— id: 93523, year: 2007, vol: 14, page: 19, stat: Journal Article,

Atomoxetine-induced salivary gland stones
Ginsberg, David L
2007 ;14(3):31-32 Mar, Primary Psychiatry
Atomoxetine is a norepinephrine reuptake inhibitor approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adults. In randomized controlled trials, approximately 70% of children and adolescents with ADHD without comorbidity responded as measured by reduced scores on a variety of ADHD scales. Prior to being studied in ADHD, atomoxetine was known as tomoxetine and studied as an antidepressant. In those trials, as well as in a recent case report atomoxetine induced mania, a finding consistent with antidepressant activity. The following is the first published report of sialolithiasis in association with atomoxetine. (journal abstract)
— id: 73395, year: 2007, vol: 14, page: 31, stat: Journal Article,

Bilateral eyelid edema due to Olanzapine
Ginsberg, David L
2007 ;14(5):33-33 May, Primary Psychiatry
Presents the first published report of bilateral eyelid edema in association with use of olanzapine. A 41-year-old previously healthy man experienced a first psychotic episode and attempted suicide by opening the veins of his forearm. This act was motivated by the delusional idea that he was infected with human immunodeficiency virus (HIV). He was diagnosed with schizoaffective disorder. Over the weeks, trials of risperidone, aripiprazole, and venlafaxine failed. With a combination of duloxetine 90 mg/day and amisulpride 400 mg/day, psychotic and depressive symptoms improved. Within 24 hours of the first (evening) dose of olanzapine 5 mg, the patient complained of a 'swollen face,' with his eyelids found to be turgid. After 10 days, olanzapine was discontinued and the eyelid swelling disappeared completely the following day. The temporal course of events described suggests an association between olanzapine and the development of bilateral eyelid edema.
— id: 92716, year: 2007, vol: 14, page: 33, stat: Journal Article,

Bupropion-induced Tactile Hallucinations
Ginsberg, David L
2007 ;14(1):24-25 Jan, Primary Psychiatry
Tactile hallucinations of insects, snakes, or other vermin crawling on the skin is known as formication. Overdoses of the norepinephrine-dopamine reuptake inhibitor bupropion have been associated with formication. The following is a report of two cases of formication occurring in association with therapeutic doses of bupropion. In the first case, a 39-year-old African-American woman suffered from posttraumatic stress disorder, major depressive disorder (MDD), and cocaine dependence in full remission for 10 months. There was no history of psychosis or mania. Her medication regimen consisted of buspirone, felodipine, fluoxetine, hydrochlorothiazide, omeprazole, simvastatin, sulindac, and psyllium powder. Bupropion sustained release (SR), titrated over 2-3 weeks to 200 mg BID, was added to augment fluoxetine. Within 3 weeks, the patient complained of bugs crawling on her skin, noting that, when using cocaine, she had similar experiences. Her symptoms abated after her total daily dose of bupropion SR was reduced to 300 mg. In the second case, a 40-year-old white woman had recurrent MDD with no history of psychosis or mania. She was taking levothyroxine, loratadine, montelukast, ranitidine, riboflavin, butalbital as needed for migraines, gabapentin or trazodone as needed for insomnia, and ibuprofen. Bupropion SR was initiated and then titrated over 3 months to 200 mg BID. The depression remitted. However, 11 months into treatment, the patient admitted that soon after increasing her dosage of bupropion to 200 mg BID she developed continuous, mild, tactile hallucinations like bugs crawling on her skin. Her tactile hallucinations resolved after the total daily dose of bupropion SR was reduced to 300 mg. The cases described above are consistent with bupropion-associated formication. Clinical caution is advised.
— id: 70996, year: 2007, vol: 14, page: 24, stat: Journal Article,

Cervical dystonia due to quetiapine-valproic acid interaction
Ginsberg, David L
2007 ;14(9):26-27 Sep, Primary Psychiatry
This is a report of a patient with an acute schizoaffective episode who developed severe cervical dystonia while being treated with a combination of quetiapine and valproic acid. A 60-year-old woman with schizoaffective disorder was admitted to the inpatient psychiatry unit at the University Hospital in Basel, Switzerland due to symptoms of mania and psychosis. She had recently been discharged from the hospital on quetiapine monotherapy 500 mg/day, which led her to remission and had been well tolerated. During that last hospitalization, she suffered two generalized seizures. She discontinued the quetiapine on her own, resulting in a rapid return of psychotic symptoms. She developed paranoia about being poisoned, as manifested by her persistent refusal of food and fluid intake. Upon readmission to the hospital, quetiapine was rapidly increased to 800 mg/day. The cervical dystonia improved with biperiden and resolved totally after reduction of both quetiapine and valproic acid. The patient was discharged on a combination of olanzapine and valproic acid.
— id: 92733, year: 2007, vol: 14, page: 26, stat: Journal Article,

Disulfiram-induced manic psychosis
Ginsberg, David L
2007 ;14(6):20-21 Jun, Primary Psychiatry
A 34-year-old man was brought by his family to the psychiatric emergency room of a Turkish hospital in May 2005. For the prior 3 days, the patient had suffered from insomnia, talked too much, and exhibited increased psychomotor activity. He claimed that God talked to him and told him that he was special. Upon admission, further evaluation revealed excessive alcohol consumption for 15 years. On average, he drank 5--7 standard units of alcohol per weekend. Mental status examination revealed that the patient had auditory hallucinations. Diagnosed with manic psychosis, the patient was started on haloperidol 20 mg/day, chlorpromazine 100 mg/day, and biperiden 10 mg/day. Within 2 days, the auditory hallucinations disappeared, mystic and megalomanic delusions improved, and insight was restored. In typical practice, disulfiram is initiated at a dose of 500 mg/day then 1 or 2 weeks later decreased to a maintenance dose of 250 mg/day. The temporal sequence of events described above, including a 12-day alcohol-free period in the context of use of higher than normal doses of disulfiram, supports an association between disulfiram and emergence of manic psychosis.
— id: 93522, year: 2007, vol: 14, page: 20, stat: Journal Article,

Do antidepressants reduce male fertility?
Ginsberg, David L
2007 ;14(12):19-21 Dec, Primary Psychiatry
Over the past 2 decades, serotonin reuptake inhibitors (SRIs) have become mainstays in the pharmacologic treatment of depression and anxiety disorders. Surprisingly given their widespread use around the world, few studies have been conducted to evaluate the impact of SRIs on male fertility. The following is a report of two men treated at a high-volume male infertility practice at New York Hospital-Cornell Medical Center in New York City who presented with a clear temporal association between selective serotonin reuptake inhibitor (SSRI) use and impairment in sperm motility and/or sperm transport (emission). Both men subsequently showed improvement in sperm counts and motility after discontinuation of their SSRIs, with one of the men also showing a similar association with the norepinephrine-dopamine reuptake inhibitor (NDRI) bupropion.
— id: 92712, year: 2007, vol: 14, page: 19, stat: Journal Article,

Lithium-induced Brugda syndrome
Ginsberg, David L
2007 ;14(10):19-22 Oct, Primary Psychiatry
The July 2007 'Psychopharmacology Reviews' discussed a report of second-degree, type 2 sinoatrial block that resulted from toxic lithium levels Other possible electrocardiogram (ECG) manifestations of lithium toxicity include prolonged QT interval, T-wave flattening and inversion, first-degree atrioventricular conduction delay, and, rarely, ventricular tachycardia and ventricular fibrillation resulting in death.
— id: 93526, year: 2007, vol: 14, page: 19, stat: Journal Article,

Lithium-induced sinoatrial block [Column/Opinion]
Ginsberg, David L
2007 ;14(7):37-39 Jul, Primary Psychiatry
For over 30 years, lithium carbonate has been a mainstay in the treatment of bipolar disorder. With a narrow therapeutic index, toxicity associated with lithium ranges from gastrointestinal complaints to marked neurologic impairment. Electrocardiogram (ECG) manifestations of lithium toxicity include prolonged QT interval, T wave flattening and inversion, first-degree atrioventricular conduction delay and, rarely ventricular tachycardia and fibrillation resulting in death.
— id: 92722, year: 2007, vol: 14, page: 37, stat: Journal Article,

Low-dose aripiprazole to treat ephedrine dependence
Ginsberg, David L
2007 ;14(12):21-22 Dec, Primary Psychiatry
A 37-year-old woman with an eating disorder and major depressive disorder, initially presented in 2005 to the University of New Mexico Mental Health Center when she was forced into treatment by her probation officer after a routine urine drug screen was positive for methamphetamine. The patient adamantly denied having ever used methamphetamine but did acknowledge a 20-year history of abusing over-the-counter medications to maintain her weight. Subsequent hair analysis confirmed the presence of ephedrine but not methamphetamine. The patient had limited insight into the problems associated with her ephedrine dependence. She refused to consider the risk of cardiac complications that could result from excessive ephedrine intake. Moreover, she continued to use ephedrine despite having to spend 3 nights in the county jail after a second urine drug screen was positive for methamphetamine. Subsequent hair analysis demonstrated this to be a false positive.
— id: 92711, year: 2007, vol: 14, page: 21, stat: Journal Article,

Methylphenidate-associated cataract and glaucoma
Ginsberg, David L
2007 ;14(5):34-34 May, Primary Psychiatry
Presents a case of bilateral complicated cataract and glaucoma following large-dose methylphenidate use for 2 years. A 10-year-old boy presented with progressive blurred vision in both eyes over the past year. He had no history of systemic disease, ocular trauma, or ocular disorder except myopia before this episode. Three months before the current visit, decreased visual acuity had been noted during a routine school physical check-up. Glaucoma and cataract were diagnosed at the ophthalmic clinic. History revealed that the patient had ADHD and had been taking methylphenidate hydrochloride 40 mg/day in two divided doses as prescribed by his psychiatrist. Over the prior 2 years, however, at the instruction of his mother, the patient had been taking 60 mg/day. A diagnosis was made of methylphenidate-associated cataract and glaucoma. Methylphenidate was discontinued. Despite maximal anti-glaucomatous medication, IOP still could not be controlled. The patient then received combined cataract and glaucoma surgery, with intraocular lens implantation for both eyes. Postoperatively, visual acuity improved with IOP within normal limits in both eyes. These improvements were sustained at 1 year follow-up.
— id: 92715, year: 2007, vol: 14, page: 34, stat: Journal Article,

Modafinil-Associated Mania
Ginsberg, David L
2007 ;14(1):23-24 Jan, Primary Psychiatry
Modafinil is a novel psychostimulant that is Food and Drug Administration-approved for the treatment of excessive daytime somnolence associated with narcolepsy, obstructive sleep apnea/hypopnea syndrome, or shift work sleep disorder. Among its pharmacologic properties, modafinil enhances glutamate neurotransmission. In contrast to other stimulants, modafinil does not cause elation or euphoria in healthy volunteers or in substance abusers. In fact, one report suggests that modafinil may be effective for the treatment of amphetamine craving and dependence, while another report indicates that it may be useful in the treatment of cocaine dependence. Because of this lower abuse potential, modafinil is a Schedule IV prescription, allowing multiple refills and prescriptions by phone. Among the most common side effects associated with modafinil in premarketing trials were headache, nausea, anxiety, and insomnia. (journal abstract)
— id: 70997, year: 2007, vol: 14, page: 23, stat: Journal Article,

Olanzapine-induced pancreatitis due to chylomicronemia
Ginsberg, David L
2007 ;14(9):26-26 Sep, Primary Psychiatry
A side effect reported in association with olanzapine is metabolic dysregulation, which includes weight gain, hyperinsulinemia, and lipid abnormalities. The following a report of olanzapine induced chylomicronemia resulting in acute pancreatitis. A 36-year-old Libyan man presented with a 3-day history of epigastric pain. While there have been several prior reports describing the association of olanzapine with acute pancreatitis, the exact mechanism remains unclear. Based on the case described here, it appears that chylomicronemia may underlie the association between olanzapine and acute pancreatitis. Regular monitoring of serum lipids is essential not only for general cardiovascular health, but to prevent this potential life-threatening condition.
— id: 92734, year: 2007, vol: 14, page: 26, stat: Journal Article,

Paroxetine Effective for Paroxysmal Atrial Fibrillation in Depressed Men
Ginsberg, David L
2007 ;14(1):25-25 Jan, Primary Psychiatry
The occurrence and duration of paroxysmal atrial fibrillation are influenced by vagal tone. The selective serotonin reuptake inhibitor (SSRI) paroxetine can modulate vagal tone at the level of the mid-brain and inhibit the vasovagal reflex. Paroxysm of refractory neurally mediated syncope has been reduced with paroxetine. That finding supports the notion that paroxetine may modulate the occurrence of atrial fibrillation that is under the influence of the vagus nerve. In one study, oral paroxetine 10 mg/day was administered to nine patients with multidrug-resistant paroxysmal atrial fibrillation. Conventional antiarrhythmic drugs were used for all the patients for a minimum of 2 weeks, and, in the case of amiodarone, at least 3 months. These agents decreased the frequency of arrhythmia events by < 30% in all patients. In contrast, the frequency decreased significantly in all patients after paroxetine was added. Notably, in three patients, atrial fibrillation resolved completely. In three other patients, the daily doses of antiarrhythmic drugs were decreased by 33% to 50%, although the frequency of atrial fibrillation still remained low. For the group as a whole, the mean atrial fibrillation frequency declined from a baseline of 13.2 to 1.0 episodes per month. These preliminary results indicate that some patients with atrial fibrillation may respond very favorably to oral treatment with paroxetine. While the pathophysiology underlying this effect is not known, several possibilities exist, including modulation of central serotonin metabolism at the level of the mid-brain and anxiolysis resulting in decreased myocardial irritability. Whether the reputed benefit of paroxetine or other SSRIs in the treatment of atrial fibrillation depends upon the presence of comorbid depression is a question worthy of further study.
— id: 70995, year: 2007, vol: 14, page: 25, stat: Journal Article,

Phenytoin-temozolomide interaction resulting in delirium
Ginsberg, David L
2007 ;14(8):20-21 Aug, Primary Psychiatry
While use of the anticonvulsant phenytoin has been associated with delirium, a substantial majority of cases occur in the context of either hepatic compromise or drug-drug interaction. The following is a report of an individual undergoing treatment for metastatic brain tumor who subsequently developed delirium likely related to an interaction between the chemotherapy agent temozolomide and phenytoin. A 68-year-old man was in his usual state of good health when he developed a personality change as well as word-finding and memory difficulty. Compared with his previous neurologic evaluation, the patient was noted to be profoundly confused, averbal, and unresponsive to most questions. No new focal neurologic findings were evident. The rapid onset and marked changes in behavior, cognition, hallucinations, and sleep-wake cycle all point to a delirium, most probably caused by an elevation in phenytoin levels; the latter possibly resulted from inhibition of phenytoin's metabolism by the coadministered temozolomide. Subsequently, the patient was lost to follow-up.
— id: 92725, year: 2007, vol: 14, page: 20, stat: Journal Article,

Quetiapine-induced erythema multiforme minor
Ginsberg, David L
2007 ;14(3):32-33 Mar, Primary Psychiatry
This article is the first published case of erythema multiforme minor in association with the second-generation antipsychotic quetiapine. This article presents a case study about a 21-year-old woman with 'school refusal' and home withdrawal for 1 year. This case study is consistent with quetiapine-induced erythema multiforme minor.
— id: 73394, year: 2007, vol: 14, page: 32, stat: Journal Article,

Rabeprazole-induced panic attacks
Ginsberg, David L
2007 ;14(9):25-25 Sep, Primary Psychiatry
Rabeprazole is an anti-ulcer drug in the class of proton pump inhibitors (PPIs). Psychiatric adverse effects reported for rabeprazole during controlled trials and post marketing experience are rare and include insomnia, anxiety, depression, somnolence, abnormal dreams, decreased libido, agitation, amnesia, and confusion. The following is a published report in which a patient developed marked anxiety and panic attacks in association with use of rabeprazole.
— id: 92735, year: 2007, vol: 14, page: 25, stat: Journal Article,

Serotonin syndrome due to duloxetine-cyclobenzaprine combination
Ginsberg, David L
2007 ;14(3):33-33 Mar, Primary Psychiatry
This article is a report of serotonin syndrome resulting from an interaction between cyclobenzaprine and the serotonin norepinephrine reuptake inhibitor duloxetine. This article presents a case study of a 53-year-old man with a history of multiple low-back surgeries. He had a history of chronic pain and depression, for which he was receiving duloxetine 60 mg/day, pregabalin 75 mg BID, bupropion 300 mg/day, and oxycodone or hydromorphone as needed for pain. The temporal sequence of events described in this article is consistent with serotonin syndrome resulting principally from an interaction between cyclobenzaprine and duloxetine.
— id: 73393, year: 2007, vol: 14, page: 33, stat: Journal Article,

Serotonin-norepinephrine reuptake inhibitor-induced hyperprolactinemia and galactorrhea
Ginsberg, David L
2007 ;14(8):20-20 Aug, Primary Psychiatry
Dopamine acts to inhibit the release of prolactin, a hormone that initiates and sustains lactation. In women, prolactin elevation can cause galactorrhea, amenorrhea, cessation of normal cyclic ovarian function, loss of libido, hirsutism, and increased long-term risk of osteoporosis and breast cancer. Presented here is a case of hyperprolactinemia and galactorrhea associated with sequential use of the serotnin norepinephrine reuptake inhibitors (SNRIs) venlafaxine and duloxetine A 40-year-old Caucasian female with three children and without any history of endocrine or reproductive pathology presented with dysthymic disorder. The patient appears to represent the first published case of SNRI-induced, dose-dependent, nonmenstrual vaginal spotting and galactorrhea accompanied by prolactin elevation. Since serum levels were not obtained it is not known if use of bupropion ER resulted in elevated levels of venlafaxine or duloxetine. Interestingly, the dopaminergic effects of bupropion were not enough to offset this patient's hyperprolactinemia, although it is possible but unproved that it may have attenuated it.
— id: 92726, year: 2007, vol: 14, page: 20, stat: Journal Article,

Topiramate-induced facial myoclonus
Ginsberg, David L
2007 ;14(12):22-23 Dec, Primary Psychiatry
The following is a report of two patients who developed reversible facial myoclonus in association with use of topiramate. The first patient was a 28-year-old man with posttraumatic frontal lobe epilepsy who was switched to topiramate monotherapy after failure on phenytoin. Topiramate was initiated at 25 mg/day, then increased by 25 mg every week. The second patient was a 49-year-old woman who presented with new-onset complex partial seizures. In both patients described above, facial myoclonus appears to be a dose-related adverse event associated with topiramate.
— id: 92710, year: 2007, vol: 14, page: 22, stat: Journal Article,

Topiramate-induced suicidality
Ginsberg, David L
2007 ;14(5):32-33 May, Primary Psychiatry
Topiramate is a sulfamate-substituted monosaccharide approved for monotherapy in partial seizures, generalized tonic clonic seizures, and migraine prophylaxis. It blocks voltage-gated sodium channels, enhancesgamma -aminobutyric acid (GABA) via action on the GABA-sub(A) receptor, antagonizes the kainate aminomethyl phosphonic acid (AMPA) subtype of the glutamate receptor, and inhibits carbonic anhydrase. Due to its ability to suppress appetite and cause weight loss, topiramate has gained increasingly widespread use among clinicians as a treatment for psychotropic-induced weight gain, binge-eating disorder, and even bulimia nervosa. Other research suggests that topiramate may also be effective for the treatment of posttraumatic stress disorder (PTSD), obstructive sleep apnea, opiate and benzodiazepine withdrawal, kleptomania, alcohol dependence, self-injurious behavior, aggression) non paraphilic sexual addiction, olfactory hallucinations, and even for the promotion of scar healing.
— id: 92717, year: 2007, vol: 14, page: 32, stat: Journal Article,

Transdermal (but not oral) selegiline effective for treatment-resistant depression [Column/Opinion]
Ginsberg, David L
2007 ;14(7):38-, Primary Psychiatry
This column presents a case of treatment-resistant depression (TRD) in which the transdermal--but not the oral--formulation of selegiline was effective.
— id: 139595, year: 2007, vol: 14, page: 38, stat: Journal Article,

Differential diagnosis of attention-deficit/hyperactivity disorder and comorbid conditions
Adler, Lenard A; Barkley, Russell A; Wilens, Timothy E; Ginsberg, David L [Ed]
2006 ;13(5):1-14 May, Primary Psychiatry
Attention-deficit/hyperactivity disorder (ADHD) is a clinical disorder that may be confused with other medical and psychiatric conditions, due to overlapping symptoms. Often, symptoms suggestive of ADHD may be explained by other diagnoses. Medical 'mimics' one should consider when diagnosing a patient with ADHD include sleep deprivation, chronic and acute illness, medication effects, cognitive deficits, and other psychiatric disorders such as Asperger's syndrome, substance use disorders, and mood disorders. ADHD in both children and adults is also associated with academic performance problems, such as learning disabilities and executive functioning deficits. Learning disabilities such as math and spelling deficits are more common in children, although both age groups experience difficulties with reading and listening comprehension. Executive deficits in response inhibition and working memory have been demonstrated to be predictive of impairment in virtually every major life activity. Evaluation of both children and adults with ADHD requires screening for comorbid medical, psychiatric, and learning disorders; executive functioning; and history of school impairment. In this monograph, Russell A. Barkley, PhD, reviews the comorbidity of adult attention-deficit/hyperactivity disorder (ADHD) and learning and executive function disorders. Next, Timothy E. Wilens, MD, discusses differential diagnosis of ADHD as well as the prevalence of psychiatric comorbidity in adult ADHD. Finally, Lenard A. Adler, MD, reviews Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for adult ADHD and reviews the diagnostic and symptom assessment instruments available for the evaluation of ADHD in this population. (journal abstract)
— id: 64594, year: 2006, vol: 13, page: 1, stat: Journal Article,

Differential Diagnosis and Treatment of Adult ADHD and Neighboring Disorders
Donnelly, Craig L; Reimherr, Frederick W; Young, Joel L; Ginsberg, David L [Ed]
2006 ;13(10):1-16 Oct, Primary Psychiatry
Attention-deficit/hyperactivity disorder (ADHD), once considered to be a childhood disorder, is diagnosed in -7 million adults in the United States, as reported by The National Comorbidity Study. Although it is now recognized that ADHD often persists into adulthood, the current diagnostic criteria is geared toward symptom identification in children. Symptoms of inattention, impulsivity, and hyperactivity evolve over the life cycle and present differently in adults. Further complicating diagnosis is that ADHD is associated with multiple functional impairments and comorbid psychiatric disorders. The Multi-Modal Treatment Study of ADHD reported that only 32% of the study population had ADHD alone; 29% had ADHD plus oppositional defiant disorder and/or conduct disorder, 14% had ADHD plus anxiety or depression, and 25% had all three disorders. Optimal treatment utilizes a multimodal approach including behavioral treatments combined with pharmacologic treatment strategies. Food and Drug Administration-approved medications for ADHD include the stimulants and nonstimulants, although tricyclic antidepressants and bupropion are also commonly used. In this monograph, Craig L. Donnelly, MD, reviews the history of ADHD and discusses the pathophysiologic progression of childhood symptoms into those commonly exhibited by adults. Next, Frederick W. Reimherr, MD, reviews comorbidity of ADHD and describes the Utah Criteria as a method of diagnosing adults through recollection of childhood problems. Finally, Joel L. Young, MD, reviews treatment approaches to adult ADHD and its comorbid conditions. (journal abstract)
— id: 70142, year: 2006, vol: 13, page: 1, stat: Journal Article,

Differential diagnosis and treatment of adult ADHD and neighboring disorders
Donnelly, Craig L; Reimherr, Frederick W; Young, Joel L; Ginsberg, David L [Ed]
2006 ;11(10,Suppl11):1-, CNS spectrums
Attention-deficit/hyperactivity disorder (ADHD), once considered to be a childhood disorder, is diagnosed in similar to 7 million adults in the United States, as reported by The National Comorbidity Study. Although it is now recognized that ADHD often persists into adulthood, the current diagnostic criteria is geared toward symptom identification in children. Symptoms of inattention, impulsivity, and hyperactivity evolve over the life cycle and present differently in adults. Further complicating diagnosis is that ADHD is associated with multiple functional impairments and comorbid psychiatric disorders. The Multi-Modal Treatment Study of ADHD reported that only 32% of the study population had ADHD alone; 29% had ADHD plus oppositional defiant disorder and/or conduct disorder, 14% had ADHD plus anxiety or depression, and 25% had all three disorders. Optimal treatment utilizes a multimodal approach including behavioral treatments combined with pharmacologic treatment strategies. Food and Drug Administration-approved medications for ADHD include the stimulants and nonstimulants, although tricyclic antidepressants and bupropion are also commonly used. In this monograph, Craig L. Donnelly, MD, reviews the history of ADHD and discusses the pathophysiologic progression of childhood symptoms into those commonly exhibited by adults. Next, Frederick W. Reimherr, MD, reviews comorbidity of ADHD and describes the Utah Criteria as a method of diagnosing adults through recollection of childhood problems. Finally, Joel L. Young, MD, reviews treatment approaches to adult ADHD and its comorbid conditions.
— id: 139597, year: 2006, vol: 11, page: 1, stat: Journal Article,

Aripiprazole-induced dystonia
Ginsberg DL
2006 ;13(6):26-27, Primary Psychiatry
— id: 64642, year: 2006, vol: 13, page: 26, stat: Journal Article,

Bupropion-induced cutaneous lupus erythematosus
Ginsberg DL
2006 ;13(4):26-, Primary Psychiatry
— id: 64177, year: 2006, vol: 13, page: 26, stat: Journal Article,

Clozapine-induced systemic lupus erythematosus
Ginsberg DL
2006 ;13(6):27-28, Primary Psychiatry
— id: 64641, year: 2006, vol: 13, page: 27, stat: Journal Article,

Memantine for catatonic schizophrenia
Ginsberg DL
2006 ;13(4):22-23, Primary Psychiatry
Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist approved for moderate-to-severe Alzheimer's disease. The NMDA receptor may be involved in the pathophysiology of schizophrenia, which is believed to be associated with excess production of glutamate in the brain and hyperexcitation of glutamate receptors, thereby allowing prolonged opening of calcium channels. Subsequently, an overabundance of calcium influx causes free-radical damage to the neuron and, eventually, neuronal death. Glutamatergic hyperfunction in the striatum may result in catatonia
— id: 64181, year: 2006, vol: 13, page: 22, stat: Journal Article,

Pindolol for psychogenic polydipsia
Ginsberg DL
2006 ;13(4):24-25, Primary Psychiatry
— id: 64179, year: 2006, vol: 13, page: 24, stat: Journal Article,

Propofol-induced priapism
Ginsberg DL
2006 ;13(6):24-25, Primary Psychiatry
— id: 64644, year: 2006, vol: 13, page: 24, stat: Journal Article,

Ropinirole-induced psychosis
Ginsberg DL
2006 ;13(4):23-, Primary Psychiatry
— id: 64180, year: 2006, vol: 13, page: 23, stat: Journal Article,

Seizures associated with off-label use of tiagabine
Ginsberg DL
2006 ;13(4):25-26, Primary Psychiatry
— id: 64178, year: 2006, vol: 13, page: 25, stat: Journal Article,

Venlafaxine-induced rapid and severe edema
Ginsberg DL
2006 ;13(3):30-31, Primary Psychiatry
Venlafaxine is a serotonin norepinephrine reuptake inhibitor widely used for the treatment of depression, generalized anxiety disorder, and social anxiety disorder, as well as a number of other psychiatric conditions for which serotonergic antidepressants are often employed. Reported side effects for venlafaxine include nausea, somnolence, insomnia, dizziness, constipation, sweating, anorexia, asthenia, nervousness, dose-dependent blood pressure elevation, increased urinary frequency, and sexual dysfunction. The following is a report of venlafaxine-induced rapid and severe edema, otherwise known as anasarca
— id: 63614, year: 2006, vol: 13, page: 30, stat: Journal Article,

Visual hallucinations due to the addition of riluzole to memantine and bupropion
Ginsberg DL
2006 ;13(6):25-26, Primary Psychiatry
— id: 64643, year: 2006, vol: 13, page: 25, stat: Journal Article,

Aripiprazole-associated incomplete right bundle-branch block
Ginsberg, David L
2006 ;13(9):29-29 Sep, Primary Psychiatry
This article discusses the uses of aripiprazole and presents a report of a case of dose-dependent incomplete right bundle-branch block in association with aripiprazole. This is the first such published report. While the incidence appears to be low, its appearance as an adverse event underscores the value of routine EKG monitoring of patients on aripiprazole as well as the other atypical antipsychotics.
— id: 69012, year: 2006, vol: 13, page: 29, stat: Journal Article,

Aripiprazole-associated new-onset diabetes mellitus
Ginsberg, David L
2006 ;13(5):25- May, Primary Psychiatry
Aripiprazole is an atypical neuroleptic indicated for the treatment of schizophrenia and acute manic and mixed episodes associated with bipolar disorder. The most commonly reported side effects in association with use of aripiprazole include insomnia, anxiety, headaches, nausea, vomiting, and somnolence. This article presents the first published reports of aripiprazole-induced new-onset diabetes mellitus.
— id: 64599, year: 2006, vol: 13, page: 25, stat: Journal Article,

Aripiprazole-associated seizure
Ginsberg, David L
2006 ;13(8):30-30 Aug, Primary Psychiatry
Aripiprazole is an atypical neuroleptic indicated for the treatment of schizophrenia and acute manic and mixed episodes associated with bipolar disorder. A potent dopamine partial agonist, aripiprazole acts as an antagonist at dopamine (D) receptors under hyperdopaminergic conditions and as a D-sub-2 agonist under hypodopaminergic conditions. It has been theorized that dopamine partial agonists may be able to stabilize the dopaminergic system without inducing a hypodopaminergic state, thereby reducing the risk of side effects associated with pure blockade of dopamine receptors. In addition to these effects, aripiprazole also acts as a partial agonist at serotonin (5-HT)-sub-1asymptotic-to > and as an antagonist at 5-HT-sub-2asymptotic-to > receptors. The most commonly reported side effects in association with use of aripiprazole include insomnia, anxiety, headaches, nausea, vomiting, and somnolence. The following is a report of aripiprazole-associated seizure.
— id: 68820, year: 2006, vol: 13, page: 30, stat: Journal Article,

Aripiprazole-induced recurrent priapism
Ginsberg, David L
2006 ;13(11):28-29, Primary Psychiatry
Priapism, characterized by abnormal, prolonged, painful erection of the penis, is a urologic emergency. If not treated within 4-6 hours, complications may occur, including difficulty urinating, urinary retention, impotence, cavernosa fibrosis, and gangrene. Even with surgery, approximately 40% to 50% of patients with priapism will become impotent. Priapism results from decreased venous outflow from the corpora cavernosa. This can be caused by physical obstruction of the venous system, blood dyscrasias that impede venous flow, solid tumors, trauma, spinal cord injuries, stroke, or blockade of postsynaptic alpha 1-adrenergic receptors that normally mediate sympathetically controlled detumescence of the penis or clitoris. In general, drug-induced priapism is believed to be mediated by the degree of aradrenergic antagonism. Opposing this tendency are anticholinergic effects. Thus, when a medication has more antiadrenergic than anticholinergic properties, it is more likely to be associated with priapism. Based on a review of available evidence, medication-induced priapism does not appear to correlate with either dose or length of treatment.
— id: 139596, year: 2006, vol: 13, page: 28, stat: Journal Article,

Azithromycin-induced psychotic depression and catatonia
Ginsberg, David L
2006 ;13(5):22-23 May, Primary Psychiatry
Previous reports have documented an association between the macrolide antibiotics clarithromycin and erythromycin with depression, mania, and acute psychosis. This is the first published report of an association between another macrolide antibiotic, azithromycin, and psychotic depression and catatonia. The patient is an 81-year-old woman with a medical history notable for eyelid carcinoma, which was treated 1 year previously with surgery and radiotherapy, and hypertension, which was treated with spironolactone and chlortalidone.
— id: 64602, year: 2006, vol: 13, page: 22, stat: Journal Article,

Baclofen-Induced Psychosis
Ginsberg, David L
2006 ;13(12):29-30 Dec, Primary Psychiatry
Baclofen, the Upsilon -aminobutyric acid (GABA)-sub(B) agonist muscle relaxant, has been commonly used to treat muscle spasms associated with various neurologic conditions including spinal injury, hemi-facial spasm, multiple sclerosis, trigeminal neuralgia, and neuroleptic-induced tardive dyskinesias. The usual dosage ranges from 10-200 mg/day. While baclofen is generally well tolerated, adverse effects are not uncommon, especially when higher doses are used. The following is a report of psychosis associated with use of therapeutic doses of baclofen.
— id: 70999, year: 2006, vol: 13, page: 29, stat: Journal Article,

Bupropion SR for Nicotine-Craving Pica in a Developmentally Disabled Adult
Ginsberg, David L
2006 ;13(12):28-28 Dec, Primary Psychiatry
Pica, defined as the ingestion of nonfood items, likely represents a form of obsessive-compulsive disorder (OCD). Predisposing factors include developmental disabilities, seizure disorders, depression, and OCD. Medication treatments for pica include selective serotonin reuptake inhibitors, tricyclic antidepressants, carbamazepine, and haloperidol. The following is a report on the successful use of the aminoketone norepinephrine and dopamine reuptake inhibitor, bupropion, for the treatment of chronic, persistent, severe nicotine-craving pica in a developmentally disabled adult. (journal abstract)
— id: 71001, year: 2006, vol: 13, page: 28, stat: Journal Article,

Clonidine-induced gynecomastia in a child
Ginsberg, David L
2006 ;13(2):33-34 Feb, Primary Psychiatry
Clonidine is an alpha -sub-2 adrenergic receptor agonist often used for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children. Presented here is a study of hyperprolactinemia and gynecomastia in association with the use of clonidine in a 6-year-old male.
— id: 62757, year: 2006, vol: 13, page: 33, stat: Journal Article,

Clozapine-induced pseudomembranous colitis
Ginsberg, David L
2006 ;13(3):31-32, Primary Psychiatry
The following is a report of clozapine-induced pseudomembranous colitis occurring after 9 years of clozapine therapy. A 38-year-old woman with a 20-year history of organic brain syndrome secondary to chicken pox encephalitis presented with disorganized speech and behavior, aggressive episodes neglect of personal hygiene, and social withdrawal. The patient responded poorly and developed extrapyramidal side effects to various trials of conventional antipsychotics as well as to the atypical antipsychotic risperidone. In 1996, the patient was started on clozapine, which was gradually titrated to a dose of 350 mg/day. Throughout this time, she had no history of upper or lower gastrointestinal complaints. Clozapine was discontinued. Subsequently, the patient has remained psychiatrically stable on a regimen of the substituted benzamide D2 antagonist sulpiride 100 mg/day, sodium valproate 2400 mg/day, and fluvoxamine 25 mg/day. This appears to be the first published case of prolonged administration of clozapine resulting in pseudomembranous colitis, which is a gastrointestinal condition that often occurs without a background of chronic enteric disease and which has previously been associated with the use of antituberculous and antibiotic drugs but not neuroleptics.
— id: 139603, year: 2006, vol: 13, page: 31, stat: Journal Article,

Cognitive decline due to simvastatin
Ginsberg, David L
2006 ;13(10):28-, Primary Psychiatry
Wagstaff et al (2003) have summarized case reports of statin-induced memory problems in patients treated with simvastatin. This article presents a report of new-onset cognitive difficulties in an older patient after initiation of simvastatin therapy. A 64-year-old white male presented with memory problems shortly after initiation of simvastatin therapy. The man had a history of bipolar disorder, characterized predominantly by depressive episodes, which had been stable over the past 2 years. At the time of presentation, the patient's medications included venlafaxine, quetiapine fumarate, simvastatin, terazosin, and carbamazepine extended-release. Simvastatin had been initiated by the patient's primary care physician for dyslipidemia. Within 1 week of starting simvastatin, the patient complained of additional memory problems. The temporal sequence of events supports a highly probable association between simvastatin and cognitive decline in this patient.
— id: 139598, year: 2006, vol: 13, page: 28, stat: Journal Article,

Dose-dependent olanzapine-induced urinary retention
Ginsberg, David L
2006 ;13(10):31-31 Oct, Primary Psychiatry
We present a report of urinary retention in an olanzapine-treated patient. A 24-year-old white man with paranoid schizophrenia was hospitalized for a psychotic episode characterized mainly by paranoid ideas and auditory hallucinations. He consumed alcohol and cannabis regularly and was an active smoker. Upon admission the patient received olanzapine 20 mg/day, but no other medication on a regular basis. Four days following admission, he received haloperidol 5 mg and lorazepam 2 mg orally. Two days later, he began to show clinical improvement consisting of decreased hallucinations and agitation and improved social interactions. However, he had difficulty initiating urination and was completely unable to void. Olanzapine was discontinued, with the urinary retention progressively disappearing over the next 24 hours.
— id: 70144, year: 2006, vol: 13, page: 31, stat: Journal Article,

Exacerbation of posttraumatic stress disorder due to duloxetine
Ginsberg, David L
2006 ;13(5):23-24 May, Primary Psychiatry
Reports the case of a 53-year-old married Vietnam veteran with PTSD and bipolar disorder not otherwise specified (NOS). In 2004, the patient received a trial of duloxetine 60 mg/day. However, within the first week he experienced a severe exacerbation of PTSD symptoms including daily flashbacks of Vietnam, nightmares, emotional numbing, increased startle response, and extreme hypervigilance. The rest of his depressive symptoms remained unchanged. Upon reduction of his daily duloxetine dosage to 30 mg, his PTSD symptoms lessened but still were more severe compared to before the introduction of duloxetine. After duloxetine was totally discontinued, his PTSD symptoms returned to baseline.
— id: 64601, year: 2006, vol: 13, page: 23, stat: Journal Article,

Fatal agranulocytosis four years after clozapine discontinuation
Ginsberg, David L
2006 ;13(2):32-33 Feb, Primary Psychiatry
The first of the atypical neuroleptics Food and Drug Administration-approved for the treatment of schizophrenia, clozapine is known to have a lower risk of causing parkinsonism and tardive dyskinesia in patients with schizophrenia. The drug is indicated for treatment-resistant schizophrenia and for reducing the risk of recurrent suicidal behavior in those with schizophrenia or schizoaffective disorder. Agranulocytosis occurs in 1% to 2% of patients using clozapine, typically within the first 4 months of treatment. According to a report, however, agranulocytosis can occur even after 11 years of continuous treatment. Described here is a study of fatal agranulocytosis occurring 4 years after discontinuation of clozapine in a 49-year-old Finnish man being treated for behavioral problems associated with moderate mental retardation.
— id: 62758, year: 2006, vol: 13, page: 32, stat: Journal Article,

Galantamine-induced QTc prolongation
Ginsberg, David L
2006 ;13(3):33-34, Primary Psychiatry
The following is a report of galantamine-induced QTc interval prolongation. A 47-year-old white male with chronic schizophrenia, diabetes, hypertension, and hyperlipidemia presented in 2004 on a psychotropic drug regimen of aripiprazole, quetiapine, lithium, benztropine and trazodone as needed for sleep. Other medications included aspirin, docusate, enalapril, insulin, lactulose, metoprolol, ranitidine, simvastatin, and vitamin E. After obtaining written informed consent, the patient was started on galantamine 4 mg BID. Immediately prior to initiation of galanfamine, his QTc was 417 msec and his heart rate was 71 beats/minute. In the 5 years prior to his starting on galantamine, on his annual electrocardiogram (EGG), his QTc interval had ranged from 420-443 msec. An EGG obtained 3 months prior to initiation of galantamine revealed a QTc of 415 msec. During the trial of galantamine, the doses of his other medications were held constant. One month after galantamine initiation, his serum lithium level was 0.44 mEq/L. Over a 2 month period, galantamine was titrated to 12 mg BID, at which time an EGG demonstrated a QTc of 518 msec. Galantamine was immediately discontinued, and over the next 1-2 weeks, the QTc shortened to 459 msec and to 414 msec, respectively. This case represents the first published report of QTc prolongation in association with galantamine.
— id: 139600, year: 2006, vol: 13, page: 33, stat: Journal Article,

Gatifloxacin-induced hallucinations
Ginsberg, David L
2006 ;13(9):29-30 Sep, Primary Psychiatry
Ciprofloxacin hydrochloride is a fluoroquinolone antimicrobial often used in ophthalmic and general medical practice. The October 2002 'Psychopharmacology Journal Watch' column contained a story on an acute psychotic reaction following the use of ciprofloxacin eyedrops. This article presents a report of hallucinations in a 19-year-old male apparently induced by another fluoroquinolone, gatifloxacin.
— id: 69011, year: 2006, vol: 13, page: 29, stat: Journal Article,

Hair loss due to lamotrigine
Ginsberg, David L
2006 ;13(10):25-26 Oct, Primary Psychiatry
Previous 'Psychopharmacology Reviews' columns have discussed the use of lamotrigine for bipolar disorder, refractory unipolar depression, treatment-resistant schizophrenia, posttraumatic stress disorder, frontal lobe dementia, and post-stroke pathological laughing and crying. Lamotrigine is an anticonvulsant that blocks voltage-gated sodium channels where it inhibits the excessive release of the excitatory amino acids glutamate and gamma -aminobutyric acid. In addition to its actions on ion channels, lamotrigine weakly inhibits monoamine transporters. At a concentration of 100-1,000 mM, lamotrigine is an inhibitor of 5-hydroxytryptamine uptake in both rat and human tissues. At similar concentrations, lamotrigine also inhibits norepinephrine and dopamine uptake into rat brain synaptosomes. Now comes a report of a woman with bipolar disorder who developed hair loss as a side effect of lamotrigine. (journal abstract)
— id: 70147, year: 2006, vol: 13, page: 25, stat: Journal Article,

Interferon-alpha -induced persistent psychosis
Ginsberg, David L
2006 ;13(10):26-27 Oct, Primary Psychiatry
Reports a case in which a patient presents with persistent and refractory psychosis after treatment with interferon (IFN)-alpha . A 50-year-old white male was brought to the emergency room by a family member who had become concerned by his increasing paranoia and bizarre behavior. His psychiatric history was significant for a 25-year history of narcotic dependence, two brief admissions to substance-dependence treatment facilities, and a remote suicide attempt. The patient was treated with olanzapine and showed substantial, albeit incomplete, remission of his symptoms. However, shortly thereafter the patient became nonadherent with treatment and experienced a worsening psychosis that necessitated readmission. Olanzapine was increased to 25 mg/day. One more month of inpatient treatment resulted in a decrease in auditory hallucinations, but there was no reduction in the persecutory delusions.
— id: 70146, year: 2006, vol: 13, page: 26, stat: Journal Article,

Lamotrigine-induced Tourette's symptoms
Ginsberg, David L
2006 ;13(2):31-32 Feb, Primary Psychiatry
Tourette's disorder (TO) was first described by Georges Gilles de la Tourette in 1885. It is characterized by multiple motor and one or more vocal tics. The lifetime prevalence of TD is 4-5/10,000, the ratio of males to females being 3:1. Up to 50% of TD patients also have attention-deficit/hyperactivity disorder, and approximately 40% also have obsessive-compulsive disorder. The pathophysiology of TD is unclear, but likely involves disordered presynaptic release of dopamine or dysfunction in postsynaptic dopamine receptors. Other possible factors associated with TD include abnormal serotonin uptake, a hyperactive endogenous opioid system, a disorder of the noradrenergic system, or excessive inhibition of excitatory amino acids that regulate dopamine uptake in neurons within the basal ganglia. While the effects of various medications on the symptoms of TD are variable, agents that reduce central activity of dopamine, norepinephrine, and opiates generally appear to reduce the severity of TD. (journal abstract)
— id: 62759, year: 2006, vol: 13, page: 31, stat: Journal Article,

Lamotrigine-induced visual hallucinations
Ginsberg, David L
2006 ;13(5):24-25 May, Primary Psychiatry
Reports the case of a 42-year-old physically healthy woman with a 12-year history of depression and alcohol abuse received a prescription for citalopram 40 mg/day. Despite near abstinence from alcohol for 6 months, she continued to experience episodes of depression and hypomania, consistent with a diagnosis of bipolar type 2 disorder. She had no prior history of auditory, visual, or tactile hallucinations. Lamotrigine 25 mg/day was initiated, and then increased to 50 mg/day after 2 weeks. The patient reported improved mood without any side effects. After another 2 weeks, lamotrigine was increased to 100 mg/day. At this point, the patient's sleep became disturbed, with frequent waking and vivid dream-like experiences during which time the patient was not fully asleep. Five days later, she experienced visual hallucinations involving seeing her daughter and her nurse. She also reported headaches and hypersensitivity to noise. After lamotrigine was reduced to 50 mg/day, the hallucinations subsided over the next 48-72 hours.
— id: 64600, year: 2006, vol: 13, page: 24, stat: Journal Article,

Low dose oral selegiline for severe refractory depression
Ginsberg, David L
2006 ;13(1):26-27 Jan, Primary Psychiatry
Although numerous effective antidepressant medications are available, many patients suffer multiple episodes that are not adequately controlled with presently available therapies. Up to 1.5% of the general population is estimated to have chronic, severe depression. Approximately 30% of these patients are medically resistant to present treatments. As a result, combination treatments of ant/depressants with other medications, so-called augmentation strategies, are frequently employed for partial or nonresponders to various monotherapies, including serotonin reuptake inhibitors (SRIs). What follows is a report of the effectiveness of the oral form of the selective, irreversible monoamine oxidase (MAO)-B inhibitor selegiline in a patient with severe, refractory depression. (journal abstract)
— id: 62824, year: 2006, vol: 13, page: 26, stat: Journal Article,

March: Venlafaxine-induced rapid and severe edema
Ginsberg, David L
2006 ;13(3):30-31, Primary Psychiatry
Venlafaxine is a serotonin norepinephrine reuptake inhibitor widely used for the treatment of depression, generalized anxiety disorder, and social anxiety disorder, as well as a number of other psychiatric conditions for which serotonergic antidepressants are often employed. Reported side effects for venlafaxine include nausea, somnolence, insomnia, dizziness, constipation, sweating, anorexia, asthenia, nervousness, dose-dependent blood pressure elevation, increased urinary frequency, and sexual dysfunction. The following is a report of venlafaxine-induced rapid and severe edema, otherwise known as anasarca.
— id: 139604, year: 2006, vol: 13, page: 30, stat: Journal Article,

Methylphenidate-Induced Rabbit Syndrome
Ginsberg, David L
2006 ;13(12):28-29 Dec, Primary Psychiatry
Rabbit syndrome is characterized by involuntary, rapid, fine, rhythmic vertical movements of the perioral muscles resembling the chewing movements of a rabbit. It usually occurs after long-term treatment with antipsychotics, including atypicals such as risperidone. Historically, rabbit syndrome has been reported with a variety of neuroleptic agents but not with other classes of psychotropic medications. Usually, patients with rabbit syndrome manifest other Parkinsonian signs such as rigidity, bradykinesia, or tremor. Methylphenidate is a psychostimulant agent that blocks catecholamine reuptake and directly stimulates the release of dopamine and norepinephrine. The following is the first published report of rabbit syndrome in association with the use of methylphenidate in an 8-year-old male with attention-deficit/hyperactivity disorder (ADHD). (journal abstract)
— id: 71000, year: 2006, vol: 13, page: 28, stat: Journal Article,

Mirtazapine-risperidone combination associated with pulmonary thromboembolism and rhabdomyolysis
Ginsberg, David L
2006 ;13(7):25-28 Jul, Primary Psychiatry
Presents the case of a 40-year-old man who developed a psychotic episode and was treated with risperidone 8 mg/day, after which he developed a hypokinetic-rigid syndrome. Biperiden 2 mg was added; a major depressive episode soon followed. Mirtazapine 45 mg/day was added to his medication regimen, and when subsequent outpatient treatment failed, he was admitted to a psychiatric day clinic. The patient improved. However, 6 weeks after the initiation of this combination therapy he began to complain of acute aching in his left leg and respiratory problems. Later, the patient's depression remitted, vocational rehabilitation was started, and the patient was discharged in a euthymic state 8 weeks after the thromboembolism. This case is the first published report of both thromboembolism and rhabdomyolysis during combined therapy with risperidone and mirtazapine. The pathophysiologic mechanism that explains this adverse event is unknown but could involve a pharmacodynamic interaction between the two agents, both of which are antagonists at 5-HT-sub-2 receptors. Clinicians who prescribe the combination of mirtazapine with risperidone ought to be aware of the possibility of this serious complication.
— id: 68631, year: 2006, vol: 13, page: 25, stat: Journal Article,

Olanzapine-induced oculogyric crisis
Ginsberg, David L
2006 ;13(9):27-28 Sep, Primary Psychiatry
This article discusses the uses of olanzapine. It also presents the first published report of a specific type of dystonic reaction, oculogyric crisis, induced by the atypical antipsychotic olanzapine.
— id: 69014, year: 2006, vol: 13, page: 27, stat: Journal Article,

Oxcarbazepine-induced thrombocytopenia
Ginsberg, David L
2006 ;13(2):35-36 Feb, Primary Psychiatry
Oxcarbazepine, an anticonvulsant medication indicated primarily for partial seizures, neuropathic pain, and trigeminal neuralgia, is also used off-label as a mood stabilizer for the treatment of bipolar disorder. One of the reputed advantages of oxcarbazepine, compared with carbamazepine, is that it is free of hematologic toxicity. The package insert of oxcarbazepine mentions the possibility of thrombocytopenia, but states that the information is derived from uncontrolled and open-label trials and that therefore causality cannot be reliably determined. Presented here is the first published case report of oxcarbazepine- induced thrombocytopenia in an adult. The case is of a 63-year-old Asian-American woman with a history of multiple past psychiatric admissions for psychotic depression, brought to the hospital for increasingly disorganized behavior and paranoid ideation.
— id: 62755, year: 2006, vol: 13, page: 35, stat: Journal Article,

Paroxetine treatment of palmar-plantar hyperhidrosis
Ginsberg, David L
2006 ;13(10):27-28 Oct, Primary Psychiatry
Presents a report in which the selective serotonin reuptake inhibitor (SSRI) paroxetine was found to be useful in amelioration of hyperhidrosis in a patient with palmar-plantar hyperhidrosis (PPH). A 32-year-old man presented with a history of excessive sweating of the palms and soles and blushing of the face since childhood, which had increased in severity over the past 6 years. The patient was diagnosed with PPH and prescribed paroxetine 10 mg/day and clonazepam 0.5 mg twice a day. Within a month, he reported marked reduction in sweating and improvement in socio-occupational functioning. Paroxetine was increased to 20 mg/day and clonazepam was tapered to discontinuation, after which time the patient maintained complete control of sweating and blushing in all situations.
— id: 70145, year: 2006, vol: 13, page: 27, stat: Journal Article,

Pisa syndrome associated with valproic acid
Ginsberg, David L
2006 ;13(3):33-, Primary Psychiatry
The following is a report of Pisa syndrome in association with the gamma -aminobutyric acid-ergic anticonvulsant and mood-stablizer medication, sodium valproate. A 65-year-old nursing home resident with schizoaffective disorder used a wheelchair due to severe arthritis. His medications included valproic acid 750 mg BID, carbamazepine 200 mg BID, and risperidone 3 mg BID, a regimen that had been stable and remained unchanged over several months. Routinely monitored, his valproic acid and carbamazepine levels never exceeded the therapeutic range. Over the course of several weeks, the nursing home staff noticed that the patient had begun leaning to one side. The only medication change to which the patient consented was a trial discontinuation of valproic acid, which resulted in immediate resumption of his posture to a stable, upright position. The finding of Pisa syndrome resolution after valproic acid discontinuation suggests that this anticonvulsant was involved in the pathogenesis of this reaction, either individually or through a pharmacodynamic interaction with another drug, most likely risperidone.
— id: 139601, year: 2006, vol: 13, page: 33, stat: Journal Article,

Psychopharmacology reviews
Ginsberg, David L
2006 ;13(4):22-26 Apr, Primary Psychiatry
This article reviews certain drug therapies in the field of psychopharmacology. The first review presents a case study in which memantine was used to treat catatonic schizophrenia. The second review presents a case report of ropinirole-induced psychosis. The third review presents a case report in which pindolol was used successfully in the treatment of psychogenic polydipsia. The fourth review describes how off-label use of tiagabine, an adjunct anticonvulsant for the treatment of partial seizures, has been associated with new-onset seizures. The final review presents a case report of bupropion-induced subacute cutaneous lupus erythematosus.
— id: 64604, year: 2006, vol: 13, page: 22, stat: Journal Article,

Quetiapine-induced hypothyroidism
Ginsberg, David L
2006 ;13(6):23-28, Primary Psychiatry
Quetiapine fumarate is an atypical neuroleptic indicated for the treatment of schizophrenia. It is also used as both a monotherapy for the acute treatment of manic episodes and as an adjunct to treatment with lithium or divalproex associated with bipolar type 1 disorder. Pharmacologically, it is an antagonist at serotonin (5-HT)1A and 5-HT2, dopamine (D)1 and D2, histamine H1 and adrenergic alpha 1 and alpha 2 receptors. According to the package insert, in clinical trials of the drug there were small dose-related decreases in thyroid hormone, particularly total T4 and free T4; however, only 0.4% of subjects studied experienced significant increases in thyroid stimulating hormone (TSH) levels. In previously reported cases of quetiapine-induced hypothyroidism, most of the patients either had a history of compromised thyroid function or had normal TSH levels. In addition, no anti-thyroid antibody titers were measured in these studies. The following is a report of a depressed patient treated with quetiapine who developed hypothyroidism that remitted after drug discontinuation.
— id: 139599, year: 2006, vol: 13, page: 23, stat: Journal Article,

Risperidone-paroxetine combination associated with hypothermia
Ginsberg, David L
2006 ;13(8):26-27 Aug, Primary Psychiatry
Hypothermia is a life-threatening emergency. Besides exposure to cold, causes of hypothermia include sepsis, hypothyroidism, hypoglycemia, or drug overdose. Classically, neuroleptics have been associated with hyperthermia, particularly in relation to the neuroleptic malignant syndrome (NMS). The February 1999 'Psychopharmacology Journal Watch' cited an article on neuroleptic-associated hypothermia. At the time, the authors reported on 10 cases of neuroleptic-associated hypothermia reported to the drug safety surveillance program of the German Federal Institute for Drugs and Medical Devices between 1988 and 1997. The reports involved 6 women and 4 men, ranging from 19-86 years of age (average age = 50 years). In all cases, neuroleptics were given for either paranoid psychosis or schizophrenia. The substances involved included various neuroleptics, some of which are not available in the United States. Nine of the patients were treated with neuroleptics (clozapine, risperidone, chlorprothixene, zotepine, levomepromazine, and pipamperone) that are more potent antagonists at the serotonin 5-HT2 receptor than at the dopamine D2 receptor. In most cases, there was a period of several days from initial exposure to medication to the onset of hypothermia. The following is a report of hypothermia in a patient taking the atypical neuroleptic risperidone in combination with the selective serotonin reuptake inhibitor paroxetine.
— id: 68823, year: 2006, vol: 13, page: 26, stat: Journal Article,

Serotonin syndrome due to fluvoxamine-oxycodone interaction
Ginsberg, David L
2006 ;13(5):25-26 May, Primary Psychiatry
A 70-year-old woman presented to the emergency room with the acute onset of confusion. Her medication regimen consisted of fluvoxamine 200 mg QAM, doxepin 50 mg QHS, diclofenac 50 mg BID, raloxifene 60 mg/day, calcium carbonate 600 mg/ day, diltiazem CD 240 mg/day, and simvastatin 40 mg/day. She denied use of herbal or over-the-counter medications. Three days prior to admission, the patient had fallen and fractured her left distal radius. She was started on slow-release oxycodone 40 mg BID for pain control. One day prior to admission, short-acting oxycodone 10 mg as needed was added to her therapy. During the 24-hour period prior to admission, she reportedly had taken a total of 60 mg of oxycodone. Subsequently, she became confused, nauseous, febrile, and began to shiver. Fluvoxamine, doxepin, and oxycodone were discontinued. Over a 48-hour interval, acetaminophen 1,000 mg was administered on five occasions. The patient slowly improved during this period. Confusion, neurologic signs, and temperature resolved while the heart returned to sinus rhythm. Prior to discharge, doxepin 50 mg was restarted without adverse effect.
— id: 64598, year: 2006, vol: 13, page: 25, stat: Journal Article,

Sertraline for severe tinnitus
Ginsberg, David L
2006 ;13(3):32-33, Primary Psychiatry
While the exact pathophysiology of tinnitus remains unknown, possible causes include cochlear deterioration; an extra-auditory response to respiratory, vascular, or muscular stimuli; a drug reaction; microvascular compression of the eighth cranial nerve; and turbulent flow in the ipsilateral internal carotid artery. Regardless of the cause, tinnitus may result in significant diminution of quality of life. Proposed treatments include retraining therapy, maskers, hyperbaric oxygen, carotid artery stenting, selective cochlear neurotomy, and biofeedback, as well as pharmacotherapy with antidepressants, benzodiazepines, lidocaine, the calcium channel blocker nimodipine, or botulinum toxin. The double-blind, placebo-demonstrates the effectiveness of the selective serotonin reuptake inhibitor (SSRI) sertraline for the treatment of severe tinnitus. The findings support a possible role for sertraline, and likely other SSRIs, for the treatment of refractory tinnitus.
— id: 139602, year: 2006, vol: 13, page: 32, stat: Journal Article,

Topiramate-associated intractable epistaxis
Ginsberg, David L
2006 ;13(9):24-27 Sep, Primary Psychiatry
Topiramate is a sulfamate-substituted monosaccharide Food and Drug Administration-approved for migraine headache prophylaxis and for the adjunctive treatment of partial-onset and primary generalized tonic-clonic seizures. It blocks voltage-gated sodium channels, enhances y-aminobutyric acid (GABA) via its actions on the GABA-sub(A) receptor, antagonizes the kainate aminomethyl phosphonic acid subtype of the glutamate receptor, and inhibits carbonic anhydrase. Due to its ability to suppress appetite and cause weight loss, it has gained increasingly widespread use among clinicians as a treatment for psychotropic-induced weight gain, binge-eating disorder, and even bulimia nervosa. Other research suggests that topiramate may also be effective for the treatment of posttraumatic stress disorder, obstructive sleep apnea, opiate and benzodiazepine withdrawal, kleptomania, alcohol dependence, self-injurious behavior, aggression, nonparaphilic sexual addiction, and olfactory hallucinations. It may also promote scar healing. (journal abstract)
— id: 69015, year: 2006, vol: 13, page: 24, stat: Journal Article,

Topiramate-induced glaucoma
Ginsberg, David L
2006 ;13(8):25-26 Aug, Primary Psychiatry
Topiramate is a sulfamate-substituted monosaccharide indicated for adjunctive treatment of adult partial-onset epilepsy. It blocks voltage-gated sodium channels, enhances y-aminobutyric acid (GABA) via its actions on the GABAA receptor, antagonizes the kainate (aminomethyl)phosphonic acid (AMPA) subtype of the glutamate receptor, and inhibits carbonic anhydrase. Due to its ability to suppress appetite and cause weight loss, it has gained increasingly widespread use among clinicians as a treatment for psychotropic-induced weight gain, binge-eating disorder, and even bulimia nervosa. Other research suggests that topiramate may also be effective for the treatment of posttraumatic stress disorder, obstructive sleep apnea, opiate and benzodiazepine withdrawal, kleptomania, alcohol dependence, self-injurious behavior, aggression, nonparaphilic sexual addiction, promotion of scar healing, and treatment of olfactory hallucinations. In studies of epilepsy, the most frequently reported side effects of topiramate were somnolence, dizziness, paresdiesias, ataxia, speech disorders, cognitive dysfunction, psychomotor slowing, headache, nausea, nystagmus, tremor, fatigue, gastrointestinal upset, visual disturbances, and renal calculi. Dose-related side effects include difficulty concentrating, tremor, mood lability, fatigue, confusion, and weight loss. Reports also indicate topiramate-induced bilateral angle-closure glaucoma, topiramate- induced depression, and oligohidrosis and metabolic acidosis. The following is a report of topiramate-induced bilateral angle-closure glaucoma in a woman prescribed topiramate off-label for mood stabilization. (journal abstract)
— id: 68824, year: 2006, vol: 13, page: 25, stat: Journal Article,

Ziprasidone-induced torsade de pointes
Ginsberg, David L
2006 ;13(8):27-29 Aug, Primary Psychiatry
Torsade de pointes (TDP) is a life-threatening ventricular arrhythmia characterized by a polymorphous QRS complex on an electrocardiogram (EKG). It is associated with a preceding prolonged ventricular repolarization represented by a lengthened QT interval. Although commonly induced by drugs, particularly in elderly women with ischemic heart disease, medication-induced TDP can occur in patients without a history of any cardiac problems. Drugs associated with TDP include Group la and III antiarrhythmics, phenothiazines, butyrophenones, and heterocyclic antidepressants. TDP may also be caused by electrolyte or metabolic abnormalities, central nervous system disease, cardiac disease, congenital syndromes, or toxins. Clinically, ziprasidone is as effective as haloperidol for the treatment of acute, positive symptoms of schizophrenia, and is effective in long-term relapse prevention. It is also approved for treating acute mania and mixed episodes associated with bipolar disorder. While it is generally not sedating and has a low likelihood of causing weight gain, some adverse effects that are associated with ziprasidone include migraine headaches, tardive dyskinesia, galactorrhea, prolonged erections, and mania. The following is a report of ziprasidone-induced TDP.
— id: 68822, year: 2006, vol: 13, page: 27, stat: Journal Article,

Zonisamide-induced mania
Ginsberg, David L
2006 ;13(9):28-29 Sep, Primary Psychiatry
Zonisamide is a synthetic 1,2-benzisoxazole derivative and anticonvulsant Food and Drug Administration-approved for the treatment of partial seizures in adults. An open-label study and a case report suggest that zonisamide may be beneficial as an antimanic agent. Other evidence suggests that zonisamide may have therapeutic potential in protecting against ischemic cerebral damage such as stroke. In epilepsy patients, zonisamide has been associated with decreased appetite and weight loss. Zonisamide has also demonstrated some utility in the treatment of obesity and binge-eating disorder. A 42-year-old woman had a 10-year history of essential tremor, which affected her upper extremities, head, and voice, and interfered with multiple tasks such as writing, pouring, dressing, and talking. The diagnosis of essential tremor was confirmed and zonisamide 100 mg/day was initiated. Approximately 36 hours later, the patient developed hyperactivity, racing thoughts, distractibility, insomnia, and talkativeness. On day 4 of treatment her husband reported that the patient had not slept in the previous 48 hours. Diagnosed as manic, the patient was taken off of zonisamide, with resolution of all manic symptoms within 24 hours. clinicians who prescribe zonisamide ought to be aware of the possibility of triggering a manic episode, including in those with no prior history of bipolar disorder.
— id: 69013, year: 2006, vol: 13, page: 28, stat: Journal Article,

Zonisamide-induced suicidal ideation
Ginsberg, David L
2006 ;13(2):34-35 Feb, Primary Psychiatry
Zonisamide is a synthetic 1,2-benzisoxazole derivative and anticonvulsant that was Food and Drug Administration approved in March 2000 for the treatment of partial seizures in adults. An open-label study and a case report suggest that zonisamide may be beneficial as an anti-manic agent. Other evidence suggests that zonisamide may have therapeutic potential in protecting against ischemic cerebral damage such as stroke. In patients with epilepsy, side effects reported in association with zonisamide include dizziness, headache, kidneys stones, diplopia, altered mental status, and even psychosis. Presented here is a study of zonisamide-induced suicidality in a 34-year-old woman with a 20-year history of complex partial seizures.
— id: 62756, year: 2006, vol: 13, page: 34, stat: Journal Article,

Paroxetine coadministration results in digitalis intoxication
Ginsberg, David. L
2006 ;13(8):29-30 Aug, Primary Psychiatry
Depression and cardiovascular disease are associated with each other. In general, selective serotonin reuptake inhibitors (SSRIs) are safe and effective antidepressants in those with coronary heart disease. Despite this, unanticipated drug-drug interactions may sometimes occur. The following is a report in which coadministration of the SSRI paroxetine resulted in digitalis intoxication.
— id: 68821, year: 2006, vol: 13, page: 29, stat: Journal Article,

Incorporating pharmacogenetics into clinical practice: Reality of a new tool in psychiatry
Mrazek, David A; Smoller, Jordan W; de Leon, Jose; Ginsberg, David L [Ed]
2006 ;11(3):1-2, CNS spectrums
Although most patients with depression ultimately respond to antidepressant therapy, >50% have inadequate response to an individual antidepressant trial. The desire to avoid adverse drug reactions is common among patients, and is an important determinant of drug selection among psychiatrists. However, since the major classes of antidepressants and antipsychotics appear to be comparable in efficacy, clinicians have little basis for selecting the most effective agent for an individual patient. Pharmacogenetics, often described as the study of genetic variation that explains differential response to medication, represents an important new avenue toward improving treatment outcomes. Genetic variation in drug-metabolizing enzymes has been recognized for decades. The main focus of current psychiatric pharmacogenetic testing is on the cytochrome P450 (CYP) 2D6 and, to a somewhat lesser extent, on the 2C19 genes. Data suggest that poor metabolizer status can be associated with an increased risk of adverse drug reactions with certain medications, and that ultra-rapid metabolizers may require higher-than-usual doses to achieve a therapeutic response. The importance of CYP enzymes in the metabolism of several antidepressant and antipsychotic drugs suggest that genetic variation may aid in medication selection or dosing. Advances in pharmacogenetic research may facilitate the development of personalized medicine in which genetic information can inform drug selection, leading to optimal drug effectiveness and minimal drug toxicity. In this monograph, David A. Mrazek, MD, provides an overview of the context of genetic testing in clinical psychiatric practice. Next, Jordan W. Smoller, MD, ScD, discusses some of the practical issues related to medication selection. Finally, Jose de Leon, MD, presents a comprehensive review of antidepressant and antipsychotic treatment based on drug metabolism, and reviews the available testing methods for CYP 2D6 and 2C19 genotypes. (journal abstract)
— id: 63820, year: 2006, vol: 11, page: 1, stat: Journal Article,

Recognition and treatment of depression with or without comorbid anxiety disorders
Zimmerman, Mark; Chelminski, Iwona; Zisook, Sidney; Ginsberg, David L
2006 ;11(1):1-16 Jan, CNS spectrums
Anxiety disorders are common in depressed patients. Several studies of the full range of Diagnostic and Statistical Manual of Mental Disoroters-defined anxiety disorders in depressed psychiatric outpatients each found that when diagnoses are based on semi-structured diagnostic interviews >40% of the patients had a comorbid anxiety disorder. The recognition of comorbidity is not simply of academic interest, but it has important clinical significance. Epidemiological studies, such as the National Comorbidity Study, have demonstrated that depressed individuals with a history of anxiety disorders are at increased risk for hospitalization, suicide attempt, and greater impairment from the depression. The co-occurrence of anxiety disorders in depressed patients has been associated with a more chronic course of depression in psychiatric patients, primary care patients, and epidemiological samples. Recent research has suggested that clinicians underrecognize anxiety disorder comorbidity in depressed patients. The clinical significance of this underrecognition is highlighted by the finding that patients often want treatment to address their anxiety disorder comorbidity. When anxiety disorders are detected they often influence clinicians' selection of antidepressant medication, though some of clinicians' prescribing biases are not supported by empirical data. In this monograph, Iwona Chelminski, PhD, reviews the significance of anxiety in patients with depression as well as diagnostic instruments for recognizing this comorbidity. Next, Mark Zimmerman, MD, addresses the factors that affect the clinician's choice of antidepressant, focusing on the influence of comorbid anxiety. Finally, Sidney Zisook, MD, discusses the differential efficacy of antidepressants as well as the role of psychotherapy in patients with comorbid anxiety and depression. (journal abstract)
— id: 62612, year: 2006, vol: 11, page: 1, stat: Journal Article,

Recognition and treatment of depression with or without comorbid anxiety disorders
Zimmerman, Mark; Chelminski, Iwona; Zisook, Sidney; Ginsberg, David L [Ed]
2006 ;13(1):1-13 Jan, Primary Psychiatry
Anxiety disorders are common in depressed patients. Several studies of the full range of Diagnostic and Statistical Manual of Mental Disorders--defined anxiety disorders in depressed psychiatric outpatients each found that when diagnoses are based on semi-structured diagnostic interviews >40% of the patients had a comorbid anxiety disorder. The recognition of comorbidity is not simply of academic interest, but it has important clinical significance. Epidemiological studies, such as the National Comorbidity Study, have demonstrated that depressed individuals with a history of anxiety disorders are at increased risk for hospitalization, suicide attempt, and greater impairment from the depression. The co-occurrence of anxiety disorders in depressed patients has been associated with a more chronic course of depression in psychiatric patients, primary care patients, and epidemiological samples. Recent research has suggested that clinicians underrecognize anxiety disorder comorbidity in depressed patients. The clinical significance of this underrecognition is highlighted by the finding that patients often want treatment to address their anxiety disorder comorbidity. When anxiety disorders are detected they often influence clinicians' selection of antidepressant medication, though some of clinicians' prescribing biases are not supported by empirical data. In this monograph, Iwona Chelminski, PhD, reviews the significance of anxiety in patients with depression as well as diagnostic instruments for recognizing this comorbidity. Next, Mark Zimmerman, MD, addresses the factors that affect the clinician's choice of antidepressant, focusing on the influence of comorbid anxiety. Finally, Sidney Zisook, MD, discusses the differential efficacy of antidepressants as well as the role of psychotherapy in patients with comorbid anxiety and depression. (journal abstract)
— id: 62823, year: 2006, vol: 13, page: 1, stat: Journal Article,

Acute psychosis associated with Coricidin HBP Cough and Cold Medicine
Ginsberg DL
2005 ;12(10):37-37, Primary Psychiatry
— id: 59253, year: 2005, vol: 12, page: 37, stat: Journal Article,

Add-on memantine for treatment-resistant obsessive-compulsive disorder
Ginsberg DL
2005 ;12(12):29-29, Primary Psychiatry
— id: 61353, year: 2005, vol: 12, page: 29, stat: Journal Article,

Addition of aripiprazole for risperidone-induced hyperprolactinemia
Ginsberg DL
2005 ;12(10):34-35, Primary Psychiatry
— id: 59256, year: 2005, vol: 12, page: 34, stat: Journal Article,

Addition of aripiprazole to offset clozapine-induced weight gain and hyperlipidemia
Ginsberg DL
2005 ;12(12):30-32, Primary Psychiatry
— id: 61350, year: 2005, vol: 12, page: 30, stat: Journal Article,

Aripiprazole-induced psychosis
Ginsberg DL
2005 ;12(12):30-30, Primary Psychiatry
— id: 61351, year: 2005, vol: 12, page: 30, stat: Journal Article,

Duloxetine for smoking cessation
Ginsberg DL
2005 ;12(10):33-33, Primary Psychiatry
— id: 59258, year: 2005, vol: 12, page: 33, stat: Journal Article,

Memantine for binge-eating disorder? Just hold the MSG
Ginsberg DL
2005 ;12(12):33-33, Primary Psychiatry
— id: 61348, year: 2005, vol: 12, page: 33, stat: Journal Article,

Nocturnal enuresis remedy desmopressin nasal spray associated with severe hyponatremia
Ginsberg DL
2005 ;12(10):35-36, Primary Psychiatry
— id: 59255, year: 2005, vol: 12, page: 35, stat: Journal Article,

Olanzapine-induced gynecomastia
Ginsberg DL
2005 ;12(10):36-37, Primary Psychiatry
— id: 59254, year: 2005, vol: 12, page: 36, stat: Journal Article,

Omega-3 fatty acids for postpartum depression
Ginsberg DL
2005 ;12(12):32-33, Primary Psychiatry
— id: 61349, year: 2005, vol: 12, page: 32, stat: Journal Article,

Riluzole for treatment-resistant obsessive-compulsive disorder
Ginsberg DL
2005 ;12(10):33-34, Primary Psychiatry
— id: 59257, year: 2005, vol: 12, page: 33, stat: Journal Article,

The new antidepressants
Ginsberg DL
2005 ;19(7):9-11 Jul, Bottom Line/Health
Sometimes medication is the best choice. Here's how to find -- and use -- the most effective drug for you.
— id: 66508, year: 2005, vol: 19, page: 9, stat: Journal Article,

Ziprasidone-associated tardive dystonia
Ginsberg DL
2005 ;12(12):29-30, Primary Psychiatry
— id: 61352, year: 2005, vol: 12, page: 29, stat: Journal Article,

Adjunctive Ropinirole for Treatment-Resistant Depression
Ginsberg, David L
2005 ;12(8):26-27, Primary Psychiatry
Presents an open-label pilot study which suggests that, in selected cases of treatment-resistant depression (TRD), ropinirole augmentation of antidepressants is effective and relatively well tolerated. The study was a 16-week, prospective, open trial conducted at the Department of Psychiatry of the University of Pisa among patients with TRD. Adult patients 18-75 years of age diagnosed with major depressive disorder were eligible for the study. Ten subjects with TRD were consecutively enrolled in the study. The mean age was 51 years, and 7 of the 10 subjects were women. The median duration of stable or unmodified antidepressant treatment prior to ropinirole augmentation was 7 weeks. Ropinirole was added to the current treatment with an endpoint mean dosage of 1.33 mg/day.
— id: 139613, year: 2005, vol: 12, page: 26, stat: Journal Article,

Chemotherapy drug cisplatin reduces valproic acid levels and efficacy
Ginsberg, David L
2005 ;12(9):25-26 Sep, Primary Psychiatry
Presents a report of a patient with epilepsy and testicular cancer in whom the chemotherapy agent, cisplatin, resulted in reduced levels and efficacy of valproic acid, culminating in a recurrence of severe, generalized, tonic-clonic seizures. Regardless of the mechanism of this interaction, clinicians who prescribe valproic acid ought to be aware of the possibility of cisplatin-induced reduction of serum valproic acid levels, and the associated loss of medication efficacy with reemergence of the underlying condition.
— id: 62657, year: 2005, vol: 12, page: 25, stat: Journal Article,

Clozapine-induced allergic vasculitis
Ginsberg, David L
2005 ;12(11):30-31, Primary Psychiatry
This article discusses a report of clozapine-induced allergic vasculitis (K. M. Penaskovic et al; see record 2005-08718-024). A 59-year-old schizophrenic man suffered from deafness, hypothyroidism, and tardive dyskinesia. Haloperidol was discontinued and clozapine initiated due to persistent extrapyramidal symptoms, tardive dyskinesia, and treatment-resistant psychotic symptoms. The patient developed a bilateral leg rash, characterized as a confluent, nonblanching, erythematous, elevated patch consistent with a palpable purpura. The rash continued to spread up his lower extremities but did not involve his palms or soles. The patient was discontinued with clozapine, and he improved with conservative management. The presentation and course of this patient, including the histopathologic findings, are consistent with a diagnosis of clozapine-induced leukocytoclastic vasculitis. The above case appears to be the first such published report of this reaction attributable to clozapine. In those treated with clozapine, the appearance of new-onset palpable purpura may be a sign of an allergic vasculitis.
— id: 63107, year: 2005, vol: 12, page: 30, stat: Journal Article,

Clozapine-Induced Eosinophilic Colitis
Ginsberg, David L
2005 ;12(8):27-28, Primary Psychiatry
Clozapine is a dibenzodiazepine derivative that has greater potency in blocking dopamine D1 compared with D2 receptors. Clozapine also has potent dopaminergic anti-D4, antiserotonergic, antimuscarinic, antiadrenergic and antihistamine effects and enhances dopamine release in the striatum. This article presents a report of clozapine induced eosinophilic colitis. A 45-year-old schizophrenic man suffered a psychotic decompensation in the setting of medication noncompliance. After reintroduction of haloperidol and risperidone, he developed neuroleptic malignant syndrome (NMS). Subsequently, he was treated with electroconvulsive therapy, concurrent with initiation of low dose clozapine, which was gradually increased. On day 14 of clozapine 200 mg/day, the patient developed a fever of 103.6degreesF and profuse bloody diarrhea. At this point, a diagnosis of clozapine-induced eosinophilic colitis was made, with clozapine discontinued. The next day, the patient's fever and diarrhea totally resolved.
— id: 139612, year: 2005, vol: 12, page: 27, stat: Journal Article,

Depression in the Elderly: The Unique Features Related to Diagnosis and Treatment
Ginsberg, David L
2005 ;12(8):?-?, Primary Psychiatry
Depression affects 6.5 million of the 35 million Americans >=65 years of age. While depression usually begins earlier in life and recurs periodically, it can present for the first time in people 80-90 years of age as well. Depression throughout the lifespan has a genetic/biological component but is also very much affected by social environmental factors. As people age, demographic factors, social support, and negative life events remain important to overall mental health, while physical illness and disability begin to take on a much more prominent role. Depression in the elderly is associated with impairment, dependency, disability, and significant distress for the individual and their family. This population is likely to present with concomitant cognitive dysfunction and medical illness, which can complicate the identification and treatment of psychiatric conditions. Bereavement is almost universal in late life and is sometimes a deterrent to appropriate diagnosis and treatment of depression. Physical frailty and diminishing social resources further complicate the treatment of depression in the elderly. Elderly individuals respond well to standard pharmacotherapy and psychotherapy treatments for depression. However, due to the high rate of relapse of depression in this population, continuous treatment is often warranted. This monograph will review depression in the elderly in the context of social disruptions, such as bereavement, caregiver strain, interpersonal conflict, role transitions, and social isolation; late-onset vascular depression and cognitive impairment; and physical illness including disability.
— id: 139608, year: 2005, vol: 12, page: ?, stat: Journal Article,

Injectable Depot Risperidone-Induced Rash: Reaction to Copolymer Matrix
Ginsberg, David L
2005 ;12(8):26-, Primary Psychiatry
Presents a report of a patient who, after having taken oral risperidone without any side effects, subsequently developed a severe allergic reaction to the depot formulation. A 46-year-old man with chronic schizophrenia was hospitalized with paranoia and disorganized thinking after using cocaine and having stopped his ziprasidone. Prior to this, he had been taking several different antipsychotics, including risperidone at bedtime. The patient received depot risperidone intermuscular. Within 4-6 hours of injection, the patient developed urticaria with an erythematous, raised pruritic rash covering large areas of his body. He was treated with oral diphenhydramine, 50 mg TID, and topical hydrocortisone cream but the rash worsened and the patient developed faint expiratory wheezing bilaterally. He was given dexamethasone IM 4 mg. Over the next 48 hours, the rash began to improve.
— id: 139614, year: 2005, vol: 12, page: 26, stat: Journal Article,

Meropenem Reduces Valproic Acid Levels and Efficacy
Ginsberg, David L
2005 ;12(8):25-, Primary Psychiatry
Presents a case report in which the antibiotic meropenem reduced serum levels of valproic acid, resulting in the precipitation of acute seizures. A 21-year-old woman with no significant past medical history presented to the emergency service with a new-onset, generalized, tonic-clonic seizure. Upon admission she experienced three episodes of generalized tonicclonic seizures, which remitted with administration of intravenous (IV) diazepam 10 mg. At this point, phenytoin IV 100 mg TID was initiated. Valproic acid 1,000 mg as a continuous IV infusion over 24 hours was introduced. The patient gradually became obtunded and required intubation for airway protection. The serum concentration of valproic acid was 52.5 mu g/mL. On day 13, meropenem IV 1,000 mg TID was initiated. On day 15, when the patient was afebrile, numerous myoclonic episodes occurred involving the arms and face. At the time, the serum valproic acid concentration was 42 mu g/mL. Despite the increased dosage, the plasma valproic acid level fell to 7 mu g/mL. After suspension of meropenem the patient became asymptomatic. The temporal sequence of events is consistent with a pharmacokinetic interaction, in which administration of meropenem resulted in reduced serum levels of valproic acid.
— id: 139615, year: 2005, vol: 12, page: 25, stat: Journal Article,

Milnacipran for SSRI-intolerant patients with premenstrual dysphoric disorder
Ginsberg, David L
2005 ;12(9):28-29 Sep, Primary Psychiatry
Milnacipran is a cyclopropane derivative which acts by inhibiting norepinephrine and serotonin reuptake at presynaptic sites. Three women (aged 27, 27 and 29 years) with premenstrual dysphoric disorder (PMDD) and intolerant to selective serotonin reuptake inhibitors (SSRIs) were successfully treated with milnacipran. These cases suggest that milnacipran is an effective agent, with minimal side effects and a low propensity to cause drug-drug interactions, for SSRI intolerant PMDD.
— id: 62653, year: 2005, vol: 12, page: 28, stat: Journal Article,

Mirtazapine treatment of neuroleptic-lnduced akathisia
Ginsberg, David L
2005 ;12(9):27-28 Sep, Primary Psychiatry
Three cases are reported that documents patients with bipolar disorder (aged 31, 37 and 32 years) in whom mirtazapine was used successfully to treat acute neuroleptic induced akathisia. If these results are confirmed, it is likely that these effects derive principally from mirtazapine's blockade of 5-HT-sub(2A/2C) receptors, which may disinhibit dopamine release in nigrostriatal projections. Large scale, double-blind, placebo-controlled clinical trials are needed to further validate these findings.
— id: 62655, year: 2005, vol: 12, page: 27, stat: Journal Article,

Mirtazapine-induced arthralgia and coagulopathy
Ginsberg, David L
2005 ;12(9):29- Sep, Primary Psychiatry
Reports the case of a 54-year-old woman with generalized anxiety disorder and complicated bereavement reaction who developed mirtazapine-induced arthralgia with an additional association to coagulopathy. While these side effects appear relatively uncommon, clinicians who prescribe mirtazapine ought to be aware of the possibility of their occurrence.
— id: 62652, year: 2005, vol: 12, page: 29, stat: Journal Article,

Modafinil-induced premature ventricular contractions
Ginsberg, David L
2005 ;12(11):27-, Primary Psychiatry
Among the most common side effects associated with modafinil in premarketing trials were headache, nausea, anxiety, and insomnia. Postmarketing, modafinil has been associated with mania and psychosis. Now comes a report of modafinil-induced premature ventricular contractions (PVCs). N. Oskooilar (see record 2005-12096-036) described the case of a 54-year-old male who presented with combat fatigue and impaired concentration. He was administered modafinil 100 mg every morning, which was titrated to 200 mg every morning then subsequently administered in divided doses. Modafinil worked well to offset his complaints; however, after 2.5 months, he developed PVCs. Given the increasingly prevalent use of modafinil, clinicians need to be aware of the possibility of precipitating PVCs, including in those with no history of cardiac disease.
— id: 63111, year: 2005, vol: 12, page: 27, stat: Journal Article,

Pilocarpine for Psychotropic Medication Associated Dry Mouth
Ginsberg, David L
2005 ;12(8):28-, Primary Psychiatry
Dry mouth is one of the most frequent side effects experienced by patients taking psychotropic drugs, particulary those with antimuscarinic and anticholinergic actions. The lack of saliva is annoying to patients, impairs their ability to chew and digest food, and is a contributor to dental morbidity, including caries and oral infection. Pilocarpine is a cholinergic muscarinic agonist that has been used to treat xerostomia induced in cancer patients by head and neck radiotherapy. In addition, in a recent placebo controlled study, doses of 20 mg/day were shown to be effective for the treatment of dry mouth and dry eyes in patients with Sjogren's syndrome.
— id: 139611, year: 2005, vol: 12, page: 28, stat: Journal Article,

Psychopharmacology Reviews: Adjunctive Rivastigmine Reduces Negative Symptoms of Schizophrenia
Ginsberg, David L
2005 ;12(7):25-26 Jul, Primary Psychiatry
Presents the case of adjunctive rivastigmine reducing the negative symptoms of schizophrenia. A 45-year-old Indian woman had residual schizophrenia of 6 years' duration. Despite treatment with risperidone 6 mg/day, over the prior 18 months, she had developed progressive passivity, lack of initiative, marked psychomotor' retardation, poverty of speech, and poor facial expression. With the support of her family, she maintained good compliance with risperidone, which completely controlled her positive symptoms. Subsequently, she began rivastigmine tartrate 1.5 mg twice daily, titrated to 6 mg/day after 2 months. She continued risperidone 6 mg/daily. A second evaluation, done after 4 weeks of drug therapy, showed 10% improvement in negative symptoms. After 6 months of combined drug treatment, the score had decreased by 41% from baseline. Neuropsychological testing revealed appreciably improved cognitive function that was directly related to the improvement in her quality of life. Additional studies with randomized, double-blind, placebo-controlled designs, are needed to more fully assess these treatments for this condition.
— id: 58709, year: 2005, vol: 12, page: 25, stat: Journal Article,

Psychopharmacology Reviews: Diazepam-Associated Gynecomastia
Ginsberg, David L
2005 ;12(7):27-27 Jul, Primary Psychiatry
Presents the case of diazepam-associated gynecomastia. An obese, 47-year-old man with an otherwise unremarkable medical history presented with breast enlargement that had first become apparent to him 2 months previously, which was 8 months after he had begun self-medicating with diazepam for anxiety. In his country, Serbia, diazepam is available over the counter. Initially, he took diazepam 5-10 mg on an as-needed basis. Dissatisfied with the results, he increased the dose to 10-30 mg/day. Two weeks prior to presentation, he had increased his dosage to 40-50 mg/ day. He denied being sedated or even feeling tired, instead reporting that over time he seemed to feel more nervous and aggressive, which in his view necessitated his increasing his dosage of diazepam. Three weeks after being advised to gradually taper off the diazepam, the patient described using the medication only occasionally, at a dosage of 5-15 mg/day. Over this period, while the patient's BMI decreased slightly, he experienced a significant breast dimension reduction, reaching near normal size, measured at 7.2 cm in width, 1.6 cm above the middle line of the chest. He also reported that he was less nervous and aggressive. Thus, given the widespread use of diazepam, as well as other benzodiazepines, it is important for clinicians to recognize that gynecomastia may sometimes be an adverse effect of this class of medications.
— id: 58707, year: 2005, vol: 12, page: 27, stat: Journal Article,

Psychopharmacology Reviews: Gabapentin-Induced Dystonia
Ginsberg, David L
2005 ;12(7):27-28 Jul, Primary Psychiatry
Presents the case of gabapentin-induced dystonia. A 72-year-old woman complained of tremors of both arms. She had a history of depression and hypertension, the latter treated with amiloride 5 mg/ day plus hydrochlorothiazide 50 mg/day. She denied use of any other medications, and had been on an adequate low-sodium diet for the past 5 years. At the time of presentation, she presented with postural and intention tremor of both arms and cephalic resting tremor without other neurologic symptoms. An electrocardiogram did not show any rhythm disorders. Diagnosed with essential tremor, she was treated with propranolol 120 mg/day. However, symptomatic bradycardia made it necessary to withdraw the drug. Gabapentin was initiated, with slow dosage escalation, to 2,100 mg/day after 7 weeks of treatment. Shortly after starting the medication, the patient developed abruptly repetitive rotatory and sustained movements of the neck, as well as proximal contractions in the arms. She stopped gabapentin on her own, with resolution of the dystonic reaction. There was no family history of dystonia. Gabapentin was restarted at a lower dose than before and was titrated to a total of 1,800 mg/day in the sixth week. Subsequently, the patient developed a recurrence of her dystonic reaction. The case described is consistent with gabapentin-induced dystonia. However, conflicting data suggests that gabapentin may be efficacious in the treatment of some types of movement disorders but in other patients may actually precipitate movement disorders. Whether the outcome is a function of dosage used, individual predisposing factors, or some combination of factors at present is not known.
— id: 58706, year: 2005, vol: 12, page: 27, stat: Journal Article,

Psychopharmacology Reviews: Itraconazole-Tadalafill Interaction Results in Priapism
Ginsberg, David L
2005 ;12(7):26-27 Jul, Primary Psychiatry
Presents the case of ifraconazole-tadafafil interaction resulting in priapism. A 56-year-old white man with erectile dysfunction (ED) but with an otherwise benign medical history had been using sildenafil 100 mg as needed, from 1999 to 2003, without adverse effects. In an effort to achieve improved and more sustained efficacy, he later switched to tadalafil 10 mg. He was not taking any concomitant medications and denied any undesirable side effects. In September 2003, due to recurrent onychomycosis of the foot, he started taking itraconazole 400 mg/day for 7 days/month. During the first day of monthly itraconazole therapy in October 2003, he took a dose of tadalafil. Within several hours, priapism occurred, lasting over 4 hours but without impeding urinary flow. However, upon use of sildenafil in the context of ongoing itraconazole therapy, he did not experience any recurrences of priapism. Given the potential seriousness of priapism, a medical emergency requiring prompt urological intervention to prevent complications such as impotence and gangrene, clinicians who prescribe tadalafil need to be aware of the potential for precipitating priapism in patients taking concomitant medications that inhibit cytochrome P450 3A4 (CYP).
— id: 58708, year: 2005, vol: 12, page: 26, stat: Journal Article,

Psychopharmacology Reviews: Lamotrigine-Induced Neutropenia
Ginsberg, David L
2005 ;12(7):25-25 Jul, Primary Psychiatry
Presents the case of lamotrigine-induced neutropenia. A 23-year-old woman was hospitalized with bipolar II depression. Her history was also remarkable for polysubstance abuse and eating disorder not otherwise specified. Two months previously, topiramate had been initiated, with which the patient had been partially compliant. On the first day of admission, topiramate 50 mg/day was initiated, then increased to 100 mg at bedtime on day 10. Subsequently, topiramate was decreased to 75 mg/day on day 15, then further decreased to 50 mg on day 26. Lamotrigine 12.5 mg at bedtime was added on day 15, then increased to 25 mg/day on day 19 and to 50 mg/day on day 26. A complete blood count (CBC) on day 2 was normal. A random CBC on day 29 revealed neutropenia, so topiramate 50 mg at bedtime and lamotrigine 50 mg/day, were discontinued. While there is no recommendation for regular monitoring of CBC in lamotrigine-treated patients, clinicians ought to be aware of the possibility of this uncommon but potentially serious adverse event.
— id: 58710, year: 2005, vol: 12, page: 25, stat: Journal Article,

Quetiapine-Induced Thrombotic Thrombocyctopenic Purpura
Ginsberg, David L
2005 ;12(8):28-29, Primary Psychiatry
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening hematologic disorder. This article presents a report of TTP in association with the atypical neuroleptic, quetiapine. A 25-year-old African American man with a history of bipolar disorder and schizophrenia presented to the emergency room with 3 days of diffuse abdominal pain and red-colored urine. Five days earlier, he had been started on quetiapine 50 mg BID by his psychiatrist in the community. Previously, he had been taking lithium, without additional medications, for 2 years. A diagnosis of TTP was made, and plasmapheresis was started.
— id: 139610, year: 2005, vol: 12, page: 28, stat: Journal Article,

Risperidone-induced delirium due to CYP 2D6 *5/*10 genotype
Ginsberg, David L
2005 ;12(9):28- Sep, Primary Psychiatry
Previous 'Psychopharmacology Reviews' columns have discussed emerging studies in psychopharmacogenomics, which correlate the variability of patient responses to psychotropic drugs to individual genetic differences. A recent report showed a 74-year-old patient with the cytochrome P450 (CYP) 2D6 *5/*10 genotype, associated with defective CYP 2D6 metabolism, which rendered him particularly susceptible to prominent risperidone induced extrapyramidal symptoms. With respect to risperidone, CYP 2D6-defective or poor metabolizers, such as the patient described above, are at increased risk for toxicity at conventional doses due to elevated serum levels of risperidone and of its principal metabolite, 9-hydroxyrisperidone. Conversely, in ultrarapid CYP 2D6 metabolizers, the concentrations of risperidone and of 9-hydroxyrisperidone will be very low. Accurately identifying these individuals would likely be of value to predict nonresponse with conventional risperidone doses, as well as to exclude questions of possible noncompliance.
— id: 62654, year: 2005, vol: 12, page: 28, stat: Journal Article,

Risperidone-induced hepatotoxicity
Ginsberg, David L
2005 ;12(11):29-, Primary Psychiatry
This article discusses a report on risperidone-induced immunoallergic hepatitis (D. Esposito et al; see record 2005-12096-032). A 28-year-old man with paranoid schizophrenia experienced a recurrence of disordered thinking and auditory hallucinations after having been free of all medications for a period of 1 year. Subsequently, he was prescribed risperidone, which was titrated to a dosage of 8 mg/day over a period of 5 weeks. Seven weeks later, he developed elevated serum levels of aspartate aminotransferase, 83 U/L (normal 10-50), and alanine aminotransferase, 123 U/L (normal 10-60). The temporal sequence of events is consistent with risperidone-induced liver toxicity. More specifically, the presence of eosinophilia and high levels of anti-smooth-muscle antibodies suggest a risperidone-induced immunoallergic reaction.
— id: 63109, year: 2005, vol: 12, page: 29, stat: Journal Article,

Sudden pregabalin discontinuation associated with focal brain edema
Ginsberg, David L
2005 ;12(9):26-27 Sep, Primary Psychiatry
Anticonvulsants are frequently used in the treatment of psychiatric conditions. In general, abrupt discontinuation of these drugs is contraindicated due to concerns about withdrawal symptoms. In a recent report, an 80-year-old woman developed delirium with focal brain splenial edema 8 days after having abruptly discontinued pregabalin, an analogue of gabapentin. While the causality is unsubstantiated at this point, the finding of focal brain edema in association with abrupt discontinuation of pregabalin ought to be a caution to clinicians about the importance of using tapering strategies when discontinuing pregabalin as well as other anticonvulsants.
— id: 62656, year: 2005, vol: 12, page: 26, stat: Journal Article,

The Role of Modified-Release Formulations in Hypnotic Therapy for Insomnia
Ginsberg, David L
2005 ;12(8):?-?, Primary Psychiatry
In addition to the psychological and medical health risks associated with lack of adequate sleep, effects of insomnia include impaired daytime functioning and decreased quality of life. Many patients experience delayed sleep onset, frequent awakenings, early waking, or nonrestorative sleep. Longitudinal data on insomnia indicate that the prevalence of persistent/chronic insomnia is high and appears to be characterized by multiple symptoms related to initiating or maintaining sleep. Physiologic studies indicate that short-term sleep restriction can cause physiologic problems that lead to long-term health consequences, such as high blood pressure, impaired glucose tolerance, and systemic inflammation. Epidemiologic studies have shown that sleep deprivation is independently associated with increased risk of cardiovascular disease, diabetes, obesity, and mortality. While the available agents are effective, those with a long half life may have carryover effects while short-acting agents may not provide enough sleep continuity. Pharmacologic therapies available for patients who suffer from insomnia include immediate-release nonbenzodiazepine hypnotics, which have a positive benefit/risk profile compared to the benzodiazepines. Modified-release (MR) formulations of these agents may offer the additional benefit of improving sleep continuity throughout the night without sacrificing the rapid elimination properties that minimize next-day residual effects. MR agents in development include zolpidem MR and indiplon MR.
— id: 139609, year: 2005, vol: 12, page: ?, stat: Journal Article,

Topiramate treatment of sexual addiction
Ginsberg, David L
2005 ;12(11):31-32, Primary Psychiatry
This article discusses a report which suggests that topiramate may also be an effective agent for the treatment of nonparaphilic sexual addiction (T. W. Fong et al; see record 2005-11734-029). A 32-year-old man presented to the University of California, Los Angeles, Impulse Control Disorders Clinic requesting help with his 'addiction to sex.' Physically, prior to engaging in sexual behaviors, he experienced increased heart rate, nervousness, dry mouth, and nausea. Topiramate was started at 25 mg/day, then increased by 25 mg every 5 days to a total dose of 200 mg/day. For the first 4 weeks, there were no reductions in his sexual activities. At week 6, however, he described a noticeable cessation of the anticipatory physical sensations and a renewed sense of control. He was able to completely stop engaging in sexual behaviors. These results ought to be viewed as preliminary and require validation in larger, placebo-controlled trials. While the mechanism of action underlying these effects are not known, one possibility is that it may be related to disinhibition of GABA in the nucleus accumbens area, targeting the arachidonic acid cascade, which may be functionally hyperactive in patients with impulse-control disorders.
— id: 63106, year: 2005, vol: 12, page: 31, stat: Journal Article,

Treatment-Refractory Epilepsy: An Evidence-Based Approach to Antiepileptic Monotherapy
Ginsberg, David L
2005 ;10(3):1-7, CNS spectrums
Treatment options for epilepsy have increased in the last decade with the introduction of several new antiepileptic drugs (AEDs). As drug selection becomes more challenging, the use of evidence-based guidelines to aid in treatment decisions has become increasingly valued. The American Academy of Neurology's (A
— id: 139616, year: 2005, vol: 10, page: 1, stat: Journal Article,

Valproate treatment of catatonia
Ginsberg, David L
2005 ;12(11):29-30, Primary Psychiatry
This article discusses a report on the successful use of sodium valproate (VPA) for the treatment of catatonia in two brothers (I. Yoshida et al; see record 2005-11734-024). The first brother, 25 years of age, was diagnosed with catatonic schizophrenia, his acute phases were characterized by wandering with delusions, motor excitement, impulsivity, aggression, bizarre behavior, and negativism. VPA 600 mg/day was administered for the first time. Within 20 days, his psychotic symptoms disappeared. The second brother, now 23 years of age, also suffered from catatonic schizophrenia. VPA 600 mg/day was administered for the first time. Within 10 days, his psychotic symptoms disappeared. In both siblings, VPA exhibited robust acute and maintenance effects against catatonia.
— id: 63108, year: 2005, vol: 12, page: 29, stat: Journal Article,

Ziprasidone for treatment-resistant generalized anxiety disorder
Ginsberg, David L
2005 ;12(11):28-29, Primary Psychiatry
Discusses the article 'Open-label Pilot Study of Ziprasidone for Refractory Generalized Anxiety Disorder' by S. H. Snyderman et al (see record 2005-11734-018). Thirteen adults (7 men, 6 women) with refractory generalized anxiety disorder (GAD) entered this 7-week ziprasidone monotherapy study. During the first week, all subjects received ziprasidone 20 mg/day. Subsequently, depending on response and tolerability, the dose could be increased in 20 mg/week increments to a maximum of 80 mg/week. The preliminary data from this short-term, open-label study suggest that ziprasidone at a dosage range of 20-80 mg/day may be of benefit to GAD patients who have not achieved sufficient improvement with serotonin reuptake inhibitors, buspirone, or benzodiazepines. Double-blind, placebo-controlled trials utitilizing a more stringent criterion for treatment resistance are needed to confirm these initial findings.
— id: 63110, year: 2005, vol: 12, page: 28, stat: Journal Article,

Symposium Monograph Supplement: Depression in the Elderly: The Unique Features Related to Diagnosis and Treatment
Ginsberg, David L [Ed]
2005 ;10(8):1-2, CNS spectrums
Depression affects 6.5 million of the 35 million Americans >=65 years of age. While depression usually begins earlier in life and recurs periodically, it can present for the first time in people 80-90 years of age as well. Depression throughout the lifespan has a genetic/biological component but is also very much affected by social environmental factors. As people age, demographic factors, social support, and negative life events remain important to overall mental health, while physical illness and disability begin to take on a much more prominent role. Depression in the elderly is associated with impairment, dependency, disability, and significant distress for the individual and their family. This population is likely to present with concomitant cognitive dysfunction and medical illness, which can complicate the identification and treatment of psychiatric conditions. Bereavement is almost universal in late life and is sometimes a deterrent to appropriate diagnosis and treatment of depression. Physical frailty and diminishing social resources further complicate the treatment of depression in the elderly. Elderly individuals respond well to standard pharmacotherapy and psychotherapy treatments for depression. However, due to the high rate of relapse of depression in this population, continuous treatment is often warranted. This monograph will review depression in the elderly (see record 2005-10992-010) in the context of social disruptions, such as bereavement, caregiver strain, interpersonal conflict, role transitions, and social isolation; late-onset vascular depression and cognitive impairment (see record 2005-10992-011); and physical illness including disability (see record 2005-10992-012); and treatment of late-life depression (see record 2005-10992-013).
— id: 139607, year: 2005, vol: 10, page: 1, stat: Journal Article,

Symposium Monograph Supplement: The Role of Modified-Release Formulations in Hypnotic Therapy for Insomnia
Ginsberg, David L [Ed]
2005 ;10(8):1-2, CNS spectrums
In addition to the psychological and medical health risks associated with lack of adequate sleep, effects of insomnia include impaired daytime functioning and decreased quality of life. Many patients experience delayed sleep onset, frequent awakenings, early waking, or nonrestorative sleep. Longitudinal data on insomnia indicate that the prevalence of persistent/chronic insomnia is high and appears to be characterized by multiple symptoms related to initiating or maintaining sleep. Physiologic studies indicate that short-term sleep restriction can cause physiologic problems that lead to long-term health consequences, such as high blood pressure, impaired glucose tolerance, and systemic inflammation. Epidemiologic studies have shown that sleep deprivation is independently associated with increased risk of cardiovascular disease, diabetes, obesity, and mortality. While the available agents are effective, those with a long half life may have carryover effects while short-acting agents may not provide enough sleep continuity. Pharmacologic therapies available for patients who suffer from insomnia include immediate-release nonbenzodiazepine hypnotics, which have a positive benefit/risk profile compared to the benzodiazepines. Modified-release (MR) formulations of these agents may offer the additional benefit of improving sleep continuity throughout the night without sacrificing the rapid elimination properties that minimize next-day residual effects. MR agents in development include zolpidem MR and indiplon MR. Paper from this symposium are by M. K. Erman (see records 2005-10992-016 and 2005-10992-020), T. Young see records 2005-10992-017), S. R. Patel see records 2005-10992-018), and D. N. Neubauer see records 2005-10992-019).
— id: 139606, year: 2005, vol: 10, page: 1, stat: Journal Article,

Optimizing treatment of schizophrenia. Enhancing affective/cognitive and depressive functioning
Ginsberg, David L; Schooler, Nina R; Buckley, Peter F; Harvey, Philip D; Weiden, Peter J
2005 Feb;10(2):1-13, CNS spectrums
Recognition and treatment of schizophrenia has largely focused on positive symptoms of the disorder, such as delusions, hallucinations, and disorganization. However, other important symptoms, such as depression, cognition, and social functioning, have not received comparable attention. Fifty percent of schizophrenic patients suffer from comorbid depression, which is a major risk factor for suicide in this population, while 10% to 25% suffer from comorbid obsessive-compulsive disorder. Cognitive deficits commonly observed in patients with schizophrenia include problems with concentration, attention, and memory, as well as problem-solving and verbal skills. These deficits are observed at early stages of the illness and can predict deficits in functional capabilities, such as occupational and social skills, educational attainment, and the ability to live independently. The severity of such impairments affects all patient in this population, including up to 10% of patients working full time and up to one third of those working part time. In light of the debilitating effects of depression, cognitive impairment, and other aspects of affective functioning on the quality of life of patients with schizophrenia, physicians need to partner with their patients to address these concerns and determine an appropriate treatment regimen. This can be done with simple functional-based cognitive questioning, the use of evidence-based psychosocial practices, and psychoeducation on the many pharmacotherapeutic options. It is recommended that depressive or suicidal symptoms of schizophrenia be treated with an antidepressant or mood stabilizer only if the symptoms have not subsided after treatment of the psychosis with an atypical antipsychotic. Additionally, relative to older medications, atypicals have demonstrated benefit in improving some of the cognitive impairments
— id: 139591, year: 2005, vol: 10, page: 1, stat: Journal Article,

Integrating Neurobiology and Psychopathology into Evidence-Based Treatment of Social Anxiety Disorder
Liebowitz, Michael R; Ginsberg, David L [Ed]
2005 ;10(10):1-5, CNS spectrums
Social anxiety disorder (SAD) is a common, chronic psychiatric disorder characterized by a persistent fear of social or performance situations in which embarrassment can occur. This disorder typically appears during the mid-adolescent years and is unremitting throughout life if not properly treated. SAD presents as two subtypes: the more common and debilitating generalized form, and the nongeneralized form, which consists predominantly of performance anxiety. The majority of patients with SAD have comorbid mental disorders, including mood, anxiety, and substance abuse. No single development theory has been proposed to account for the origins of SAD, although current understanding of the etiology of SAD posits an interaction between psychological and biological factors. Risk factors include environmental and parenting influences and dysfunctional cognitive and conditioning events in early childhood. The neurobiology of SAD appears to involve neurochemical dysfunction, as evidenced by studies of neuroreceptor imaging, neuroendocrine function, and profiles of response to specific medications. Clinical trials have demonstrated that benzodiazepines and antidepressants are effective in the treatment of SAD. The selective serotonin reuptake inhibitors are emerging as the first-line treatment for SAD, based on their proven safety, tolerability, and efficacy. Goals for ongoing future research include development of approaches to achieve remission, to convert nonresponders and partial responders to full responders, and to prevent relapse and maintain long-term efficacy. This monograph explores the epidemiology, clinical presentation, and differential diagnosis of SAD, with a focus on neural circuitry of social relationships and neurochemical dysfunction. The prevalence, rates of recognition and treatment, patterns of comorbidity, quality-of-life issues, and natural history of SAD are discussed as well as pharmacologic and psychosocial treatment strategies for SAD.
— id: 139605, year: 2005, vol: 10, page: 1, stat: Journal Article,

Management of painful physical symptoms associated with depression and mood disorders
Wise, Thomas N; Arnold, Lesley M; Malefic, Vladimir; Ginsberg, David L [Ed]
2005 ;12(11):1-14, Primary Psychiatry
Depression is a common, recurring illness that continues to be underdiagnosed and undertreated in both psychiatric and primary care settings. It is increasingly being recognized that painful physical symptoms, which commonly exist comorbid with depressive disorders, play a role in complicating diagnosis of depression. Patients tend to discuss physical pain with primary care physicians and emotional pain with psychiatrists, often oblivious to the fact that both may be aspects of one disorder. Those who present with somatic complaints are three times less likely to be accurately diagnosed than patients with psychosocial complaints. However, thorough evaluation of mood and anxiety disorders in primary care is sparse due to the limited time primary care physicians can spend with each patient. Better recognition and treatment of both physical and emotional symptoms associated with mood disorders may increase a patient's chance of achieving remission, which is the optimum therapeutic goal. Abnormalities of serotonin and noradrenaline are strongly associated with depression and are thought to play a role in pain perception. Brain-derived neurotrophic factor, which is increased with antidepressant treatment, appears to influence regulation of mood and perception of pain. Clinical evidence indicates that dual-acting agents may have an advantage in modulating pain over those agents that increase either serotonin or noradrenaline alone. The novel dual-acting agents, such as venlafaxine and duloxetine, are better tolerated than tricyclic antidepressants and monoamine oxidase inhibitors. These agents have demonstrated efficacy in depression and in diabetic neuropathic pain independently. Therefore, unless otherwise stated, all inferences to studies of pain in this monograph refer to neuropathic pain in nondepressed patients. (journal abstract)
— id: 63105, year: 2005, vol: 12, page: 1, stat: Journal Article,

Add-on sibutramine for olanzapine-induced weight gain
Ginsberg, David L
2004 ;11(7):24-24 Jul, Primary Psychiatry
Anticonvulsant topiramate, oral hypoglycemic metformin, or the histamine H2 antagonist nizatidine, have been used to offset the weight gain associated with psychotropic medications. Weight gain is a significant problem with many of these medications, especially the atypical neuroleptics clozapine and olanzapine, which have also been associated with the development of elevated serum triglycerides and diabetes mellitus. Sibutramine, a medication approved by the Food and Drug Administration for the management of obesity, including weight loss and its maintenance, produces its effects by norepinephrine, serotonin, and dopamine reuptake inhibition, primarily via its secondary (Mi) and primary (M2) amine metabolites. Unlike many methamphetamine derivatives traditionally used for weight loss, it is not associated with abuse potential. The most common side effects associated with it include dry mouth, anorexia, headache, insomnia, and, in some patients, an increase in blood pressure and tachycardia due to anticholinergic activity. Adverse psychiatric effects reported postmarketing include psychosis, hypomania, and panic attacks. Now comes a randomized, double-blind, placebo-controlled trial of add-on sibutramine for olanzapine-induced weight gain. While the full findings of this study await publication, this early abstract indicates that addition of sibutramine may be a useful antidote to olanzapineinduced weight gain and perhaps even metabolic abnormalities.
— id: 57893, year: 2004, vol: 11, page: 24, stat: Journal Article,

Citalopram-induced hepatotoxicity
Ginsberg, David L
2004 ;11(7):23-23 Jul, Primary Psychiatry
Selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for depression due not only to their efficacy, but to their favorable side-effect profile and safety in overdose. Despite extensive use over the last 10-15 years, only isolated cases of liver injury have been seen with the use of fluoxetine, sertraline, paroxetine, fluvoxamine, and the serotonin-norepinephrine reuptake inhibitor venlafaxine. The article presents the first published case report of significant hepatotoxicity related to the SSRI citalopram. The temporal relation between hepatotoxicity and the introduction of citalopram, along with the resolution observed after drug iscontinuation, supports a diagnosis of citalopraminduced hepatocellular injury. Overall, the incidence of hepatoxicity occuring in relation to citalopram appears quite low. Nonetheless, in patients prescribed the drug, consideration ought to be given to periodic monitoring of liver function tests, particularly in those with liver disease.
— id: 57895, year: 2004, vol: 11, page: 23, stat: Journal Article,

Lamotrigine effective for treatment-resistant schizophrenia
Ginsberg, David L
2004 ;11(7):20-24 Jul, Primary Psychiatry
The article presents a randomized, double-blind, placebo-controlled crossover trial of lamotrigine augmentation of clozapine in treatment-resistant, chronic schizophrenia. Thirty-four hospitalized, treatment-resistant chronic schizophrenic patients participated in this double-blind, placebo-controlled, 14-week, crossover trial in which lamotrigine 200 mg/day was gradually added to their ongoing clozapine treatment. Clinical assessments using the Positive and Negative Syndrome Scale (P
— id: 57898, year: 2004, vol: 11, page: 20, stat: Journal Article,

Mecamylamine augmentation of SSRIs for refractory depression
Ginsberg, David L
2004 ;11(7):23-24 Jul, Primary Psychiatry
Although numerous effective antidepressant medications are available, many patients suffer multiple episodes that are not adequately controlled with presently available therapies. Up to 1.5% of the general population is estimated to have chronic, severe depression. Approximately 30% of these patients are medically resistant to present treatments. As a result, combination treatments of antidepressants with other medications (ie, so-called augmentation strategies) are frequently employed for partial or nonresponders to various monotherapies, including serotonin selective reuptake inhibitors (SSRIs). Now comes a study of the high-affinity nicotinic acetylcholine receptor antagonist mecamylamine hydrochloride as an augmenting agent for treatment of major depressive disorder (MDD) in patients who are partial responders to SSRIs. While quite preliminary, this appears to be the first published report on the use of a central, high-affinity nicotinic antagonist for the augmentation of SSRIs in partial responders. Interestingly, it is well known that approximately 50% of patients with MDD are cigarette smokers, with smoking believed to exert antidepressant and anxiolytic effects. Clearly these results are early and require the completion of this and other studies for validation; however, the use of drugs targeting the nicotinic receptor for the treatment of depression is a novel approach worthy of further attention.
— id: 57894, year: 2004, vol: 11, page: 23, stat: Journal Article,

Paroxetine effective for severe nondermatological pruritus
Ginsberg, David L
2004 ;11(7):22-23 Jul, Primary Psychiatry
The article presents a study indicating that the selective serotonin reuptake inhibitor (SSRI), paroxetine may be effective in the treatment of severe nondermatological pruritus. Twenty-six subjects (13 men and 13 women) with a mean of 65 years of age, most with malignant disease, were enrolled in this randomized, double-blind, placebo-controlled, crossover study of paroxetine and placebo. Seventeen subjects had solid tumors, four had hematological malignancies, and five had various nonmalignant or idiopathic conditions, such as osteoporosis, rheumatoid arthritis, or Parkinson's disease. The intensity of pruritus was measured subjectively with a numerical analogue scale. Two subjects dropped out of the study due to side effects of paroxetine, specifically severe nausea and vomiting. The study indicates that for some patients, paroxetine has beneficial effects in the treatment of severe pruritus of nondermatological origin. The investigators speculate that paroxetine's antipruritic activity may be due to modification of central opioid receptors involved in processing of itch signals.
— id: 57896, year: 2004, vol: 11, page: 22, stat: Journal Article,

Paroxetine use during pregnancy associated with neonatal intracerebral bleeding
Ginsberg, David L
2004 ;11(7):21-22 Jul, Primary Psychiatry
In studies evaluating the safety of Selective serotonin reuptake inhibitors (SSRIs) during pregnancy, while no increase in major anomalies has been reported, several studies have found a greater risk of neonatal complications, including premature delivery, lower Apgar scores, and neurobehavioral effects, such as tremulousness, erratic motor activity, and underarousal. The article presents a case report of neonatal intracerebral hemorrhage in association with maternal use of paroxetine throughout pregnancy. Recently, there have been reports of neonatal intracerebral hemorrhage in association with maternal use of paroxetine throughout pregnancy. In evaluating the potential adverse effects of prenatal exposure to SSRIs and in deciding whether to use these medications during pregnancy, physicians and parents must balance these concerns against the seriousness of depression and its risks both to mother and baby, and should consider the effectiveness of other nonmedication treatments, such as psychotherapy. In the interim, clinicians who prescribe SSRIs during pregnancy ought to be aware of the possibility of precipitating bleeding in the neonate, particularly in patients who have a past personal or family history of bleeding. In all pregnant women taking SSRIs during pregnancy, consideration should be given to advising against concomitant use of aspirin, NSAIDs, or other medications which may impair clotting.
— id: 57897, year: 2004, vol: 11, page: 21, stat: Journal Article,

New Challenges for Anxiety Disorders: Where Treatment, Resilience, and Economic Priority Converge
Pollack, Mark H; Stein, Murray B; Davidson, Jonathan R. T; Ginsberg, David L [Ed]
2004 ;9(4):1-10, CNS spectrums
Anxiety disorders are highly prevalent, are increasing in incidence, affect individuals early in life, and significantly impact health care and quality of life. As such, they are serious public health problems that deserve attention now and in the future. Over the last 10-20 years, there has been marked improvement in pharmacologic and psychosocial interventions for anxiety. Due to their broad spectrum of efficacy against common comorbidities and lack of association with abuse and dependence, serotonergic and mixed serotonergic noradrenergic antidepressants are first-line therapies for anxiety disorders. Benzodiazepines are still widely used in clinical practice because they are well tolerated and work quickly and effectively. Other medications that are emerging as potentially useful for selected populations with anxiety include atypical neuroleptics and anticonvulsants. Cognitive-behavioral therapy (CBT) is at least as effective as medication for many patients with anxiety disorders and facilitates maintenance of benefit over the long term. Resilience, the capacity to bounce back from adversity, can be reliably measured with a psychometrically valid scale, the Connor-Davidson Resilience Scale. Compared with the general population, individuals with anxiety disorders exhibit decreased resilience. Studies have shown that pharmacologic treatment combined with CBT may increase resilience within 2-3 months. Emerging neurobiologic research indicates that noradrenergic pathways and 5-HT2 transporter efficiency may mediate effects on resiliency.
— id: 139618, year: 2004, vol: 9, page: 1, stat: Journal Article,

Special needs of women with bipolar disorder
Swann, Alan C; Ginsberg, David L [Ed]
2004 ;9(8):1-11, CNS spectrums
While the prevalence of bipolar disorder is roughly equal in women and men, the course of illness tends to be more severe in women. In 50% of women with bipolar disorder, illness onset occurs at or within 1 year of menarche. Despite this pattern, most women with bipolar disorder are not accurately diagnosed until they have had a child and developed an episode of PPD. The occurrence of PPD in a patient with recurrent depression but no history of mania or hypomania should raise the index of suspicion for the presence of an underlying bipolar disorder. Medications used in the treatment of bipolar disorder can result in side effects, such as sexual dysfunction or weight gain, and in drug-drug interactions. Carbamazepine, oxcarbazepine, and topiramate can reduce the effectiveness of oral contraceptive pills while sodium valproate may be associated with polycystic ovary syndrome, which is the most common cause of menstrual disturbance in women of reproductive age. Contrary to popular belief, pregnancy does not protect against bipolar disorder relapse. Thus, physicians must be proactive in protecting the mother from relapse. In general, physicians should use nonpharmacologic measures as much as possible, pharmacology when necessary, and consider electroconvulsive therapy when the risks of medications are too great. Psychotic, floridly manic, or profoundly depressed patients should be given medication, for which information concerning safety during pregnancy and breastfeeding exist. For less severe problems, nonpharmacologic strategies can be employed and include promoting the maintenance of healthy nutrition and activity, protecting social and activity/sleep rhythms, educating patients and their families on how to recognize a prodrome of illness, and the use of cognitive-behavioral therapy to address mild symptoms of anxiety, depression, or substance abuse.
— id: 139617, year: 2004, vol: 9, page: 1, stat: Journal Article,

Treatment of bipolar depression
Post, Robert M; Baldassano, Claudia F; Perlis, Roy H; Ginsberg, David L
2003 Dec;8(12):1-10, CNS spectrums
Bipolar disorder is underdiagnosed and often mistaken for unipolar depression. Bipolar patients spend 33% of their time in a state of depression compared to 11% of time spent in a manic state. Duration of time depressed and severity of depression are associated with increased risk for suicide, which occurs in 10% to 20% of bipolar patients. Antidepressants are increasingly being used as adjuncts in the depressed phase of bipolar disorder, although they provide a moderate risk for switch into mania. Lithium and some antiepileptics and atypical antipsychotics have shown antidepressant effects in the treatment of bipolar disorder. Other adjuncts for treatment-refractory patients include monoamine oxidase inhibitors and electroconvulsive therapy
— id: 139592, year: 2003, vol: 8, page: 1, stat: Journal Article,

Gabapentin as prophylaxis against steroid-induced mania
Ginsberg, D L; Sussman, N
2001 Jun;46(5):455-456, Canadian journal of psychiatry
— id: 139593, year: 2001, vol: 46, page: 455, stat: Journal Article,

Effects of nefazodone on body weight: a pooled analysis of selective serotonin reuptake inhibitor- and imipramine-controlled trials
Sussman N; Ginsberg DL; Bikoff J
2001 Apr;62(4):256-260, Journal of clinical psychiatry
BACKGROUND: Evidence suggests that the newer antidepressant drugs may differ with respect to their effects on body weight, especially during long-term treatment. However, the published data about treatment-emergent weight change with the newer antidepressants are limited. Most reports of unexpected selective serotonin reuptake inhibitor (SSRI)-associated weight gain are anecdotal or from small controlled trials. To determine if differences exist among the newer antidepressants, the authors retrospectively analyzed data from clinical trials comparing nefazodone with SSRIs and with imipramine. METHOD: Weight change data supplied by Bristol-Myers Squibb from 6 completed clinical trials comparing the antidepressant nefazodone (N = 523) with 3 SSRIs, fluoxetine, sertraline, and paroxetine (N = 513), as well as 3 trials comparing nefazodone (N = 225) with the tricyclic antidepressant imipramine (N = 224) were analyzed. In all studies, nefazodone was found to be equal in efficacy to the comparator antidepressants. Studies that included both acute and long-term treatment phases were included in the analysis. Acute phases of the trials lasted either 6 or 8 weeks, and long-term phases varied in duration from 16 to 46 weeks. The analysis included summarizing the number and percentage of patients in each group with a > or = 7% change in body weight from baseline at any point in the long-term and acute phases, at endpoint, and at week 16 of the long-term phases. RESULTS: Using 7% or greater weight change as the measure of clinical significance, 4.3% of SSRI-treated patients had lost weight at any point in the acute phase versus 1.7% of those treated with nefazodone (p = .017). However, at any point during the long-term phase, significantly more SSRI-treated patients than nefazodone-treated patients showed a significant increase in body weight (17.9% vs. 8.3%; p = .003). At any point in the acute phase, significantly more imipramine-treated patients than nefazodone-treated patients had a 7% or greater increase in body weight (4.9% vs. 0.9%; p = .027), and for the long-term phase the comparison yielded 24.5% versus 9.5%. The difference during the long-term phase was statistically significant in women (p = .017), but not in men (p = .078) due to the small numbers of men in each group. CONCLUSION: SSRIs caused more weight loss during short-term treatment but more weight gain during long-term treatment. These results lend support to the observation that some antidepressants have a greater expected risk of weight gain than others during long-term therapy
— id: 20640, year: 2001, vol: 62, page: 256, stat: Journal Article,

Effects of psychotropic drugs on weight
Sussman, Norman; Ginsberg, David
1999 ;29(10):580-594 Oct, Psychiatric annals
Reviewed the literature discussing weight gain and loss as side effects of psychotropic drugs. Such psychotropic drugs include antidepressants (selective serotonin reuptake inhibitors [SSRIs], nefazodone hydrochloride, venlafaxine hydrochloride, mirtazapine, and bupropion hydrochloride), antipsychotics, and mood stabilizers (lithium, valproate sodium, carbamazepine, gabapentin, lamotrigine, and topiramate). Causes of weight gain include decreased metabolic rate, increased food intake, and reduced physical activity. Few studies address the prevalence and extent of weight changes associated with treatment of psychiatric disorders. Clinical trials do not always comprehensively examine weight changes, especially delayed weight gain. Studies showed that SSRIs can induce short-term weight loss, which can be therapeutic, but that the drug is associated with long-term weight gain.
— id: 71894, year: 1999, vol: 29, page: 580, stat: Journal Article,

Rethinking side effects of the selective serotonin reuptake inhibitors: Sexual dysfunction and weight gain
Sussman N; Ginsberg D
1998 ;28(2):89-97, Psychiatric annals
Discusses selective serotonin reuptake inhibitors (SSRIs) and their side effects. Side effects are typically categorized by organ system involvement (e.g., hematologic, nervous, renal) and frequency of occurrence (e.g., frequent, infrequent and rare). There could be 1 of 4 side effects: early onset-time limited, early onset-persistent, later onset, and withdrawal-emergent. Sexual dysfunction and weight gain can also be associated with SSRI use. The exact incidence, cause or causes, and optimal management of each of these side effects need to be determined. One potential outcome from studies of these side effects is that this research may reveal the underlying physiological mechanisms that mediate drug effects on appetite and sexual functions.
— id: 8170, year: 1998, vol: 28, page: 89, stat: Journal Article,