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PG CME Table of Contents   
Year : 2008  |  Volume : 50  |  Issue : 4  |  Page : 298-300
Postgraduate corner: Continuing medical education


Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India

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How to cite this article:
Andrade C. Postgraduate corner: Continuing medical education. Indian J Psychiatry 2008;50:298-300

How to cite this URL:
Andrade C. Postgraduate corner: Continuing medical education. Indian J Psychiatry [serial online] 2008 [cited 2020 Sep 21];50:298-300. Available from: http://www.indianjpsychiatry.org/text.asp?2008/50/4/298/44755



   CME Questions Top


A) The premenstrual syndrome describes the cognitive, emotional, and physical symptoms that women commonly experience shortly before the onset of menstruation. The disorder has been known by different names, including late luteal phase dysphoric disorder (LLPDD) and premenstrual dysphoric disorder (PMD or PMDD). Many treatments have been described; these include antidepressant drugs, diuretics, oral contraceptives, calcium, vitamin supplements, exercise, and others. With this background, mark True or False against each of the following statements:

  1. SSRIs are no better than placebo for PMD.
  2. Antidepressant medication is effective in PMD even if administered only during the luteal phase of the menstrual cycle.


B) Topiramate is one of the most recent treatments to be introduced for the management of alcohol dependence. How does it act? Alcohol increases inhibitory GABAergic neurotransmission and decreases excitatory glutamatergic neurotransmission; dopamine, at least in part, mediates the rewarding effects associated with alcohol intake. Topiramate exerts similar GABAergic and glutamatergic effects. It increases GABAergic neurotransmission by action at a nonbenzodiazepine site on the GABA-A receptor and decreases glutamatergic activity by blocking AMPA and kainate receptors. However, unlike alcohol, topiramate indirectly inhibits the release of dopamine in the mesocorticolimbic system. Thus, topiramate can substitute for the GABAergic and glutamatergic effects of alcohol, thereby blunting the neuronal hyperexcitability associated with alcohol discontinuation. And, topiramate can block alcohol-mediated dopamine release, thereby decreasing the rewarding effects of the beverage. Both these actions can be therapeutic in alcohol-dependent patients. With this background, mark True or False against each of the following statements:

  1. Topiramate therapy is preferably instituted after withdrawal from alcohol.
  2. In alcohol-dependent patients, the target dose of topiramate is 100 mg/day.
  3. From a medical and psychological perspective, controlled drinking could be an acceptable goal of topiramate therapy.
  4. Smoking behavior may decrease in alcohol-dependent patients who receive topiramate.
  5. The efficacy of topiramate remains to be proven in alcohol-dependent patients in conventional clinical practice.




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   References Top

1.Shah NR, Jones JB, Aperi J, Shemtov R, Karne A, Borenstein J. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis. Obstet Gynecol 2008;111:1175-82.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Johnson BA, Ait-Daoud N, Bowden CL, DiClemente CC, Roache JD, Lawson K, et al . Oral topiramate for treatment of alcohol dependence: a randomised controlled trial. Lancet 2003;361:1677-85.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K, et al . Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA 2007;298: 1641-51.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Miranda R Jr, MacKillop J, Monti PM, Rohsenow DJ, Tidey J, Gwaltney C, et al . Effects of topiramate on urge to drink and the subjective effects of alcohol: a preliminary laboratory study. Alcohol Clin Exp Res 2008;32:489-97.   Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Johnson BA, Ait-Daoud N, Akhtar FZ, Ma JZ. Oral topiramate reduces the consequences of drinking and improves the quality of life of alcohol-dependent individuals: a randomized controlled trial. Arch Gen Psychiatry 2004;61:905-12.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K, et al . Improvement of physical health and quality of life of alcohol-dependent individuals with topiramate treatment: US multisite randomized controlled trial. Arch Intern Med 2008;168:1188-99.   Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Johnson BA, Ait-Daoud N, Akhtar FZ, Javors MA. Use of oral topiramate to promote smoking abstinence among alcohol-dependent smokers: a randomized controlled trial. Arch Intern Med 2005;165:1600-5.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Sofuoglu M, Poling J, Mouratidis M, Kosten T. Effects of topiramate in combination with intravenous nicotine in overnight abstinent smokers. Psychopharmacology (Berl) 2006;184: 645-51.   Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Reid MS, Palamar J, Raghavan S, Flammino F. Effects of topiramate on cue-induced cigarette craving and the response to a smoked cigarette in briefly abstinent smokers. Psychopharmacology (Berl) 2007;192:147-58.   Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Fernandez Miranda JJ, Marina Gonzalez PA, Montes Pirez M, Dmaz Gonzalez T, Gutierrez Cienfuegos E, Antuqa Dmaz MJ, et al . Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study. Actas Esp Psiquiatr 2007;35:236-42.  Back to cited text no. 10    
11.De Sousa AA, De Sousa J, Kapoor H. An open randomized trial comparing disulfiram and topiramate in the treatment of alcohol dependence. J Subst Abuse Treat 2008;34:460-3.  Back to cited text no. 11    

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Correspondence Address:
Chittaranjan Andrade
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.44755

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