High expectations have been put into new/atypical neuroleptics for the treatment of schizophrenia... more High expectations have been put into new/atypical neuroleptics for the treatment of schizophrenia: the higher extrapyramidal-motor tolerability and better efficacy in treating negative symptoms supposedly result in a more favourable influencing of the overall course of the disease and in a higher quality of life for the patients. This article will report about the state of evaluation and therapeutic advantages of new/atypical neuroleptics, and thereby deal with problems of definition and methodology. It also describes differences in the unwanted adverse events profile of the different new/atypical antipsychotics.
Obsessive-compulsive disorder (OCD) is a chronic and often incapacitating disorder that is freque... more Obsessive-compulsive disorder (OCD) is a chronic and often incapacitating disorder that is frequently complicated by mood and additional anxiety diagnoses. Although appropriate pharmacotherapy is often of great benefit, full remission is rare. Separate multi-center, placebo-controlled trials of clomipramine, paroxetine, fluoxetine, sertraline and fluvoxamine, respectively, have established the unparalleled efficacy and safety of the serotonin reuptake inhibitors (SRIs) in the treatment of OCD. Direct comparisons of SRIs suggest similar efficacy, but reduced tolerability for clomipramine in comparison to fluoxetine, fluvoxamine, sertraline and paroxetine in patients with OCD. Although 60-80% of OCD patients will respond to SRI treatment, partial symptom reduction (mean improvement, 25-40% from baseline) remains the rule. Controlled trials of adjuvant lithium, buspirone, thyroid hormone or clonazepam added to ongoing SRI therapy have failed to demonstrate substantial further antiobsessive effects. The prese...
The prevalence of obsessive-compulsive disorder was measured in five US communities among more th... more The prevalence of obsessive-compulsive disorder was measured in five US communities among more than 18,500 persons in residential settings as part of the National Institute of Mental Health (Bethesda, Md)--sponsored Epidemiologic Catchment Area program. Lifetime prevalence rates ranged from 1.9% to 3.3% across the five Epidemiologic Catchment Area sites for obsessive-compulsive disorder diagnosed without DSM-III exclusions and 1.2% to 2.4% with such exclusions. These rates are about 25 to 60 times greater than had been estimated on the basis of previous studies of clinical populations.
Abnormality of the serotonin (5-hydroxytryptamine – 5-HT) system and particularly hypersensitivit... more Abnormality of the serotonin (5-hydroxytryptamine – 5-HT) system and particularly hypersensitivity of postsynaptic 5-HT receptors remained the leading hypothesis for the underlying pathophysiology of obsessive compulsive disorder (OCD) during the 1980s. A number of lines of evidence supported this serotonergic hypothesis, not least the treatment studies which demonstrated clearly and consistently that anti-obsessional efficacy was a function of serotonin re-uptake inhibition. Studies of markers and biological probes provided further evidence: platelet studies, for example, linked reductions in 5-HT activity with clinical response, and treatment response was correlated with decreased 5-hydroxyindolacetic acid (5-HIAA) levels within the cerebrospinal fluid of OCD patients. Added to this was the evidence from the behavioral or physiological responses observed following serotonergic challenge with the serotonin agonists meta-chlorophenylpiperazine, a compound with high affinity for 5-HT...
The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum (CINP), 2003
Comorbidity in bipolar disorder is the rule rather than the exception more than 60% of bipolar pa... more Comorbidity in bipolar disorder is the rule rather than the exception more than 60% of bipolar patients have a comorbid diagnosis and is associated with a mixed affective or dysphoric state; high rates of suicidality; less favourable response to lithium and poorer overall outcome. There is convincing evidence that rates of substance use and anxiety disorders are higher among patients with bipolar disorder compared to their rates in the general population. The interaction between anxiety disorders and substance use goes both ways: patients with bipolar disorder have a higher rate of substance use and anxiety disorder, and vice versa. Bipolar disorder is also associated with borderline personality disorder and ADHD, and to a lesser extent with weight gain. As more than 40% of bipolar patients have anxiety disorder, it is indicated that while diagnosing bipolar patients, systematic enquiry about different anxiety disorders is called for. This also presents a therapeutic challenge, sinc...
Over the past decade, epidemiological, phenomenological, pharmacological, neurobiological, brain ... more Over the past decade, epidemiological, phenomenological, pharmacological, neurobiological, brain imaging and genetic research has contributed to a substantial change in our understanding of obsessive-compulsive disorder (OCD). Once regarded as a rare psychodynamic illness, OCD is now recognized as a common condition affecting 2-3% of the population. Better recognition combined with the demonstrated efficacy of serotonin reuptake inhibitors, such as clomipramine and the selective serotonin reuptake inhibitors (SSRIs), has dramatically improved the prognosis of this disorder, which exacts a considerable personal and economic burden. While the aetiology is still not understood, increasingly sophisticated research techniques are enabling us to begin to uncover the underlying pathophysiology of this illness. This paper reviews some of the recent developments which have enhanced our understanding of OCD and considers their potential impact on clinical management.
High expectations have been put into new/atypical neuroleptics for the treatment of schizophrenia... more High expectations have been put into new/atypical neuroleptics for the treatment of schizophrenia: the higher extrapyramidal-motor tolerability and better efficacy in treating negative symptoms supposedly result in a more favourable influencing of the overall course of the disease and in a higher quality of life for the patients. This article will report about the state of evaluation and therapeutic advantages of new/atypical neuroleptics, and thereby deal with problems of definition and methodology. It also describes differences in the unwanted adverse events profile of the different new/atypical antipsychotics.
Obsessive-compulsive disorder (OCD) is a chronic and often incapacitating disorder that is freque... more Obsessive-compulsive disorder (OCD) is a chronic and often incapacitating disorder that is frequently complicated by mood and additional anxiety diagnoses. Although appropriate pharmacotherapy is often of great benefit, full remission is rare. Separate multi-center, placebo-controlled trials of clomipramine, paroxetine, fluoxetine, sertraline and fluvoxamine, respectively, have established the unparalleled efficacy and safety of the serotonin reuptake inhibitors (SRIs) in the treatment of OCD. Direct comparisons of SRIs suggest similar efficacy, but reduced tolerability for clomipramine in comparison to fluoxetine, fluvoxamine, sertraline and paroxetine in patients with OCD. Although 60-80% of OCD patients will respond to SRI treatment, partial symptom reduction (mean improvement, 25-40% from baseline) remains the rule. Controlled trials of adjuvant lithium, buspirone, thyroid hormone or clonazepam added to ongoing SRI therapy have failed to demonstrate substantial further antiobsessive effects. The prese...
The prevalence of obsessive-compulsive disorder was measured in five US communities among more th... more The prevalence of obsessive-compulsive disorder was measured in five US communities among more than 18,500 persons in residential settings as part of the National Institute of Mental Health (Bethesda, Md)--sponsored Epidemiologic Catchment Area program. Lifetime prevalence rates ranged from 1.9% to 3.3% across the five Epidemiologic Catchment Area sites for obsessive-compulsive disorder diagnosed without DSM-III exclusions and 1.2% to 2.4% with such exclusions. These rates are about 25 to 60 times greater than had been estimated on the basis of previous studies of clinical populations.
Abnormality of the serotonin (5-hydroxytryptamine – 5-HT) system and particularly hypersensitivit... more Abnormality of the serotonin (5-hydroxytryptamine – 5-HT) system and particularly hypersensitivity of postsynaptic 5-HT receptors remained the leading hypothesis for the underlying pathophysiology of obsessive compulsive disorder (OCD) during the 1980s. A number of lines of evidence supported this serotonergic hypothesis, not least the treatment studies which demonstrated clearly and consistently that anti-obsessional efficacy was a function of serotonin re-uptake inhibition. Studies of markers and biological probes provided further evidence: platelet studies, for example, linked reductions in 5-HT activity with clinical response, and treatment response was correlated with decreased 5-hydroxyindolacetic acid (5-HIAA) levels within the cerebrospinal fluid of OCD patients. Added to this was the evidence from the behavioral or physiological responses observed following serotonergic challenge with the serotonin agonists meta-chlorophenylpiperazine, a compound with high affinity for 5-HT...
The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum (CINP), 2003
Comorbidity in bipolar disorder is the rule rather than the exception more than 60% of bipolar pa... more Comorbidity in bipolar disorder is the rule rather than the exception more than 60% of bipolar patients have a comorbid diagnosis and is associated with a mixed affective or dysphoric state; high rates of suicidality; less favourable response to lithium and poorer overall outcome. There is convincing evidence that rates of substance use and anxiety disorders are higher among patients with bipolar disorder compared to their rates in the general population. The interaction between anxiety disorders and substance use goes both ways: patients with bipolar disorder have a higher rate of substance use and anxiety disorder, and vice versa. Bipolar disorder is also associated with borderline personality disorder and ADHD, and to a lesser extent with weight gain. As more than 40% of bipolar patients have anxiety disorder, it is indicated that while diagnosing bipolar patients, systematic enquiry about different anxiety disorders is called for. This also presents a therapeutic challenge, sinc...
Over the past decade, epidemiological, phenomenological, pharmacological, neurobiological, brain ... more Over the past decade, epidemiological, phenomenological, pharmacological, neurobiological, brain imaging and genetic research has contributed to a substantial change in our understanding of obsessive-compulsive disorder (OCD). Once regarded as a rare psychodynamic illness, OCD is now recognized as a common condition affecting 2-3% of the population. Better recognition combined with the demonstrated efficacy of serotonin reuptake inhibitors, such as clomipramine and the selective serotonin reuptake inhibitors (SSRIs), has dramatically improved the prognosis of this disorder, which exacts a considerable personal and economic burden. While the aetiology is still not understood, increasingly sophisticated research techniques are enabling us to begin to uncover the underlying pathophysiology of this illness. This paper reviews some of the recent developments which have enhanced our understanding of OCD and considers their potential impact on clinical management.
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Papers by Y. Sasson