dothiepin-hydrochloride and Neurotic-Disorders

It has been known for many years that diagnosis within the neurotic spectrum of disorders is temporally unstable and also that life events can be major precipitants of change in symptoms. Reasons for this instability could include inherent inadequacy of current diagnostic practice, the influence of life events as an agent of diagnostic shift, and an innate course of disorder with features dependent on the stage at which disorder presents (e.g., development of panic to agoraphobia). These possibilities were examined in a prospective study that was initially a randomised controlled trial. Two hundred ten patients recruited from primary care psychiatric clinics with DSM-III diagnosed dysthymic, generalised anxiety, and panic disorders were randomly allocated to either drug treatment (mainly antidepressants), cognitive-behaviour therapy, or self-help therapy over a 2 year period, irrespective of original diagnosis. Life events were recorded by using a standard procedure over the period 6 months before starting treatment and at five occasions over 2 years; 181 (86%) of the patients had follow-up data and 76% maintained compliance with the original treatment allocated over the 2 years; and 155 of the 181 patients (86%) had at least one diagnostic change in this period. There was no difference in the number of diagnostic changes between the three original diagnostic groups, but dysthymic disorder changed more frequently to major depressive episode than did GAD or panic disorder (20; 11; 12) (%) and panic disorder changed more frequently to agoraphobia (with or without panic) than did dysthymia or GAD (18; 8; 6) (%). There was no relationship between loss events and depressive diagnoses or between addition events and anxiety diagnoses, but greater numbers of conflict events were associated with diagnostic change. More life events were associated with the flamboyant and dependent personality disorders, reinforcing other evidence that many life events are internally generated by personality characteristics and cannot be regarded as truly independent.

Topics: Cognitive Behavioral Therapy; Diazepam; Dothiepin; Humans; Life Change Events; Longitudinal Studies; Neurotic Disorders; Personality Disorders; Prospective Studies; Psychiatric Status Rating Scales; Self-Help Groups; Treatment Outcome

Repeated assessments of psychopathology, together with personality status, were made over two years on 181 psychiatric out-patients with generalised anxiety disorder (59), panic disorder (66), or dysthymic disorder (56) diagnosed using an interview schedule for DSM-III. Patients were randomly allocated to drug treatment, cognitive and behaviour therapy, or a self-help treatment programme. Although there were no overall differences in compliance rate and efficacy between the three modes of treatment, the psychological treatment methods, particularly self-help, were more effective in patients without personality disorder, and those with personality disorder responded better to drug treatment, primarily antidepressants. The findings suggest that assessment of personality status could be a valuable aid to selection of treatment in neurotic disorders and that self-help approaches are particularly valuable once personality disorder has been excluded.

Topics: Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Depressive Disorder; Diazepam; Dothiepin; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurotic Disorders; Panic Disorder; Personality Assessment; Self-Help Groups

The validity of the general neurotic syndrome, a combination of anxiety, depression and dependent personality disorder, was examined in a 2-year study of outpatients with dysthymic, panic and generalized anxiety disorder diagnosed using a structured interview schedule. The general neurotic syndrome, found in a third of the patients, was associated with greater mental disorder and a significantly worse outcome than patients without the syndrome. It did not, however, predict response to treatment. Further analysis revealed that the general neurotic syndrome was a better predictor of short- and long-term outcome than any other variable apart from initial psychopathology score. It is argued that the syndrome may represent a personality diathesis that makes the individual more vulnerable to both anxiety and depressive symptoms.

Topics: Adjustment Disorders; Anxiety Disorders; Cognitive Behavioral Therapy; Depressive Disorder; Diazepam; Dothiepin; England; Follow-Up Studies; Humans; Life Change Events; Neurotic Disorders; Panic Disorder; Personality Disorders; Psychiatric Status Rating Scales; Self Care

Ninety three patients took part in a two centre double blind controlled clinical trial designed to assess the efficacy of dothiepin (Prothiaden) as compared with placebo and a soft biteguard in the treatment of psychogenic facial pain. The results showed the superiority of dothiepin over placebo in achieving pain relief; 71% of patients were pain free in the dothiepin group at nine weeks compared with 47% in the placebo group. The biteguard conferred no benefit and compliance in its use was poor. Out of 84 patients followed up for 12 months, 68 (81%) became pain free. An adverse life event before development of pain, minimal previous surgical treatment, and freedom from pain at nine weeks were strong prognostic indicators for successful treatment. These results are clear evidence of the efficacy of dothiepin in psychogenic facial pain, though the drug may be needed for up to a year.

Topics: Adolescent; Adult; Aged; Clinical Trials as Topic; Depressive Disorder; Dibenzothiepins; Dothiepin; Double-Blind Method; Facial Neuralgia; Female; Humans; Male; Middle Aged; Neurotic Disorders; Prognosis; Temporomandibular Joint Dysfunction Syndrome; Time Factors

Topics: Adolescent; Adult; Clinical Trials as Topic; Dibenzothiepins; Dothiepin; Double-Blind Method; Female; Humans; Male; Middle Aged; Neurotic Disorders; Psychiatric Status Rating Scales

Topics: Dibenzothiepins; Dothiepin; Drug Administration Schedule; England; Humans; Neurotic Disorders

Topics: Dibenzothiepins; Dothiepin; Humans; Neurotic Disorders

The therapeutic response to psychotropic drugs was analyzed in 208 patients hospitalized at the Psychiatric Clinic of the Medical Faculty of the Purkinje University (Brno, Czechoslovakia). The patients showed symptoms characteristic of borderline states. The examinations were carried out with the use of modified scale SCL-90 supplemented with 90 additional signs. It was found that the patients with slowly progressing schizophrenia responded to the psychotropic drugs in a way differing from that observed in the patients with the borderline states. It is suggested that patients with slowly progressing schizophrenia have a specific biological background of the disease that determines the type of the response.

Topics: Depressive Disorder; Diagnosis, Differential; Diazepam; Dibenzothiepins; Dothiepin; Humans; Methotrimeprazine; Neurasthenia; Neurotic Disorders; Schizophrenia; Schizotypal Personality Disorder

Topics: Anxiety Disorders; Dibenzothiepins; Dothiepin; Female; Humans; Neurotic Disorders; Personality; Personality Inventory