Serotonin syndrome (SS) is a potentially life-threatening condition associated with increased serotonergic activity in central nervous system and may occur during the use of serotonergic drugs. Although increasing frequency of serotonergic drug use in children, pediatricians, emergency medicine and pediatric intensive care specialists have not enough knowledge and experience about SS that is a potentially life-threatening condition. A 12-year-old girl patient was admitted to our emergency room with the history of involuntary contractions on her extremities and alteration of consciousness. Her physical examination showed agitation, hyperthermia, dilated pupils, tremor, increased deep tendon reflexes, positive spontaneous clonus, agitation, flushed skin and diaphoresis, excessive perspiration, and continuous horizontal ocular movements. The patient diagnosed as SS by clinical history, physical and laboratory findings. In this paper, we will discuss SS occurred in a 12-year-old girl after concurrent clomipramine and risperidone use.
Central Nervous System ; Child* ; Clomipramine* ; Consciousness ; Critical Care ; Dihydroergotamine ; Early Diagnosis ; Emergency Medicine ; Emergency Service, Hospital ; Extremities ; Female ; Fever ; Humans ; Physical Examination ; Pupil ; Reflex, Stretch ; Risperidone ; Serotonin Agents ; Serotonin Syndrome* ; Serotonin* ; Skin ; Specialization ; Tremor

A 5-year-old, castrated male, Maltese was presented with history of acute flaccid paralysis. The dog was presented with sudden loss of muscle tone and involuntary movements of hind limbs. Neurologic examination revealed reduced postural reaction in the bilateral hind limbs. MRI of brain showed moderate hydrocephalus, but other examination results were normal. Based on the characteristic episodes and examination results, canine cataplexy was suspected. Treatment was initiated with clomipramine as cataplexy control. Clinical signs resolved with 3-month medication. This case demonstrates therapeutic diagnosis of cataplexy. To the author's knowledge, this is the first report of cataplexy treating with clomipramine.
Animals ; Brain ; Cataplexy ; Clomipramine ; Dogs ; Dyskinesias ; Extremities ; Humans ; Hydrocephalus ; Male ; Muscles ; Narcolepsy ; Neurologic Examination ; Paralysis

An 11-year-old, toy poodle dog was presented with dermatologic lesions and mammary gland tumor (MGT) evaluation. A solitary, lobulated MGT (size 2.5 x 3.5 cm) was affecting the 5th left mammary gland. Firm, oval plaque skin lesions were present on the left dorsal carpal area. The skin lesions were alopecic and salivary staining. The dog had historical separation anxiety and excessive licking of skin lesions were observed. Based on the clinical and histopathologic examinations, MGT was diagnosed with mammary complex adenoma and the skin lesions were diagnosed with acral lick dermatitis. Behavior modification treatment using oral clomipramine was effective.
Adenoma ; Animals ; Anxiety, Separation ; Behavior Therapy ; Child ; Clomipramine* ; Dermatitis* ; Dogs* ; Humans ; Mammary Glands, Human ; Play and Playthings ; Skin

Premature ejaculation (PE) is the most common form of male sexual dysfunction. Until very recently, scientific investigation of PE has been hampered by a lack of standardized definitions and objective, validated questionnaires. In recent years both the definition and the management of PE have changed from the traditional authority-based to a more evidence-based approach. In 2007, the International Society for Sexual Medicine (ISSM) established an ad hoc committee consisting of 21 internationally recognized experts, to establish a new definition of PE including intravaginal ejaculation latency time (IELT). As diagnostic tools, a brief self-administered questionnaire, the premature ejaculation diagnostic tool (PEDT), was developed and validated. Current accepted treatment options of PE include behavior therapy, topical desensitizing agents, selective serotonin reuptake inhibitors (SSRIs), clomipramine, tramadol, PDE-5 inhibitors. However, it should be noted that all of the medications currently used for treatment of PE were originally developed to treat other medical disorders such as depression or erectile dysfunction. Dapoxetine, a new SSRI, has a unique pharmacokinetic profile, with a short time to maximum serum concentration, and rapid elimination. By 24 hours, plasma concentrations are less than 5% of peak values. These attributes make Dapoxetine suitable for on-demand therapy of PE. This paper reviewed new diagnostic tools and treatment options for PE.
Behavior Therapy ; Benzylamines ; Clomipramine ; Depression ; Ejaculation ; Erectile Dysfunction ; Humans ; Male ; Naphthalenes ; Phosphodiesterase 5 Inhibitors ; Plasma ; Premature Ejaculation ; Surveys and Questionnaires ; Serotonin Uptake Inhibitors ; Tramadol

Premature ejaculation (PE) is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration (FDA). Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.
Anesthetics, Local ; Behavior Therapy ; Clomipramine ; therapeutic use ; Ejaculation ; Humans ; Lidocaine ; administration & dosage ; Male ; Prilocaine ; administration & dosage ; Serotonin Uptake Inhibitors ; therapeutic use ; Sexual Dysfunction, Physiological ; psychology ; therapy

Premature ejaculation(PE) is the most prevalent male sexual complaint, yet it remains underdiagnosed and undertreated. The sympathetic, parasympathetic, and somatic spinal centers, under the influence of sensory genital and cerebral stimuli integrated and processed at the spinal cord level, act in synergy to command physiologic events occurring during ejaculation. Experimental evidence indicates that serotonin(5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation and pharmacologic manipulation of the serotonergic system has been performed in rats, with the antidepressant selective serotonin reuptake inhibitors(SSRIs) exhibiting the greatest efficacy in delaying ejaculation. Over the last decade, an increasing number of studies of drug treatment of PE have been published. A meta-analysis of those studies demonstrated similar efficacies for daily treatment with the serotonergic antidepressants paroxetine hemihydrate, clomipramine, sertraline and fluoxetine, with paroxetine(hydrochloride) hemihydrate exerting the strongest effect on ejaculation. On the basis of fundamental insights into serotonergic neurotransmission, it has been suggested that on-demand selective serotonin reuptake inhibitor(SSRI) treatment will not lead to similarly impressive delays in ejaculation as has been observed with daily SSRI treatment. Apart from daily treatment with SSRIs, PE can be delayed by on-demand use of topical anaesthetics. Treatment with phosphodiesterase type 5 inhibitors may be used if PE is accompanied by erectile difficulties.
Animals ; Antidepressive Agents ; Brain ; Clomipramine ; Ejaculation ; Fluoxetine ; Humans ; Male ; Neurophysiology ; Paroxetine ; Phosphodiesterase 5 Inhibitors ; Premature Ejaculation ; Rats ; Serotonin ; Sertraline ; Spinal Cord ; Synaptic Transmission

Oral (p.o.) administration has a delayed onset time of several weeks and moderate efficacy in obsessive-compulsive disorder (OCD), therefore a more rapidly effective treatment is required. The aim of this paper was to review available data detailing the clinical outcome of intravenously (i.v.) administered antiobsessional drug in OCD patients. Review of the research indicates that i.v. administration exhibits a faster onset and greater improvement than p.o. administration. I.v. pulse administration showed clinically significantly faster onset than i.v. gradual administration. I.v. administration was safe and rapidly effective in treatment resistant OCD patients and might be a valuable new treatment.
Administration, Intravenous ; Citalopram ; Clomipramine ; Humans ; Obsessive-Compulsive Disorder

OBJECTIVES: Patients with obsessive-compulsive disorder (OCD) frequently exhibit complex clinical features, including comorbidity with other psychiatric disorders, which challenge diagnostic and therapeutic practice. This study presents a number of Korean experts' ratings of the appropriateness of treatments for patients with comorbid OCD and other psychiatric disorders. METHODS: The Korean Treatment Algorithm Project for Obsessive-Compulsive Disorder (KTAP-OCD 2007) developed a questionnaire that included questions about seven psychiatric comorbid conditions: major depressive disorder, bipolar disorder, panic or social anxiety disorder, schizophrenia, attention deficit hyperactive disorder (ADHD), oppositional/conduct/antisocial disorder, and Tourette disorder. Answers from 24 respondents were analyzed to assess first-line and second-line treatments for each comorbid condition. RESULTS: Experts selected cognitive behavior therapy (CBT) in conjunction with medication as the treatment for comorbidity with major depressive disorder, anxiety disorders, ADHD, or Tourette disorder. They selected a selective serotonin reuptake inhibitor (SSRI) combined with atypical antipsychotics as the treatment of choice for patients with comorbid OCD and schizophrenia. When patients had comorbid OCD and bipolar disorder, experts preferred adjunctive serotonin reuptake inhibitors to CBT. In all cases, experts were less likely to select clomipramine for second-line treatment. CONCLUSION: The findings from the KTAP-OCD 2007 survey on psychiatric comorbid conditions were generally consistent with foreign guidelines. However, more guidelines might be required for comorbidity with bipolar disorder and the use of clomipramine.
Antipsychotic Agents ; Anxiety Disorders ; Bipolar Disorder ; Clomipramine ; Cognitive Therapy ; Comorbidity ; Surveys and Questionnaires ; Depressive Disorder, Major ; Humans ; Obsessive-Compulsive Disorder* ; Panic ; Schizophrenia ; Serotonin ; Serotonin Uptake Inhibitors ; Tourette Syndrome

OBJECTIVES: Patients with obsessive-compulsive disorder (OCD) frequently exhibit complex clinical features, including comorbidity with other psychiatric disorders, which challenge diagnostic and therapeutic practice. This study presents a number of Korean experts' ratings of the appropriateness of treatments for patients with comorbid OCD and other psychiatric disorders. METHODS: The Korean Treatment Algorithm Project for Obsessive-Compulsive Disorder (KTAP-OCD 2007) developed a questionnaire that included questions about seven psychiatric comorbid conditions: major depressive disorder, bipolar disorder, panic or social anxiety disorder, schizophrenia, attention deficit hyperactive disorder (ADHD), oppositional/conduct/antisocial disorder, and Tourette disorder. Answers from 24 respondents were analyzed to assess first-line and second-line treatments for each comorbid condition. RESULTS: Experts selected cognitive behavior therapy (CBT) in conjunction with medication as the treatment for comorbidity with major depressive disorder, anxiety disorders, ADHD, or Tourette disorder. They selected a selective serotonin reuptake inhibitor (SSRI) combined with atypical antipsychotics as the treatment of choice for patients with comorbid OCD and schizophrenia. When patients had comorbid OCD and bipolar disorder, experts preferred adjunctive serotonin reuptake inhibitors to CBT. In all cases, experts were less likely to select clomipramine for second-line treatment. CONCLUSION: The findings from the KTAP-OCD 2007 survey on psychiatric comorbid conditions were generally consistent with foreign guidelines. However, more guidelines might be required for comorbidity with bipolar disorder and the use of clomipramine.
Antipsychotic Agents ; Anxiety Disorders ; Bipolar Disorder ; Clomipramine ; Cognitive Therapy ; Comorbidity ; Surveys and Questionnaires ; Depressive Disorder, Major ; Humans ; Obsessive-Compulsive Disorder* ; Panic ; Schizophrenia ; Serotonin ; Serotonin Uptake Inhibitors ; Tourette Syndrome

OBJECTIVETo observe the efficacy of Modified Xiaoyao Decoction (MXD) combining clomipramine in treatment of depression.

METHODSOne hundred and five depression patients were randomly assigned to two groups. The treated group (53 patients), all were differentiated as Gan-qi stagnation syndrome type and treated with MXD combining clomipramine 25-50 mg/d. The control group (52 patients) treated with clomipramine 75-225 mg/d alone. The treatment lasted for 8 weeks in both groups. Scores of depression was assessed with Hamilton Depression Scale (HAMD) before treatment and at the 2nd, 4th, 8th week of the treatment, efficacy and adverse reactions were evaluated with Global Impression of Change (CGI) and Treatment Emergent Symptom Scale (TESS) respectively.

RESULTSAfter treatment the scores in both groups were significantly different from those before treatment (P < 0.01), but no significant difference was found between the two groups (P > 0.05). Main adverse reactions were dry mouth, constipation in the treated group, much less than those in the control group, which were mainly dry mouth, constipation, dizziness, insomnia, blurred vision and prolonged Q-T interval (P < 0.01).

CONCLUSIONMXD combining clomipramine has the efficacy on depression similar to clomipramine, but has less adverse reactions.

Adolescent ; Adult ; Antidepressive Agents, Tricyclic ; therapeutic use ; Clomipramine ; therapeutic use ; Depression ; drug therapy ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Treatment Outcome ; Young Adult