People with mental health problems will have more choice over their treatment under new guidance published by the Department of Health. The document, 'Our Choices in Mental Health', sets out the national framework that will make more choice available locally to people who use mental health services in England.
More choice in mental health will give people:
Power to choose their own path through services and keep control over their lives;
Preferences to choose how, when, where and what treatments they receive;
Personalised services organised around their lifestyles.
The framework provides advice and information for service users and carers on the kind of choices they should expect to receive in the future and on how practitioners can extend the choices they offer in mental health services. The document also includes positive practice examples showing how these improvements are already being achieved in many areas.
Our Choices in Mental Health has been written in consultation with service users and carers and is one part of a package of information about choice in mental health. Other resources launched today include a checklist to help local communities in extending choice and a website providing on-line support.
Speaking as she launched the document at Newham Psychological Therapies Centre in east London, Rosie Winterton said:
"We want patients to be able to choose how, when and where to access help. We want them to be able to choose the treatment that best suits their needs and to access the support they need to keep or regain their independence. The guidance we are publishing today and our wider programme of work to provide greater choice will help to change this situation and really empower service users."
The 2003 national consultation on Choice asked people how services could become more personal. Our Choices in Mental Health now provides ideas on getting started, practical support and examples of positive practice from across England.
Laurie Bryant, an expert on service improvement and a service user working in National Institute for Mental Health in England said:
"Choice listens to me, involves me, responds to me, values me and supports me on my road to recovery. If we are serious about putting service users at the heart of modern mental health services, providing choice is essential."
Lu Duhig, a carer on the steering group which produced Our Choices in Mental Health said:
"Given that one in four people will experience a mental illness in any one year, giving people real choice in mental health services is a clear priority for us. We need to help people get the right health, social care or non-statutory, community-based support that they want that will help them manage their own lives and support their recovery."
Also published recently was 'Choice in Mental Health: NSF review autumn assessment 2005' - a survey of how much choice is currently being provided for mental health patients.
Both this document and the 'Our Choices in Mental Health' guidance can be found on mhchoice.uk
For further information please go to:
UK Department of Health
понедельник, 27 июня 2011 г.
суббота, 25 июня 2011 г.
Valdoxan(reg): A New Approach to The Treatment of Depression
First Melatonergic Agonist Antidepressant Shows Efficacy and Tolerability Benefits Over Existing Therapies -
Valdoxan(reg) (agomelatine), the first melatonergic (MT1 and MT2 receptor) agonist antidepressant, is an innovation in the
treatment of depression with several advantages over existing treatments according to data presented during the 13th Congress
of the Association of European Psychiatrists. Besides being an effective antidepressant, Valdoxan has shown particular
advantages in improving the often disrupted sleep patterns of depressed patients, without affecting daytime vigilance.
"Agomelatine is an interesting and potentially very valuable antidepressant that is effective in both moderate and severe
depression", says Professor Stuart Montgomery from the Imperial College School of Medicine in London. "The new agent has a
unique mode of action, improves sleep without affecting daytime alertness and its efficacy is not compromised by sexual side
effects, tolerability problems or discontinuation symptoms."
Antidepressant efficacy
The antidepressant efficacy of Valdoxan has been shown at a standard dose of 25 mg, once daily in the evening, in a
dose-ranging study performed in major depressive disorder (MDD)1. In this multicentre, placebo-controlled, dose-ranging
study over eight weeks, Valdoxan was shown to be an effective antidepressant at a dose of 25 mg once daily, by reducing the
initial HAMD score to a similar extent to that of the SSRI paroxetine. Further studies versus placebo and comparators have
confirmed the efficacy of Valdoxan in adults of all ages, including the severely depressed and elderly depressed. Results
from another clinical trial presented here in Munich show that Valdoxan has a similar efficacy to the SNRI venlafaxine.
Improvements of disturbed wake-sleep cycles
"The ability to relieve sleep problems without being sedative is a key advantage for depressed patients who frequently suffer
from sleep disturbances associated with their depression", points out Christian Guilleminault, MD, from Stanford University
Sleep Disorders Clinic, California.
Due to its unique pharmacological profile, Valdoxan is the only antidepressant to have a specific action on circadian
rhythms, which are often imbalanced in depressed patients. By improving disturbed wake-sleep patterns, according to Dr
Guilleminault, Valdoxan is able to relieve sleep complaints of depressed patients with a favourable impact on daytime
vigilance.
Tolerability profile
Data presented by Professor Montgomery shows that Valdoxan provides antidepressant efficacy, but lacks typical antidepressant
side effects. The new agent does not appear to impair sexual function. A study comparing Valdoxan with venlafaxine showed
comparable antidepressant efficacy of both treatments, but significantly less sexual dysfunction of Valdoxan compared to the
SNRI. In addition, a placebo-controlled, double-blind study comparing Valdoxan with paroxetine showed that, after one week
of treatment discontinuation, no signs of discontinuation symptoms* were seen in the agomelatine group compared to
significant discontinuation symptoms in the paroxetine group.2
Valdoxan was discovered and developed by Servier. The drug is currently in Phase III and a registration dossier for an
indication in MDD was recently submitted to the European Regulatory Agency (EMEA).
Discontinuation symptoms occur when treatment with certain antidepressants (mainly SSRIs and SNRIs) is stopped. They can
include nausea, headache, dizziness, sleep disturbances, anxiety and irritability.
servier
For further information, please contact:
Moira Gitsham, Tonic Life Communications (+33 5 46 00 08 20, moira.gitshamtoniclc)
or
Matthew Kent, Tonic Life Communications (+44 207 798 9900, matthew.kenttoniclc)
References
1 L???o H, Hale A, D'haenen H. Int Clin Psychopharmacol. 2002; 17:239-247
2 Montgomery SA, Kennedy SH, Burrows GD, Lejoyeux M, Hindmarch I. Int Clin Psychopharmacol. 2004; 19 :271-280
servier
Valdoxan(reg) (agomelatine), the first melatonergic (MT1 and MT2 receptor) agonist antidepressant, is an innovation in the
treatment of depression with several advantages over existing treatments according to data presented during the 13th Congress
of the Association of European Psychiatrists. Besides being an effective antidepressant, Valdoxan has shown particular
advantages in improving the often disrupted sleep patterns of depressed patients, without affecting daytime vigilance.
"Agomelatine is an interesting and potentially very valuable antidepressant that is effective in both moderate and severe
depression", says Professor Stuart Montgomery from the Imperial College School of Medicine in London. "The new agent has a
unique mode of action, improves sleep without affecting daytime alertness and its efficacy is not compromised by sexual side
effects, tolerability problems or discontinuation symptoms."
Antidepressant efficacy
The antidepressant efficacy of Valdoxan has been shown at a standard dose of 25 mg, once daily in the evening, in a
dose-ranging study performed in major depressive disorder (MDD)1. In this multicentre, placebo-controlled, dose-ranging
study over eight weeks, Valdoxan was shown to be an effective antidepressant at a dose of 25 mg once daily, by reducing the
initial HAMD score to a similar extent to that of the SSRI paroxetine. Further studies versus placebo and comparators have
confirmed the efficacy of Valdoxan in adults of all ages, including the severely depressed and elderly depressed. Results
from another clinical trial presented here in Munich show that Valdoxan has a similar efficacy to the SNRI venlafaxine.
Improvements of disturbed wake-sleep cycles
"The ability to relieve sleep problems without being sedative is a key advantage for depressed patients who frequently suffer
from sleep disturbances associated with their depression", points out Christian Guilleminault, MD, from Stanford University
Sleep Disorders Clinic, California.
Due to its unique pharmacological profile, Valdoxan is the only antidepressant to have a specific action on circadian
rhythms, which are often imbalanced in depressed patients. By improving disturbed wake-sleep patterns, according to Dr
Guilleminault, Valdoxan is able to relieve sleep complaints of depressed patients with a favourable impact on daytime
vigilance.
Tolerability profile
Data presented by Professor Montgomery shows that Valdoxan provides antidepressant efficacy, but lacks typical antidepressant
side effects. The new agent does not appear to impair sexual function. A study comparing Valdoxan with venlafaxine showed
comparable antidepressant efficacy of both treatments, but significantly less sexual dysfunction of Valdoxan compared to the
SNRI. In addition, a placebo-controlled, double-blind study comparing Valdoxan with paroxetine showed that, after one week
of treatment discontinuation, no signs of discontinuation symptoms* were seen in the agomelatine group compared to
significant discontinuation symptoms in the paroxetine group.2
Valdoxan was discovered and developed by Servier. The drug is currently in Phase III and a registration dossier for an
indication in MDD was recently submitted to the European Regulatory Agency (EMEA).
Discontinuation symptoms occur when treatment with certain antidepressants (mainly SSRIs and SNRIs) is stopped. They can
include nausea, headache, dizziness, sleep disturbances, anxiety and irritability.
servier
For further information, please contact:
Moira Gitsham, Tonic Life Communications (+33 5 46 00 08 20, moira.gitshamtoniclc)
or
Matthew Kent, Tonic Life Communications (+44 207 798 9900, matthew.kenttoniclc)
References
1 L???o H, Hale A, D'haenen H. Int Clin Psychopharmacol. 2002; 17:239-247
2 Montgomery SA, Kennedy SH, Burrows GD, Lejoyeux M, Hindmarch I. Int Clin Psychopharmacol. 2004; 19 :271-280
servier
четверг, 23 июня 2011 г.
US FDA Approves SEROQUEL XR(R) For Add-On Treatment Of Major Depressive Disorder
AstraZeneca (NYSE: AZN) announced that the US Food and Drug Administration (FDA) has approved once-daily SEROQUEL XR® (quetiapine fumarate) Extended Release Tablets as adjunctive (add-on) treatment to antidepressants in adults with Major Depressive Disorder (MDD). SEROQUEL XR is the only medication in its class approved by the FDA to treat both major depressive disorder as adjunctive therapy and acute depressive episodes associated with bipolar disorder as monotherapy.(1)(2)
MDD affects approximately 14.2 million American adults in a given year, and today it is often treated with antidepressants(3). Selective serotonin reuptake inhibitors, or SSRIs, are among the most commonly prescribed class of antidepressant medications for depression; however, in many cases patients fail to respond adequately to treatment(4). Results from a National Institute of Mental Health study, STAR*D, showed that approximately 63% of patients did not achieve remission with the SSRI citalopram when used as a first-line treatment(4). Additionally, this study reported that overall approximately one-third of patients with MDD failed to achieve study defined remission(4). This approval for SEROQUEL XR provides physicians with a new adjunctive treatment option for patients with MDD who have an inadequate response to their current antidepressant.
In addition to the FDA approval for the adjunctive indication in MDD, AstraZeneca has received a Complete Response Letter (CRL) from the FDA asking for additional information for the sNDAs for SEROQUEL XR as acute monotherapy and maintenance monotherapy for the treatment of MDD in adult patients.
AstraZeneca is evaluating the contents of the CRL. AstraZeneca will continue discussions with the FDA and will provide a response to the agency in due course. The CRL does not change the current recommendations for the treatment of patients taking SEROQUEL XR for approved indications in schizophrenia and bipolar disorder.
The FDA has required that AstraZeneca implement a Risk Evaluation and Mitigation Strategy (REMS). The REMS for SEROQUEL XR requires a Medication Guide and periodic assessments that will include a survey of patients' understanding of the potential risks of SEROQUEL XR. The REMS applies to all approved indications.
"Many people with major depressive disorder, despite being treated with currently approved medications, continue to experience depressive symptoms," said Dr. Richard Weisler. Adjunct Professor of Psychiatry at University of North Carolina School of Medicine and Adjunct Associate Professor at Duke University Medical Center. "SEROQUEL XR may provide another effective treatment option for the depressive symptoms associated with MDD as adjunctive treatment to antidepressants."
"Today's FDA approval of SEROQUEL XR is based on a clinical development program in MDD involving 939 patients randomized across two studies that assessed the efficacy and safety of once-daily treatment with SEROQUEL XR as adjunctive treatment to antidepressants," said Lisa Schoenberg, VP Specialty Care, AstraZeneca. "This new indication for SEROQUEL XR marks an important milestone in the treatment of MDD, as there is a significant need for additional options that may help patients with this devastating condition who are not adequately responding to their antidepressant therapy."
SEROQUEL XR is part of a class of drugs called atypical antipsychotics and is approved for a number of mental health disorders. In addition to today's approval for the adjunctive treatment of MDD, SEROQUEL XR is currently approved for the acute and maintenance treatment of bipolar disorder and schizophrenia.
Major Depressive Disorder sNDA Submission
The FDA approval of SEROQUEL XR for MDD was based on a supplemental new drug application (sNDA) comprising findings from two Phase III, placebo-controlled studies that assessed the efficacy and safety of once-daily treatment with SEROQUEL XR as adjunctive treatment in patients with MDD. Studies 6 and 7 were acute adjunctive therapy studies (with ongoing antidepressant therapy) involving 939 patients randomized (628 randomized to SEROQUEL XR) who had an inadequate response to their antidepressant therapy(5,6). Patients were on various antidepressants prior to study entry including SSRI's (paroxetine, fluoxetine, sertraline, escitalopram, or citalopram), SNRI's (duloxetine and venlafaxine), TCA (amitryptiline) and other (buproprion)(1).
The primary endpoint in these studies was the change from baseline to end of treatment in the Montgomery-Asberg Depression Rating Scale(MADRS) total score. The recommended dose range of SEROQUEL XR in MDD is 150 to 300mg/day(5,6).
In both studies efficacy with SEROQUEL XR was superior to placebo, as assessed by the primary endpoints(1). SEROQUEL XR 300 mg once daily as adjunctive treatment to other antidepressant therapy was superior to antidepressant alone in reduction of MADRS total score in both trials. SEROQUEL XR 150 mg once daily as adjunctive treatment was superior to antidepressant therapy alone in reduction of MADRS total score in one trial. In these studies, the most commonly observed adverse reactions associated with the use of SEROQUEL XR (incidence of 5% or greater and at least twice that of placebo) were somnolence (150 mg: 37%, 300 mg: 43%), dry mouth (150 mg: 27%, 300 mg 40%), fatigue (150 mg: 14%, 300 mg: 11%) and constipation (150 mg only: 11%)(1). The adverse events seen with SEROQUEL XR in these studies were generally consistent with the known profile of SEROQUEL XR in other indications(5,6).
About Major Depressive Disorder
MDD affects approximately 14.2 million American adults in a given year and today it is often treated with antidepressants(3). Unlike normal instances of sadness, loss, or passing mood states, MDD is persistent and can interfere with an individual's thoughts, behavior, mood, activity, and physical health. Depression is one of the leading causes of disability in the US(8).
Symptoms of depression include:persistently sad or irritable mood; pronounced changes in sleep, appetite, and energy; difficulty thinking, concentrating, and remembering; physical slowing or agitation; lack of interest in or pleasure from activities that were once enjoyed; feelings of guilt, worthlessness, hopelessness, and emptiness; recurrent thoughts of death or suicide(9). The diagnostic criteria for a major depressive episode in MDD is the same as a depressive episode of bipolar disorder with the major distinguishing feature between the disorders being the absence of manic or hypomanic episodes in MDD(9).
SEROQUEL XR Regulatory Milestones
SEROQUEL XR, a once-daily, extended-release formulation of quetiapine fumarate, was approved in the US in 2007 for the treatment of schizophrenia in adult patients and in October 2008 for the acute treatment of the depressive episodes associated with bipolar disorder, the manic and mixed episodes associated with bipolar I disorder, and the maintenance treatment of bipolar I disorder as adjunctive therapy to lithium or divalproex.
Important Safety Information for SEROQUEL XR
SEROQUEL XR is indicated for the treatment of major depressive disorder, as adjunctive treatment to antidepressants in adults with major depressive disorder; the acute treatment of depressive episodes in bipolar disorder; acute manic or mixed episodes in bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex; for the maintenance treatment of bipolar I disorder as adjunct therapy to lithium or divalproex; and the treatment of schizophrenia. Patients should be periodically reassessed to determine the need for continued treatment and the appropriate dose.
Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk (1.6 to 1.7 times) of death, compared to placebo (4.5% vs 2.6%, respectively). SEROQUEL XR is not approved for the treatment of patients with dementia-related psychosis. (See Boxed Warning.)
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of major depressive disorder and other psychiatric disorders. Patients of all ages started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. SEROQUEL XR is not approved for use in patients under the age of 18 years. (See Boxed Warning.)
A potentially fatal symptom complex, sometimes referred to as Neuroleptic Malignant Syndrome (NMS), has been reported in association with administration of antipsychotic drugs, including quetiapine. Rare cases of NMS have been reported with quetiapine. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. The management of NMS should include immediate discontinuation of antipsychotic drugs.
Hyperglycemia, in some cases extreme and associated with ketoacidosis, hyperosmolar coma, or death, has been reported in patients treated with atypical antipsychotics, including quetiapine. The relationship of atypical use and glucose abnormalities is complicated by the possibility of increased risk of diabetes in the schizophrenic population and the increasing incidence of diabetes in the general population. However, epidemiological studies suggest an increased risk of treatment-emergent, hyperglycemia-related adverse reactions in patients treated with atypical antipsychotics. Patients starting treatment with atypical antipsychotics who have or are at risk for diabetes should undergo fasting blood glucose testing at the beginning of and periodically during treatment. Patients who develop symptoms of hyperglycemia should also undergo fasting blood glucose testing.
Undesirable alterations in lipids have been observed with SEROQUEL XR use. Increases in total cholesterol, LDL-cholesterol and triglycerides, and decreases in HDL-cholesterol have been reported in clinical trials. Appropriate clinical monitoring is recommended, including fasting blood lipid testing at the beginning of and periodically during treatment.
Increases in weight have been observed in clinical trials. Patients receiving SEROQUEL XR should receive regular monitoring of weight.
Leukopenia, neutropenia, and agranulocytosis (including fatal cases), have been reported temporally related to atypical antipsychotics, including quetiapine. Patients with a pre-existing low white blood cell (WBC) count or a history of drug induced leukopenia/neutropenia should have their complete blood count monitored frequently during the first few months of therapy. In these patients, SEROQUEL XR should be discontinued at the first sign of a decline in WBC absent other causative factors. Patients with neutropenia should be carefully monitored, and SEROQUEL XR should be discontinued in any patient if the absolute neutrophil count is
MDD affects approximately 14.2 million American adults in a given year, and today it is often treated with antidepressants(3). Selective serotonin reuptake inhibitors, or SSRIs, are among the most commonly prescribed class of antidepressant medications for depression; however, in many cases patients fail to respond adequately to treatment(4). Results from a National Institute of Mental Health study, STAR*D, showed that approximately 63% of patients did not achieve remission with the SSRI citalopram when used as a first-line treatment(4). Additionally, this study reported that overall approximately one-third of patients with MDD failed to achieve study defined remission(4). This approval for SEROQUEL XR provides physicians with a new adjunctive treatment option for patients with MDD who have an inadequate response to their current antidepressant.
In addition to the FDA approval for the adjunctive indication in MDD, AstraZeneca has received a Complete Response Letter (CRL) from the FDA asking for additional information for the sNDAs for SEROQUEL XR as acute monotherapy and maintenance monotherapy for the treatment of MDD in adult patients.
AstraZeneca is evaluating the contents of the CRL. AstraZeneca will continue discussions with the FDA and will provide a response to the agency in due course. The CRL does not change the current recommendations for the treatment of patients taking SEROQUEL XR for approved indications in schizophrenia and bipolar disorder.
The FDA has required that AstraZeneca implement a Risk Evaluation and Mitigation Strategy (REMS). The REMS for SEROQUEL XR requires a Medication Guide and periodic assessments that will include a survey of patients' understanding of the potential risks of SEROQUEL XR. The REMS applies to all approved indications.
"Many people with major depressive disorder, despite being treated with currently approved medications, continue to experience depressive symptoms," said Dr. Richard Weisler. Adjunct Professor of Psychiatry at University of North Carolina School of Medicine and Adjunct Associate Professor at Duke University Medical Center. "SEROQUEL XR may provide another effective treatment option for the depressive symptoms associated with MDD as adjunctive treatment to antidepressants."
"Today's FDA approval of SEROQUEL XR is based on a clinical development program in MDD involving 939 patients randomized across two studies that assessed the efficacy and safety of once-daily treatment with SEROQUEL XR as adjunctive treatment to antidepressants," said Lisa Schoenberg, VP Specialty Care, AstraZeneca. "This new indication for SEROQUEL XR marks an important milestone in the treatment of MDD, as there is a significant need for additional options that may help patients with this devastating condition who are not adequately responding to their antidepressant therapy."
SEROQUEL XR is part of a class of drugs called atypical antipsychotics and is approved for a number of mental health disorders. In addition to today's approval for the adjunctive treatment of MDD, SEROQUEL XR is currently approved for the acute and maintenance treatment of bipolar disorder and schizophrenia.
Major Depressive Disorder sNDA Submission
The FDA approval of SEROQUEL XR for MDD was based on a supplemental new drug application (sNDA) comprising findings from two Phase III, placebo-controlled studies that assessed the efficacy and safety of once-daily treatment with SEROQUEL XR as adjunctive treatment in patients with MDD. Studies 6 and 7 were acute adjunctive therapy studies (with ongoing antidepressant therapy) involving 939 patients randomized (628 randomized to SEROQUEL XR) who had an inadequate response to their antidepressant therapy(5,6). Patients were on various antidepressants prior to study entry including SSRI's (paroxetine, fluoxetine, sertraline, escitalopram, or citalopram), SNRI's (duloxetine and venlafaxine), TCA (amitryptiline) and other (buproprion)(1).
The primary endpoint in these studies was the change from baseline to end of treatment in the Montgomery-Asberg Depression Rating Scale(MADRS) total score. The recommended dose range of SEROQUEL XR in MDD is 150 to 300mg/day(5,6).
In both studies efficacy with SEROQUEL XR was superior to placebo, as assessed by the primary endpoints(1). SEROQUEL XR 300 mg once daily as adjunctive treatment to other antidepressant therapy was superior to antidepressant alone in reduction of MADRS total score in both trials. SEROQUEL XR 150 mg once daily as adjunctive treatment was superior to antidepressant therapy alone in reduction of MADRS total score in one trial. In these studies, the most commonly observed adverse reactions associated with the use of SEROQUEL XR (incidence of 5% or greater and at least twice that of placebo) were somnolence (150 mg: 37%, 300 mg: 43%), dry mouth (150 mg: 27%, 300 mg 40%), fatigue (150 mg: 14%, 300 mg: 11%) and constipation (150 mg only: 11%)(1). The adverse events seen with SEROQUEL XR in these studies were generally consistent with the known profile of SEROQUEL XR in other indications(5,6).
About Major Depressive Disorder
MDD affects approximately 14.2 million American adults in a given year and today it is often treated with antidepressants(3). Unlike normal instances of sadness, loss, or passing mood states, MDD is persistent and can interfere with an individual's thoughts, behavior, mood, activity, and physical health. Depression is one of the leading causes of disability in the US(8).
Symptoms of depression include:persistently sad or irritable mood; pronounced changes in sleep, appetite, and energy; difficulty thinking, concentrating, and remembering; physical slowing or agitation; lack of interest in or pleasure from activities that were once enjoyed; feelings of guilt, worthlessness, hopelessness, and emptiness; recurrent thoughts of death or suicide(9). The diagnostic criteria for a major depressive episode in MDD is the same as a depressive episode of bipolar disorder with the major distinguishing feature between the disorders being the absence of manic or hypomanic episodes in MDD(9).
SEROQUEL XR Regulatory Milestones
SEROQUEL XR, a once-daily, extended-release formulation of quetiapine fumarate, was approved in the US in 2007 for the treatment of schizophrenia in adult patients and in October 2008 for the acute treatment of the depressive episodes associated with bipolar disorder, the manic and mixed episodes associated with bipolar I disorder, and the maintenance treatment of bipolar I disorder as adjunctive therapy to lithium or divalproex.
Important Safety Information for SEROQUEL XR
SEROQUEL XR is indicated for the treatment of major depressive disorder, as adjunctive treatment to antidepressants in adults with major depressive disorder; the acute treatment of depressive episodes in bipolar disorder; acute manic or mixed episodes in bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex; for the maintenance treatment of bipolar I disorder as adjunct therapy to lithium or divalproex; and the treatment of schizophrenia. Patients should be periodically reassessed to determine the need for continued treatment and the appropriate dose.
Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk (1.6 to 1.7 times) of death, compared to placebo (4.5% vs 2.6%, respectively). SEROQUEL XR is not approved for the treatment of patients with dementia-related psychosis. (See Boxed Warning.)
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of major depressive disorder and other psychiatric disorders. Patients of all ages started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. SEROQUEL XR is not approved for use in patients under the age of 18 years. (See Boxed Warning.)
A potentially fatal symptom complex, sometimes referred to as Neuroleptic Malignant Syndrome (NMS), has been reported in association with administration of antipsychotic drugs, including quetiapine. Rare cases of NMS have been reported with quetiapine. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. The management of NMS should include immediate discontinuation of antipsychotic drugs.
Hyperglycemia, in some cases extreme and associated with ketoacidosis, hyperosmolar coma, or death, has been reported in patients treated with atypical antipsychotics, including quetiapine. The relationship of atypical use and glucose abnormalities is complicated by the possibility of increased risk of diabetes in the schizophrenic population and the increasing incidence of diabetes in the general population. However, epidemiological studies suggest an increased risk of treatment-emergent, hyperglycemia-related adverse reactions in patients treated with atypical antipsychotics. Patients starting treatment with atypical antipsychotics who have or are at risk for diabetes should undergo fasting blood glucose testing at the beginning of and periodically during treatment. Patients who develop symptoms of hyperglycemia should also undergo fasting blood glucose testing.
Undesirable alterations in lipids have been observed with SEROQUEL XR use. Increases in total cholesterol, LDL-cholesterol and triglycerides, and decreases in HDL-cholesterol have been reported in clinical trials. Appropriate clinical monitoring is recommended, including fasting blood lipid testing at the beginning of and periodically during treatment.
Increases in weight have been observed in clinical trials. Patients receiving SEROQUEL XR should receive regular monitoring of weight.
Leukopenia, neutropenia, and agranulocytosis (including fatal cases), have been reported temporally related to atypical antipsychotics, including quetiapine. Patients with a pre-existing low white blood cell (WBC) count or a history of drug induced leukopenia/neutropenia should have their complete blood count monitored frequently during the first few months of therapy. In these patients, SEROQUEL XR should be discontinued at the first sign of a decline in WBC absent other causative factors. Patients with neutropenia should be carefully monitored, and SEROQUEL XR should be discontinued in any patient if the absolute neutrophil count is
вторник, 21 июня 2011 г.
Spain: 21st Congress Of The College Of Neuropsychopharmacology, Aug. 30-Sept. 3, 2008
Neuropsychopharmacology and mental disorders: Bridging the gap between science and medicine
The enormous burden and amount of suffering associated with mental disorders represent one of the biggest challenges for health care systems in Europe today. This challenge is marked by the immense scope and costs of mental disorders. Important factors are their persistent increase due to an aging population, the rapid socioeconomic changes currently taking place, and, finally, the large unmet treatment needs, combined with insufficient awareness of their existence and significance. There is a compelling need to improve the life of people suffering from mental disorders and to assert the importance of a scientific approach to the disease manifestations, causes and treatments.
The European College of Neuropsychopharmacology (ECNP) is a unique and remarkably broad interdisciplinary platform which strongly emphasises translational research with the aim to apply new knowledge on fundamental disease mechanisms to clinical applications and vice versa. This approach takes into account the context in which mental health care is operating. ECNP bridges the gap between basic research, clinical science and medical practice, paving the way for improved pharmacological treatments, which will improve the quality of life of millions of people suffering from mental disorders.
Mental health in Europe
Mental and behavioural disorders are present at all ages and across different cultures and population groups and are major causes of disability worldwide. In the European Union (EU) over 80 million people of all ages are estimated to suffer from mental disorders and more than one third of the EU population is, or has been, affected by at least one disorder in the last twelve months; based on lifetime risk, the figure is even higher, with 50% of the population being affected (Wittchen et al., 2005). Mental disorders are often characterized by an onset early in life and an unfavourable long-term course of the illness, with adverse effects on school performance and academic career, social functioning and somatic health throughout life, frequently associated with immense suffering also for the patients?? families, partners and friends.
Taking into account the high degree of psychiatric comorbidity, the most frequent mental disorders in the European Union are anxiety disorders, followed by depressive, somatoform and addictive disorders involving nicotine, alcohol and drugs (Wittchen & Jacobi, 2005). Depression, for instance, is the second most important cause of disability and increases the risk of suicide, which in the EU is higher than death from traffic accidents, homicide or HIV/AIDS (EU 2005). Moreover, in the past decades there has been a steep increase in the risk of depression and related disorders, such as burn-out, especially among women. This development predominantly seems to be related to the rapid societal changes currently taking place, with vanishing traditional roles, growing workplace stress and unemployment ranking first among a variety of influential factors. Furthermore, current demographic changes due to an aging population will lead to a rising prevalence of mental illness and neurological disorders with typical behavioural and psychological symptoms, especially dementia and Parkinson??s disease.
The majority of the EU population will suffer from a mental disorder at least once in their lifetime, with the lifetime risk continuing to increase.
Besides the pain experienced by those struck by these disorders and their families, mental illness causes considerable economic costs due to lost productivity, disability and social-service payments, and increased morbidity and mortality. Currently, the resources spent on mental health care, including prevention and health promotion, are far from proportional to the costs incurred by mental health problems, which have been estimated at between 3% and 4% of gross national product (WHO 2003; Jan?©-Llopis & Anderson, 2006). According to an ECNP/EBC project, mental disorders in Europe rank first in terms of direct and indirect health-related economic costs, reaching a total of over 290 billion euros (Wittchen et al., 2005). Unlike somatic diseases with their typically high direct costs, mental disorders cause relatively low direct costs and extremely high indirect costs, above all through the loss of productivity as a consequence of the disease, e.g. work days lost due to disability, retirement or premature death. Moreover, when mental disorders are not recognized and treated, the treatment of comorbid somatic illnesses is usually less efficient and therefore more expensive.
Recent data consistently demonstrate an association of all mental disorders with generally low treatment rates: according to an epidemiological survey comprising over 150,000 subjects from 16 European countries, only 26% of all patients ever received professional health care services (Wittchen & Jacobi, 2005). Furthermore, according to a recent worldwide study comprising 84,850 adults in 17 countries with diverse economic backgrounds, at least two thirds of the people who are mentally ill go without treatment in the countries covered by the study. In Europe, 74% of all mentally ill persons are not treated, compared with only 8% of diabetics remaining untreated (Wittchen & Jacobi 2005; Wang et al., 2007; Thornicroft 2007). In most cases, treatment starts late, after many years of illness, when severe complications are already present, and among those treated, appropriate therapy is rarely provided.
In adolescents and young adults, in particular, the vast majority of disorders of the brain remain untreated.
On account of the scope of the problem and the enormous costs involved, mental disorders have recently attracted the interest of both politicians and public-health experts in many countries. Mental disorders clearly call for concerted action on various levels, ranging from the investigation of the determinants and risk factors to systematic programs to explore the benefits of preventive measures and early intervention, from substantially increased funding for basic and clinical research to better training and medical education. Since recent research has identified and further developed effective interventions and improved the treatments available, early therapeutic intervention has become increasingly important in terms of its potential benefits. More than ever before, any support for mental health is bound to have a positive impact, as it results in improved care.
Raising awareness of mental disorders among the public at large as well as among physicians, politicians and policy-makers is a matter of great urgency; at the same time, every effort has to be made to tackle the stigma and discrimination associated with these conditions.
European College of Neuropsychopharmacology (ECNP)
ECNP is a non-profit scientific society established in 1987 on the initiative of scientists and clinicians working in Europe in the convergent disciplines in neuropsychopharmacology and related areas. ECNP is a source of scientific progress and promotes the further development of medical practice in psychiatry and neurology. ECNP has set itself the task of bringing together clinicians and basic researchers to discuss and exchange ideas and experience in neuropsychopharmacology in order to enhance the quality of research and treatment in this field. One of its major objectives is the translation of new knowledge derived from preclinical science (involving neurochemistry, imaging, and genetics) into the design of therapeutic investigations, clinical practice and policy.
ECNP sees its main functions in the encouragement of research and education:
its objectives in the field of research are to offer investigators an opportunity for interdisciplinary communication through regular scientific meetings and to promote the application of a broad range of scientific disciplines to the study of drug effects on the brain and on behaviour in the interest of an improved understanding and treatment of mental disorders.
its educational goals are to encourage young scientists to enter research careers in neuropsychopharmacology, to develop new insights into behavioural and mental disorders, and to provide up-to-date information about their pharmacological treatment. Therefore, young scientists are always the focus of attention of ECNP's scientific activities.
The role of neuropsychopharmacology & ECNP
Neuropsychopharmacology bridges the gap between basic neuroscience and the treatment of neurological and psychiatric diseases. Its aim is to understand the biological basis for altered emotions, thought processes and the complex mental states that occur in mental illness. On a more practical level, its goal is to develop specific therapeutic molecules to regulate the biological mechanisms of mental disorders, i.e. the neuronal interactions that give rise to these disorders. For this purpose,neuropsychopharmacology investigates the selective effect of drugs on the central nervous system (CNS) and their use in treating disorders such as anxiety, mania, depression, schizophrenia, dementia or neurological and addictive disorders in the most rational and empirical manner. The interaction between nerve cells (neurons) that underlies complex mental functions such as thinking, learning, memory or emotion is mediated by a large number of chemical neurotransmitters and neuromodulators. Disturbances in neurotransmitter function are seen as the main cause of mental disorders and certain neurological disorders such as Parkinson??s or Alzheimer??s disease. To understand neurotransmitter function in mental health and disease, ECNP has stimulated cross-disciplinary forces - ranging from psychiatry to neurology, pharmacology and psychology - to carry out research on brain mechanisms and functions. A broad range of professionals, including clinicians and researchers, are engaged in brain imaging, chronobiology, neurochemistry, neuroimmunology, genetics, molecular biology and epidemiology.
The most profound research challenge in neuropsychopharmacology is to understand the mechanism underlying brain functions in normal and pathological mental states.
ECNP??s support to research activities is oriented towards the development of new drugs acting on specific receptors within a neurotransmitter system. These drugs should be designed to allow the direct targeting of specific sites of relevant neuronal activity, thereby maximizing the efficacy of the drug within the clinical target and minimizing adverse events. From the translational perspective of neuropsychopharmacology, scientists not only want to understand the mechanisms of action of drugs used for treatment, but also to use drug-treatment findings to learn more about the pathogenesis and pathophysiology of the underlying disorders. In this manner, a new level of integration of basic preclinical research, clinical neuroscience and clinical therapeutics becomes a key objective. This objective can inform and guide advances in neuropsychopharmacology and lead to a next generation of promising new treatments for mental disorders. The research presented at the ECNP Congresses so far has led to improved treatment for people with mental disorders ranging from autism, addictions and Alzheimer's disease to mood disorders, psychoses and schizophrenia.
ECNP puts emphasis on understanding how basic discoveries are relevant to patient symptoms and illness, as well as on identifying and testing promising new medications with novel mechanisms. In so doing, ECNP is paving the way for improved pharmacological treatments, which will improve the quality of life of millions of people suffering from mental disorders.
21st ECNP Congress, Barcelona, Spain
From 30 August - 3 September 2008, more than 6,500 neuroscience researchers, psychiatrists, neurologists, psychologists and practitioners from all over the world will gather in Barcelona at the 21st ECNP Congress. The programme will not only present the latest findings and breakthroughs in neuropsychopharmacology and related areas in both clinical and preclinical settings, but also cover the various aspects of pharmacotherapy of brain disorders and its benefits for patients with psychiatric and neurological disorders in terms of quality of life. The ECNP Congress is expected to stimulate discussion about ways of implementing new knowledge and the most effective therapeutic approaches, while taking into account the current economic background of such therapy. In addition, this high-level scientific meeting - the largest of its kind in Europe - will deal with the impact of current social, economic and cultural changes on mental health care, e.g. neuro-ethics, effects of migration etc.
Highlights of the 21st ECNP Congress
The comprehensive programme of the ECNP Congress includes over 100 topics to be presented by more than 600 experts. The outstanding highlights are:
Antidepressants in general and in suicide prevention
Neurogenesis in the adult brain: the association with stress and depression
The consensus statement 2007 on bipolar depression
The first autism disease genes
Antihypertensive treatment on cognitive functions in Alzheimer's disease
Alcoholism-associated molecular adaptations in brain neurocognitive circuits
In addition, cutting-edge research findings and future perspectives in the fields of depression, bipolar affective disorders, schizophrenia, dementia, anxiety disorders, obsessive compulsive disorder, drugs & addiction, autism, suicide prevention, and basic neuroscience will be presented in plenary lectures, symposia and educational updates. The challenges and consequences of current socioeconomic changes for mental health care are taken into account. Great emphasis will be placed on clear take-home messages that can easily be translated into clinical practice by medical professionals.
ECNP is proud to present the report of the ECNP Consensus Meeting 2007 on 'bipolar depression'. Through annual consensus meetings on specific topics, ECNP aims to facilitate the dialogue between European regulatory authorities, the scientific community and the pharmaceutical industry in order to achieve a common policy in neuropsychopharmacology.
ECNP has received over 800 papers for poster presentation, of which 744 papers have been accepted for poster presentation, each of them offering an exciting insight into the research activities of (young) scientists.
The aim of ECNP is that the 21st ECNP Congress will highlight the contribution of neuropsychopharmacology to medical practice and help all of us to raise awareness for mental disorders both among physicians and the public at large.
References
[EU 2005] Green Paper Improving the Mental Health of the population. Towards a strategy on mental health for the European Union
Jan?©-Llopis, E; Anderson P (Eds.) Mental health promotion and mental disorder prevention across European Member States. Luxembourg: European Communities, 2006
Thornicroft G. Most people with mental illness are not treated. Lancet 2007;370:807-808
Wang PS, Aquilar-Gaxiola S, Alonso J, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 2007;370:841-850
[WHO 2003] Investing in Mental Health. Geneva: World Health Organisation, 2003
Wittchen H.-U., J?¶nnson B., Olesen J. Towards a better understanding of the size and burden and cost of brain disorders in Europe. European Neuropsychopharmacology 15, 2005, 355-356
Wittchen H.U. & Jacobi F. Size and burden of mental disorders in Europe - A critical review and appraisal of 27 studies. European Neuropsychopharmacology 15, 2005, 357-376
The enormous burden and amount of suffering associated with mental disorders represent one of the biggest challenges for health care systems in Europe today. This challenge is marked by the immense scope and costs of mental disorders. Important factors are their persistent increase due to an aging population, the rapid socioeconomic changes currently taking place, and, finally, the large unmet treatment needs, combined with insufficient awareness of their existence and significance. There is a compelling need to improve the life of people suffering from mental disorders and to assert the importance of a scientific approach to the disease manifestations, causes and treatments.
The European College of Neuropsychopharmacology (ECNP) is a unique and remarkably broad interdisciplinary platform which strongly emphasises translational research with the aim to apply new knowledge on fundamental disease mechanisms to clinical applications and vice versa. This approach takes into account the context in which mental health care is operating. ECNP bridges the gap between basic research, clinical science and medical practice, paving the way for improved pharmacological treatments, which will improve the quality of life of millions of people suffering from mental disorders.
Mental health in Europe
Mental and behavioural disorders are present at all ages and across different cultures and population groups and are major causes of disability worldwide. In the European Union (EU) over 80 million people of all ages are estimated to suffer from mental disorders and more than one third of the EU population is, or has been, affected by at least one disorder in the last twelve months; based on lifetime risk, the figure is even higher, with 50% of the population being affected (Wittchen et al., 2005). Mental disorders are often characterized by an onset early in life and an unfavourable long-term course of the illness, with adverse effects on school performance and academic career, social functioning and somatic health throughout life, frequently associated with immense suffering also for the patients?? families, partners and friends.
Taking into account the high degree of psychiatric comorbidity, the most frequent mental disorders in the European Union are anxiety disorders, followed by depressive, somatoform and addictive disorders involving nicotine, alcohol and drugs (Wittchen & Jacobi, 2005). Depression, for instance, is the second most important cause of disability and increases the risk of suicide, which in the EU is higher than death from traffic accidents, homicide or HIV/AIDS (EU 2005). Moreover, in the past decades there has been a steep increase in the risk of depression and related disorders, such as burn-out, especially among women. This development predominantly seems to be related to the rapid societal changes currently taking place, with vanishing traditional roles, growing workplace stress and unemployment ranking first among a variety of influential factors. Furthermore, current demographic changes due to an aging population will lead to a rising prevalence of mental illness and neurological disorders with typical behavioural and psychological symptoms, especially dementia and Parkinson??s disease.
The majority of the EU population will suffer from a mental disorder at least once in their lifetime, with the lifetime risk continuing to increase.
Besides the pain experienced by those struck by these disorders and their families, mental illness causes considerable economic costs due to lost productivity, disability and social-service payments, and increased morbidity and mortality. Currently, the resources spent on mental health care, including prevention and health promotion, are far from proportional to the costs incurred by mental health problems, which have been estimated at between 3% and 4% of gross national product (WHO 2003; Jan?©-Llopis & Anderson, 2006). According to an ECNP/EBC project, mental disorders in Europe rank first in terms of direct and indirect health-related economic costs, reaching a total of over 290 billion euros (Wittchen et al., 2005). Unlike somatic diseases with their typically high direct costs, mental disorders cause relatively low direct costs and extremely high indirect costs, above all through the loss of productivity as a consequence of the disease, e.g. work days lost due to disability, retirement or premature death. Moreover, when mental disorders are not recognized and treated, the treatment of comorbid somatic illnesses is usually less efficient and therefore more expensive.
Recent data consistently demonstrate an association of all mental disorders with generally low treatment rates: according to an epidemiological survey comprising over 150,000 subjects from 16 European countries, only 26% of all patients ever received professional health care services (Wittchen & Jacobi, 2005). Furthermore, according to a recent worldwide study comprising 84,850 adults in 17 countries with diverse economic backgrounds, at least two thirds of the people who are mentally ill go without treatment in the countries covered by the study. In Europe, 74% of all mentally ill persons are not treated, compared with only 8% of diabetics remaining untreated (Wittchen & Jacobi 2005; Wang et al., 2007; Thornicroft 2007). In most cases, treatment starts late, after many years of illness, when severe complications are already present, and among those treated, appropriate therapy is rarely provided.
In adolescents and young adults, in particular, the vast majority of disorders of the brain remain untreated.
On account of the scope of the problem and the enormous costs involved, mental disorders have recently attracted the interest of both politicians and public-health experts in many countries. Mental disorders clearly call for concerted action on various levels, ranging from the investigation of the determinants and risk factors to systematic programs to explore the benefits of preventive measures and early intervention, from substantially increased funding for basic and clinical research to better training and medical education. Since recent research has identified and further developed effective interventions and improved the treatments available, early therapeutic intervention has become increasingly important in terms of its potential benefits. More than ever before, any support for mental health is bound to have a positive impact, as it results in improved care.
Raising awareness of mental disorders among the public at large as well as among physicians, politicians and policy-makers is a matter of great urgency; at the same time, every effort has to be made to tackle the stigma and discrimination associated with these conditions.
European College of Neuropsychopharmacology (ECNP)
ECNP is a non-profit scientific society established in 1987 on the initiative of scientists and clinicians working in Europe in the convergent disciplines in neuropsychopharmacology and related areas. ECNP is a source of scientific progress and promotes the further development of medical practice in psychiatry and neurology. ECNP has set itself the task of bringing together clinicians and basic researchers to discuss and exchange ideas and experience in neuropsychopharmacology in order to enhance the quality of research and treatment in this field. One of its major objectives is the translation of new knowledge derived from preclinical science (involving neurochemistry, imaging, and genetics) into the design of therapeutic investigations, clinical practice and policy.
ECNP sees its main functions in the encouragement of research and education:
its objectives in the field of research are to offer investigators an opportunity for interdisciplinary communication through regular scientific meetings and to promote the application of a broad range of scientific disciplines to the study of drug effects on the brain and on behaviour in the interest of an improved understanding and treatment of mental disorders.
its educational goals are to encourage young scientists to enter research careers in neuropsychopharmacology, to develop new insights into behavioural and mental disorders, and to provide up-to-date information about their pharmacological treatment. Therefore, young scientists are always the focus of attention of ECNP's scientific activities.
The role of neuropsychopharmacology & ECNP
Neuropsychopharmacology bridges the gap between basic neuroscience and the treatment of neurological and psychiatric diseases. Its aim is to understand the biological basis for altered emotions, thought processes and the complex mental states that occur in mental illness. On a more practical level, its goal is to develop specific therapeutic molecules to regulate the biological mechanisms of mental disorders, i.e. the neuronal interactions that give rise to these disorders. For this purpose,neuropsychopharmacology investigates the selective effect of drugs on the central nervous system (CNS) and their use in treating disorders such as anxiety, mania, depression, schizophrenia, dementia or neurological and addictive disorders in the most rational and empirical manner. The interaction between nerve cells (neurons) that underlies complex mental functions such as thinking, learning, memory or emotion is mediated by a large number of chemical neurotransmitters and neuromodulators. Disturbances in neurotransmitter function are seen as the main cause of mental disorders and certain neurological disorders such as Parkinson??s or Alzheimer??s disease. To understand neurotransmitter function in mental health and disease, ECNP has stimulated cross-disciplinary forces - ranging from psychiatry to neurology, pharmacology and psychology - to carry out research on brain mechanisms and functions. A broad range of professionals, including clinicians and researchers, are engaged in brain imaging, chronobiology, neurochemistry, neuroimmunology, genetics, molecular biology and epidemiology.
The most profound research challenge in neuropsychopharmacology is to understand the mechanism underlying brain functions in normal and pathological mental states.
ECNP??s support to research activities is oriented towards the development of new drugs acting on specific receptors within a neurotransmitter system. These drugs should be designed to allow the direct targeting of specific sites of relevant neuronal activity, thereby maximizing the efficacy of the drug within the clinical target and minimizing adverse events. From the translational perspective of neuropsychopharmacology, scientists not only want to understand the mechanisms of action of drugs used for treatment, but also to use drug-treatment findings to learn more about the pathogenesis and pathophysiology of the underlying disorders. In this manner, a new level of integration of basic preclinical research, clinical neuroscience and clinical therapeutics becomes a key objective. This objective can inform and guide advances in neuropsychopharmacology and lead to a next generation of promising new treatments for mental disorders. The research presented at the ECNP Congresses so far has led to improved treatment for people with mental disorders ranging from autism, addictions and Alzheimer's disease to mood disorders, psychoses and schizophrenia.
ECNP puts emphasis on understanding how basic discoveries are relevant to patient symptoms and illness, as well as on identifying and testing promising new medications with novel mechanisms. In so doing, ECNP is paving the way for improved pharmacological treatments, which will improve the quality of life of millions of people suffering from mental disorders.
21st ECNP Congress, Barcelona, Spain
From 30 August - 3 September 2008, more than 6,500 neuroscience researchers, psychiatrists, neurologists, psychologists and practitioners from all over the world will gather in Barcelona at the 21st ECNP Congress. The programme will not only present the latest findings and breakthroughs in neuropsychopharmacology and related areas in both clinical and preclinical settings, but also cover the various aspects of pharmacotherapy of brain disorders and its benefits for patients with psychiatric and neurological disorders in terms of quality of life. The ECNP Congress is expected to stimulate discussion about ways of implementing new knowledge and the most effective therapeutic approaches, while taking into account the current economic background of such therapy. In addition, this high-level scientific meeting - the largest of its kind in Europe - will deal with the impact of current social, economic and cultural changes on mental health care, e.g. neuro-ethics, effects of migration etc.
Highlights of the 21st ECNP Congress
The comprehensive programme of the ECNP Congress includes over 100 topics to be presented by more than 600 experts. The outstanding highlights are:
Antidepressants in general and in suicide prevention
Neurogenesis in the adult brain: the association with stress and depression
The consensus statement 2007 on bipolar depression
The first autism disease genes
Antihypertensive treatment on cognitive functions in Alzheimer's disease
Alcoholism-associated molecular adaptations in brain neurocognitive circuits
In addition, cutting-edge research findings and future perspectives in the fields of depression, bipolar affective disorders, schizophrenia, dementia, anxiety disorders, obsessive compulsive disorder, drugs & addiction, autism, suicide prevention, and basic neuroscience will be presented in plenary lectures, symposia and educational updates. The challenges and consequences of current socioeconomic changes for mental health care are taken into account. Great emphasis will be placed on clear take-home messages that can easily be translated into clinical practice by medical professionals.
ECNP is proud to present the report of the ECNP Consensus Meeting 2007 on 'bipolar depression'. Through annual consensus meetings on specific topics, ECNP aims to facilitate the dialogue between European regulatory authorities, the scientific community and the pharmaceutical industry in order to achieve a common policy in neuropsychopharmacology.
ECNP has received over 800 papers for poster presentation, of which 744 papers have been accepted for poster presentation, each of them offering an exciting insight into the research activities of (young) scientists.
The aim of ECNP is that the 21st ECNP Congress will highlight the contribution of neuropsychopharmacology to medical practice and help all of us to raise awareness for mental disorders both among physicians and the public at large.
References
[EU 2005] Green Paper Improving the Mental Health of the population. Towards a strategy on mental health for the European Union
Jan?©-Llopis, E; Anderson P (Eds.) Mental health promotion and mental disorder prevention across European Member States. Luxembourg: European Communities, 2006
Thornicroft G. Most people with mental illness are not treated. Lancet 2007;370:807-808
Wang PS, Aquilar-Gaxiola S, Alonso J, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 2007;370:841-850
[WHO 2003] Investing in Mental Health. Geneva: World Health Organisation, 2003
Wittchen H.-U., J?¶nnson B., Olesen J. Towards a better understanding of the size and burden and cost of brain disorders in Europe. European Neuropsychopharmacology 15, 2005, 355-356
Wittchen H.U. & Jacobi F. Size and burden of mental disorders in Europe - A critical review and appraisal of 27 studies. European Neuropsychopharmacology 15, 2005, 357-376
воскресенье, 19 июня 2011 г.
Gene Linked To Major Depression
Gene variants that cause low expression of the brain chemical NPY are linked to negative emotional processing and higher
risk of developing some major depressive disorders said US scientists in a new study published this week.
The team of University of Michigan-led researchers used three different approaches to show that people with a genotype that
produces lower levels of neuropeptide Y (NPY) had measurably stronger brain responses to negative stimuli and psychological
responses to physical pain and were more likely to be found among groups diagnosed with a major depressive disorder.
They hope their discovery will help doctors diagnose and treat depression and other psychiatric conditions earlier and help
developers create therapies that can be adapted to suit the genetic profile of individual patients.
You can read how they arrived at their findings in the paper they wrote that was published online on 7 February in the
Archives of General Psychiatry.
Previous studies have shown that NPY restores calm after stressful events.
With this study, senior author Dr Jon-Kar Zubieta, a professor of psychiatry and radiology and research professor at the
Molecular and Behavioral Neurosciences Institute at the University of Michigan in Ann Arbor, and colleagues, discovered what
happens when people don't have enough of the brain chemical and what the reason might be.
They found that people with genes that cause lower levels of NPY are more responsive to negative stimuli in parts of the brain
linked to emotion and this makes them less resilient to stress and more likely to develop a major depressive disorder.
Lead author Dr Brian Mickey, an assistant professor in the Department of Psychiatry at the University of Michigan Medical
School and researcher at the university's Molecular and Behavioral Neurosciences Institute, told the media that these genetic
features can be assessed in any person and they hope they and other scientists will be able to use them to work out a person's
individual risk of developing depression and anxiety:
"This is what we mean when we talk about 'personalized medicine'," he explained.
The researchers also hope the discovery will add another piece of vital information to the "genetic map" of depression.
"This appears to be another mechanism, independent of previous targets in depression research, such as serotonin, dopamine and
norepinephrine," said Zubieta, whose disclosure information in the article shows he has acted as consultant to three major drug
companies in the last year.
For their study, Zubieta and colleagues recruited a total of 179 participants: 44 individuals with major depressive disorder and
137 healthy controls.
With the help of genotyping by colleagues at the Laboratory of Neurogenetics at the National Institute on Alcohol Abuse and
Alcoholism in Bethesda, Maryland, they established that 84% of the participants (152 individuals) had either low, intermediate or
high expression of NPY.
They then used three approaches to examine the link between NPY gene expression and emotional processing.
For the first, they invited each participant to look at words with neutral, negative and positive emotional connotations (eg
"material", "murder", "hopeful") while they watched their brain activity using functional magnetic resonance imaging
(fMRI).
They observed that in response to the negative words, participants with low NPY showed stronger activity in the prefrontal
cortex than participants with high NPY. This part of the brain plays a key role in emotional processing.
Mickey said this observation shows that:
"... individuals with the risk-associated NPY gene variant tend to activate this key brain region more than other people, even in
the absence of stress and before psychiatric symptoms are present."
For the second approach, Zubieta and colleagues invited each participant to undergo a pain stress test where they received an
injection of saline solution into a jaw muscle. The pain lasted about 20 minutes and there was no lasting harm from the
procedure. The researchers adjusted the level of the pain until it registered a 4 on a scale of 1 to 10 for each
participant.
The participants described how positive or negative their feelings were before and after the pain challenge.
The results showed that those with low NPY expression reported more negative feelings both before and after the pain
challenge,
which the researchers said suggests they were more emotionally affected while anticipating the stress challenge and also when
they thought about it afterwards.
And in the third approach, they compared NPY genotypes in the two groups and found that the group with major depressive
disorder had a higher proportion of participants with low expression of NPY.
They concluded that:
"These findings support a model in which NPY genetic variation predisposes certain individuals to low NPY expression, thereby
increasing neural responsivity to negative stimuli within key affective circuit elements, including the medial prefrontal and
anterior cingulate cortices."
"These genetically influenced neural response patterns appear to mediate risk for some forms of MDD [major depressive
disorder]," they added.
Zubieta said these findings go further than just linking a gene to an illness:
"We're expanding the understanding of the physiology of depression," he said.
Funds from from the National Institutes of Mental Health, National Institute on Drug Abuse, the Intramural Research Program of
the National Institute on Alcohol Abuse and Alcoholism, and the Phil F Jenkins Research Fund helped pay for the
study.
"Emotion Processing, Major Depression, and Functional Genetic Variation of Neuropeptide Y."
Brian J. Mickey, Zhifeng Zhou, Mary M. Heitzeg, Elizabeth Heinz, Colin A. Hodgkinson, David T. Hsu, Scott A. Langenecker,
Tiffany M. Love, Marta Peci?±a, Tal Shafir, Christian S. Stohler, David Goldman, Jon-Kar Zubieta.
Arch Gen
Psychiatry, Vol 68, No 2, pp 158-166, Published online 7 Feb 2011.
DOI:10.1001/archgenpsychiatry.2010.197
Additional source: University of Michigan Health System (press release, 7 Feb 2011).
, PhD
risk of developing some major depressive disorders said US scientists in a new study published this week.
The team of University of Michigan-led researchers used three different approaches to show that people with a genotype that
produces lower levels of neuropeptide Y (NPY) had measurably stronger brain responses to negative stimuli and psychological
responses to physical pain and were more likely to be found among groups diagnosed with a major depressive disorder.
They hope their discovery will help doctors diagnose and treat depression and other psychiatric conditions earlier and help
developers create therapies that can be adapted to suit the genetic profile of individual patients.
You can read how they arrived at their findings in the paper they wrote that was published online on 7 February in the
Archives of General Psychiatry.
Previous studies have shown that NPY restores calm after stressful events.
With this study, senior author Dr Jon-Kar Zubieta, a professor of psychiatry and radiology and research professor at the
Molecular and Behavioral Neurosciences Institute at the University of Michigan in Ann Arbor, and colleagues, discovered what
happens when people don't have enough of the brain chemical and what the reason might be.
They found that people with genes that cause lower levels of NPY are more responsive to negative stimuli in parts of the brain
linked to emotion and this makes them less resilient to stress and more likely to develop a major depressive disorder.
Lead author Dr Brian Mickey, an assistant professor in the Department of Psychiatry at the University of Michigan Medical
School and researcher at the university's Molecular and Behavioral Neurosciences Institute, told the media that these genetic
features can be assessed in any person and they hope they and other scientists will be able to use them to work out a person's
individual risk of developing depression and anxiety:
"This is what we mean when we talk about 'personalized medicine'," he explained.
The researchers also hope the discovery will add another piece of vital information to the "genetic map" of depression.
"This appears to be another mechanism, independent of previous targets in depression research, such as serotonin, dopamine and
norepinephrine," said Zubieta, whose disclosure information in the article shows he has acted as consultant to three major drug
companies in the last year.
For their study, Zubieta and colleagues recruited a total of 179 participants: 44 individuals with major depressive disorder and
137 healthy controls.
With the help of genotyping by colleagues at the Laboratory of Neurogenetics at the National Institute on Alcohol Abuse and
Alcoholism in Bethesda, Maryland, they established that 84% of the participants (152 individuals) had either low, intermediate or
high expression of NPY.
They then used three approaches to examine the link between NPY gene expression and emotional processing.
For the first, they invited each participant to look at words with neutral, negative and positive emotional connotations (eg
"material", "murder", "hopeful") while they watched their brain activity using functional magnetic resonance imaging
(fMRI).
They observed that in response to the negative words, participants with low NPY showed stronger activity in the prefrontal
cortex than participants with high NPY. This part of the brain plays a key role in emotional processing.
Mickey said this observation shows that:
"... individuals with the risk-associated NPY gene variant tend to activate this key brain region more than other people, even in
the absence of stress and before psychiatric symptoms are present."
For the second approach, Zubieta and colleagues invited each participant to undergo a pain stress test where they received an
injection of saline solution into a jaw muscle. The pain lasted about 20 minutes and there was no lasting harm from the
procedure. The researchers adjusted the level of the pain until it registered a 4 on a scale of 1 to 10 for each
participant.
The participants described how positive or negative their feelings were before and after the pain challenge.
The results showed that those with low NPY expression reported more negative feelings both before and after the pain
challenge,
which the researchers said suggests they were more emotionally affected while anticipating the stress challenge and also when
they thought about it afterwards.
And in the third approach, they compared NPY genotypes in the two groups and found that the group with major depressive
disorder had a higher proportion of participants with low expression of NPY.
They concluded that:
"These findings support a model in which NPY genetic variation predisposes certain individuals to low NPY expression, thereby
increasing neural responsivity to negative stimuli within key affective circuit elements, including the medial prefrontal and
anterior cingulate cortices."
"These genetically influenced neural response patterns appear to mediate risk for some forms of MDD [major depressive
disorder]," they added.
Zubieta said these findings go further than just linking a gene to an illness:
"We're expanding the understanding of the physiology of depression," he said.
Funds from from the National Institutes of Mental Health, National Institute on Drug Abuse, the Intramural Research Program of
the National Institute on Alcohol Abuse and Alcoholism, and the Phil F Jenkins Research Fund helped pay for the
study.
"Emotion Processing, Major Depression, and Functional Genetic Variation of Neuropeptide Y."
Brian J. Mickey, Zhifeng Zhou, Mary M. Heitzeg, Elizabeth Heinz, Colin A. Hodgkinson, David T. Hsu, Scott A. Langenecker,
Tiffany M. Love, Marta Peci?±a, Tal Shafir, Christian S. Stohler, David Goldman, Jon-Kar Zubieta.
Arch Gen
Psychiatry, Vol 68, No 2, pp 158-166, Published online 7 Feb 2011.
DOI:10.1001/archgenpsychiatry.2010.197
Additional source: University of Michigan Health System (press release, 7 Feb 2011).
, PhD
пятница, 17 июня 2011 г.
In Central African Republic, Violence, Traumatic Events Associated With Depression And Anxiety
More than three-quarters of adults in the Central African Republic report witnessing or personally experiencing traumatic events during the most recent wave of violence, and more than half meet criteria for depression or anxiety, according to a report in the August 4 issue of JAMA, a theme issue on violence and human rights.
"For decades, the Central African Republic has experienced violence, economic stagnation and institutional failure," the authors write as background information in the article. "The latest wave of violence erupted in 2001 and continues to this day in some areas. Yet there has been little attention to the conflict and even less research to document and quantify the conflict's human cost."
To study levels of violence in the country, Patrick Vinck, Ph.D., and Phuong N. Pham, M.P.H., Ph.D., of the University of California, Berkeley, and Tulane University, New Orleans, conducted a survey of 1,879 adults (average age 36.4) from October to December 2009 in five administrative units of the Central African Republic. This included three units in the south, which has been free from recent violence, and two in the north, in which violence continues. Participants were asked about deaths in their households, exposure to traumatic events, sense of insecurity and physical and mental health status.
"High percentages of respondents reported witnessing or having personally experienced potential traumatic events over the course of the conflicts," the authors write. A total of 80.8 percent reported being displaced, 76.4 percent reported witnessing violence, 67.3 percent had been threatened with death, 60.7 percent had property stolen or destroyed, 10.8 percent reported abduction and 3.6 percent experienced sexual violence. In addition, more than one in four respondents reported a bad or very bad level of security walking in their village at night (29 percent), meeting strangers (27.4 percent) or traveling to the nearest town or village (25.7 percent).
The death rate was five per 1,000 individuals per month, with violence accounting for 0.8 deaths per 1,000 per month. A total of 35 percent of the participants reported their physical health as good or very good, whereas 29 percent described it as bad or very bad. Depression was identified among 55.3 percent of participants, and anxiety among 52.5 percent. Exposure to violence and self-reported physical health status was associated with these mental health conditions.
"Mortality rates, lower levels of physical health and access to health services and symptom scores for anxiety were higher among study respondents in the two northern prefectures experiencing ongoing violence compared with those in the south," the authors write. "Mortality rates in all the areas in the study were three to five times higher than that for sub-Saharan Africa and were higher than rates in some comparable conflict and post-conflict areas."
The findings could be used to advocate aid program and security sector reforms to protect civilians, the authors note. "The associations of violence with physical and mental health need to be further explored to develop a better framework in which to offer health care services in conflict and post-conflict situations," they write. "Unaddressed, these issues could further undermine Central African Republic's development and slow its progress toward social reconstruction."
"For decades, the Central African Republic has experienced violence, economic stagnation and institutional failure," the authors write as background information in the article. "The latest wave of violence erupted in 2001 and continues to this day in some areas. Yet there has been little attention to the conflict and even less research to document and quantify the conflict's human cost."
To study levels of violence in the country, Patrick Vinck, Ph.D., and Phuong N. Pham, M.P.H., Ph.D., of the University of California, Berkeley, and Tulane University, New Orleans, conducted a survey of 1,879 adults (average age 36.4) from October to December 2009 in five administrative units of the Central African Republic. This included three units in the south, which has been free from recent violence, and two in the north, in which violence continues. Participants were asked about deaths in their households, exposure to traumatic events, sense of insecurity and physical and mental health status.
"High percentages of respondents reported witnessing or having personally experienced potential traumatic events over the course of the conflicts," the authors write. A total of 80.8 percent reported being displaced, 76.4 percent reported witnessing violence, 67.3 percent had been threatened with death, 60.7 percent had property stolen or destroyed, 10.8 percent reported abduction and 3.6 percent experienced sexual violence. In addition, more than one in four respondents reported a bad or very bad level of security walking in their village at night (29 percent), meeting strangers (27.4 percent) or traveling to the nearest town or village (25.7 percent).
The death rate was five per 1,000 individuals per month, with violence accounting for 0.8 deaths per 1,000 per month. A total of 35 percent of the participants reported their physical health as good or very good, whereas 29 percent described it as bad or very bad. Depression was identified among 55.3 percent of participants, and anxiety among 52.5 percent. Exposure to violence and self-reported physical health status was associated with these mental health conditions.
"Mortality rates, lower levels of physical health and access to health services and symptom scores for anxiety were higher among study respondents in the two northern prefectures experiencing ongoing violence compared with those in the south," the authors write. "Mortality rates in all the areas in the study were three to five times higher than that for sub-Saharan Africa and were higher than rates in some comparable conflict and post-conflict areas."
The findings could be used to advocate aid program and security sector reforms to protect civilians, the authors note. "The associations of violence with physical and mental health need to be further explored to develop a better framework in which to offer health care services in conflict and post-conflict situations," they write. "Unaddressed, these issues could further undermine Central African Republic's development and slow its progress toward social reconstruction."
среда, 15 июня 2011 г.
Stress Can Be The Cause Of Unexplained Chest Pain
Each year, many people seek emergency treatment for unexplained chest pains. A thesis from the Sahlgrenska Academy, University of Gothenburg, Sweden, indicates several common factors among those affected, including stress at work, anxiety, depression and a sedentary lifestyle.
Chest pain is a common reason for patients to seek emergency treatment. A considerable number of patients are diagnosed with unexplained chest pain, which means that the pain cannot be linked to biomedical factors such as heart disease, or some other illness. The patient group is significant in size, with just over 20,000 patients seeking hospital treatment in 2006, and so far researchers have been unable to identify specific causes for unexplained chest pain.
"Many suffer from recurring bouts of pain over several years, while the healthcare services are unable to find out what's causing it," says Registered nurse Annika Janson Fagring, the author of the thesis.
In her thesis, Annika Janson Fagring describes and analyses symptoms among patients with unexplained chest pain. The results show that most of them are middle-aged, and that over a third of those affected were born outside Sweden. The chest pain had a negative impact on the patients' daily life in the form of tiredness, anxiety and fear of death.
"The main difference between women and men with unexplained chest pain is that men were more likely to perceive their lives and jobs as being stressful, while women tended more to suffer from symptoms of depressions and anxiety," says Annika Janson Fagring.
The patients, both men and women, experienced more symptoms of depression and anxiety, and work-related stress when compared with a reference group of people who were not suffering from heart disease. The male patients were more physically active in their spare time than the female patients, but compared with the reference group, both the men and the women with unexplained chest pain led a more sedentary lifestyle.
The thesis also looks at the development of symptoms and the prognosis for patients with unexplained chest pain over a period of time, compared with patients suffering from angina and patients who had suffered a heart attack. A register study revealed that from 1987 up until 2000, the number of patients with diagnosed unexplained chest pain increased, and then levelled out. The number of patients with angina increased up until 1994 and has since fallen, while the number of patients who have suffered heart attacks has fallen throughout the whole period examined.
There were fewer deaths among patients with unexplained chest pain a year after they became ill, compared with patients that became ill with angina or suffered heart attacks. Deaths among men a year after falling ill with unexplained chest pain were a third higher compared with men in the rest of the population, while women did not display any increased risk of death.
Annika Janson Fagring says that the thesis shows that it is important to improve knowledge and understanding of the symptoms experienced by patients with unexplained chest pain, in order to be able to offer more individualised care.
Thesis for the Degree of Doctor of Philosophy at the Institute of Health and Care Sciences at the Sahlgrenska Academy, University of Gothenburg.
Title of thesis: Unexplained chest pain in men and women - symptom perception and outcome
The thesis was defended on Friday 6 February at 1.00 p.m., in lecture theatre 2119, Arvid Wallgrens backe 2, Gothenburg, Sweden
Opponent: Professor Anders Waldenstr?¶m, Ume?? University, Ume??
Chest pain is a common reason for patients to seek emergency treatment. A considerable number of patients are diagnosed with unexplained chest pain, which means that the pain cannot be linked to biomedical factors such as heart disease, or some other illness. The patient group is significant in size, with just over 20,000 patients seeking hospital treatment in 2006, and so far researchers have been unable to identify specific causes for unexplained chest pain.
"Many suffer from recurring bouts of pain over several years, while the healthcare services are unable to find out what's causing it," says Registered nurse Annika Janson Fagring, the author of the thesis.
In her thesis, Annika Janson Fagring describes and analyses symptoms among patients with unexplained chest pain. The results show that most of them are middle-aged, and that over a third of those affected were born outside Sweden. The chest pain had a negative impact on the patients' daily life in the form of tiredness, anxiety and fear of death.
"The main difference between women and men with unexplained chest pain is that men were more likely to perceive their lives and jobs as being stressful, while women tended more to suffer from symptoms of depressions and anxiety," says Annika Janson Fagring.
The patients, both men and women, experienced more symptoms of depression and anxiety, and work-related stress when compared with a reference group of people who were not suffering from heart disease. The male patients were more physically active in their spare time than the female patients, but compared with the reference group, both the men and the women with unexplained chest pain led a more sedentary lifestyle.
The thesis also looks at the development of symptoms and the prognosis for patients with unexplained chest pain over a period of time, compared with patients suffering from angina and patients who had suffered a heart attack. A register study revealed that from 1987 up until 2000, the number of patients with diagnosed unexplained chest pain increased, and then levelled out. The number of patients with angina increased up until 1994 and has since fallen, while the number of patients who have suffered heart attacks has fallen throughout the whole period examined.
There were fewer deaths among patients with unexplained chest pain a year after they became ill, compared with patients that became ill with angina or suffered heart attacks. Deaths among men a year after falling ill with unexplained chest pain were a third higher compared with men in the rest of the population, while women did not display any increased risk of death.
Annika Janson Fagring says that the thesis shows that it is important to improve knowledge and understanding of the symptoms experienced by patients with unexplained chest pain, in order to be able to offer more individualised care.
Thesis for the Degree of Doctor of Philosophy at the Institute of Health and Care Sciences at the Sahlgrenska Academy, University of Gothenburg.
Title of thesis: Unexplained chest pain in men and women - symptom perception and outcome
The thesis was defended on Friday 6 February at 1.00 p.m., in lecture theatre 2119, Arvid Wallgrens backe 2, Gothenburg, Sweden
Opponent: Professor Anders Waldenstr?¶m, Ume?? University, Ume??
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