S-25-01

A. Bateson. Leeds, United Kingdom

S-25-02

Z. Bhagwagar. Oxford, United Kingdom

S-25-03

Selective GABA-ERGIC treatment for human anxiety - Is there a new class of anxiolytics?

P. Zwanzger, D. Eser, T. Baghai, F. Padberg, C. Schüle, C. Nothdurfter, H.-J. Möller, R. Rupprecht. Klinikum der Universität Klinik für Psychiatrie, München, Germany

Objective: There is a large body of evidence that a dysfunction of GABAA receptors and/or dysregulation of CNS GABA concentrations play an important role in the pathophysiology of panic disorder (PD). Therefore, selective enhancement of GABAergic ueurotransmission and increase of CNS GABA could be a promising strategy for the treatment of anxiety.

Methods: The effects of selective GABAergic compounds vigabatrin and tiagabine were investigated on experimental induced panic attacks in healthy volunteers. Moreover, also the effects of these compounds on panic and anxiety symptoms in patients with panic disorder have been studied.

Results: The results show that the enhancement of endogenous GABA through blockade of the GABA transaminase by vigabatrin or through inhibition of GABA transporter I by tiagabine exert anxiolytic effects on CCK-4 induced panic. Studies in healthy volunteers have shown that similarly to benzodiazepines both compounds lead to a marked and significant reduction of panic symptoms elicited by CCK-4. After vigabatrin treatment benzodiazepine like effects on HPA axis activity have been observed as well. Moreover, first investigations in patients with PD showed an improvement of panic and anxiety with both compounds.

Conclusion: Therefore, targeting the GABA binding site of the GABAA -receptor complex by selective enhancement of GABAergic neurotransmission represents an interesting novel approach for the future development of anxiolytic compounds.

S-25-04

Current state of the art in the pharmacotherapy of anxiety disorders

S. Kasper, M. Stamenkovic. Medizinische Universitiit Allgem. Psychiatrie, Wien, Austria

Objective: In the recent 20 years, a large number of randomized controlled trials has been performed for different indications of anxiety disorders, specifically for panic disorder (PD), generalized anxiety disorder (GAD), social phobia (SAND), posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). Whereas in former years it was believed that anxiety disorders can only be treated with benzodiazepines, it soon emerged that the group of selective serotonin re-uptake inhibitors (SSRI) as well as serotonin and norepinephrine re-uptake inhibitors (SNRI) have a favorable profile in this condition, specifically for the necessary long-term treatment. Not all of the compound studied have been performed in acute as well as long-term treatment paradigms. There is a need for studying the newer SSRI and SNRI also in a comparative design amongst the others since the majority of data are only obtained with the newer medication compared to older compounds, e.g., clomipramine compared to placebo. Recent data indicate that the group of atypical antipsychotics might also be beneficial fort he indication of GAD. Recently, pregabaline represents a new class of anxiolytic with no activity at GABAA, GABAB or benzodiazepine receptors. By modulation of the release of exultatory neurotransmitters, including glutamate and Substance P, the mechanism of action can be understood. Since there is a large comorbidity between depression and anxiety disorders it would be helpful if studies are undertaken in the future also on this comorbidity.

S-25-05

Adult ADHD and substance abuse

M. Casas, R.-Q. Josep A, B. Rosa, E. Gemma, M. Xavier. Unitat de Psychiatria Hospital, Barcelona, Spain

Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent childhood psychiatric disorder (3-7%). There are few prevatence studies concerning ADHD in adults, however ADHD affects up to 4% of adults. Comorbidity across life span in ADHD is not the exception but the rule. Approximately 70% of those diagnosed with ADHD in adulthood have a second disorder. One of the most common comorbidities in adult ADHD is a substance use disorder (SUD). There is a bidirectional relationship between ADHD and SUD. Prevalence studies of SUD patients have shown that between 15% to 25% may have ADHD. On the other hand, ADHD is a risk factor for subsequent development of a SUD. Several authors have found a lifetime rate of a SUD of 50% in adults with ADHD. It is very SUDs are key in the clinical expression of ADHD, differential diagnosis and in the therapeutic approach. ADHD patients show earlier onset, higher addiction severity and poorer treatment outcomes than non dually diagnosed drug users. The presence of ADHD can jeopardise SUD treatment. There are some clinical trials that evaluate the efficacy and safety of psychostimulants in adult ADHD with SUD.