Faculty Bibliography

Attention-deficit/hyperactivity disorder (ADHD), once considered to be a childhood disorder, is diagnosed in -7 million adults in the United States, as reported by The National Comorbidity Study. Although it is now recognized that ADHD often persists into adulthood, the current diagnostic criteria is geared toward symptom identification in children. Symptoms of inattention, impulsivity, and hyperactivity evolve over the life cycle and present differently in adults. Further complicating diagnosis is that ADHD is associated with multiple functional impairments and comorbid psychiatric disorders. The Multi-Modal Treatment Study of ADHD reported that only 32% of the study population had ADHD alone; 29% had ADHD plus oppositional defiant disorder and/or conduct disorder, 14% had ADHD plus anxiety or depression, and 25% had all three disorders. Optimal treatment utilizes a multimodal approach including behavioral treatments combined with pharmacologic treatment strategies. Food and Drug Administration-approved medications for ADHD include the stimulants and nonstimulants, although tricyclic antidepressants and bupropion are also commonly used. In this monograph, Craig L. Donnelly, MD, reviews the history of ADHD and discusses the pathophysiologic progression of childhood symptoms into those commonly exhibited by adults. Next, Frederick W. Reimherr, MD, reviews comorbidity of ADHD and describes the Utah Criteria as a method of diagnosing adults through recollection of childhood problems. Finally, Joel L. Young, MD, reviews treatment approaches to adult ADHD and its comorbid conditions. (journal abstract)

Previous 'Psychopharmacology Reviews' columns have discussed the use of lamotrigine for bipolar disorder, refractory unipolar depression, treatment-resistant schizophrenia, posttraumatic stress disorder, frontal lobe dementia, and post-stroke pathological laughing and crying. Lamotrigine is an anticonvulsant that blocks voltage-gated sodium channels where it inhibits the excessive release of the excitatory amino acids glutamate and gamma -aminobutyric acid. In addition to its actions on ion channels, lamotrigine weakly inhibits monoamine transporters. At a concentration of 100-1,000 mM, lamotrigine is an inhibitor of 5-hydroxytryptamine uptake in both rat and human tissues. At similar concentrations, lamotrigine also inhibits norepinephrine and dopamine uptake into rat brain synaptosomes. Now comes a report of a woman with bipolar disorder who developed hair loss as a side effect of lamotrigine. (journal abstract)

Presents a report in which the selective serotonin reuptake inhibitor (SSRI) paroxetine was found to be useful in amelioration of hyperhidrosis in a patient with palmar-plantar hyperhidrosis (PPH). A 32-year-old man presented with a history of excessive sweating of the palms and soles and blushing of the face since childhood, which had increased in severity over the past 6 years. The patient was diagnosed with PPH and prescribed paroxetine 10 mg/day and clonazepam 0.5 mg twice a day. Within a month, he reported marked reduction in sweating and improvement in socio-occupational functioning. Paroxetine was increased to 20 mg/day and clonazepam was tapered to discontinuation, after which time the patient maintained complete control of sweating and blushing in all situations.

We present a report of urinary retention in an olanzapine-treated patient. A 24-year-old white man with paranoid schizophrenia was hospitalized for a psychotic episode characterized mainly by paranoid ideas and auditory hallucinations. He consumed alcohol and cannabis regularly and was an active smoker. Upon admission the patient received olanzapine 20 mg/day, but no other medication on a regular basis. Four days following admission, he received haloperidol 5 mg and lorazepam 2 mg orally. Two days later, he began to show clinical improvement consisting of decreased hallucinations and agitation and improved social interactions. However, he had difficulty initiating urination and was completely unable to void. Olanzapine was discontinued, with the urinary retention progressively disappearing over the next 24 hours.

Reports a case in which a patient presents with persistent and refractory psychosis after treatment with interferon (IFN)-alpha . A 50-year-old white male was brought to the emergency room by a family member who had become concerned by his increasing paranoia and bizarre behavior. His psychiatric history was significant for a 25-year history of narcotic dependence, two brief admissions to substance-dependence treatment facilities, and a remote suicide attempt. The patient was treated with olanzapine and showed substantial, albeit incomplete, remission of his symptoms. However, shortly thereafter the patient became nonadherent with treatment and experienced a worsening psychosis that necessitated readmission. Olanzapine was increased to 25 mg/day. One more month of inpatient treatment resulted in a decrease in auditory hallucinations, but there was no reduction in the persecutory delusions.

Ciprofloxacin hydrochloride is a fluoroquinolone antimicrobial often used in ophthalmic and general medical practice. The October 2002 'Psychopharmacology Journal Watch' column contained a story on an acute psychotic reaction following the use of ciprofloxacin eyedrops. This article presents a report of hallucinations in a 19-year-old male apparently induced by another fluoroquinolone, gatifloxacin.

Zonisamide is a synthetic 1,2-benzisoxazole derivative and anticonvulsant Food and Drug Administration-approved for the treatment of partial seizures in adults. An open-label study and a case report suggest that zonisamide may be beneficial as an antimanic agent. Other evidence suggests that zonisamide may have therapeutic potential in protecting against ischemic cerebral damage such as stroke. In epilepsy patients, zonisamide has been associated with decreased appetite and weight loss. Zonisamide has also demonstrated some utility in the treatment of obesity and binge-eating disorder. A 42-year-old woman had a 10-year history of essential tremor, which affected her upper extremities, head, and voice, and interfered with multiple tasks such as writing, pouring, dressing, and talking. The diagnosis of essential tremor was confirmed and zonisamide 100 mg/day was initiated. Approximately 36 hours later, the patient developed hyperactivity, racing thoughts, distractibility, insomnia, and talkativeness. On day 4 of treatment her husband reported that the patient had not slept in the previous 48 hours. Diagnosed as manic, the patient was taken off of zonisamide, with resolution of all manic symptoms within 24 hours. clinicians who prescribe zonisamide ought to be aware of the possibility of triggering a manic episode, including in those with no prior history of bipolar disorder.

This article discusses the uses of aripiprazole and presents a report of a case of dose-dependent incomplete right bundle-branch block in association with aripiprazole. This is the first such published report. While the incidence appears to be low, its appearance as an adverse event underscores the value of routine EKG monitoring of patients on aripiprazole as well as the other atypical antipsychotics.

This article discusses the uses of olanzapine. It also presents the first published report of a specific type of dystonic reaction, oculogyric crisis, induced by the atypical antipsychotic olanzapine.

Topiramate is a sulfamate-substituted monosaccharide Food and Drug Administration-approved for migraine headache prophylaxis and for the adjunctive treatment of partial-onset and primary generalized tonic-clonic seizures. It blocks voltage-gated sodium channels, enhances y-aminobutyric acid (GABA) via its actions on the GABA-sub(A) receptor, antagonizes the kainate aminomethyl phosphonic acid subtype of the glutamate receptor, and inhibits carbonic anhydrase. Due to its ability to suppress appetite and cause weight loss, it has gained increasingly widespread use among clinicians as a treatment for psychotropic-induced weight gain, binge-eating disorder, and even bulimia nervosa. Other research suggests that topiramate may also be effective for the treatment of posttraumatic stress disorder, obstructive sleep apnea, opiate and benzodiazepine withdrawal, kleptomania, alcohol dependence, self-injurious behavior, aggression, nonparaphilic sexual addiction, and olfactory hallucinations. It may also promote scar healing. (journal abstract)