The present meta-analysis addressed the empirical evidence regarding the treatment of major depression with atypical features. The superiority of monoamine oxidase inhibitors (MAOIs) compared with ...other antidepressants in the treatment of major depression with atypical features has been frequently reported. According to the CONSORT Statement, studies included in our meta-analysis had to meet several criteria, especially a double-blind, controlled condition and an operational diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-III or DSM-IV criteria, respectively. Four databases for research-based evidence were used in a systematic review: Medline, Embase, Psyndex and PsycInfo. Only eight publications met inclusion/exclusion criteria, resulting in 11 comparisons. Our results contrast an effect size of 0.45 (95% confidence interval) for a comparison of MAOIs vs. placebo with an effect size of 0.02 (95% confidence interval: − 0.10–0.14) for a comparison of MAOIs vs. selective serotonin reuptake inhibitors. The effect size for MAOIs vs. tricyclic antidepressants was 0.27 (95% confidence interval: 0.16–0.42). MAOIs may be more effective for atypical major depressive disorder than tricyclic antidepressants. Most clinical research has been conducted on irreversible MAOIs. Additional studies testing more recently developed antidepressants (including reversible MAOIs) with an improved safety profile would be warranted. The available data are insufficient for a direct comparison between MAOIs and selective serotonin reuptake inhibitors.
The assessment of handedness is of interest in some psychiatric populations, above all in schizophrenic patients, because there may be a relationship between neurodevelopmental, hemispheric damage ...and psychiatric disease processes (Crow TJ. Schizophrenia Bulletin 1990;16:433–443; Tyler M, Diamond J, Lewis S. Schizophrenia Research 1995;18:37–41). Various methods to assess handedness have been proposed. In order to detect the most precise instrument for the assessment of handedness, two different measures, a questionnaire and a computational procedure for movement analysis, were compared in a group of healthy subjects. The ability of the methods to discriminate not only between the groups of right-handers (
n=12) and left-handers (
n=23), but also between left-handers trained in school to use the non-dominant right hand (‘inconsistent’ left-handers;
n=11) and those allowed to use their left hand for writing (‘consistent’ left-handers;
n=12) was investigated. For future investigations, our main concern was to determine if one method had superiority over the other. The results revealed that the Edinburgh Handedness Inventory (EHI) distinguishes just as well as the computational method between right-handers and non-right-handers. However, more precise discrimination between the subgroups of ‘consistent’ and ‘inconsistent’ left-handers is possible using digitized analysis of hand-motor performance. According to our results handedness should be assessed not only with the EHI, but also with the computer-aided analysis of hand-movements.
Heterogeneity of performance of screening tools in different patient groups has rarely been considered in the literature on depression screening in primary care. The objectives of the present study ...were to assess and to compare diagnostic accuracy of three screening questionnaires (Brief Patient Health Questionnaire, General Health Questionnaire-12, WHO-5) in identifying depression across various patient subpopulations and to assess the accuracy of the unaided clinical assessment of primary care physicians in the same subgroups. We conducted a cross-sectional validation study in 448 primary care patients. Two-by-two tables as well as receiver operating characteristics were applied. Results indicated that diagnostic accuracy (sensitivity, specificity) of the three screening instruments as well as of the clinical diagnoses differed in the various patient groups. Superiority of one screening tool over the other depends on the subgroup considered. Gender, age, form (subtype), and severity of depression influence the test characteristics of a screening tool. This should be considered if routine depression screening should be widely introduced. Of course, the benefit of routine screening also depends on efforts made for treatment and monitoring of patients in whom depression was diagnosed.
Neurological soft signs (NSS) are minor neurological deviations signifying unspecific brain dysfunction. Several studies have reported an abnormally high prevalence of NSS in obsessive-compulsive ...disorder (OCD); however, the significance of their presence in OCD patients is not yet clear. We reviewed studies that investigated NSS in OCD patients, using a clinical examination or kinematical methods. In most studies, OCD patients showed an excess of NSS, especially in the areas of motor coordination, sensory integration and primitive reflexes. NSS in OCD patients may be associated with more severe obsessions as well as disturbances of visuo-spatial function and visual memory. Moreover, they may be already present at childhood, combined with anxiety disorders, thus possibly representing a marker of high risk for OCD. In conclusion, more studies are needed in order to assess both sensory and motor soft signs associated with OCD in a methodologically rigorous manner, to integrate the results with neuroimaging findings and to elucidate the role of NSS as markers of neuropsychological dysfunction in OCD.
In a subgroup of patients with obsessive-compulsive disorder (OCD), motor soft signs, tics and other movement disorders can be observed, indicating a special pathogenetic involvement of basal ...ganglia.
The main objective of this study was to verify the hypothesis that such motor dysfunction characterises a subgroup of OCD patients with poor treatment response. For assessing even subtle motor dysfunction, a new method for kinematical analysis of hand movements has been applied.
We examined the performance of 45 in-patients who met the DSM-IV criteria for OCD before and under therapy (sertraline and behaviour therapy) using a digitising tablet and kinematical analysis of simple handwriting and drawing movements. All subjects wrote a sentence, their signature and letter sequences. Moreover, they drew circles under different conditions. Three kinematical parameters (stroke duration, variation coefficient of peak velocity, stroke length) were calculated to quantify hand-motor performance.
Prior to therapy, non-responders wrote with significantly smaller amplitudes than responders. Additionally, non-responders drew significantly larger circles with the non-dominant hand at baseline, as compared to responders. Disturbances of handwriting were more frequent in non-responders than in responders.
Kinematical analysis of handwriting movements seems to be interesting for the prediction of poor response to treatments in OCD patients.
The diagnosis of movement disorders and the distinction between their possible generation by drug-treatment or illness can be done more objectively by using digitized analyses of hand movements. The ...aim of this study was to define this method, that is to identify its reliability and the influence of several covariables upon measurements, in healthy subjects. Simple writing and drawing tests were administered, using a digitizing tablet, transmitting signals to a computer for processing. The kinematic parameters identified in this way provided objective, reliable and valid measures for the dynamics and the degree of automation of hand movements. Analysis of the data showed that younger subjects write faster and with a higher degree of automation than older subjects. Other moderating variables, such as verbal intelligence and customary motor activity in everyday life (motoric practice) could be identified, whereas personality and gender were found to have little influence. There were no significant differences between left-handers and right-handers in hand movements. The movement parameters had a high test–retest stability. The results of this study in healthy subjects indicate that age, verbal intelligence and motor practice should be considered when evaluating the effects of drug-treatment or psychiatric illness upon hand-movement in patients.
Movement disorders such as disturbances of fine motor co-ordination are a frequent phenomenon in patients with obsessive-compulsive disorder (OCD).
Our aim was to investigate changes of hand-motor ...dysfunction in OCD patients under the influence of 10-week treatment with sertraline and behaviour therapy.
We examined the performance of 40 patients satisfying DSM-IV criteria for OCD before and under this therapy using a digitising tablet and kinematic analysis of handwriting and drawing movements. Forty healthy controls were also tested (test-retest interval: 10 weeks).
The speed of drawing was significantly lower in OCD patients than in controls (mean+/-standard deviation=197.03+/-113.26 mm/s for patients and 182.48+/-189.61 mm/s for controls; P=0.01). After 10 weeks of therapy, this parameter normalised in patients (from 197.03+/-113.26 mm/s to 163.66+/-101.92 mm/s; P=0.001).
Hand-motor dysfunction (especially bradykinesia) improves with a serotonin-enhancing therapy in OCD patients.
Objectives: In clinical practice patients with severe mania (agitation, insomnia and aggressive behaviour) still receive effective, but often not well tolerated typical antipsychotics. The aim of ...this study was to test the first‐generation atypical antipsychotic zotepine regarding its antimanic efficacy, tolerability and to find an adequate dosage for a loading strategy.
Method: Twelve patients (seven male) with an acute and severe manic episode, according to DSM‐IV, received zotepine loading in individual dosages (up to 600 mg/day) over a maximum period of 3 weeks. Clinical efficacy was measured using the Young‐Mania Rating Scale (Y‐MRS) total score. Response was defined as a 50% reduction in the Y‐MRS score. Safety was assessed by systematic collection of data on side effects and weight; Hamilton Rating Scale for Depression (HAM‐D) scores were used to detect a switch into depression.
Results: Two patients dropped out of the study after 2 days. Nine of ten patients (baseline mean Y‐MRS: 45 ± 7) were classified as responders, with five of them responding within 4 days. One patient did not respond sufficiently. No switch into a depressive episode occurred.
Conclusions: This open pilot study suggests that zotepine with a median daily dosage of 250 mg/day is effective with a rapid therapeutic effect in severely manic patients. In general, patients tolerated the drug well; dose‐dependent extrapyramidal side effects, an increase in weight and autonomic side effects occurred to a lesser degree. This is the first study assessing zotepine monotherapy in manic patients. Controlled studies are warranted.
Many studies have shown a high prevalence of discrete neuromotor disturbances in schizophrenic patients. It was hypothesized that these disturbances are lateralized and reflect a neurodevelopmental ...disorder underlying schizophrenia. A new method for assessing subtle motor dysfunction and hemispheric asymmetries is the registration of hand movements with a digitizing tablet. Using this method, we studied hand–motor dysfunction and its lateralization in schizophrenics, as compared with healthy controls.
All subjects (27 schizophrenic patients, 13 of them without neuroleptic medication, the others under neuroleptics; 31 healthy controls) drew super-imposed concentric circles. We computed kinematic parameters reflecting velocity and automatization to quantify neurological soft signs (NSS).
The patients had significant impairments of regularity of repetitive hand movements, as compared with the healthy controls (F≥5.35;
p≤0.024
∗). Comparing differences of left- and right-hand performance between patients and controls, we found longer stroke duration (
F=(15,98);
p=0.000***) and decreased automatization (
F=18,14;
p=0.000***), especially on the left side in schizophrenic patients.
Measuring hand movements with a digitizing tablet is a sensitive method for assessing subtle motor dysfunction in schizophrenic patients, not reflected in the scores of clinical scales. Our findings show NSS in schizophrenic patients, independently of neuroleptics. Further, the hypothesis of lateralization of cerebral structures generating NSS towards the right hemisphere in schizophrenia is supported.
