Patient Care Neurology & Psychiatry - November 2007 - (Page 7)

MEDICINE in the News biweekly intervals on neurobehavioral and side effect rating scales. The 2 treatment regimens were equally effective. Patients who completed the treatment (fewer than half of the total sample) showed roughly equivalent degrees of improvement in agitation and psychotic symptoms. A significant difference did emerge, however, with respect to side effects: Participants in the risperidone group showed a significantly heavier burden of side effects than those taking citalopram. The authors caution that their findings must be replicated before treatment with citalopram or other SSRIs can be recommended as alternatives to antipsychotics for the treatment of agitation or psychosis in dementia. 1. Pollock BG, Mulsant BH, Rosen J, et al. A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia [published online ahead of print Sep 10, 2007]. Am J Geriatr Psychiatry. Managing psychotic symptoms in dementia patients patients psychotic behavD ementiacaregivers.often displayguidelines recomiors that make management difficult for physicians and Current mend atypical antipsychotics to manage these patients’ symptoms. Now a small study indicates that treatment with a selective serotonin reuptake inhibitors (SSRIs) such as citalopram may be just as effective, with a lesser risk of adverse events.1 Researchers conducted a randomized, controlled trial in 103 nondepressed patients with dementia who had been hospitalized because of behavioral symptoms. Participants were recruited for the study if they had at least 1 moderate to severe target symptom, including aggression, agitation, hostility, suspiciousness, hallucinations, or delusions. Participants were assigned to receive either citalopram or risperidone. Their symptoms were followed over a 12week period and analyzed at baseline and weekly or When anxious patients turn to CAM remedies A preference for complementary and alternative medicine (CAM) is becoming increasingly common among American consumers. What is the evidence (or lack thereof) for safety and efficacy of CAM remedies? A review of evidence in the treatment of anxiety disorders is a good place to start.1 The researchers derived their leads on which herbal remedies and supplements were commonly used or had claims for the treatment of anxiety from the same source patients are likely to consult: the Internet. The researchers consulted http://www.naturaldatabase.com, http://www.revolutionhealth.com/drugs-treatments, and http://www.healthyplace. com. Then they searched Medline for clinical trials, guidelines, and meta-analyses that tested these preparations in treating patients with diagnosed anxiety disorders. Candidate remedies for which data were available included kava, inositol (part of the vitamin B complex—B8), St John’s wort, vaNOVEMBER 2007 lerian, Sympathyl (a mixture of California poppy, hawthorn, and elemental magnesium), passionflower, and omega-3 fatty acids. Only 2 remedies get a thumbsup from the study. Kava gets an A evidence rating (consistent, good quality, patient-oriented evidence) for short-term use in patients with mild to moderate anxiety disorders who are not using alcohol or other medications metabolized by the liver. Inositol, 12 to 18 mg/d, has a B-level rating (inconsistent or limited quality patient-oriented evidence) for treating panic disorder and obsessive compulsive disorder (but not in combination with an selective serontonin reuptake inhibitor). St John’s wort, valerian, Sympathyl, passionflower, omega-3 fatty acids, and all other supplements, the authors write, have little therapeutic value. 1. Saeed SA, Bloch RM, Antonacci DJ. Herbal and dietary supplements for treatment of anxiety disorders. Am Fam Physician. 2007; 76:549-556. News from the FDA Risperdal (risperidone) has been approved for the treatment of schizophrenia in adolescents aged 13 to 17 and for the short-term treatment of manic or mixed episodes of bipolar disorder in children and adolescents aged 10 to 17. Haldol (haloperidol) labeling has been revised to include information on cases of sudden death, QT prolongation, and torsades de pointes in patients treated with the drug. The medication may cause adverse cardiovascular events when given IV or at higher-than-recommended doses. WRITTEN BY JUDITH ASCH-GOODKIN AND DEBORAH KAPLAN www.patientcareonline.com Visit our Web site for ® Click-through links to the Internet resources listed in these pages PATIENT CARE NEUROLOGY & PSYCHIATRY 7 http://health.com/drugs-treatments, http://www.patientcareonline.com

Table of Contents Feed for the Digital Edition of Patient Care Neurology & Psychiatry - November 2007

Patient Care Neurology & Psychiatry - November 2007 Contents Research Digest Medicine in the News The 15-Minute Visit Dementia workup and treatment: Do the drugs really work? Help for Your Patients Who Suffer from Specific Phobias Clinical Clips Case & Comment The Science of Healing Classified Advertising

Patient Care Neurology & Psychiatry - November 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.