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Evaluating the prescribing and management practices of venlafaxine at a public sector psychiatric hospital
- Authors: Naidu, Bavika
- Date: 2020-04
- Subjects: Venlafaxine , Anxiety disorcers -- Treatment , Depression, Mental -- Treatment
- Language: English
- Type: text , Thesis , Masters , M.Pharm
- Identifier: http://hdl.handle.net/10962/123200 , vital:35414
- Description: Neuropsychiatric conditions have been ranked third in South Africa according to some of the most recent reviews of disease burden, following human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases (Bateman, 2012:70; South African Depression and Anxiety Group, 2018). For depressive disorders, the conventional selective serotonin reuptake inhibitors (e.g. fluoxetine), are common first-step treatments due to their relatively low toxicity and high tolerability (Rush et al., 2006:1231). The class of selective noradrenaline reuptake inhibitors (e.g. venlafaxine) is relatively new on the market. The first SNRI to be marketed in the United States was venlafaxine immediate-release (IR). It was approved by the United States FDA in 1993 (Sansone and Sansone, 2014:37) and was soon followed by the introduction of a micro-encapsulated extended-release (XR) formulation in 1997. Currently there is no published or readily available information concerning the prescribing and management patterns of venlafaxine as well as the incidence and types of adverse effects experienced by patients in the public health sector of South Africa besides the established increased in blood pressure.
- Full Text:
- Authors: Naidu, Bavika
- Date: 2020-04
- Subjects: Venlafaxine , Anxiety disorcers -- Treatment , Depression, Mental -- Treatment
- Language: English
- Type: text , Thesis , Masters , M.Pharm
- Identifier: http://hdl.handle.net/10962/123200 , vital:35414
- Description: Neuropsychiatric conditions have been ranked third in South Africa according to some of the most recent reviews of disease burden, following human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases (Bateman, 2012:70; South African Depression and Anxiety Group, 2018). For depressive disorders, the conventional selective serotonin reuptake inhibitors (e.g. fluoxetine), are common first-step treatments due to their relatively low toxicity and high tolerability (Rush et al., 2006:1231). The class of selective noradrenaline reuptake inhibitors (e.g. venlafaxine) is relatively new on the market. The first SNRI to be marketed in the United States was venlafaxine immediate-release (IR). It was approved by the United States FDA in 1993 (Sansone and Sansone, 2014:37) and was soon followed by the introduction of a micro-encapsulated extended-release (XR) formulation in 1997. Currently there is no published or readily available information concerning the prescribing and management patterns of venlafaxine as well as the incidence and types of adverse effects experienced by patients in the public health sector of South Africa besides the established increased in blood pressure.
- Full Text:
Exploring the influence of mindfulness-based stress reduction (MBSR) programmes on participants' experience of time, particularly the present (here and now): a case study of Eastern Cape participants
- Authors: Schofield, Lorna
- Date: 2012
- Subjects: Acceptance -- commitment therapy , Stress management , Mindfulness -- based cognitive therapy -- Case studies , Job stress -- Prevention , Meditation -- Therapeutic use -- Case studies , Depression, Mental -- Treatment
- Language: English
- Type: Thesis , Masters , M Soc Sc (C Psy)
- Identifier: vital:11611 , http://hdl.handle.net/10353/d1005640 , Acceptance -- commitment therapy , Stress management , Mindfulness -- based cognitive therapy -- Case studies , Job stress -- Prevention , Meditation -- Therapeutic use -- Case studies , Depression, Mental -- Treatment
- Description: This study aims to explore the extent to which participating in a Mindfulness-Based Stress Reduction (MBSR) programme may result in shifts in people’s relationship with time, notably whether they become more present-focussed. The eight week MBSR programme advocates mindfulness, which is defined as paying attention on purpose in the present moment without judgement, as a way of reducing stress. The programme has been available in East London since 2009. A case study of eight MBSR programme participants’ experiences using narrative analysis was conducted. Narrative psychology and social constructionism provided the theoretical basis in which our storied lives are located in culturally inscribed narratives, with specific discourses around time and stress. Time discourses tend to pressurise people to believe that it is better to go about daily life at a fast pace, which requires significant hurrying and rushing with pervasive senses of time urgency. Stress discourse locates stress management within individuals. One-on-one semi structured interviews were held so that participants could reflect on their experience of time and the present moment orientation of the programme. Participants’ perceived a shift in how they experienced time with greater awareness of being present-focussed and they identified stress reduction benefits, which included feeling calmer, less panicked and more self-accepting. However, some of the participants maintaining the formal mindfulness practices like the body scan, meditation and mindful movement after the programme often proved difficult, as they were drawn back into their dominant narratives around time which were characterised by busyness, productivity and time scarcity.
- Full Text:
- Authors: Schofield, Lorna
- Date: 2012
- Subjects: Acceptance -- commitment therapy , Stress management , Mindfulness -- based cognitive therapy -- Case studies , Job stress -- Prevention , Meditation -- Therapeutic use -- Case studies , Depression, Mental -- Treatment
- Language: English
- Type: Thesis , Masters , M Soc Sc (C Psy)
- Identifier: vital:11611 , http://hdl.handle.net/10353/d1005640 , Acceptance -- commitment therapy , Stress management , Mindfulness -- based cognitive therapy -- Case studies , Job stress -- Prevention , Meditation -- Therapeutic use -- Case studies , Depression, Mental -- Treatment
- Description: This study aims to explore the extent to which participating in a Mindfulness-Based Stress Reduction (MBSR) programme may result in shifts in people’s relationship with time, notably whether they become more present-focussed. The eight week MBSR programme advocates mindfulness, which is defined as paying attention on purpose in the present moment without judgement, as a way of reducing stress. The programme has been available in East London since 2009. A case study of eight MBSR programme participants’ experiences using narrative analysis was conducted. Narrative psychology and social constructionism provided the theoretical basis in which our storied lives are located in culturally inscribed narratives, with specific discourses around time and stress. Time discourses tend to pressurise people to believe that it is better to go about daily life at a fast pace, which requires significant hurrying and rushing with pervasive senses of time urgency. Stress discourse locates stress management within individuals. One-on-one semi structured interviews were held so that participants could reflect on their experience of time and the present moment orientation of the programme. Participants’ perceived a shift in how they experienced time with greater awareness of being present-focussed and they identified stress reduction benefits, which included feeling calmer, less panicked and more self-accepting. However, some of the participants maintaining the formal mindfulness practices like the body scan, meditation and mindful movement after the programme often proved difficult, as they were drawn back into their dominant narratives around time which were characterised by busyness, productivity and time scarcity.
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Past trauma, anxious future a case-based evaluation of the Ehlers and Clark model for PTSD applied in Africa
- Authors: Van der Linde, Francois
- Date: 2007
- Subjects: Cognitive therapy , Post-traumatic stress disorder -- Africa , Rape trauma syndrome -- Treatment -- Africa , Rape victims -- Africa , Anxiety -- Treatment , Depression, Mental -- Treatment , Post-traumatic stress disorder -- Patients Case studies
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3075 , http://hdl.handle.net/10962/d1002584
- Description: This research report documents the therapeutic intervention undertaken with a 23-year-old Swazi rape victim. The format of this research report takes the form of a case study that follows the principles proposed by Fishman (2005). Its aim is to document the treatment process of an individual of African decent in order to establish whether the treatment model can be effective in clinical settings and in contexts and cultural settings different from that in which it was developed. The Ehlers and Clark (2000) cognitive therapy model for post-traumatic stress disorder (PTSD) was utilised to assess, conceptualise, and treat the case. The client entered therapy three years after being raped for a third time. The case formulation identified factors maintaining the disorder as well as how other traumatic and abusive events earlier in her life influenced her response to the rapes. Data consisted off audio-tape recordings and detailed written synopses of each assessment and therapy session, psychometric measurement instruments and self-report scales completed throughout the intervention, material written by the client, and a research interview conducted by an independent party. She was treated for PTSD and comorbid depression over a period of five months in accordance with the principles described by Ehlers and Clark and a narrative of the treatment process was written. The case narrative in conjunction with quantitative data suggested that this model assisted the client in initiating a healing process. As such the model was found to be both effective and transportable to an African context. Various points of discussion are highlighted, including the challenges of working with PTSD and comorbid major depression, the client-therapist relationship, and that a client and therapist from different cultures, backgrounds, and with different home languages can work together effectively using the Ehlers and Clark model.
- Full Text:
- Authors: Van der Linde, Francois
- Date: 2007
- Subjects: Cognitive therapy , Post-traumatic stress disorder -- Africa , Rape trauma syndrome -- Treatment -- Africa , Rape victims -- Africa , Anxiety -- Treatment , Depression, Mental -- Treatment , Post-traumatic stress disorder -- Patients Case studies
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3075 , http://hdl.handle.net/10962/d1002584
- Description: This research report documents the therapeutic intervention undertaken with a 23-year-old Swazi rape victim. The format of this research report takes the form of a case study that follows the principles proposed by Fishman (2005). Its aim is to document the treatment process of an individual of African decent in order to establish whether the treatment model can be effective in clinical settings and in contexts and cultural settings different from that in which it was developed. The Ehlers and Clark (2000) cognitive therapy model for post-traumatic stress disorder (PTSD) was utilised to assess, conceptualise, and treat the case. The client entered therapy three years after being raped for a third time. The case formulation identified factors maintaining the disorder as well as how other traumatic and abusive events earlier in her life influenced her response to the rapes. Data consisted off audio-tape recordings and detailed written synopses of each assessment and therapy session, psychometric measurement instruments and self-report scales completed throughout the intervention, material written by the client, and a research interview conducted by an independent party. She was treated for PTSD and comorbid depression over a period of five months in accordance with the principles described by Ehlers and Clark and a narrative of the treatment process was written. The case narrative in conjunction with quantitative data suggested that this model assisted the client in initiating a healing process. As such the model was found to be both effective and transportable to an African context. Various points of discussion are highlighted, including the challenges of working with PTSD and comorbid major depression, the client-therapist relationship, and that a client and therapist from different cultures, backgrounds, and with different home languages can work together effectively using the Ehlers and Clark model.
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Regulation of tryptophan-2,3-dioxygenase and pineal indoleamines by selected tryptophan derivatives and antidepressants
- Authors: Walsh, Harold Archibold
- Date: 1997
- Subjects: Antidepressants , Tryptophan -- Physiological effect , Tryptophan -- Therapeutic use , Depression, Mental -- Treatment
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:4017 , http://hdl.handle.net/10962/d1004077
- Description: The regulation of tryptophan-2,3-dioxygenase (TDO) (EC 1.13.1.12) and, to a lesser extent, pineal indoleamines, both in vitro and in vivo, is examined in this study. Rat liver TDO is a cytosolic enzyme which plays a crucial role in the regulation of circulating tryptophan (TRP) levels. Stimulation of this enzyme by heme enhances the catabolism of TRP, making less TRP available for uptake into the brain and other tissues, and for protein synthesis. At pH 7, the enzyme has an approximate Km of 100μM, is subject to substrate inhibition immediately beyond Sopt([S] at Vmax), and response of the enzyme is cooperative in both uninhibited and inhibited regions. Hill analysis of the uninhibited region reveals a biphasic plot and two classes of binding sites. Negative cooperativity is brought about through deprotonation of the enzyme. Substrate iphibition also occurs at both acidic and basic pH values with concomitant shifts in Sopt. The results obtained indicate that substrate inhibition could be an additional mechanism whereby the flux through the TRP-kynurenine pathway is regulated. TDO is subject to a diurnal rhythm, with peak activity during the pre-dark period and the loweSt activity towards the end of the dark period. It is possible that the enzyme controls the synthesis of the neurotransmitter serotonin (5-HT), and that the circadian rhythm in TDO activity is due to the endogenous rhythm of melatonin (aMT) production by the pineal gland. In the present study, aMT displaces TRP from bovine serum albumin (BSA) in vitro, and it is therefore possible for the indoleamine to regulate the availability of TRP for uptake into the brain for conversion to its derivatives. Chronic intraperitoneal administration of aMT affects physiological hepatic parameters in rats, such as TDO activity and stromal fatty acid composition, whilst no observable effect is demonstrable with respect to protein synthesis, nucleic acid metabolism, membrane fatty acid composition and pineal indole biosynthesis. On the other hand, chronic treatment of rats with antidepressants, the tricyclic desmethylimipramine (DMI) and the selective serotonin reuptake inhibitor (SSRI), fluoxetine, reveals significant negative alterations in TDO concentrations and pineal indole amine synthesis. Combining aMT with any of these two drugs normalises the activity of the hepatic enzyme. DMI is found to be an effective inhibitor of TDO in the micromolar range in vitro, and also affects total enzyme concentrations in vivo. Fluoxetine has no effect on TDO in vitro, but in vivo also reduces total enzyme levels in the liver. However, the SSRI does not affect conjugation between apo- and holoenzyme. Instead, it decreases extant holoenzyme levels. Indoleamine synthesis by the pineal gland, in organ culture, is altered by both antidepressants, although in different ways. DMI increases N-acetylserotonin levels and reduces the output of methoxyindole acetic acid and meth6xytryptophol. Fluoxetine treatment markedly reduces aMT concentrations and also brings about high levels of the 5-HT catabolites, 5-hydroxytryptophol and 5-hydroxyindole acetic acid. Insulin also lowers aMT synthesis significantly in pineal organ cultures, via a mechamsm that involves inhibition of the enzyme, N-acetyl transferase, that regulates aMT synthesis. The effects of insulin on pineal indole metabolism are due to the observation that a carbohydrate rich diet which induces insulin release elevates plasma TRP and brain 5-HT, but has no effect on pineal TRP and indole amine synthesis. It could thus be possible for insulin to have an effect on the pineal, since the latter is outside the blood brain barrier. The finilings of this study support the biogenic amine deficiency hypothesis, implicating some of the major biogenic amines such as noradrenaline (NA), 5-HT and aMT in depression. There is believed to be a deficiency of NA and 5-HT at their respective synapses in the depressed state. The drug DMI could act, firstly, by inhibiting TDO and thus increasing plasma TRP levels, and could, secondly, stimulate NA release and inhibit NA reuptake at the pineal membrane. The combined effect would be to enhance aMT synthesis, with eventual remission. Fluoxetine, on the other hand, appears to utilize a slightly different mode of action to DMI, which seems to focus on the preservation of 5-HT. The fact that aMT counteracts the effects of both antidepressants, and restores the activity of TDO to that of the controls, is also consistent with the observation that the therapeutic action of drugs such as these coincides willi the restoration of normal plasma levels of the neurohormone in depressives. In view of the biogenic amine deficiency hypothesis of depression and the contentious claim that TDO is the major peripheral determinant of brain TRP, brain 5-HT and ultimately aMT, the regulation of TDO is investigated and discussed. The study concludes that TDO activity is regulated by a number of endogenous compounds which are mainly derivatives of TRP, such as aMT and oxidized nicotinamide adenine dinucleotide and exogenous substances, of which DMI and fluoxetine are but two. In addition, modulation of IDO activity in depression appears to be an important aspect of antidepressant action. aMT, the product of the pineal gland, also has the potential to increase plasma TRP and hence forebrain TRP levels, and ultimately 5-HT concentrations, firstly by displacing TRP from serum albumin and secondly by inhibiting TDO.
- Full Text:
- Authors: Walsh, Harold Archibold
- Date: 1997
- Subjects: Antidepressants , Tryptophan -- Physiological effect , Tryptophan -- Therapeutic use , Depression, Mental -- Treatment
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:4017 , http://hdl.handle.net/10962/d1004077
- Description: The regulation of tryptophan-2,3-dioxygenase (TDO) (EC 1.13.1.12) and, to a lesser extent, pineal indoleamines, both in vitro and in vivo, is examined in this study. Rat liver TDO is a cytosolic enzyme which plays a crucial role in the regulation of circulating tryptophan (TRP) levels. Stimulation of this enzyme by heme enhances the catabolism of TRP, making less TRP available for uptake into the brain and other tissues, and for protein synthesis. At pH 7, the enzyme has an approximate Km of 100μM, is subject to substrate inhibition immediately beyond Sopt([S] at Vmax), and response of the enzyme is cooperative in both uninhibited and inhibited regions. Hill analysis of the uninhibited region reveals a biphasic plot and two classes of binding sites. Negative cooperativity is brought about through deprotonation of the enzyme. Substrate iphibition also occurs at both acidic and basic pH values with concomitant shifts in Sopt. The results obtained indicate that substrate inhibition could be an additional mechanism whereby the flux through the TRP-kynurenine pathway is regulated. TDO is subject to a diurnal rhythm, with peak activity during the pre-dark period and the loweSt activity towards the end of the dark period. It is possible that the enzyme controls the synthesis of the neurotransmitter serotonin (5-HT), and that the circadian rhythm in TDO activity is due to the endogenous rhythm of melatonin (aMT) production by the pineal gland. In the present study, aMT displaces TRP from bovine serum albumin (BSA) in vitro, and it is therefore possible for the indoleamine to regulate the availability of TRP for uptake into the brain for conversion to its derivatives. Chronic intraperitoneal administration of aMT affects physiological hepatic parameters in rats, such as TDO activity and stromal fatty acid composition, whilst no observable effect is demonstrable with respect to protein synthesis, nucleic acid metabolism, membrane fatty acid composition and pineal indole biosynthesis. On the other hand, chronic treatment of rats with antidepressants, the tricyclic desmethylimipramine (DMI) and the selective serotonin reuptake inhibitor (SSRI), fluoxetine, reveals significant negative alterations in TDO concentrations and pineal indole amine synthesis. Combining aMT with any of these two drugs normalises the activity of the hepatic enzyme. DMI is found to be an effective inhibitor of TDO in the micromolar range in vitro, and also affects total enzyme concentrations in vivo. Fluoxetine has no effect on TDO in vitro, but in vivo also reduces total enzyme levels in the liver. However, the SSRI does not affect conjugation between apo- and holoenzyme. Instead, it decreases extant holoenzyme levels. Indoleamine synthesis by the pineal gland, in organ culture, is altered by both antidepressants, although in different ways. DMI increases N-acetylserotonin levels and reduces the output of methoxyindole acetic acid and meth6xytryptophol. Fluoxetine treatment markedly reduces aMT concentrations and also brings about high levels of the 5-HT catabolites, 5-hydroxytryptophol and 5-hydroxyindole acetic acid. Insulin also lowers aMT synthesis significantly in pineal organ cultures, via a mechamsm that involves inhibition of the enzyme, N-acetyl transferase, that regulates aMT synthesis. The effects of insulin on pineal indole metabolism are due to the observation that a carbohydrate rich diet which induces insulin release elevates plasma TRP and brain 5-HT, but has no effect on pineal TRP and indole amine synthesis. It could thus be possible for insulin to have an effect on the pineal, since the latter is outside the blood brain barrier. The finilings of this study support the biogenic amine deficiency hypothesis, implicating some of the major biogenic amines such as noradrenaline (NA), 5-HT and aMT in depression. There is believed to be a deficiency of NA and 5-HT at their respective synapses in the depressed state. The drug DMI could act, firstly, by inhibiting TDO and thus increasing plasma TRP levels, and could, secondly, stimulate NA release and inhibit NA reuptake at the pineal membrane. The combined effect would be to enhance aMT synthesis, with eventual remission. Fluoxetine, on the other hand, appears to utilize a slightly different mode of action to DMI, which seems to focus on the preservation of 5-HT. The fact that aMT counteracts the effects of both antidepressants, and restores the activity of TDO to that of the controls, is also consistent with the observation that the therapeutic action of drugs such as these coincides willi the restoration of normal plasma levels of the neurohormone in depressives. In view of the biogenic amine deficiency hypothesis of depression and the contentious claim that TDO is the major peripheral determinant of brain TRP, brain 5-HT and ultimately aMT, the regulation of TDO is investigated and discussed. The study concludes that TDO activity is regulated by a number of endogenous compounds which are mainly derivatives of TRP, such as aMT and oxidized nicotinamide adenine dinucleotide and exogenous substances, of which DMI and fluoxetine are but two. In addition, modulation of IDO activity in depression appears to be an important aspect of antidepressant action. aMT, the product of the pineal gland, also has the potential to increase plasma TRP and hence forebrain TRP levels, and ultimately 5-HT concentrations, firstly by displacing TRP from serum albumin and secondly by inhibiting TDO.
- Full Text:
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