Obsession

Beginning in the 1960s, ben2odia2epiae anxiolytics and hypnotics rapidly became the standard prescription dmg treatment. In the 1980s, buspkone [36505-84-7] (3), which acts as a partial agonist at the serotonin [50-67-9] (5-hydroxytryptamine, 5-HT) type lA receptor, was approved as treatment for generali2ed anxiety. More recently, selective serotonin reuptake inhibitors (SSRIs) have been approved for therapy of panic disorder and obsessive—compulsive behavior. 

SSRIs are well tolerated. Adverse effects for compounds in this class include nervousness, tremor, dizziness, headache, insomnia, sexual dysfunction, nausea, and diarrhea. In addition, the tricycHc antidepressant clomipramine (33), which is a potent nonselective serotonin reuptake inhibitor, is approved for treatment of obsessive—compulsive disorder. 

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

Doxepin [1668-19-5] (38), unlike other commercially available tricyclics, has an oxygen atom in the bridge between the two aromatic rings. It is marketed as a cis—trans mixture (1 5) of isomers, both of which are active. This close relative of amitriptyline (33) has both sedative and anxiolytic properties associated with its antidepressant profile. Maprotiline [10262-69-8] (39) and amoxapine [14028-44-5] (40) are pharmacologically, although not chemically, similar to the tricycHc secondary amines. Clomipramine [303-49-1] (41) has similar pharmacological and antidepressant efficacy. However, clomipramine is approved by the U.S. FDA only for the treatment of obsessive—compulsive disorder. Representative brands of tricycHc antidepressants marketed in the United States are Hsted in Table 2. 

A further motive is the passion for clarity, which was nicely illustrated many years ago during a conversation between Dirac and Oppenheimer (Pais 1995). Dirac was astonished by Oppenheimer s passion for Dante, and for poetry generally, side by side with his obsession with theoretical physics. Why poetry Dirac wanted to... 

By the beginning of the nineteenth centui"y, Fulton turned his attention to his obsession with submarines and steamships. He made uo secret of his goal for submarines—he intended to build them in order to destroy all ships of war so that appropriate attention could be devoted by society to the fields of education, industry and free speech. In 1801, he managed to stay under water for four hours and twenty minutes in one of his devices, and in 1805 he demonstrated the ability to utilize a torpedo to blow up a well built ship of two hundred tons. Unfortunately for Robert, neither the French nor British government was particularly impressed with the unpredictable success, nor the importance of his innovations so he packed his bags and returned to America in December of 1806. 

Ord-Hume, A. (1977). Perpetual Motion The History of an Obsession. New York St. Manin s Press. 

To Michael Faraday, science was an obsession one of his biographers described him as a "work maniac." An observer (Faraday had no students) said of him. 

Everything about Mas has been almost obsessively considered, which is fine, when you re keeping company with one of their cocktails, which wear the attention well. The details of the small estab-... 

Antidepressants are small heterocyclic molecules entering the circulation after oral administration and passing the blood-brain barrier to bind at numerous specific sites in the brain. They are used for treatment of depression, panic disorders, generalized anxiety disorder, social phobia, obsessive compulsive disorder, and other psychiatric disorders and nonpsychiatric states. 

Obsessive-compulsive disorders Erythrocytes from patients with obsessive-compulsive disorder have significantly higher calpain activities than normal controls which could not be attributed to differences in memory function46... 

HT has been implicated in the etiology of numerous disease states, including depression, anxiety, social phobia, schizophrenia, obsessive compulsive disorders,... 

Antidepressant drugs are used to manage depressive episodes such as major depression or depression accompanied by anxiety. These drugs may be used in conjunction with psychotherapy in severe depression. The SSRIs also are used to treat obsessive-compulsive disorders. The uses of individual antidepressants are given in the Summary Drug Table Antidepressants. Treatment is usually continued for 9 months after recovery from the first major depressive episode. If the patient, at a later date, experiences another major depressive episode, treatment is continued for 5 years, and with a third episode, treatment is continued indefinitely. 

The enantiomerically pure 3-arylglutaric ester are precursors for the synthesis of (—)-paroxetine [10], a selective serotonin reuptake inhibitor used in the treatment of depression, obsessive compulsive disorder, and panic, and (i )-Baclofen [11], a GABAb receptor agonist, which is used cHnically in the treatment of spasticity (Chart 5.1). 

Extrapolation to other countries is not easy. Canada has a very different health-care system to the USA. A small-scale study involving 466 anxiety disorder patients in Quebec established a clear relationship between the severity of the disorder and utilization of health services (McCusker et al, 1997). Patients with obsessive-compulsive disorder were particularly likely to seek treatment. No information on dmg use was presented. 

Generalized anxiety disorder has been relatively neglected from the point of view of both health economics and pharmacoeconomics. The changing diagnostic criteria have made it difficult to compare data over time, leading researchers to focus on the more clearly defined disorders such as panic and obsessions. Drug treatment has been dominated by the benzodiazepines, usually available genetically and cheaply. However, as the final section of this chapter will show, all this is in flux. 

The anxiety disorders are common and surprisingly disabling conditions. Studies on the health economics of generalized anxiety disorder, panic disorder, social anxiety disorders and obsessive compulsive disorder document the cost to the individual and to society. Attention has focused on the major psychiatric disorders such as depression, schizophrenia and the dementias. Studies suggest that many anxiety disorders are of early onset and too often chronic they are quite common and impose a heavy burden on society. More studies will be needed to discern the fine grain in the survey material and to identify more precisely the location and type of societal costs. These factors will vary from country to country, from district to district, between men and women and between various age groups. 

Dupont RL, Rice DP, Shiraki S, et al (1995). Economic costs of obsessive-compulsive (Xisotdct. Med Interface 9y 102—9. 

Obsessive-compulsive and spectrum disorders overview and quality of life issues. J Clin Psychiatry 57 (suppl. 8), 3-6. 

Knapp M, Henderson J, Patel A (2000). Costs of obsessive-compulsive disorder a review. In Maj M, Sartorius N, Okasha A, Zohar J, eds, Obsessive Compulsive Disorder. Chichester John Wiley, 253—75. 

Rasmussen SA, Eisen JL, Pato MT (1993). Current issues in the pharmacologic management of obsessive compulsive disorder. J Clin Psychiatry 54 (suppl. 6), 4—9. 

Stein DJ, Roberts M, Hollander E, et al (1996). Quality of life and pharmaco-economic aspects of obsessive-compulsive disorder. A South African survey. SAfrMedJ86, 1579-85. 

Pharmacologically, a principal point relates to the cost-effectiveness of the newer indications for SSRIs in the less common disorders such as obsessive—compulsive disorder and social phobia. These conditions do place a disproportionate burden on health-care systems, and clinical trials of the newer indications are convincing. However, no cost-effectiveness study has yet been petformed to assess this, and prescribing will continue to be based on individual clinical need. 

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