Executive dysfunction (ED) is an important clinical dimension that need to be evaluated in neurologic and psychiatric disorders, due to this factor’s impact over patients functionality, quality of life, and overall prognosis. Working memory, inhibition, set shifting, and fluency are the most widely accepted dimensions of ED. The evaluation of these aspects in clinical practive should be more frequently implemented, because they may offer an image about the patients ability to cope with new situations, stressful events, social challenges being included.

To determine the most appropriate methods of ED evaluation in psychiatric practice.

A literature review was conducted through main electronic databases, and papers published between January 2000 and August 2020 were included in the analysis.

Wisconsin Card Sorting Test (WCST), Halstead-Reitan Neuropsychological Battery, Cambridge Neuropsychological Automated Battery (CANTAB), Wechsler Adult Intelligence Scale (WAIS), and Controlled Oral Word Association Test (COWAT) have been the most frequently cited instruments for ED evaluation. The neuropsychiatric disorders in which ED was recommended in clinical trials were schizophrenia and other psychotic disorders, neurocognitive disorders, bipolar disorders, and major depressive disorders. An integrated approach, that combines initial evaluation and periodic monitoring of symptoms severity, global functioning, quality of life, and ED severity should be considered standard-of-practice for neuropsychiatric disorders.

ED is an important dimension of clinical evaluation in many psychiatric disorders that is useful because the results may correlate to the patients prognosis, quality of life, and overall functional evolution.

No significant relationships.

Psychosocial interventions for Alzheimer’s dementia (AD) may increase patients quality of life and overall functioning, while it decreases caregivers burden. Therefore psychotherapies represent an important component of the case management, beside pharmacological approaches.

To review the current psychotherapeutic options available for patients diagnosed with AD, that may be added to their ongoing pharmacological treatment.

A literature review was conducted through main electronic databases, and papers published between January 2000 and August 2020 were included in the analysis.

Cognitive stimulation therapy is based on general cognitive abilities training, with an accent over the social interaction, and it has been associated with significant improvement when compared to wait list or standard care. Reminiscence therapy, usually administered in a group format, focuses on past experinces, triggered by photos, newspaper fragments, music tunes etc., and according to a meta-analysis it may increase communicational, cognitive, and affective abilities. Validation therapy is based on a very empathic communication and tries to acknowledge patients perspective over the world, but the data to support its efficacy is limited for AD. Multisensorial stimulation is based on the assumption that stimuli deprivation is involved in the onset of anxiety, restlessness, insomnia etc, and may lead to short-term non-cognitive symptoms. Music therapy, art therapy, and animal-assisted therapy are also indicated, but more trials are needed to confirm their efficacy.

A large number of psychotherapeutic interventions are explored for AD patients, but most of them have low levels of evidence.

Mindfulness-based cognitive therapy (MBCT) is a third wave cognitive-behavioral therapy (CBT) that incorporates meditation exercises in the classical, structured intervention. Mindfulness has been associated with psychological well-being, and certain symptoms that occur in major depressive disorder (MDD), e.g. worries, ruminations, ideas of incapacity or self-devaluation, are considered potential targets for MBCT.

To evaluate the current level of evidence for the MCBT efficacy in MDD.

A literature serach was performed in the main electronic databases, targeting clinical trials that evaluated in a randomized manner the efficacy of MCBT versus active comparators or placebo in patients with MDD.

MBCT was efficient in a 10-week randomized controlled trial (RCT) versus standard treatment, and it decreased ruminations, increased patients quality of life, mindfulness abilities, and self-compassion. In another randomized, 8-week RCT, MBCT prevented relapses in MDD, with similar rates when compared to psychoeducation and standard treatment. A 26-month follow-up study evidenced the persistence of symptoms improvement detected after 12 months of the trial, when compared to active control group and treatment as usual. MCBT was compared to cognitive therapy in a randomized 8-week trial, and both treatments had similar efficacy in MDD relapse prevention.

MCBT may be an useful adjuvant to the current treatment in acute MDD, but it may also decrease the risk of relapse after psychotherapy termination.

Sleep disturbances can occur as a result of major stressful events. Additionally, research evidence suggests that COVID-19 pandemic may have negatively impacted the quality of sleep among various populations. However, individuals respond differently to the stress, uncertainty and social isolation related with COVID-19 pandemic.

This study aimed to explore the changes in sleep quality and pattern among voluntary psychiatric patients visiting our clinic in Romania during COVID-19 pandemic.

We implemented a cross-sectional study over a period of 3 months, utilizing a Romanian-translated version of the Pittsburgh Sleep Quality Index (PSQI) which was administered through Google Forms web application. Participants lacking digital skills were provided with guidance for completing the questionnaire. Informed consent was obtained prior to participating in this study and data anonymity and confidentiality were ensured.

Among a total of 98 responders, 63% reported a global PSQI score greater than 5, indicating poor sleep. Approximately 25% of participants subjectively marked their sleep as either fairly bad or very bad. When analysing the 7 components of PSQI, our participants struggled most with long sleep latency. About a third of participants reported using sleep medication (both prescription and over-the-counter) three or more times a week within the past month.

Considering the fact that the current situation is likely to evolve for an unknown period of time, there is a dire need to assess the effect of prolonged adjustments in daily routine and their impact on the sleep and the quality of life of our patients.

Binge-eating disorder (BED) is a difficult-to-manage clinical entity, that may associate both organic (e.g., obesity, metabolic syndrome) and psychiatric (e.g., anxiety, mood, or substance use disorders) co-morbidity. Psychotherapeutic and pharmacological approaches are usually combined in order to reach the best outcome for these patients, but the disorder seems to have prolonged evolution even under appropriate therapeutic managment.

To evaluate the most evidence-based therapies focused on BED.

A literature review was conducted through main electronic databases, and papers published between January 2000 and August 2020 were included in the analysis.

Cognitive-behavioral therapy (CBT) is supported by multiple trials, and it led to decreased number of binge episodes and increased rates of remission. Behavioral activation may improve certain symptoms of BED (depressive mood, anxiety), but not the binge episodes frequency. Interpersonal group therapy (IPT) may be helpful for BED patients with an external locus of control and significant interpersonal dificulties. Dialectical behavior therapy (DBT) has been applied in BED patients, but the results have been inconclusive. Lisdexamfetamine dimesylate is the only FDA approved drug for this indication, as dasotraline was rejected by FDA and its research discontinued by the manufacturer. Fluoxetine, sertraline, escitalopram, duloxetine, bupropion, atomoxetine, reboxetine, armodafinil, disulfiram, baclofen, zonisamide, lamotrigine, topiramate, samidorphan, liraglutid, and orlistat need more trials in order to validate their efficacy, especially on long term.

There is only one drug currently FDA approved for this indication, lisdexamfetamine, and a number of psychotherapies, with CBT and IPT being the most supported by evidence.

Cognitive behavioral therapies (CBT) represent a heterogeneous group of psychotherapies in continuous development that share a directive, structured, collaborative approach. Due to a high degree of treatment-resistant cases of major depressive disorder (MDD), new augmentation therapies are urgently needed, in order to increase the chance of recovery in these patients.

To analyze data that may support the indication of third wave CBT in patients with MDD.

A literature search was performed in the main electronic databases, and papers published between January 2000 and August 2020 were included.

Acceptance and commitment therapy has been associated with positive results, but data are derived from low quality trials (n=2). Dialectical-behavioral therapy (DBT)-based skill group have been also associated with favorable outcome, in MDD patients (n=2). Mindfulness-based cognitive therapy (MBCT) was also proven effective in the treatment in MDD (n=4), treatment-resistant MDD included, but the difference between MBCT and active comparators was not always significant. Metacognitive therapy (MCT) has been evaluated in good quality clinical trials (n=4), and its efficacy was confirmed. Mild and moderate MDD patients may benefit from compassion-focused therapy (CFT) (n=1). Behavioral activation (BA) is dedicated to MDD patients and according to a meta-analysis (n=26 randomized controlled trials) BA is superior to other active comparators, although the quality of clinical trials was modest.

Third generation CBT could be useful in MDD patients as augmentative strategy, but more good-quality data are necessary before recommending them in an evidence-based treatment guideline as a distinctive intervention from classical CBT.

To evaluate the impact of conflicting patient and psychiatrist conceptualizations of the depression over the treatment response and general prognosis.

A group of 25 patients, mean age 36.8, diagnosed with major depressive disorder, first depressive episode, according to DSM IV TR criteria, have completed a closed-ended questionnaire that included their perspective over the depression (on a 7 points Likert scale, from the pure medical/pharmacological, to the pure psychological/reactive paradigm). Psychiatrists who managed their treatment responded to a similar questionnaire regarding their preferred method of treatment. Patients were evaluated initially and after 3 and 6 months using Hamilton Depression Rating Scale-17 items (HAMD), Beck Depression Inventory (BDI), Global Assessment of Functioning. Patients satisfaction over the treatment (on a 10 points visual analogic scale) was evaluated at endpoint.

Patients who received a treatment corresponding to their preferred paradigm (n=17) responded better (−5.6 on HAMD, −4.5 on BDI, +7.6 on GAF, p< 0.01) to the treatment, compared to the group where the paradigms weren’t the same. The satisfaction over the treatment was also significant higher in the first group (+2.5, p< 0.01). Patients who have discussed their beliefs about the disorder and were informed by their psychiatrists about the advantages of the treatment had a greater rate of response to treatment (p< 0.05).

Psychiatrists should routinely explore the patient conceptualization of the depression and to discuss together the best treatment approach. Prognosis, patient satisfaction and treatment response are significantly influenced by exploring the patient beliefs about its disorder.

To evaluate the impact of depression treatment over the quality of life in oncologic patients.

A group of 27 patients, 14 male and 13 female, mean age 56,3, diagnosed with lung (n=7), gastric (n=7), prostate (n=5), colon (n=4) and breast (n=4) cancer, were also diagnosed with moderate or severe depression (Hamilton Depression Rating Scale-17 items score at the inclusion was over 14). These patients received a combined, psychopharmacological (escitalopram mean daily dose 15 mg, n=15 or mirtazapine, mean daily dose 30 mg, n=12) and psychotherapeutic (cognitive behavior therapy) approach for 3 months and were monitored using monthly HAMD, Global Assessment of Functioning and Lehman Quality of Life Interview (QOLI). Patients didn’t present any significant axis I, II or III comorbid condition.

Patients responded well to the combined therapy, as the final HAMD (-11.2, p< 0.01) and GAF (+12.3, p< 0.01) scores reflected, with no significant inter-group difference (p=0.23). The quality of life scales regarding health, family relations and social relations from the QOLI registered significant improvement compared to baseline (+10%, +12.2% and +12.5% respectively, p< 0.01). Patients who had the higher response rate to the treatment also had the higher rate of life quality improvement (r=0.65).

The treatment of depression in oncologic patients is a necessity, due to the impact of depressive symptoms over the patient quality of life and is associated with a significant rate of success. The improvements are observed especially in the patient perception of health, family and social relationship and functioning.

To evaluate the efficacy of three different strategies in the management of self-aggressive behavior (defined as repeated overdoses, explicit suicidal attempts or self-mutilation) observed in heroin dependent patients.

A group of 16 patients, mean age 26.2, diagnosed with heroin dependence, were treated as outpatients, with (1) oxcarbazepine (mean daily dose 900 mg), (2) cognitive behavioral therapy focused on coping strategies and cognitive restructuring (2 sessions per week) or (3) the combination of the previous two methods. All the included patients were monitored for 6 months using Inventory of Drug Taking Situations (IDTS), Clinical Global Impression-Improvement (CGI-I), Suicide Attempt-Self Injury Interview-Short Version (SAS II-B) and Global Assessment of Function (GAF). The randomization of the patients in the three groups was single blinded.

Oxcarbazepine was well tolerated and no drop out related to adverse events was registered. Patients that received combined therapy registered an improvement (p< 0.01) in all self-aggressive behaviors (33% to baseline), global functioning (25%) and clinical impression (24%). There was a significant difference between this group and the psychotherapy only treated group (p< 0.01 on SAS II-B, GAF, CGI), but not significant when it was compared to oxcarbazepine group (p=0.06). Regarding the impact of treatment strategies over the severity of addiction, only the combined therapy had some success, by decreasing with 11% the IDTS score.

The combined therapy, using CBT and oxcarbazepine, reduced the risk for self-aggressive behaviors on medium term in heroin dependent patients and mildly decreased the severity of the dependence.

To evaluate the comparative efficacy of 3 antidepressants, each representative of a distinct psychopharmacologic class, in the treatment of depressive disorders associated to Parkinson disease with dementia (PDD).

A group of 23 patients, mean age 72.1, diagnosed with PDD for at least 2 years, who were admitted in our department for a major depressive episode (DSM IV TR), received antidepressant treatment with escitalopram (mean dose 15 mg daily, n=7), duloxetine (mean dose 45 mg daily, n=8) or trazodone (mean dose 150 mg daily, n=8). All patients received treatment for PDD with rivastigmine or donepezil continuously, for at least 12 months. The distribution of patients on the antidepressant treatment was randomized, in a single-blind manner. Patients were evaluated monthly, for 6 months, using Montgomery Asberg Depression Rating Scale, Hamilton Rating Scale for Depression- 17 items, Clinical Global Impression-Improvement and Mini Mental Status Examination.

Patients treated with duloxetine had the most significant improvement in the depressive symptoms, as the endpoint MADRS (-18.6+/-2.3, p< 0.01), HAMD (-13.2+/-1.1, p< 0.01) and CGI-I (- 3.2+/-0.5, p< 0.01) scores reflected. The differences between escitalopram and trazodone didn’t reach a significant level but, overall, both improved the depressive symptoms compared to baseline (p< 0.05). The difference between duloxetine and the other two antidepressants became significant after 8 weeks (p< 0.01). The severity of dementia symptoms didn’t vary significantly between the three groups at endpoint.

Duloxetine had proven itself more efficient than escitalopram and trazodone in the improvement of the depressive symptoms in PDD.

To establish the frequency of self-image distorsions in alcohol dependent patients and if addressing them through a targeted psychotherapeutic approach would be beneficial.

A group of 45 patients, 32 male and 13 female, mean age 39.6, diagnosed with alcohol dependence (DSM IV TR), were evaluated for establishing the severity of self-image distorsions, using-baseline and endpoint- Rotter Incomplete Sentence Test (RIST) and Thematic Apperception Test (TAT); for the monitoring of the dependence severity and its associated impairments we used Inventory of Drug Taking Situations (IDTS)-alcohol focused version and Global Assessment of Function (GAF) every 4 weeks for 6 months. From the initial group, 38 (84.4%) patients have been found with moderate and severe self-image distorsions (feeling of insecurity and inferiority, external locus of control, frequent use of denial, regression and projection). They received cognitive-behavior therapy (CBT) focused on restructuring cognitive dysfunctional beliefs about self and experimenting new ways to relate to self and significant others.

The psychotherapeutic approach decreased the overall severity of alcohol dependence (-35.7 on IDTS, p< 0.01) and consequently improved the global functioning (+18.2 on GAF, p< 0.01) after 6 months. These results correlated with the improvement of self-image, reflected on the severity of P-Ego scale from RIST (-23.2%, p< 0.01) and on the improvement of defense system (more frequent use of anticipation, suppression and rationalization and less of denial and projection).

Patients with alcohol dependence have very often self-image distorsions and could, therefore, benefit from a psychotherapy that addresses specifically this phenomenon.

Patients with dual diagnosis, major depressive disorders and cluster B personality disorders, must be carefully monitored because of the refractory cases high incidence to either psychotherapeutic or pharmacologic therapy, when applied alone. In histrionic patients the the emphasis during psychotherapy must be on the collaborative therapeutic relationship and on the goals operationalizing process.

We prospectively evaluated 12 patients, female, mean age 35.5 years, diagnosed with major depressive disorder and histrionic personality disorder (according to DSM IV TR criteria) treated with antidepressants (fluoxetine 30 mg/day, n=5, paroxetine 30 mg/day, n=4, mirtazapine 45 mg/day, n=3) and weekly sessions of cognitive-behavioural therapy, for 6 months. We used Beck Depression Inventory (BDI)- 21 items form initially and every two weeks until the endpoint. The Global Assessment of Functioning (GAF) was used also, with the same frequency. The specific schemas of histrionic personality disorder had been addressed simultaneously with depressive specific dysfunctional beliefs.

There were 4 cases of discontinuation after a mean duration of 10.6 weeks. These patients presented at 6 months a higher score on BDI (+6.5) and a lower degree of social and professional level of functioning (-15 on GAF); a follow-up evaluation (after one year from baseline) observed more residual symptoms or recurrence of depression than patients that participated in all study sessions (mean BDI score 15.6vs.9.5, GAF 78vs.89, 2vs.0.5 depression episodes incidence).

Adressing dysfunctional schemas of histrionic personality disorder improves the long term prognosis in depressed patients with dual diagnosis.

Alzheimer Dementia (AD) is known as the most common cause of degenerative dementias that decrease patient life expectancy, quality of life and increase caregivers burden. Objective: To determine the evolution of cognitive and non-cognitive symptoms under donepezil treatment and to evaluate the impact of these symptoms evolution over the caregivers.

This prospective, open-label, trial included a group of 56 patients, 34 male and 22 female, mean age 72.4, diagnosed with AD according to DSM-IV-TR criteria. Patients received either donepezil (n= 30) or 1400 UI/day mean dose of vitamin E (n=26). We evaluated these patients monthly during 1 year using Mini-Mental State Examination (MMSE), AD Assessment Scale (ADAS), Hamilton Depression Rating Scale (HAMD)-17 items, Brief Psychiatric Rating Scale (BPRS)- 18 items, Global Assessment of Functioning Scale (GAF), Burden Interview (BI).

Patients presented significant better evolution under donepezil on cognitive symptoms as scores evolution on ADAS-Cognitive behavior subscale (+1.5+/-0.2 vs. +10.4+/-0.8, p<0.0001) and MMSE (-0.8+/-0.2 vs. –7.7+/-0.4, p<0.0001) reflected. The non-cognitive symptoms evolution was also better under donepezil treatment, as the ADAS-Noncognitive behavior subscale (+2.6+/-0.4 vs. +8.2+/-0.7, p<0.0001), HAMD (increases of 4.5 vs. 8.2, p<0.001) and BPRS (increases of 6.7 vs.14.2, p<0.0001) reflected. The evolution of GAF was better in the donepezil group (-10.5 vs. –27.5, p<0.0001) and the burden of caregivers was significant less in the same group (+10.2 vs. +30.8 on BI, p<0.0001).

Donepezil is efficient in controlling both cognitive and non-cognitive symptoms in mild to moderate AD and therefore it decreases also the caregivers burden.

Patients with schizophrenia that are treated with first generation, but also with several second generation antipsychotics, frequently describe negative changes in self-perception and daily activities due to weight gain. A systematic analysis of the weight gain influence over the body image is necessary because it could offer a perspective over the patient's discomfort, improving his/her chances to therapeutic compliance and a better life quality. Psychotherapy, change of antipsychotics, nutritional counselling, ocupational therapy or physical exercises scheduling could be solutions to these cases.

A group of 34 patients, 18 female and 16 male, diagnosed with chronic schizophrenia (DSM IV TR), mean age 45.3, treated with antipsychotic agents for at least 2 years (haloperidol 15 cases, olanzapine 10 cases, amisulpride 5 cases, risperidone 4 cases) were evaluated in order to configure a body image profile, using self-reports, investigator-based reports and Draw-a-Person-Test (DAP). Patients included in this evaluation presented a mean weight gain of 10%, reported to their premorbid value.

The body image was negative in 82.3% with marked dysfunctional believes about self in 64.7%, while the rest of 17.6% had mild to moderate levels of self-blame or hopelessness automatic thoughts associated to weight gain. Only 17.7% patients had a neutral or positive body image, also their mean weight gain was equally to the negative body image group.

Negative body image is usually associated to weight gain as a side event to antipsychotic drugs, therefore is important to ventilate the patient's dysphoric feelings and to choose the optimal therapy.

Venlafaxine extended release (XR) stands as an optimal therapeutic choice for the major depressive disorder (MDD) and generalized anxiety disorder (GAD) dual diagnosis.

We focused upon the evaluation of venlafaxine XR efficacy in treating MDD and GAD dual diagnosis patients, using an selective serotoninergic reuptake inhibitor comparator, fluoxetine.

A 23 patients group, 13 male and 10 female, mean age 36.7, admitted in our clinic, that met the DSM IV TR criteria for both MDD and GAD, were distributed in two groups, receiving venlafaxine XR in 75-150 mg flexible dose (n=12) or fluoxetine 20-40 mg flexible dose (n=11). We assessed patients evolution under treatment every two weeks for 6 months using Hamilton Depression Rating Scale 17 items (HAMD-17), Hamilton Anxiety Scale for Anxiety (HAMA), Global Assessment of Functioning Scale (GAF) and Clinical Global Impressions (CGI).

In the intent-to-treat (ITT) and last-observation-carried-forward (LOCF) analysis, differences between groups became statistically significant at week 4, venlafaxine XR treated patients improved better as HAMD-17 (-7.8 points, p<0.05) and HAMA (-8.9 points, p<0.05) reflected. The end-point HAMD-17 and HAMA scores were smaller in the venlafaxine treated group (6.7 and 9.1, p<0.05). Endpoint CGI (1.5) and GAF (92) scores were also better in venlafaxine XR treated group (p<0.01).

The 6 months clinical trial proved venlafaxine XR superior to the active comparator, fluoxetine, in the treatment of MDD and GAD dual diagnosis.

Somatization disorder is frequently associated in epidemiologic trials with depressive, anxiety, other somatoform or substance related disorders, as well as with personality disorders. An examination of psychiatric comorbidity in patients diagnosed with somatization disorder is strongly advised due to the impact of these associated conditions over the prognosis and treatment.

To establish the incidence of psychiatric dual diagnosis in hospitalized patients with somatization disorder.

A group of 37 patients, 22 female and 15 male, mean age 45.9, were evaluated using Structured Clinical Interview for DSM Axis I (SCID-I) and Axis II (SCID-II) disorders at the admission in our department for a diagnosis of somatization disorder. All patients included in this trial were known with somatization disorder for at least one year prior to this admission.

Patients diagnosed with somatization disorder presented mostly depressive disorders (46%, n = 17), anxiety disorders (37.8%, n = 14), substance related disorders (16.2%, n = 6) and personality disorders (67.5%, n = 25). A more detailed analysis on axis I established major depressive disorder as the most frequent diagnosis (37.8%, n = 14), followed by panic disorder (27%, n = 10) and alcohol dependence (13.5%, n = 5), while on axis II the histrionic (21.6%, n = 8) and obsessive-compulsive (19%, n = 7) personality disorders were the most frequently associated conditions. A number of 21 patients presented at least three axis I and/or II simultaneous diagnosis (64.8%).

The most frequently comorbidities in somatization disorder are major depressive disorder and panic disorder on axis I, as well as histrionic and obsessive-compulsive personality disorder on axis II.

One of the main goals of psychotherapy should be increasing the patient's quality of life. This purpose is of extreme importance in patients diagnosed with cancer that have to fight with anxiety, depression, social and occupational adjustment difficulties.

We included in a 3 months weekly sessions program of cognitive psychotherapy a number of 12 patients, 8 female and 4 male, mean age 52.4, diagnosed with malignant tumors (lung cancer 2 cases, ovarian cancer 2 cases and stomach cancer one case). The assessment included Cancer Coping Questionnaire (CCQ)- 21 items version, Hamilton Rating Scale for Anxiety (HAM-A), Beck Depression Inventory-21 items (BDI), Global Assessment of Functioning (GAF) and the dysfunctional beliefs monitoring throughout all the 3 months of this trial. Therapy focused on working with “realistic” negative automatic thoughts, attention switch on resources instead of loses, stimulating emotional expression of frustration, anger or blaming, involving in planning activities and isolation prevention. Inclusion criteria: CCQ baseline value under 42, either anxiety or depressive symptoms, or both, that interfere with daily functioning (HAM-A score over 20, BDI over 15, GAF under 75).

All patients that reach the endpoint (two drop-outs recorded) improved their cognitive approach to cancer because their coping methods improved and dysfunctional beliefs decreased in frequency and strength. CCQ score improved with 34.5%, HAM-A decreased with 15+/-2.5%, BDI decreased with 18+/-1.5% and GAF increased with 10+/-1.1% at endpoint.

Cognitive therapy is an usefull approach in oncologic patients, helping them to focus on resources, activity and relational support.

Poor sleep quality causes frequently and seriously impairments in older people daily functioning. More than that, inadequate treatment of insomnia side effects further decrease patients quality of life.

We examined whether between nonbenzodiazepine and benzodiazepine hypnotic treatment are significant differences regarding sleep quality, total sleep time, sleep onset latency, number of awakenings during the night, global functioning and side effects.

A group of 40 outpatients, 16 male and 24 female, mean age 67.9, diagnosed with insomnia, was divided in two equally groups, each of them receiving for at least 7 days either zolpidem 5 mg/day or diazepam 10 mg/day, overnight. Inclusion criteria: age over 65. Exclusion criteria: physical illness and psychiatric disorders that disrupt sleep, simultaneous administration of other sedative drugs. An assessment using Clinical Global Impressions (CGI), Global Assessment of Functioning (GAF) and self reports for depth, total perceived time, onset latency of sleep, number of awakenings during night and side effects were realised every day for a week.

The intent-to-treat (ITT) and last-observation-carried-forward (LOCF) analysis reflected statisticaly significant differences from the day 2 in four variables- depth of sleep (+3/+1.2, p<0.01), number of awakenings(+3.2/+4.9, p<0.01), GAF (+7.8/+5.5, p<0.01) and CGI (-1.9/-0.7, p<0.01) in favor of zolpidem treated patients. Also, side effects were significantly more frequent reported in benzodiazepine group (15/10, dropouts 3/1, p<0.01).

Zolpidem is a first choice treatment in older people because it is well tolerated and have a good efficacy profile compared to diazepam.

Selective serotonin reuptake inhibitors (SSRIs) are frequently used for irritable bowel syndrome, while duloxetine was evaluated in other similar psycho-somatic syndromes.

This prospective, single-blind trial intends to compare the efficacy of SSRIs and duloxetine in the treatment of irritable bowel syndrome.

A group of 22 patients, 15 female and 7 male, mean age 50.2, diagnosed with irritable bowel syndrome according to the Rome II Diagnostic Criteria (1992) were treated with either an SSRI (escitalopram 20 mg/day, n = 6 or fluoxetine 40 mg/day, n = 6) or duloxetine (90 mg/day, n = 10). Patients were evaluated initially and every 4 weeks, for 6 months, using Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale 17 items version (HAMD), Clinical Global Impressions -Severity/Improvement (CGI-I/S) and a 7-points Likert scale (LS) for self-evaluated severity.

Duloxetine improved anxiety and depressive symptoms, as reflected by the significant decrease of HAMA (−17.6 points, p < 0.05) and HAMD scores (−18.2 points, p < 0.05) at week 12. SSRIs also reduced the affective symptoms, significantly to baseline (p < 0.05), but less than duloxetine (−14.3, −15.2) at week 12, with no significant difference at week 24 (p = 0.120). The CGI-I results paralleled the decrease of HAMD and HAMA, while the LS evaluation of gastrointestinal symptoms improved similarly in both groups, with no significant difference (p = 0.09).

Duloxetine is an efficient agent in the treatment of irritable bowel syndrome, because it decreases the mood symptoms more rapidly than SSRIs. The overall efficacy of SSRIs and duloxetine at 6 months is nevertheless similar.