Vasilios Masdrakis

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• Associate Professor of Psychiatry, M.D. Ph.D.
• National and Kapodistrian University Medical School, First Department of Psychiatry, Eginition Hospital, Athens, Greece at National and Kapodistrian University of Athens

Background: As the remission rate of panic disorder (PD) achieved with conventional pharmacotherapy ranges between 20% and 50%, alternative psychopharmacological strategies are needed. We aimed to firstly review data regarding use of antipsychotic and non-benzodiazepine anticonvulsant medication in PD patients with or without comorbidities; sec...

Objective: Data regarding the potential association between the outcome of psychotherapy of panic disorder (PD) and biological parameters are few. In 21 (16 females) consecutively referred, medication-free, acutely ill PD outpatients, without comorbidities, except agoraphobia, we systematically explored for potential neuroendocrine and clinical co...

Objective It has been hypothesised that early-onset panic disorder (PD) may constitute a biologically distinct subtype of PD, but the few relevant data are inconclusive. We systematically explored for potential psychopathological and hormonal differences between early-onset (age at onset ≤ 27 years) versus late-onset PD, in consecutively-referred,...

The probable implication of testosterone in the neurobiology of anxiety disorders, and particularly panic disorder (PD), is poorly studied. We explored for potential differences concerning testosterone (T) plasma levels and the ratio testosterone/cortisol (T/C) between medication-free, consecutively-referred patients with acute exacerbation of PD c...

Anxiety symptoms and anxiety disorders are common in community settings and primary and secondary medical care. Anxiety symptoms are often mild and only transient, but many people are troubled by severe symptoms that cause both considerable personal distress and a marked impairment in social and occupational function. The principal anxiety disorder...

Anxiety disorders are very prevalent and often persistent mental disorders, with a considerable rate of treatment resistance which requires regulatory clinical trials of innovative therapeutic interventions. However, an explicit definition of treatment‐resistant anxiety disorders (TR‐AD) informing such trials is currently lacking. We used a Delphi...

Current classificatory systems recognize that the features of separation anxiety disorder can have their onset across the life course, it no longer being necessary to establish that the characteristic symptoms first emerged during childhood or adolescence, to make the diagnosis in an adult. Adult-onset separation anxiety disorder is a common and di...

Background Previous research has investigated the efficacy of clozapine in reducing suicidality in patients with schizophrenia and schizoaffective disorder. We aimed to systematically review published evidence, including studies concerning clozapine administration to treat: (a) refractory suicidality in other mental disorders, including bipolar dis...

Objectives: Administration of antidepressant drugs - principally selective serotonin reuptake inhibitors (SSRIs) - may induce clinically significant 'apathy' which can affect treatment outcomes adversely. We aimed to review all relevant previous reports. Methods: We performed a PUBMED-search of English-language studies, combining terms concernin...

Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). Method: A consensus panel of 33 international experts representing 22 countrie...

Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008.Method: A consensus panel of 34 international experts representing 22 c...

Aims The potential association between oxytocin (OXT) plasma levels and clinical and hormonal parameters in panic disorder (PD) especially in its acute phase – has not been investigated as yet. This was the aim of this article. Method Twenty-four consecutively-referred, acutely-ill, medication-free PD patients with (PDA, N = 21) or without agoraph...

Background Fibromyalgia (FM) and generalized anxiety disorder (GAD) share common clinical features: they both affect women more than men, their diagnosis is based solely on clinical criteria, and some of the symptoms such as anxiety, aches and muscle tension, sleep disorders, and cognitive dysfunction occur in both diseases. For both conditions, an...

Psychiatric hospitalization poses a risk for Posttraumatic Stress Disorder (PTSD), partly because of coercion. However, the role of legal status is less clear, while factors like insight, exposure to violence and affective disorders have not been addressed adequately. The present study aims at assessing PTSD rates after hospitalization and evaluati...

Anxiety disorders affect approximately one in six people, causing significant problems in their quality of life and that of their families with a significant percentage of mentally ill people not showing compliance with treatment or not receiving appropriate treatment. Research data therefore reveal the need to develop new and effective interventio...

Preclinical studies suggest the implication of the adipocyte hormone leptin in anxiety and fear processes. We explored for potential differences regarding plasma leptin, cortisol and the ratio leptin/Body Mass Index (BMI) between 27 medication-free female patients with Panic Disorder (PD) and 42 age-matched female controls, and for potential associ...

Objective: A few case-reports have previously described transient psychotic-like symptoms in non-psychotic patients with panic disorder (PD). We aimed to systematically explore whether PD patients without any current or past psychosis can be differentiated according to the severity of 'psychoticism' as a dimension, comprising clinical features suc...

Objective: Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). Methods: Findings in biomarker...

{\bf Objective:}$ Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). ${\bf Methods:}$ Finding...

A subgroup of patients with Panic Disorder (PD) exhibits increased sensitivity to caffeine administration. However, the association between caffeine-induced panic attacks and post-caffeine hypothalamic-pituitary-adrenal (HPA)-axis activation in PD patients remains unclear. In a randomized, double-blind, cross-over experiment, 19 PD patients underwe...

Background/aim: Indoleamine 2, 3-dioxygenase (IDO) induction has been suggested as a mechanism by which immune activation affects tryptophan metabolism and serotonin synthesis in major depressive disorder (MDD). We investigated IDO and changes in inflammatory mediators in patients with MDD undergoing effective treatment. Patients and methods: Fo...

Long-term benzodiazepine (BDZ) use and dependence affect cognitive functioning adversely and partly irreversibly. Emerging evidence suggests that pregabalin (PGB) might be a safe and efficacious treatment of long-term BDZ use. The aim of the present study was to investigate the changes in several core cognitive functions after successful treatment...

Increased heartbeat perception accuracy (HBP-accuracy) may contribute to the pathogenesis of Panic Disorder (PD) without or with Agoraphobia (PDA). Extant research suggests that HBP-accuracy is a rather stable individual characteristic, moreover predictive of worse long-term outcome in PD/PDA patients. However, it remains still unexplored whether H...

Objectives: Major Depression with severe anxiety has been proposed as a distinct clinical variant of Major Depressive Disorder (MDD). This proposal invites the investigation of the differential biological correlates of the anxious versus non-anxious MDD. One such research area might be their possible differential associations with androgens. Meth...

Social anxiety disorder (social phobia) is a common and typically long-standing medical condition, characterized by an excessive fear of being observed or evaluated negatively in social or performance situations. Efficacious interventions in acute treatment include cognitive behavioural therapy and a range of medications including many antidepressa...

A PREVIOUS REVIEW SUMMARIZED WHAT WAS THEN KNOWN ABOUT THE POTENTIAL ROLE OF PREGABALIN IN THE TREATMENT OF PATIENTS WITH GENERALIZED ANXIETY DISORDER (GAD): this review provides an update on its pharmacological properties and presumed mechanism of action, the liability for abuse, and efficacy and tolerability in patients with GAD. Pregabalin has a...

Pleasurable sexual activity is an essential component of many human relationships, providing a sense of physical, psychological, and social well-being. Epidemiological and clinical studies show that depressive symptoms and depressive illness are associated with impairments in sexual function and satisfaction, both in untreated and treated patients....

Objective: Anxious major depressive disorder (A-MDD) is differentially diagnosed from nonanxious MDD (NA-MDD) as MDD with a cut-off score ≥ 7 on the HAM-D anxiety-somatization factor (ASF). We investigated whether additional HAM-D items discriminate A-MDD from NA-MDD. Moreover, we tested the validity of ASF criterion against HAM-A, gold standard o...

Objectives Previous studies have provided evidence on the possible relationship between mental pain (psychache) and suicide. The aim of the present study was to investigate whether more intense psychache is related with higher suicide risk independently of the severity of depression. Methods Orbach's Mental Pain Scale was administered in 58 women...

According to Shneidman's theory, mental pain or "psychache", which refers to an endopsychicpainful experience consisted of excessively felt negative feelings, is a key component to theunderstanding of suicidal behaviour, as to its psychological features. Shneidman himself supportedthat 'suicide is caused by psychache', more precisely suicide occurs...

Aim of this research was to investigate, in Greek population, the degree of burden of caregivers of psychiatric patients, the ratio of burden and demographic and other factors. Finally, the purpose of this study was to evaluate the effect which, the burden has on quality of life and mental health of caregivers. Materials and methods: For this purpo...

Both old and newer antidepressants and some atypical antipsychotics, such as ziprasidone and quetiapine, used as augmentation agents in severe major depression, are known to increase corrected QT (QTc) interval. We investigated the safety of the coadministration of electroconvulsive therapy with an antidepressant-ziprasidone-quetiapine combination...

Several recent reports attest to zolpidem's strong potential for abuse, dependence, and severe withdrawal symptoms upon its discontinuation. We report, for the first time, on 1 case of heavy zolpidem abuse and dependence with severe withdrawal symptoms twice treated safely and successfully with pregabalin, a newer antiepileptic agent devoid of know...

Both electroconvulsive therapy (ECT) and paliperidone (PLP) can induce, though infrequently, severe cardiac side-effects. Thus far, no studies are available on the cardiac safety of their co-administration. We report on the cardiac safety of the ECT-PLP combination in nine female inpatients who underwent this treatment modality. In a total of 83 EC...

Objectives Both tricyclic antidepressants and some atypical antipsychotics, such as ziprasidone and quetiapine, used as augmentation agents in severe major depression, are known to increase QTc interval to a moderate extent (10-20 msec). Moreover, electroconvulsive therapy (ECT) also increases patients’ propensity to arrhythmias. Finally, females a...

Objectives The potential efficacy of various antiepileptic drugs in the treatment of Panic Disorder (PD) with (PDA) or without Agoraphobia has been studied in clinical trials, though not as yet that of lamotrigine (LTG). Methods We administered LTG to four outpatients with PDA according to DSM-IV-TR criteria, as an augmentation therapy (three pati...

Objectives Patients with psychotic or mood disorders often undergo electroconvulsive therapy (ECT) while receiving antipsychotic and/or other pharmacological agents. Paliperidone (PLP) -a benzisoxazole derivative and the principal active metabolite of risperidone- is a second-generation antipsychotic which has been developed in an osmotic controlle...

Several anticonvulsants, although as yet not lamotrigine (LTG), have been found useful in the treatment of panic disorder with (PDA) or without agoraphobia. We administered LTG (200 mg/d) to 4 outpatients with PDA, as an augmentation therapy (3 patients with chronic and severe agoraphobia) or monotherapy (1 drug-naive patient with first-onset PDA)...

In clinical practice, a nonnegligible proportion of patients with mood or psychotic disorders undergo electroconvulsive therapy (ECT) concomitantly with pharmacotherapy. Ziprasidone, a combined serotonin and dopamine receptor antagonist, is a second-generation antipsychotic agent with a lower incidence of extrapyramidal motor symptoms and prolactin...

Extant pharmacological options for motor conversion disorder include mainly antidepressants and benzodiazepines. We report on the case of a 42-year-old female patient with frequent daily episodes of almost complete paralysis for the last 6 months resistant to an escitalopram-lorazepam combination at adequate doses. By contrast, the adjunctive admin...

Increased arterial stiffness (AS) might be one significant acute mediator of the well-attested association between female depression and cardiovascular disease. We tested this hypothesis in an inpatient sample of 20 drug-free women undergoing a new clinically severe major depressive episode of recent onset with an adequately matched mentally health...

During the last seven years, we have completed various pilot studies using Repetitive Transcranial Magnetic Stimulation (rTMS), trying to evaluate its efficacy. In this context, we have selected some patients suffering from drug resistant major depression, who wanted to be treated with rTMS and gave them an intensive treatment. We raised the magnet...

Breath-holding (BH) has been used as a simple probe to increase endogenous carbon dioxide (CO2). In patients with Panic Disorder (PD), lower baseline BH duration is associated with caffeine-induced panic attacks. In this paper, we assessed BH duration in PD patients in relation to panic attacks induced by caffeine intake. BH duration and state anxi...

The antiepileptic agent topiramate has proved its efficacy in a variety of other conditions as well, including several kinds of tremor and migraine prophylaxis. We report on the case of a 42-year-old depressive female patient with comorbid migraine attacks, whereby the adjunction of topiramate as an antimigraine agent at the dosage of 50 mg/d to he...

A proportion of patients with panic disorder (PD) display an increased sensitivity to the anxiogenic/panicogenic properties of caffeine. The aim of this study is to identify probable baseline differences between PD patients who panic and those who do not, after caffeine administration. In a randomized, double-blind, cross-over experiment performed...

It has been suggested that the efficacy of electroconvulsive therapy (ECT) in the treatment of major depressive episodes may be enhanced by concurrent administration of antidepressant medication. Therefore, the issue of how safe the combination of these 2 treatment modalities is warrants investigation. Escitalopram (ESC) is a novel selective seroto...

Antiepileptic drugs (AED) are increasingly used in the treatment of migraine. Pregabalin (PGB) is an AED that has been used in the treatment of partial seizures, of various types of pain, and of certain anxiety disorders, but to the best of our knowledge, there has been no report on the use of PGB in the treatment of migraine. We report the case of...

In clinical practice, a proportion of patients with psychotic or mood disorders are treated with electroconvulsive therapy (ECT) while receiving concomitantly antipsychotic and/or other psychotropic agents. Aripiprazole is a second-generation antipsychotic that seems to have a favorable side-effect profile. However, to the best of our knowledge, th...

Tolerance, dependence, and adverse effects on cognitive functions are well-known consequences of long-term use of benzodiazepines (BDZ), especially at high doses, raising thorny therapeutic problems in their discontinuation. One promising pharmacological agent in BDZ discontinuation might be the newer anti-epileptic pregabalin, already successfully...

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Tolerance, dependence, and adverse effects on cognitive functions are well known consequences of long-term use of benzodiazepines (BDZ), especially at high doses; this raises thorny therapeutic problems in their discontinuation. One promising pharmacological agent in BDZ discontinuation might be the newer antiepileptic, pregabalin (PGB), which has...

Sir: Despite the marked progress in the pharmacologic treatment of obsessive-compulsive disorder (OCD)—espe- cially with high doses of serotonin reuptake inhibitors (SRIs), alone or in combination with low doses of antipsy- chotics—a substantial proportion of patients fail to respond to it. 1 In such cases, an augmentation tactic with drugs from ot...

Levetiracetam, an anti-epileptic agent that enhances GABAergic neurotransmission, is one of the newest alternative treatments of Tourette syndrome (TS). We present the case of a 23-year-old female patient suffering from TS since the age of 7, who exhibited poor response to a variety of agents (haloperidol, pimozide, clonidine and various adjunctive...

Despite the recent progress in the pharmacological treatment of obsessive-compulsive disorder (OCD)--especially with high doses of serotonin reuptake inhibitors, alone or in combination with low doses of antipsychotics--a non-negligible proportion of patients remains refractory to it. For these patients augmentation tactics with drugs from other ch...

Escitalopram (ESC) is the S-isomer of the racemic compound citalopram, and has been shown to be an efficacious treatment for major depressive disorder. Several studies or case reports are available describing its side effects, none of which however refer to its potential to induce ankle oedema. We report the case of a 69-year-old female depressed p...

This is a brief review of the history and the current state of the behavioral and cognitive theories on the etiology and treatment of panic disorder with agoraphobia (PDA). Throughout the 1960s and 1970s, behavioral theories focused on agoraphobia and exposure therapies were developed. Exposure-based treatments proved to markedly reduce escape and...

Type-1 diabetes mellitus (DM) is a lifelong serious condition which often renders the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, risky - especially for acute manic episodes. We present such a case whereby the application of standard anti-manic treatments would have jeopardized a patient...

The use of atypical antipsychotics in schizophrenic patients has been associated with a risk of weight gain. Similarly, recovery from depression is often followed by improved appetite, greater food intake and potential increase in weight. A Caucasian 33-year-old schizophrenic female patient was being treated with 6 mg/day of risperidone and 15 mg/d...

There is some evidence that repetitive transcranial magnetic stimulation (rTMS) may be effective in treating depression. Using an intensive methodology of rTMS in two drug-resistant patients, we observed a good antidepressant effect, but also, induction of manic symptoms.

Resumen Comunicamos el caso de una paciente con una historia de dependencia de zolpidem. Esta mujer desarrolló rápidamente tolerancia y dependencia, tomando 50-100 mg, y a veces hasta 300 mg, de zolpidem diariamente. Nuestra paciente sufrió también episodios de alteración de la conciencia, acompañados por alucinaciones visuales.

We report the case of a patient with a history of zolpidem dependence. The patient, after a stressful life event, started using zolpidem. She rapidly developed tolerance and dependence, taking 50-100 mg, and sometimes up to 300 mg, of zolpidem daily. Also, our patient suffered episodes of altered consciousness, accompanied by visual hallucinations.