clozapine and Anxiety-Disorders

Behavioural symptoms such as anxiety, depression and psychosis are common in Parkinson's disease (PD), and dementia occurs in about 90% of the patients. These symptoms can be more disabling than the motor dysfunction and they negatively impact quality of life, increase caregiver distress and are more frequently associated with nursing home placement. Depression can be treated with counselling and pharmacotherapy. Tricyclic antidepressants or selective serotonin reuptake inhibitors are widely used, but there is still need for controlled clinical trials. Management of psychosis in PD is complex and includes elimination of identifiable risk factors, reduction of polypharmacy and administration of atypical neuroleptics, which can alleviate psychotic symptoms without worsening motor functions. Clozapine is the best documented atypical neuroleptic shown to be effective against psychosis in PD patients. Cholinesterase inhibitors may prove additional benefit in psychotic PD patients. Recent evidence from small double-blind and open-label trials suggests that cholinesterase inhibitors may be effective in the treatment of dementia associated with PD.

Topics: Antipsychotic Agents; Anxiety Disorders; Cholinesterase Inhibitors; Clozapine; Dementia; Depressive Disorder; Humans; Mental Disorders; Parkinson Disease; Psychotic Disorders

Symptoms of generalized anxiety disorder are commonly observed in elderly persons and especially in those suffering from dementia. In the demented elderly, these symptoms are often defined as agitation. Approximately 60% of demented persons will present with symptoms of agitation at some point during the course of their illness. The presence of agitation has devastating consequences for the patient and the caregiver. This paper reviews some of the existing literature with regard to the etiology and treatment of agitation in the demented elderly. Agitated behaviors are generally divided in three categories (verbal agitation physically nonaggressive agitation, and aggressive agitation). It is suggested that each category may have a different etiology and treatment; verbal agitation is often related to underlying medical conditions, physically nonaggressive behavior responds to behavioral treatment, and aggressive agitation is more likely to respond to a combination of behavioral and pharmacologic treatment.

Topics: Aged; Aggression; Antipsychotic Agents; Anxiety Disorders; Behavior Therapy; Buspirone; Carbamazepine; Clozapine; Combined Modality Therapy; Decision Trees; Dementia; Humans; Ondansetron; Psychomotor Agitation; Serotonin; Trazodone

We previously demonstrated that three months into the COVID-19 pandemic, the impact on individuals with treatment-resistant psychotic disorders was modest. Here, we examined and compared the psychological and social impact of the COVID-19 pandemic on the same patient cohort 12 months after their initial study engagement.. Semi-structured interviews were conducted with 54 individuals (85.7% response rate) between June 12 and July 29, 2021, 12 months after their initial interviews. Participants' subjective experience of the impact of the COVID-19 pandemic on anxiety symptoms, social and vocational functioning was measured utilising the same Likert scales at both time points. Anxiety symptoms were additionally measured using subjective (Beck Anxiety Inventory) and objective (Hamilton Anxiety Rating Scale (HARS)) psychometric instruments. Paired. A minor increase in anxiety symptoms was demonstrated utilising the HARS (1.9 points,. No significant overall clinical change in symptomatology or functioning over time was noted.The study demonstrated that positive views regarding vaccination and optimism for the future were evident for some participants.

Topics: Anxiety; Anxiety Disorders; Clozapine; COVID-19; Humans; Pandemics

Chronic stress is one of the main risk factors of bone loss. While the neurons and neural circuits of the ventromedial hypothalamus (VMH) mediate bone loss induced by chronic stress, the detailed intrinsic mechanisms within the VMH nucleus still need to be explored. Astrocytes in brain regions play important roles in the regulation of metabolism and anxiety-like behavior through interactions with surrounding neurons. However, whether astrocytes in the VMH affect neuronal activity and therefore regulate chronic stress-induced anxiety and bone loss remain elusive. In this study, we found that VMH astrocytes were activated during chronic stress-induced anxiety and bone loss. Pharmacogenetic activation of the Gi and Gq pathways in VMH astrocytes reduced and increased the levels of anxiety and bone loss, respectively. Furthermore, activation of VMH astrocytes by optogenetics induced depolarization in neighboring steroidogenic factor-1 (SF-1) neurons, which was diminished by administration of N-methyl-D-aspartic acid (NMDA) receptor blocker but not by alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor blocker. These results suggest that there may be a functional "glial-neuron microcircuit" in VMH nuclei that mediates anxiety and bone loss induced by chronic stress. This study not only advances our understanding of glial cell function but also provides a potential intervention target for chronic stress-induced anxiety and bone loss therapy.

Topics: Animals; Anxiety Disorders; Astrocytes; Bone Density; Bone Resorption; Chronic Disease; Clozapine; Elevated Plus Maze Test; Emotions; Genes, Reporter; GTP-Binding Protein alpha Subunits, Gi-Go; GTP-Binding Protein alpha Subunits, Gq-G11; Male; Mice; Mice, Inbred C57BL; Neurons; Open Field Test; Optogenetics; Proto-Oncogene Proteins c-fos; Random Allocation; Receptors, N-Methyl-D-Aspartate; Stress, Psychological; Ventromedial Hypothalamic Nucleus

Topics: Antimanic Agents; Antipsychotic Agents; Anxiety Disorders; Clozapine; Female; gamma-Aminobutyric Acid; Humans; Lithium Compounds; Male; Schizophrenia; Sulpiride

Topics: Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Anxiety Disorders; Asthma; Bronchodilator Agents; Buspirone; Clozapine; Comorbidity; Cooperative Behavior; Depressive Disorder, Major; Dose-Response Relationship, Drug; Drug Interactions; Drug Resistance; Drug Therapy, Combination; Humans; Long-Term Care; Patient Care Team; Piperazines; Referral and Consultation; Schizophrenia; Schizophrenic Psychology; Theophylline; Triazoles

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Anxiety Disorders; Clozapine; Cyclopropanes; Female; Humans; Male; Milnacipran; Schizophrenia

The present cross-sectional study examined the relationships of psychopathology, side effects, and sociodemographic factors with treatment outcomes in terms of patients' quality of life (QOL), functioning, and needs for care.. Sixty outpatients with chronic schizophrenia who had been treated with either clozapine or olanzapine for at least 6 months were investigated.. Most psychopathological symptoms as well as psychic side effects, weight gain, and female sex were associated with lower QOL, while cognitive symptoms correlated with better QOL. Female sex, cognitive symptoms, and parkinsonism negatively influenced occupational functioning, and negative symptoms determined a lesser likelihood of living independently. Age, education, depression/anxiety, negative symptoms, and psychic side effects were predictors of patients' needs for care.. Our results highlight the complex nature of patient outcomes in schizophrenia. They reemphasize the need of targeting effectiveness, i.e. both symptomatic improvement as well as drug safety, in such patients.

Topics: Adult; Age Factors; Antipsychotic Agents; Anxiety Disorders; Benzodiazepines; Clozapine; Cognition; Comorbidity; Cross-Sectional Studies; Depressive Disorder; Educational Status; Female; Humans; Male; Olanzapine; Parkinsonian Disorders; Quality of Life; Schizophrenia; Schizophrenic Psychology; Sex Factors; Socioeconomic Factors; Treatment Outcome; Weight Gain

Topics: Adult; Anxiety Disorders; Buspirone; Clozapine; Drug Interactions; Drug Therapy, Combination; Gastrointestinal Hemorrhage; Humans; Hyperglycemia; Male; Schizophrenia, Paranoid

The manifestation of depersonalisation, its relationship with anxiety and depression, as well as its influence on the course of endogenous psychoses were investigated. Forty patients with severe depersonalisation were treated with the benzodiazepine, phenazepam, and 14 with clozapine. The data indicate that depersonalisation results from anxiety; it follows an anxiety attack and is successfully treated with anxiolytic drugs. In the case of endogenous depression, depersonalisation leads to lingering depressive phase, increasing the patients' resistance to antidepressive therapy. The protective and the harmful role of depersonalisation is discussed.

Topics: Adult; Anti-Anxiety Agents; Anxiety Disorders; Benzodiazepines; Benzodiazepinones; Bipolar Disorder; Clozapine; Depersonalization; Depressive Disorder; Diagnosis, Differential; Dibenzazepines; Female; Humans; Hypochondriasis; Male; Middle Aged

Topics: Adult; Anxiety Disorders; Clozapine; Dibenzazepines; Female; Humans; Male; Middle Aged; Neurotic Disorders; Psychopathology; Sleep Wake Disorders