ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05931.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A comprehensive neuropsychological test battery was administered to 10 consecutive patients undergoing neurosurgical intervention, capsulotomy, as a last resort treatment for chronic, incapacitating, and otherwise intractable illness, either obsessive‐compulsive disorder (OCD;n= 5) or non‐OCD anxiety disorder (n= 5). The aim was to study the neuropsychology of severe anxiety disorders before and after a defined neurosurgical intersection of connections between the frontal lobes and related brain regions. Although extremely disabled by their illness before surgery, the patients performed within the normal range on most tests. After capsulotomy, there was significant improvement on measures of clinical morbidity and of psychosocial functioning, and the general neuropsychological performance remained remarkably intact. In a subgroup of 5 patients, however, perseverative responses were more common postoperatively, possibly indicating dysfunction of systems involving the frontal lobes. Although admittedly sparse, these data can be interpreted as suggesting that in vulnerable individuals, capsulotomy may give rise to increased perseverative behaviour in the laboratory, and possibly in the real world as well. This risk must be weighed against the potential clinical benefit of capsulotomy in this extremely disabled, sometimes suicidal patient populat

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb09737.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05932.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05933.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The treatment of depression in the elderly population needs a thorough and careful work‐up and an aggressive therapeutic approach. Any treatment initiative in this population often becomes difficult because of accompanying physical illness, concomitant medication, possible degenerative changes in central nervous system and age‐related altered metabolic status. Despite unevenness in research findings, pharmacological treatment remains the mainstay of management of depression among elderly people. Currently available antidepressants, although effective, are problematic because of the increased vulnerability of the elderly to side effects. Recent research efforts to improve the efficacy and safety of drug treatment of depression resulted in development of reversible and selective monoamine oxidase inhibitors of the isoenzyme A (RIMA), with antidepressant efficacy comparable to tricyclic antidepressants and newer generation antidepressants. RIMAs include moclobemide, brofaromine, toloxatone and cimoxatone. Moclobemide is the most investigated available RIMA for therapeutic use at present. Its absorption and disposition in elderly individuals do not differ significantly from those in young healthy volunteers and depressed patients. The results of present clinical studies show that, in elderly depressed patients, moclobemide is at least as effective as other antidepressants. Its particular advantage is, however, that it is as well tolerated in elderly people as in younger people. There are only few significant adverse events, and they are generally less frequent and less severe than those with TCAs. An additional attribute of moclobemide seems also to be its beneficial effect on cognitive functi

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05921.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Aggressive behaviour by psychiatric inpatients was investigated on the same ward during two separate 6‐month periods before and after a 50% decrease in number of beds but without changes in catchment area. Character of the patient group, patient turnover and medical practices as well as total number of staff on duty on the ward was virtually the same during the two periods. It is therefore assumed that differences in aggressive behaviour are mainly explained by effects due to the decreased number of bedsper se.It was found that the 50% reduction did not affect the overall aggression frequency. However, inter‐patient violence increased while the number of more severe aggressive incidents towards staff members decrea

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb09738.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05934.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05935.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Dysthymia is a relatively common disorder and is frequently associated with other mental conditions such as major depression and anxiety. A number of controlled and uncontrolled studies have indicated that conventional as well as more recent antidepressants such as moclobemide, a selective, reversible inhibitor of monoamine oxidase (MAOI), may be effective in dysthymia and dysthymia‐like disorders. However, assessment of the results of previous studies is confounded by the relative lack of standards in diagnostic criteria, outcome measures, dosage and duration of treatment. Applying DSM‐III‐R criteria, the efficacy of moclobemide in dysthymia has been confirmed in a significant study from South America, and other comparable studies are under way. The potential role of selective, reversible MAOIs such as moclobemide can be more firmly established when results of additional investigations have become avai

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05922.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The clinically tested reversiblc inhibitors of monoamine oxidase A (RIMAs) include brofaromine, moclobemide and toloxatone. Moclobemide has shown unequivocal antidepressant activity against serious deprcssivc illness in 4 placebo‐controlled double‐blind trials. It has been compared with amitriptyline, imipramine, clomipramine, desipramine, maprotiline, fluoxetine, fluvoxamine, tranylcypromine. toloxatone, mianserin and amineptine in the treatment of depressive disorders. Meta‐analysis showed convincing evidence of moclobemide efficacy, comparable with the most potent antidepressants available. The efficacy of moclobemide has been demonstrated in psychotic and non‐psychotic depression, in depression with and without melancholia, in endogenous depression (both unipolar and bipolar), in retarded depression and in agitated depression. The efficacy of moelobemide, allied to the unusually benign side effect profile, has led to exploration of its use in other disorders. Two small studies have given encouraging results in the treatment of attention‐deficit hyperactivity disorder. Large placebo‐controlled studies have shown the activity of moclobemide in the depression that accompanies dementia (such as senile dementia of Alzheimer type). The results also suggested that, in this patient population, cognitive ability improved in parallel. Social phobia has also been shown to improve on treatment with either moclobemide or brofaromine. Clinical trials are in progress on the effect of moclobemide in chronic fatigue syndrome. Moreover, there are encouraging results with the use of brofaromine and moclobemide in panic disorder. Other disorders in which treatment with RIMA is of interest include agoraphobia, bulimia, borderline personality disorder, post‐traumatic stress disorder, compulsive hair pulling (trichotillomania), dysmorphophobia, kleptomania as well as various anxi

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05923.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY