Parkinson’s disease (PD) is a progressive neurological disorder that associates multiple psychiatric symptoms and disorders, like depression, neurocognitive impairment, sleeping disorders, etc. Insomnia is frequently detected in this population, with a prevalence of over 50% according to several studies.

To present a case series dedicated to the treatment of insomnia in patients diagnosed with PD, who did not meet diagnostic criteria for any other psychiatric disorder.

A number of three patients (2 male, one female, mean age 65.2 years) diagnosed with PD, were evaluated for insomnia. They were all initiated on quetiapine XR 50 mg QD, and up-titrated according to the individual response. All these patients were undergoing treatment for their neurological disease, which remained stable for the next 3 months. A structured clinical evaluation was performed monthly, and safety measurements were also performed. All patients self-evaluated their insomnia severity on a 10-point visual analogic scale (VAS).

After 3 months, patients reported a favorable evolution of their insomnia- VAS score improved significantly to baseline (from 7.3 to 3.3), without significant adverse events (metabolic parameters and QTc values did not change significantly during the treatment period). Daytime sleepiness was not reported as being significant by any of these patients. The mean dose of quetiapine XR used was 75 mg QD (50-150 mg QD), and the mean duration of the needed treatment for insomnia was 8.3 weeks (4-11 weeks).

Quetiapine XR could be useful in patients with PD-related insomnia, and the mean dose is usually below 100 mg QD.

No significant relationships.

Postpartum depression (PPD) is an important cause of discomfort and dysfunction that impair the quality of life and the daily functionality not only of the patient but also of her child and her family, in its entirety. New treatment options have been made available for this pathology, but their use is restricted by methodological aspects, like the difficulty of administration, lack of enough data regarding their long-term efficacy, and costs.

To conduct a literature review in order to find the most evidence-based pharmacological interventions for PPD.

A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “postpartum depression” AND “treatment” OR “pharmacological agents”. All papers published between January 2000 and August 2021 were included.

Among the most evidence-based agents for PPD treatment are serotonin selective reuptake inhibitors (SSRIs). As individual agents, sertraline seems to be the most supported antidepressant by evidence from clinical trials, followed by escitalopram/citalopram, and fluoxetine. Other antidepressants supported by clinical data were venlafaxine, desvenlafaxine, nortriptyline, and bupropion. A 6-12 months maintenance treatment is considered optimal after remission, in women with a low risk of recurrence. Brexanolone, zuranolone, and ganaxolone are members of a new class of drugs studied for postpartum depression, but currently, only the first agent is FDA-approved for this indication.

SSRIs are the most supported by evidence treatments for PPD, and brexanolone is a drug with a new mechanism, dedicated to this pathology that provides new hope for recovery.

No significant relationships.

The ongoing debate regarding the treatment efficacy for negative and cognitive symptoms in schizophrenia is a subject of continuous frustration among psychiatrists. These symptoms are reputedly hard to tackle therapeutically and their impact on long-term functional prognosis made them an important target for the maintenance treatment.

To review the literature in order to find the most adequate treatment options for negative and cognitive symptoms of schizophrenia.

A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE, www.clinicaltrials.gov) using the search paradigm “schizophrenia” AND “negative symptoms” AND “cognitive symptoms” AND “pharmacological treatment”. All papers published between January 2000 and August 2021 were included.

The efficacy of atypical antipsychotics over cognitive dysfunctions in schizophrenia decreases with time, without significant differences between the agents. Clozapine, amisulpride, olanzapine, and risperidone have superior efficacy over positive and negative symptoms, with small to moderate effect sizes. Meta-analyses show decreased severity of negative symptoms during treatment with atypical antipsychotics, especially with clozapine, amisulpride, olanzapine, zotepine, and risperidone. Atypical antipsychotics had a superior effect over neurocognitive domains when compared to the typical antipsychotics. Newer atypical antipsychotics, with partial D2/D3 agonism, are preferred to other atypical agents, although based on a low level of evidence. Antidepressants, especially mirtazapine, may be a solution for negative symptoms, while modafinil/armodafinil is also useful as an add-on.

Although new therapeutic options are explored, there is a paucity of encouraging results from the pipeline regarding the treatment efficacy over negative/cognitive symptoms.

No significant relationships.

Type I bipolar disorder (BDI) is characterized by a chronic evolution, with recurrent mood episodes that severely disrupt the overall functionality and quality of patients’ life. An adequate maintenance treatment is necessary to prevent relapses and to improve the functional prognosis of these patients.

To find data regarding the most evidence-based therapeutic strategies in the maintenance phase of BDI.

A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “type I bipolar disorder” AND “mood stabilizers” AND “antipsychotics” AND “anticonvulsants”. All papers published between January 2000 and August 2021 were included.

The main recommendation is to continue in the maintenance phase the same medication that has proven its efficacy and tolerability in the acute phase. In BDI the most evidence-supported pharmacological approaches for the maintenance phase were lithium, valproate, lamotrigine, and carbamazepine as anticonvulsants/mood stabilizers, as well as olanzapine, quetiapine, and aripiprazole as antipsychotics. Lithium and valproate have been associated with positive influence over neuroplasticity, while antipsychotics have considerably higher metabolic adverse events. Monotherapy is recommended, but drugs associations are frequently met in clinical practice. There are no consistent data about the superiority of one class over the other, but lithium has a proven effect of decreasing the suicide rate in this population.

Both anticonvulsants and antipsychotics are used in the maintenance phase of the BDI, without significant differences in the efficacy rates. However, benefits and risks should be weighted for each class and each individual agent recommended.

No significant relationships.

A debate regarding the comparative efficacy and tolerability of oral and long-acting injectable antipsychotics (LAIs) in patients diagnosed with schizophrenia is still open in the mind of clinicians. While the adherence is intuitively improved by the LAIs, the acceptance of this treatment is not always good.

To conduct a literature review in order to find the data about the comparative efficacy of oral and LAI antipsychotics in schizophrenia, during the maintenance phase.

A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “schizophrenia” AND “maintenance treatment” AND “oral antipsychotics” OR “long-acting injectable antipsychotics”. All papers published between January 2000 and August 2021 were included.

Based on the reviewed clinical trials (n=37), LAI antipsychotics are associated with an efficacy and tolerability profile similar to or slightly superior to the oral formulation. This is confirmed for both typical and atypical antipsychotics that have been detected by this review. The main advantage of the LAIs is their superior therapeutic compliance and the possibility of early detection for non-adherent patients. However, not all data are unanimously supporting this perspective: while observational trials favor LAI antipsychotics, randomized trials included in the meta-analyses do not detect significant differences between the two types of formulations.

LAIs are associated with superior adherence, but their overall efficacy and tolerability are only slightly superior to those of the oral equivalents. Moreover, there are differences in the results related to the methodology of the trials, therefore data should be interpreted with care.

No significant relationships.

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.

Fibromyalgia is a chronic condition, with a high degree of psychiatric comorbidity and an insufficiently explained pathogenesis. Therefore, its therapeutic management is challenging, with both pharmacological and non-pharmacological approaches being suggested as treatment options.

To analyze the current level of evidence in favour of pharmacological treatment for fibromyalgia.

A literature review was performed through the main medical databases using the search paradigm “fibromyalgia” AND “pharmacological therapy” OR “antidepressants” OR “moodstabilizers” OR “anxiolytics”. All papers published between January 2000 and August 2020 were included in the primary analysis.

A gradually increasing interest for the treatment of fibromyalgia has been observed in the last decade, and the number of clinical trials for this indications has almost doubled in this period, when compared to the previous decade. Pregabalin, duloxetine, and milnacipran are the most supported by evidence pharmacological treatments for fibromyalgia, especially for the pain component. Amitriptyline, gabapentin, cyclobenzaprine, and tramadol have also been studied in various clinical trials, but tehre are less evidence to support their use. Cognitive dysfunctions, sleep disorders, and mood disturbances benefit from far less investigation in clinical trials, therefore no clear recommendation can be made regarding the superiority of an agent over another.

The pain component of fibromyalgia benefits from treatment with pregabalin, duloxetine, and milnacipran, while the affective component and the cognitive dimension still need more research from the psychopharmacological perspective.

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.

Burn-out syndrome is an underestimated entity in the medical environment, and lack of health policies for screening, prevention and early phase treatment strategies may be responsable for complications of this syndrome, e.g. major depression, substance use disorders, or anxiety disorders. Large variations in the estimation of burn-out prevalence in healthcare providers may be related to poorly designed epidemiological trials and lack of well-defined criteria for diagnosis.

To analyse the current evidence in the literature about the diagnosis and treatment of burn-out syndrome in physicians and auxiliary personnel.

A literature review was performed through the main medical databases (Cochrane Database of Systematic reviews, PubMed, Thomson Reuters/Web of Science, SCOPUS, EMBASE, CINAHL) using the search paradigm “burn-out” AND “healthcare providers” OR “physicians” AND “nurses”. All papers published between January 2000 and August 2020 were included in the primary analysis.

A large number of papers were detected in the primary analysis (n=245), but only 15 remained after the inclusion/exclusion criteria were applied. Maslach Inventory for Burnout is the most extensively used instrument for screening, but its validity is questioned, and new instruments have been created, but less frequently applied. Cognitive behavioral therapy led to improvement of the emotional exhaustion in multiple trials. Meditation techniques, music therapy, structured physical exercises, and management-related interventions have been associated with low to moderate degree of success.

Burn-out syndrome is a still insufficiently explored diagnosis and more good-quality epidemiological and clinical trials are needed in order to support adequate prevention and treatment strategies.

Psoriazis and major depressive disorder (MDD) have a high degree of overlap, and inflammatory citokines like tumor necrosis factor alpha, interleukins 1, 2, 6 and 10, and C-reactive protein have been involved in their common pathogenesis. The prevalence of MDD in patients with psoriazis has been reported to range between 28% to 67%.

To monitor the core symptoms evolution in patients diagnosed with psoriazis and MDD during antidepressant treatment.

Four patients diagnosed with psoriazis and MDD (according to the DSM-5 criteria) were monitored during 6 months using Physician Static Global Assessment (PSGA), Hamilton Depression Rating Scale (HDRS)-17 items, and Global Assessment of Functioning (GAF). All patients underwent specific psoriazis and antidepressant treatment (with flexible dose of sertraline 100-200 mg daily, n=2, or escitalopram 10-20 mg/day, n=2).

All patients significantly improved their depressive symptoms during sertraline or escitalopram treatment (-8.7 points on HAMD at week 24, p<0.001), while their global functioning increased (+24.7 on GAF, p<0.001). The PSGA score decreased and reached a level of signifiance at week 24 (-1.2, P<0.01). The duration of active periods of psoriazis was less longer during the 6 months of monitoring than in the 6 months previous to the antidepressant initiation (by self-report, -10.5 days). No treatment discontinuation due to low tolerability was reported.

Antidepressant treatment with selective serotonin reuptake inhibitors is efficient and well tolerated in patients with MDD and psoriazis. The duration of active symptoms of psoriazis tends to be less longer than previous to the antidepressant initiation.

In the context of COVID-19 pandemic, first-line responders (FLR) are exposed to multiple stress factors, ranging from lack of adequate protective equipment to worries about family health due to work-related exposure to the new coronavirus. Therefore, FLR became themselves a vulnerable population that need prevention strategies for professional stress-related disorders (PSRD).

To explore the literature in order to find evidence-based prevention strategies for PSRD in FLR, strategies resulted from other epidemiological crisis situations (MERS-CoV, H1N1, SARS-CoV) that may be applied in the current pandemic.

A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “professional stress-related disorders” AND “first line responders” AND “prevention”. All papers published between January 2000 and June 2020 were included.

Reported prevalence of post-traumatic stress disorder in FLR involved in epidemiological crises was between 10% and 33%. Evidence-based recommendations for PSRD prevention are lacking, and only general advices have been detected. These suggestions were clustered on institutional level (e.g., involving of medical personnel in administrative decisions, encouraging personal initiatives, longer pauses between shifts) and individual level (e.g., training of coping abilities, relaxation techniques, and peer-focused group support). Several guidelines for prevention of mental disorders in workplace exist, but they are not focused on FLR.

The need to elaborate guidelines for prevention of PSRD in FLR can not be overemphasized, especially in the pandemic period, in order to avoid the onset of stress-related complications, and to preserve a good quality of the medical activity.

Chronic fatigue syndrome (CFS) is a complex condition, with an insufficiently known pathophysiology, that raises multiple challenges to the treating physicians. Due to its yet mostly unknown underlying mechanisms, there is no consensus treatment recommendation for CFS. The risk to associate major depression, anxiety disorders or substance use disorders is frequently reported, and this co-morbidity further complicates the evolution of CFS.

To search the existing literature for pharmacological and psychotherapeutic recommendations in CFS.

A literature search was performed using the main electronic databases using the paradigm „chronic fatigue syndrome” AND „psychopharmacological treatment” OR „psychotherapy”. All papers published between January 2000 and August 2020 were included in the primary analysis.

Anti-inflamatory drugs (corticosteroids and non-steroidal drugs), antidepressants, moodstabilizers, anxiolytics, immuno-modulatory drugs, and antivirals have been investigated for CFS, but the trials had low-quality designs, used various definition of CFS, and different criteria for monitoring the efficacy of treatment. Cognitive behavioral therapy (CBT) may be promising for decreasing the fatigue severity, but larger trials are needed. Graded exercise therapy (GET) also may be of some use for improving patients ability to engage in activities, but caution should be in order because of the risk of over-exercising that may exacerbate the core CFS symptoms.

Larger trials are needed in order to validate pharmacological and psychotherapeutic recommendations for CFS. No drug may be considered first line treatment for this indication, while CBT and GET may be useful, although they do not address all the central symptoms of CFS.

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.