Search

Aims The purpose of this study was to evaluate the clinical impact of addition of [11C]Pittsburgh compound-B positron emission tomography (11 C- PiB PET) on routine clinical diagnosis of Alzheimer's disease ( AD) dementia and mild cognitive impairment ( MCI), and to assess diagnostic agreement between clinical criteria and research criteria of the National Institute on Aging-Alzheimer's Association. Methods The diagnosis in 85 patients was made according to clinical criteria. Imaging examinations, including both magnetic resonance imaging and single-photon emission computed tomography/computed tomography to identify neuronal injury ( NI), and 11 C- PiB PET to identify amyloid were performed, and all subjects were re-categorized according to the research criteria. Results Among 40 patients with probable AD dementia ( ProAD), 37 were NI-positive, 29 were 11 C- PiB-positive, and 27 who were both NI- and 11 C- PiB-positive were categorized as having ' ProAD dementia with a high level of evidence of the AD pathophysiological process'. Among 20 patients with possible AD dementia ( PosAD), 17 were NI-positive, and six who were both NI- and 11 C- PiB-positive were categorized as having ' PosAD with evidence of the AD pathophysiological process'. Among 25 patients with MCI, 18 were NI-positive, 13 were 11 C- PiB-positive, and 10 who were both NI- and 11 C- PiB-positive were categorized as having ' MCI due to AD-high likelihood'. Conclusions Diagnostic concordance between clinical criteria and research criteria may not be high in this study. 11 C- PiB PET may be of value in making the diagnosis of dementia and MCI in cases with high diagnostic uncertainty. [ABSTRACT FROM AUTHOR]

The answers to a questionnaire on the practical prescription in mood disorders from 298 Japanese psychiatrists was obtained. As the first-line treatment, a majority of respondents chose newer tricyclic agents (TCA) or non-TCA for moderate depression and older TCA for severe depression both with and without psychotic features. Combination therapy with antidepressants and anxiolytics was fairly popular in moderate depression, while antidepressant/neuroleptic combination was more common in severe psychotic depression. Sulpiride was the most favored drug for dysthymia. Although lithium was the most popular for bipolar mania, respondents were divided on the treatment of bipolar depression. [ABSTRACT FROM AUTHOR]

The algorithms for the treatment of bipolar disorder are presented. Lithium is the first choice when treating acute mania. Other options are antipsychotics or mood stabilizers such as carbamazepine and valproate. Mood stabilizers (often in combinations) are drugs of choice for maintenance treatment. For the treatment of acute depression under lithium maintenance, increase doses of lithium or addition of antidepressants may be necessary. [ABSTRACT FROM AUTHOR]

Objective: The use of an algorithm may facilitate measurement-based treatment and result in more rational therapy. We conducted a 1-year, open-label study to compare various outcomes of algorithm-based treatment (ALGO) for schizophrenia versus treatment-as-usual (TAU), for which evidence has been very scarce., Methods: In ALGO, patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) were treated with an algorithm consisting of a series of antipsychotic monotherapies that was guided by the total scores in the positive and negative syndrome scale (PANSS). When posttreatment PANSS total scores were above 70% of those at baseline in the first and second stages, or above 80% in the 3rd stage, patients proceeded to the next treatment stage with different antipsychotics. In contrast, TAU represented the best clinical judgment by treating psychiatrists., Results: Forty-two patients (21 females, 39.0 ± 10.9 years-old) participated in this study. The baseline PANSS total score indicated the presence of severe psychopathology and was significantly higher in the ALGO group (n = 25; 106.9 ± 20.0) than in the TAU group (n = 17; 92.2 ± 18.3) (P = 0.021). As a result of treatment, there were no significant differences in the PANSS reduction rates, premature attrition rates, as well as in a variety of other clinical measures between the groups. Despite an effort to make each group unique in pharmacologic treatment, it was found that pharmacotherapy in the TAU group eventually became similar in quality to that of the ALGO group., Conclusion: While the results need to be carefully interpreted in light of a hard-to-distinguish treatment manner between the two groups and more studies are necessary, algorithm-based antipsychotic treatments for schizophrenia compared well to treatment-as-usual in this study.