The European Journal of Psychiatry

Sirolimus and nefazodone interaction in a renal transplant patient

Background and Objectives: Our case demonstrates the first report of an interaction with sirolimus and nefazodone in a stable renal transplant patient. Nefazodone can inhibit cytochrome P450 3A4 and may result in elevated concentrations of sirolimus since sirolimus is metabolized by cytochrome P450 3A4. Methods: A 44-year-old patient was taking nefazodone pre-transplant and post-transplant. When nefazodone was discontinued the sirolimus level was undetectable. Results: This drug interaction was not suspected because the patient was on nefazodone pre-transplant. Conclusions: It is very important to monitor the sirolimus trough level when nefazodone is initiated, discontinued, or the dose is adjusted to prevent sirolimus subtherapeutic or supratherapeutic trough levels.

The association between previous psychological trauma and mental health among gastric cancer patients

Background and Objectives: This study explores the association between previous trauma and psychiatric symptoms and well-being among gastric cancer patients. Based on the vulnerability model, it was hypothesized that cancer patients who report a history of trauma would exhibit higher level of psychiatric symptoms and lower well-being. Methods: A sample of 123 consecutive cancer patients was interviewed and administered a battery of questionnaires in order to assess their psychiatric symptoms, well-being along with demographics and health behaviors in a cross-sectional design. The patients were divided based on previous exposure to psychological trauma. A set of hierarchical linear regressions was conduced in order to learn the association between previous trauma and mental health. Results: Patients who reported previous exposure to trauma did not differ in the level of psychiatric symptoms from patients who did not report previous history of psychological trauma. However, the former had significantly lower future life satisfaction and lower level of perceived social support. After controlling for covariates, patients who reported previous exposure also had higher levels of depressive symptoms. Conclusions: The study results may suggest that the association between previous trauma and mental health of gastric cancer patients is more complex. Cancer patients who report a history of psychological trauma and who face an immediate threat to life do not differ on most indices, but they do show specific vulnerabilities: they are more susceptible to depressive symptoms and to lower future life satisfaction.

Community treatment orders: Bioethical basis

Background and Objectives: Numerous opinions and medico-legal controversies have arisen up to the date from community treatment orders in Western countries, but underlying bioethical questions have not been specifically studied. The aim of this work is to contribute to further clarify the bioethical conflicts arising from community treatment orders. Methods: The bioethical deliberation of the author is principally based on what can be considered the deontologist-principlist dominant paradigm. These principles, as first described by Beauchamp and Childress in 1979, will be applied in this work to the actual situation of involuntary outpatient treatment. Results: The author's deliberation considers that community treatment orders are consistent first with the deontologist-principlist dominant paradigm of practical reason, respecting its four general categories of basic principles. It also respects the principles of the medical ethics of virtue, subsumed in the personalism of ontological matrix, in the same way as its ethos affects the intrinsic purpose which is the dignity of the person; and with the consequentialist utilitarianism because it seeks the proportionality of the common good. A community treatment order prescription must ultimately be based on a bioethical exercise of responsibility by the clinician, judiciously weighing up the classic principal prima facie duties which must necessarily be translated into a real duty referring to a specific patient and context. Conclusions: Community treatment orders are seen as a method of therapeutic intervention with a bioethical basis resistant to criticism.

The A1 allele of the DRD2 TaqA1/A2 polymorphism as risk factor for PTSD

Background and Objectives: Dopaminergic neurotransmission is implicated in stress responses. The dopamine D2 receptor gene (DRD2) has been studied by the authors to assess its possible role as a predictor of those who are at a higher risk to develop PTSD after major psychological trauma. Methods: Over one year period 75 children and adolescents 6-18 yrs of age who had been exposed to moderate to severe burns were recruited from the burn unit at the Alexandria University Hospital for the study. Patients and their family were interviewed within the first 10 days of exposure. After signing a written consent form a 2 ml blood sample was obtained for genetic studies of the TaqA1/A2 polymorphism site of the DRD2 gene. Patients were reevaluated three and six months later for assessment of PTSD. Results: Among the 75 children recruited in the study, 26 died due to their burn injury, 19 dropped out as parents refused follow up and 30 continued the study follow up visits. Fourteen carried the A1A2 genotype. Of these 11 (78.6%) developed PTSD. Sixteen carried the A2A2 genotype. Of these only one child (6.3%) developed PTSD. The results were significant at p < 0.001 with a relative risk 12.5. Conclusions: Following exposure to severe stress, the presence of the Taq A1 allele of the DRD2 gene results in a significant increase in the risk of developing PTSD.

Alcohol and drug dependence in adults with attention-deficit/hyperactivity disorder: Data from Germany

Background and Objectives: The objective of the present study was to obtain information about the prevalence of addiction disorders in ADHD patients in a German study population, to compare the prevalence of addiction disorders in ADHD patients to that in the normal population according to the German Epidemiological Addiction Survey, and to determine which drugs are consumed most by ADHD patients. Participants: The sample consisted of 61 patients (average age 35.11 ± 9.33 years) from our ADHD consultation who were consecutively included in our study over a period of 12 months. Measurements: We diagnosed ADHD according to DSM-IV-R and by assessing the WURS-k, CAARS and BROWN ADD scales. For diagnosing addiction we conducted the EuropASI, the IDCL, the QOD and the FTNA. For differential diagnosis we assessed the SCL-K. Results: About half of our study population of ADHD patients were diagnosed with a dependence disorder (50.8%, n = 31). Twenty one dot three percent (n = 13) were suffering from an alcohol dependence, 13.1% (n = 8) from a substance use disorder (SUD) and 18% (n = 11) from a combination of both addictions. The drug consumed most commonly by ADHD patients was cannabis. Alcohol and substance abuse commenced significantly earlier in patients with ADHD than in patients with addiction disorders without comorbid ADHD. Conclusions: Our data show that the risk of developing a dependence disorder is elevated in ADHD patients. Clinicians should bear in mind that the characteristics of a dependence in ADHD patients are clinically more pronounced and that an addiction in ADHD patients starts earlier than usually expected.

Use of antidepressants among 0-26 year olds in Finland during 1997-2007

Background and Objectives: The use of antidepressants has increased in many Western countries among children, adolescents and young adults. The objective of this study was to analyse changes in incidence and prevalence of antidepressant use among patients aged 0 to 26 years from year 1997 to 2007. Methods: This is an observational population-based drug utilization study using a nationwide prescription register including data on reimbursed purchases of antidepressants for outpatient use. Results: The incidence and prevalence of antidepressant use increased about three fold during the study period. Among children less than 14 years of age both incidence and prevalence were low during the study period. In the age group 14-26 years, the incidence increased from 6.4 to 16.1 (per 1000 person-years) among men and from 9.7 to 28.3 among women, while the prevalence went up from 10.4 to 30.4 among men and from 15.5 to 56.8 among women. By the age of 26 years, 11.6% of men and 17.8% of women had purchased antidepressants at least once. The first antidepressant prescriptions were mainly prescribed by a specialist for children aged 7 to 15 years and by a non-specialist for the older age groups. Conclusions: Use of antidepressants has increased remarkably among adolescents and young adults during recent years. Further studies are warranted to analyse whether the increase in use is due to an increase in depression incidence, a lower threshold of prescribing medications or a lack of psychosocial treatment resources.