OCD May Heighten Moral Sensitivity

OCD May Heighten Moral Sensitivity Individuals with obsessive-compulsive disorder (OCD) appear far more sensitive when it comes to moral dilemmas.

“Faced with a problem of this type, people suffering from this type of anxiety disorder show that they worry considerably more,” said Carles Soriano, Ph.D., researcher at Hospital de Bellvitge in Barcelona.

For the new study, scientists looked at the neurofunctional basis of this increased moral sensitivity. Using functional magnetic resonance imaging, they measured the brain activity of a group of 73 patients with OCD and 73 healthy patients.

All participants had to face a variety of moral problems in which they had to choose between two alternatives both leading to very negative consequences.

For example, they were asked to imagine themselves in a hypothetical war. Enemy soldiers lie in wait to attack and the entire village is hiding in a cellar. A baby starts to cry. If nobody makes the baby stop, the enemy soldiers will find them. Would it be justifiable to smother the baby’s cry, possibly suffocating it to save the others?

The results demonstrated that during situations of moral dilemma, the brains of those with OCD showed a higher degree of activation in the orbitofrontal cortex, especially in the medial part, which is associated with decision making and the development of moral sentiment.

“The majority [of people with OCD] are characterized by being obsessed with dirt and compulsive cleaning or by doubting that they have carried out important actions properly, like turning off the gas. Such behavior makes then repeatedly check whether they have performed such actions,” said Soriano.

There are other types of obsessions and compulsions as well, such as needing objects in the environment to be perfectly symmetrical and in order.   

There are also those that suffer from involuntary and unwanted thoughts of a sexual or religious kind.  They may feel unsure whether they have committed a sexual act that is unacceptable in their opinion or they worry that they have blasphemed God.

“The last group of patients is identified for precisely having a higher level of moral hypersensitivity,” said Soriano.

The research included help from experts at Barcelona’s Hospital del Mar and the University of Melbourne in Australia.

Source:  Archives of General Psychiatry
 

 
Very anxious woman photo by shutterstock.



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Biting Nails? You could be Insane!

Tense situations call for nail biting, be it the world cup, the board exam results or maybe the final seconds of a lottery showdown. But if you find yourself biting nails all the time you may be suffering from obsessive compulsive disorder.   

Nail-biting has been classified as a type of obsessive compulsive disorder (OCD) by the American Psychiatric Association (APA) in their upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

According to Wikipedia, People with obsessive compulsive disorder are known to produce repetitive behaviours aimed at reducing anxiety.

Other habits like hair-pulling and skin-picking — habits of “pathological grooming”– will also be included in the OCD classification, as reported by news.com.au

The DSM-V is the known ‘Bible of psychiatrists’ and is used by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and even policy makers.

A word of advice for the nail biters then — choose nail cutters over your teeth to stay in the sane category.  

Patients with obsessive-compulsive disorder worry considerably more than … – News

Patients with obsessive-compulsive disorder are characterised by persistent thoughts and repetitive behaviours. A new study reveals that sufferers worry considerably more than the general population in the face of morality problems.

Along with the help of experts from the Barcelona’s Hospital del Mar and the University of Melbourne (Australia), researchers at the Hospital de Bellvitge in Barcelona have proven that patients with obsessive-compulsive disorder, known as OCD, are more morally sensitive.

“Faced with a problem of this type, people suffering from this type of anxiety disorder show that they worry considerably more,” as explained to SINC by Carles Soriano, researcher at the Catalan hospital and one of the lead authors of the work published in the journal Archives of General Psychiatry.

Using functional magnetic resonance imaging, the experts studied the neurofunctional basis of this increased moral sensitivity. They measured the brain activity of a group of 73 patients with OCD and 73 healthy patients when faced with different moral problems in which they had to choose between two alternatives both leading to very negative consequences.

For example, they were faced the dilemma of the crying baby, a classic in philosophy classes. They were asked to imagine themselves in a hypothetical war. Enemy soldiers lie in wait to attack and the entire village hides in a cellar. A baby starts to cry. If nobody makes the baby stop, the soldiers will discover everyone. Would it be justifiable to smother the baby’s cry running the risk of suffocating it to save the others?

“The brain activations displayed by participants in the face of such a moral question were compared to those displayed for trivial choices, like choosing between going to the countryside or the beach for the weekend,” as Soriano points out.

The results verified that during situations of moral dilemma those subjects with OCD displayed a higher degree of activation in the orbitofrontal cortex, especially in the medial part, which is linked to decision making processes and the development of moral sentiment.

“The data allows us for the first time to objectify the existence of cerebral dysfunctions related to alterations in complex cognitions, such as experiencing morality,” adds the researcher from Catalonia. “This allows us to expand further on the characterisation of altered cerebral mechanisms in OCD.”

Anxiety compulsion

Parents’ Social Anxiety May Raise Kids’ Risk for Anxiety Disorder

From

Published: November 7, 2012 5:27 PM

 — Mary Elizabeth Dallas

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Parental social anxiety should be considered a risk factor for childhood anxiety, according to researchers.

In a new study, researchers from Johns Hopkins Children’s Center found that kids with parents who have social anxiety disorder — the most common form of anxiety — are at greater risk for developing an anxiety disorder than kids whose parents have other forms of anxiety.

The study revealed that the parental behaviors that contributed to children’s anxiety included a lack of warmth and affection as well as high levels of criticism and doubt.

“There is a broad range of anxiety disorders, so what we did was home in on social anxiety, and we found that anxiety-promoting parental behaviors may be unique to the parent’s diagnosis and not necessarily common to all those with anxiety,” the study’s senior investigator, Golda Ginsburg, professor of child and adolescent psychiatry at the Johns Hopkins University School of Medicine, said in a university news release.

In conducting the study, Ginsburg’s team examined the interactions between 66 anxious parents and their children, whose ages ranged from 7 to 12 years. Of the parents, 21 had social anxiety; the rest were diagnosed with another form of anxiety, such as panic disorder or obsessive-compulsive disorder.

Each parent-child team was videotaped while working together to write speeches about themselves and also to copy designs on an Etch-a-Sketch. They were given five minutes to complete each task. On a scale of one to five, the researchers rated the affection and criticism the parents showed their children.

The study authors found that parents with social anxiety were less warm and affectionate toward their children. These parents also criticized their children more, and tended to doubt their child’s ability to complete each task.

Ginsburg, who also is a child anxiety expert at Johns Hopkins Children’s Center, added that doctors treating parents with social anxiety should discuss the risk their condition poses to their children. The researchers noted that controlling environmental factors that contribute to anxiety can help prevent these children from developing the disorder.

“Children with an inherited propensity to anxiety do not just become anxious because of their genes, so what we need are ways to prevent the environmental catalysts — in this case, parental behaviors — from unlocking the underlying genetic mechanisms responsible for the disease,” Ginsburg explained.

The study authors noted that anxiety disorder affects one in five children in the United States. If left untreated, the condition can lead to depression, substance abuse and poor performance in school.

The study was released online in advance of print publication in an upcoming issue of the journal Child Psychiatry and Human Development.

More information

The U.S. National Institute of Mental Health has more about anxiety disorders.

Copyright © 2012 HealthDay. All rights reserved.

Nail biting doesn’t belong in psychiatry’s list of OCD symptoms

News that the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) may classify nail biting as a form of obsessive-compulsive disorder has confirmed the worst fears of the psychiatric handbook’s critics. The threshold of what is deemed a disorder is lowered with each successive edition, with nearly all forms of human behaviour now becoming pathologised. Of the 180 or so disorders one could have suffered from in the mid 1980s, there are now approaching 400.

Academics, GPs and psychiatrists have all spoken out against this trend. Petitions have been raised expressing grave doubts about DSM, and a stream of academic books and articles ridicule its scientific claims. Yet these critiques seem to be ignored. Most clinicians working in the NHS use the DSM, and a fitness-to-practise case has even been brought against a clinician who challenged the DSM categories she was supposed to be applying.

The proposed inclusion of nail biting in lists of OCD symptoms is a good example of the manual’s failures. Pre-DSM psychiatry emphasised the difference between symptom and underlying structure. Someone could bite their nails as a way of redirecting anger when they felt cross, or even because they had the delusional belief that their nail embodied some evil that had to be excised from the body. The symptom – nail biting – was simply the clue to what lay beneath it.

OCD itself is another case in point. The DSM treats it as a disorder, defined by symptoms such as compulsions, rituals and intrusive thoughts. Yet the actual category of OCD is suspect for a simple reason: the same surface symptoms can appear in two distinct underlying clinical groups – the neuroses and the psychoses.

In neurosis, obsessive symptoms can be a way of warding off anxiety, particularly about the proximity of love and hate. One of Freud’s patients worried that a stone in the road might cause an accident when his loved one’s carriage travelled along it later that day. He put it by the side of the road, only to then worry that this was absurd and then return it to its original place. Behind the repetitive ritual was a conflict of affection and aggression.

In psychosis, although the person may complain of the cleaning, checking or counting rituals they have to carry out, these activities may protect them from more acute terrors. It is well-known, for example, that the appearance of OCD-style phenomena in schizophrenia or manic-depressive psychosis is generally a good prognostic sign. By introducing an order, they can be less a problem than a way of treating a problem.

In the DSM approach, this distinction is all too often lost. The piece of behaviour becomes in itself transparent, simply one more item on a checklist of symptoms. You don’t need to know what the nail biting means to that individual patient, just whether they do it or not. Meaning has been stripped from the diagnostic enterprise, in favour of pure external classification.

Clinicians who want to pursue a dialogue here find that they are allocated less and less time with their patients by a bureaucratic and managerial healthcare system. The tragedy is that this deprives us of having any authentic understanding of the symptom, and it introduces a rigid, normative vision of human behaviour. We can know what is a disorder, and what isn’t, without listening to what the person has to say.

Yet nail biting might be a totally irrelevant detail for one person, a terrible curse or a pleasurable habit for another. Classifying such behaviour externally as a symptom, without taking into account what it means to that person, is profoundly inhuman. It is yet another vehicle for imperatives telling us how we should live and how we shouldn’t.

Nail-biting to be classified as type of obsessive compulsive disorder

The American Psychiatric Assiociation will classify nail-biting as a type of obessive compulsive disorder (OCD) in their upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Other “pathological grooming” habits like hair-pulling and skin-picking – collectively known as trichotillomania – will also be included in the OCD classification, News.com.au reported.

The DSM-V is known as the ‘bible of psychiatrists’ and is used by international clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers.

According to Wikipedia, obsessive compulsive disorder is characterised by intrusive thoughts that produce repetitive behaviours aimed at reducing anxiety.

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Parents With Social Anxiety Disorder Pass Their Fears to Children

Parents who suffer from social phobia can pass the disorder to their children. A new study has found that parents with social anxiety disorder are more likely to pass on the traits to their kids than parents who suffer from other kinds of anxiety disorders.

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Social anxiety disorder or social phobia is when people have excessive fear of being judged and are constantly embarrassed. These people find it difficult to do common things like signing a check in front of other people.

“There is a broad range of anxiety disorders so what we did was home in on social anxiety, and we found that anxiety-promoting parental behaviors may be unique to the parent’s diagnosis and not necessarily common to all those with anxiety,” said Golda Ginsburg a child anxiety expert at Johns Hopkins Children’s Center and senior author of the study. Ginsburg is also a professor of child and adolescent psychiatry at The Johns Hopkins School of Medicine.

Researchers found that parents who have social phobia display a set of behaviors that increase the child’s risk of developing anxiety disorders. Children growing up with such parents often receive criticism and doubt at home and insufficient warmth and affection, making the children anxious.

Researchers say that they haven’t proven that children whose parents have social anxiety will grow up to be socially anxious. However, they add that physicians who are treating parents must be aware that their children might also be suffering from some level of anxiety.

“Parental social anxiety should be considered a risk factor for childhood anxiety, and physicians who care for parents with this disorder would be wise to discuss that risk with their patients,” Ginsburg said in a statement.

The present study included 66 parent-child pairs. Researchers gave each pair tasks that included preparing speeches and replicating complex designs on an Etch-a-Sketch device.

In the study group, 21 parents were diagnosed with social anxiety disorder and 45 parents had been diagnosed with generalized anxiety disorders like panic attacks and obsessive compulsive disorder.

Researchers found that parents who had social anxiety disorder were more critical of the child’s abilities and showed less affection towards their children.

“Children with an inherited propensity to anxiety do not just become anxious because of their genes, so what we need are ways to prevent the environmental catalysts-in this case, parental behaviors-from unlocking the underlying genetic mechanisms responsible for the disease,” Ginsburg added.


Published by Medicaldaily.com

Nail-biting may be classified as type of obsessive compulsive disorder

Nail-biting is OCD behaviour

The American Psychiatric Assiociation will classify nail-biting as a type of obessive compulsive disorder. Picture: Thinkstock
Source: Supplied





NAIL-BITING may be classified as a type of obsessive compulsive disorder (OCD) in the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).


Other “pathological grooming” habits such as hair-pulling and skin-picking – collectively known as trichotillomania – will also be included in the OCD classification.

The DSM-V, published by the American Psychiatric Association, is known as the “Bible of psychiatrists”.

It is used by international clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers.

According to Wikipedia, obsessive compulsive disorder is characterised by intrusive thoughts that produce repetitive behaviors aimed at reducing anxiety.

Symptoms can include excessive cleaning, repeated checking, hoarding and nervous rituals such as opening and closing a door several times before entering or leaving a room.

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Sydney forensic psychiatrist Dr Robert Kaplan has written several papers on the subject, identifying seemingly harmless habits such as hair-pulling, face picking and nail-biting as signs of psychiatric disorder.

“(Trichotillomania) is a very interesting phenomenon,” he said. “You see it in children of primary school age and you also see it in adult men and women.

“If you talk to sufferers you find that they are very stressed and embarrassed about it.”

Dr Kaplan said trichotillomania affected between eight per cent to 14 per cent of women and slightly fewer men.

The proposed classification of nail-biting and other forms of “pathological grooming” does not mean that all finger-munchers will be diagnosed with OCD.

“As with hair pulling and skin picking, nail biting isn’t a disorder unless it is impairing, distressing and meets a certain clinical level of severity,” Dr. Carol Mathews, a psychiatrist at the University of California, San Francisco, told US website Women’s Health.

Most people who bite their nails don’t fit in this category, which is only comprised by “a very small minority of people,” she said.

Depression and Entrepreneurs

Brad Feld

Amy and I wrote a meaningful amount about entrepreneurs and depression in Startup Life. Since we finished the final draft a few weeks ago, I’ve given several talks where depression came up as I’ve woven my own experience with depression into the short (less than 15 minute) version of my story. I’ve received a surprising (to me) number of emails from people thanking me talking about it publicly, along with my discussion of the anxiety disorder (obsessive compulsive disorder) that I’ve struggled with my entire adult life and that was severe during the serious depressive episode I had in my early to mid 20s.

So the idea of depression has been on my mind. It doesn’t surprise me that I feel down and flat as I sit here in the Charlotte, North Carolina airport on my way to Lexington, Kentucky on day 16 of a 19 day trip. I’m tired, strung out, missing home, missing Amy, and running out of extrovert energy. I’ve had a great time with all the people I’ve been with and the events I’ve had around Startup Communities. I’ve had several extraordinary experiences like dinner last night in Toronto with a dozen fantastic entrepreneurs who I hope to have continuous involvement – as a friend and potential investor – in the future. But as I sit here, I’m surrounded by a lot of grey, and it’s not just the clouds outside that are the remnants of the storm.

I’ve reached out to most of my friends in New York to check in on them. They are all doing fine even though a few were hit hard and are now effectively homeless as lower Manhattan gets cleaned up. I picked a spot in the airport far away from the TV – I couldn’t stand the endless news cycle that mixed Sandy with Romney with Obama. I had some extra carbs hoping that would help – it just made me feel sleepy. Yup – I know what this feeling is.

I know many entrepreneurs who deal with different levels of depression. My close friend Jerry Colonna is extraordinarly eloquent about this and how it impacts entrepreneurs. Ben Huh, the CEO of Cheezburger, wrote a powerful post about his struggle with depression titled When Death Feels Like A Good Option. And I’ve had many conversations with other entrepreneurs about my, and their, struggle with depression.

For some reason we’ve embraced failure as an entrepreneurial trait that is ok, but we still struggle with acknowledging and talking about depression. Entrepreneurs function with a wide range of stresses and emotions that often have overwhelming intensity. In many cases, we are afraid of admitting depression, and are often highly functional when we are depressed. But that doesn’t deny the fact that entrepreneurs get depressed. To deny this, is to deny reality, and that’s against my value system.

I just went back and read what we wrote in Startup Life about depression and it made me smile. I’m really proud of the work that Amy and I did on that book – I think it is the best book I’ve been involved in writing (Venture Deals, which I wrote with Jason Mendelson, is a close second) and I’m hopeful that it has a lot of impact and value for entrepreneurs and their partners.

Just writing all of this makes me feel better. Thanks for listening. Time to get on the plane and go to Lexington.


Read more posts on Feld Thoughts »

Psychosis Symptoms Tied to Higher Suicide Risk in Adolescents

Symptoms of psychosis were associated with greatly increased risk for suicidal behavior in the general adolescent population as well as in adolescents who have nonpsychotic disorders, such as depression, attention-deficit/hyperactivity disorder, anxiety disorders, or obsessive compulsive disorder, according to two separate epidemiologic studies reported online Oct. 29 in the Archives of General Psychiatry.

Among adolescents in the general population, as well as the subgroup of adolescents who had nonpsychotic DSM-III diagnoses, those who reported suicidal ideation, suicide planning, or suicidal acts were 10 times more likely than those who did not to affirm on direct questioning that they had experienced psychotic symptoms – mainly auditory hallucinations, said Ian Kelleher, Ph.D., of the department of psychiatry, Royal College of Surgeons in Ireland, Dublin, and his associates.

“The immediate clinical relevance of these findings is that all patients presenting at risk for suicidal behavior should receive a thorough assessment of psychotic symptoms and not just a screening to rule out psychotic disorder,” they noted.

Both primary care physicians and psychiatric clinicians must recognize that psychotic symptoms in a nonpsychotic patient signify a high suicide risk. “Research has shown that the largest increase in suicide risk in the general population occurs after there has already been contact with mental health services and that approximately half of patients who complete suicide [had] contact with primary care providers in the month preceding their death[s],” the investigators added.

Hallucinations and delusions, the classic symptoms of psychosis, are far more prevalent in the general population than are diagnosable psychotic disorders. They are “especially common in young people, with a meta-analysis of general population studies demonstrating a median prevalence of 17% in children aged 9-12 years and 7.5% in adolescents aged 13-17 years,” the researchers wrote.

And psychosis is known to raise the risk of suicide dramatically. Yet no studies to date have examined the relationship between psychotic symptoms and suicidal behaviors among adolescents. Dr. Kelleher and his colleagues did so using data from two independent cross-sectional epidemiologic studies of the general Irish population.

The Adolescent Brain Development (ABD) study assessed the prevalence of psychotic symptoms among 1,131 students aged 11-13 years in 16 mainstream schools, representing more than half of the total school population in that age group. The Challenging Times (CT) study assessed the prevalence of psychiatric disorders among 743 students aged 13-15 years in eight mainstream schools.

For this study, Dr. Kelleher and his associates analyzed the results of in-depth diagnostic interviews for 212 subjects from the ABD study and 211 from the CT study, as well as the interview responses of their parents.

Overall, 22% of the ABD sample and 7% of the CT sample reported experiencing psychotic symptoms when they were specifically asked about them, almost all of them during the preceding year. “From our clinical experience, young people will rarely volunteer information on psychotic symptoms unless questioned directly about such experiences. Adolescents are usually willing to talk openly about their experiences, however, in response to direct but sensitive questioning.”

Examples of such questions included: “Sometimes people when they are alone hear things or see things, and they’re not quite sure where they came from. Does that ever happen to you?” and “Was there ever a time when you thought that your imagination was playing tricks on you?”

In the two cohorts combined, 44 subjects reported suicidal ideation, 16 reported making specific suicidal plans, and 8 reported suicidal acts.

Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin …

/PRNewswire/ — Reportlinker.com announces that a new market research report is available in its catalogue: Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin Re-uptake Inhibitors (SSRIs) Continue to Dominate in the Absence of Effective Therapeutic Alternatives http://www.reportlinker.com/p01020574/Antidepressants-Market-to-2018—Despite-Safety-Concerns-Selective-Serotonin-Re-uptake-Inhibitors-SSRIs-Continue-to-Dominate-in-the-Absence-of-Effective-Therapeutic-Alternatives.html#utm_source=prnewswireutm_medium=prutm_campaign=Drug_and_Medication Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin Re-uptake Inhibitors (SSRIs) Continue to Dominate in the Absence of Effective Therapeutic Alternatives Summary GBI Research, the leading business intelligence provider, has released its latest research, “Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin Re-uptake Inhibitors (SSRIs) Continue to Dominate in the Absence of Effective Therapeutic Alternatives”, which provides insights into the antidepressants market until 2018. The report is built using data sourced from our proprietary databases and primary and secondary research, in addition to analysis from our in-house specialized team of experts. The report provides an in-depth analysis of the major antidepressants therapies, including SSRIs, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) and Tricyclic Antidepressants (TCAs), covering Major Depressive Disorder (MDD), Obsessive-Compulsive Disorder (OCD), Generalized Anxiety Disorder (GAD) and Panic Disorder (PD). The report provides the sales for the global antidepressant market in addition to the individual indication markets. It also examines the global antidepressant market treatment usage patterns, in addition to the geographical distribution of antidepressants across the US, the top five countries of Europe, and Japan. The report also includes insights into the antidepressants RD product pipeline and explores the competitive landscape, including major players in the antidepressants market. Finally, the report also includes analysis on the Mergers and Acquisitions (MAs) and licensing agreements that took place in antidepressant market. GBI Research analysis shows that the overall global antidepressant market for the four indications, (MDD, OCD, GAD and PD) was valued at $11.9 billion in 2011, growing from $10.5 billion in 2004 and indicating a Compounded Annual Growth Rate (CAGR) of 1.7%. The market is forecast to reach revenues of approximately $13.4 billion by 2018 for the above mentioned four major indications, increasing at a CAGR of 1.8%. Overall the number of prescriptions for antidepressant has risen, but this has been offset by a number of patent expiries and high generic entry. Drugs currently in development have taken on a new multi-targeted approach, combining targets known to be beneficial for the treatment of MDD, OCD, GAD and PD. The future of the antidepressant market is reliant on the positive safety profiles of drugs in the pipeline, with no disease-modifying therapies expected to enter the market in the near future. Scope – The report analyzes the treatment usage patterns, market characterization, pipeline analysis, competitive landscape and key MA trends in the global antidepressant market for MDD, OCD, GAD and PD. – Data and analysis on the antidepressant market in the leading geographies of the world – the US, the UK, Germany, France, Italy, Spain, and Japan. – Annualized market data for the antidepressant market from 2004 to 2011, with forecasts to 2018. – Market data on the geographical landscape and therapeutic landscape, including market size, market share, annual cost of therapy, sales volume and treatment usage patterns (diseased population, diagnosis population and prescription population). – Key drivers and restraints that have had a significant impact on the market. – The competitive landscape of the global antidepressant market including top company benchmarking. The key companies studied in this report are Eli Lilly, Bristol-Myers Squibb, GlaxoSmithKline, Forest laboratories and Lundbeck. – Key MA activities and licensing agreements that took place between 2009 and 2012 in the antidepressants therapeutics market. Reasons to buy – Align their product portfolio to markets with high growth potential. – Build effective strategies to launch their pipeline products by identifying potential geographies. – Exploit in-licensing and out-licensing opportunities by identifying products that might fill their portfolio gaps. – Develop key strategic initiatives by studying the key strategies of top competitors. – Device a more tailored country strategy through the understanding of key drivers and barriers and the market potential of each indication. – Develop market entry and market expansion strategies by identifying the geographic markets poised for strong growth. – Reinforce RD pipelines by identifying new target mechanisms which can produce first-in-class molecules which are safer and more efficacious. 1 Table of Contents 1 Table of Contents 6 1.1 List of Tables 9 1.2 List of Figures 10 2 Antidepressants Market to 2018 – Introduction 12 3 Market Overview 13 3.1 Introduction 13 3.2 Classification of Antidepressants 14 3.2.1 Selective Serotonin Reuptake Inhibitors 15 3.2.2 Serotonin-Norepinephrine Reuptake Inhibitors 15 3.2.3 Noradrenergic and Specific Serotonergic Antidepressants 15 3.2.4 Norepinephrine Reuptake Inhibitors 16 3.2.5 Norepinephrine-Dopamine Reuptake Inhibitors 16 3.2.6 Norepinephrine-Dopamine Disinhibitors 16 3.2.7 Serotonin Antagonist and Reuptake Inhibitors 16 3.2.8 Tricyclic Antidepressants 16 3.2.9 Tetracyclic Antidepressants 17 3.2.10 Monoamine Oxidase Inhibitors 17 3.2.11 Others 18 3.3 Adverse Effects 18 3.4 Major Marketed Products in the Antidepressants Therapy Area 18 3.5 Future Developments 20 3.6 Revenue 21 3.7 Annual Cost of Therapy 23 3.8 Treatment Usage Patterns 24 3.8.1 Diseased Population 25 3.8.2 Diagnosed Population 25 3.8.3 Prescription Population 25 3.9 Drivers and Restraints of the Antidepressants Market 26 3.9.1 Drivers 26 3.9.2 Restraints 27 4 Therapeutic Landscape 28 4.1 Antidepressants Market for Major Depressive Disorder 28 4.1.1 Introduction 28 4.1.2 Revenue and Forecasts 30 4.1.3 Annual Cost of Therapy 31 4.1.4 Treatment Usage Patterns 32 4.1.5 Geographical Segmentation 33 4.2 Drivers and Restraints for the Antidepressants Market for Major Depressive Disorder 35 4.2.1 Drivers 35 4.2.2 Restraints 35 4.3 Antidepressants Market for Obsessive-Compulsive Disorder 37 4.3.1 Introduction 37 4.3.2 Revenue and Forecasts 39 4.3.3 Annual Cost of Therapy 40 4.3.4 Treatment Usage Patterns 41 4.3.5 Geographical Segmentation 42 4.4 Drivers and Restraints for the Antidepressants Market for Obsessive-Compulsive Disorder 44 4.4.1 Drivers 44 4.4.2 Restraints 44 4.5 Antidepressants Market for Generalized Anxiety Disorder 45 4.5.1 Introduction 45 4.5.2 Revenue and Forecasts 46 4.5.3 Annual Cost of Therapy 48 4.5.4 Treatment Usage Patterns 49 4.5.5 Geographical Segmentation 51 4.6 Drivers and Restraints for the Antidepressants Market for Generalized Anxiety Disorder 54 4.6.1 Drivers 54 4.6.2 Restraints 54 4.7 Antidepressants Market for Panic Disorder 55 4.7.1 Introduction 55 4.7.2 Revenue and Forecasts 58 4.7.3 Annual Cost of Therapy 59 4.7.4 Treatment Usage Patterns 60 4.7.5 Geographical Segmentation 62 4.8 Drivers and Restraints for the Antidepressants Market for Panic Disorder 64 4.8.1 Drivers 64 4.8.2 Restraints 64 5 Geographical Landscape 66 5.1 The US 67 5.1.1 Revenue and Forecasts 67 5.1.2 Annual Cost of Therapy 69 5.1.3 Treatment Usage Patterns 70 5.2 EU5 72 5.2.1 Revenue and Forecasts 72 5.2.2 Annual Cost of Therapy 73 5.2.3 Treatment Usage Patterns 74 5.3 Japan 75 5.3.1 Revenue and Forecasts 75 5.3.2 Annual Cost of Therapy 76 5.3.3 Treatment Usage Patterns 77 6 Pipeline Analysis 79 6.1 Introduction 79 6.2 Summary of the Current Antidepressants RD Pipeline 79 6.3 Profiles of Key Late-Stage Drugs in the Antidepressants Market 82 6.3.1 Vortioxetine (Lu AA21004) 82 6.3.2 F-2695 (levomilnacipran) 83 6.3.3 LY-2216684 (edivoxetine) 84 6.3.4 OPC-34712 84 6.3.5 EB-1010/Amitifadine 85 6.3.6 PNB01 86 7 Competitive Landscape 87 7.1 Competitive Profiling 87 7.1.1 H. Lundbeck 87 7.1.2 AstraZeneca 88 7.1.3 Eli Lilly and Company 89 7.1.4 Forest Laboratories 90 7.1.5 Pfizer Inc. 92 7.1.6 GlaxoSmithKline 93 7.1.7 Bristol-Myers Squibb Company 94 8 Strategic Consolidations 96 8.1 Merger and Acquisition Deals 96 8.1.1 Paladin Labs Completes Acquisition of Labopharm 96 8.1.2 High River Acquires 6.5% Stake in Forest Laboratories 96 8.1.3 Forest Laboratories Completes Acquisition of Clinical Data 96 8.1.4 Azur Pharma Completes Merger with Jazz Pharmaceuticals in All Stock Transaction 97 8.1.5 Nuvo Research Acquires ZARS Pharma 97 8.1.6 Sun Pharmaceutical Acquires Remaining 24% Stake of Caraco Pharmaceutical 98 8.2 Licensing Agreements 98 8.2.1 Labopharm Enters into Licensing Agreement with Angelini Group for OLEPTRO 98 8.2.2 Omeros Expands Licensing Agreement with Daiichi Sankyo 98 8.2.3 Jazz Pharmaceuticals Enters into Sub-Licensing Agreement with Anchen 98 8.2.4 AstraZeneca Enters into Collaboration and Licensing Agreement with Targacept 99 8.2.5 Indevus Pharmaceuticals Enters into Licensing Agreement with Teva Pharmaceutical 99 8.2.6 Impax Laboratories Enters into Licensing Agreement with Wyeth 99 8.2.7 Mylan Enters into Licensing Agreement with GlaxoSmithKline 99 8.2.8 Tikvah Therapeutics Signs Licensing Agreement with Therapade Technologies 99 8.2.9 GlaxoSmithKline Signs an Agreement with Fabre-Kramer Pharmaceuticals 100 8.2.10 Jazz Pharmaceuticals Enters into Licensing Agreement with Solvay 100 8.2.11 Targacept Enters into Licensing Agreement with Yale University 100 8.3 Co-Development Deals 100 8.3.1 Lundbeck Enters into Co-Development Agreement with Otsuka Pharmaceutical 100 8.3.2 Eli Lilly Terminates Co-Development Agreement with Boehringer Ingelheim 101 8.3.3 Lundbeck Enters into Co-Development Agreement with Takeda 101 9 Appendix 102 9.1 Market Definitions 102 9.2 Abbreviations 102 9.3 Sources 104 9.4 Research Methodology 105 9.4.1 Coverage 105 9.4.2 Secondary Research 105 9.4.3 Primary Research 106 9.5 Therapeutic Landscape 107 9.5.1 Epidemiology-based Forecasting 107 9.5.2 Market Size by Geography 109 9.6 Geographical Landscape 110 9.7 Pipeline Analysis 110 9.8 Competitive Landscape 110 9.8.1 Expert Panel Validation 110 9.9 Contact Us 110 9.10 Disclaimer 110 1.1 List of Tables Table 1: Global Antidepressants Market, Marketed Products, 2012 19 Table 2: Antidepressants Market, Global, Revenue ($bn), 2004–2011 21 Table 3: Antidepressants Market, Global, Revenue Forecast ($bn), 2011–2018 22 Table 4: Antidepressants Market, Global, Annual Cost of Therapy ($), 2004–2011 23 Table 5: Antidepressants Market, Global, Annual Cost of Therapy ($), 2011–2018 23 Table 6: Antidepressants Market, Global, Treatment Usage Patterns (millions), 2004–2011 24 Table 7: Antidepressants Market, Global, Treatment Usage Patterns (millions), 2011–2018 24 Table 8: Antidepressants Market, MDD, Global, Revenue ($bn), 2004–2011 30 Table 9: Antidepressants Market, MDD, Global, Revenue Forecast ($bn), 2011–2018 30 Table 10: Antidepressants Market, MDD, Global, Annual Cost of Therapy ($), 2004–2011 31 Table 11: Antidepressants Market, MDD, Global, Annual Cost of Therapy ($), 2011–2018 31 Table 12: Antidepressants Market, MDD, Global, Treatment Usage Patterns (millions), 2004–2011 32 Table 13: Antidepressants Market, MDD, Global, Treatment Usage Patterns (millions), 2011–2018 32 Table 14: Antidepressants Market, MDD, Global, Market Segmentation by Geography ($bn), 2004–2011 34 Table 15: Antidepressants Market, MDD, Global, Market Segmentation by Geography ($bn), 2011–2018 34 Table 16: Common Obsessions and Compulsions in Obsessive-Compulsive Disorder 38 Table 17: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Revenue ($bn), 2004–2011 39 Table 18: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Revenue Forecast ($bn), 2011–2018 39 Table 19: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Annual Cost of Therapy ($), 2004–2011 40 Table 20: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Annual Cost of Therapy ($), 2011–2018 40 Table 21: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Treatment Usage Patterns (millions), 2004–2011 41 Table 22: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Treatment Usage Patterns (millions), 2011–2018 41 Table 23: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Market Segmentation by Geography ($m), 2004–2011 43 Table 24: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Market Segmentation by Geography ($m), 2011–2018 43 Table 25: Antidepressants Market, Generalized Anxiety Disorder, Global, Revenue ($bn), 2004–2011 47 Table 26: Antidepressants Market, Generalized Anxiety Disorder, Global, Revenue Forecast ($bn), 2011–2018 47 Table 27: Antidepressants Market, Generalized Anxiety Disorder, Global, Annual Cost of Therapy ($), 2004–2011 48 Table 28: Antidepressants Market, Generalized Anxiety Disorder, Global, Annual Cost of Therapy ($), 2011–2018 48 Table 29: Antidepressants Market, Generalized Anxiety Disorder, Global, Treatment Usage Patterns (millions), 2004–2011 50 Table 30: Antidepressants Market, Generalized Anxiety Disorder, Global, Treatment Usage Patterns (millions), 2011–2018 50 Table 31: Antidepressants Market, Generalized Anxiety Disorder, Global, Market Segmentation by Geography ($m), 2004–2011 53 Table 32: Antidepressants Market, Generalized Anxiety Disorder, Global, Market Segmentation by Geography ($m), 2011–2018 53 Table 33: Antidepressants Market, Panic Disorder, Global, Revenue ($m), 2004–2011 58 Table 34: Antidepressants Market, Panic Disorder, Global, Revenue ($m), 2011–2018 58 Table 35: Antidepressants Market, Panic Disorder, Global, Annual Cost of Therapy ($), 2004–2011 59 Table 36: Antidepressants Market, Panic Disorder, Global, Annual Cost of Therapy ($), 2011–2018 59 Table 37: Antidepressants Market, Panic Disorder, Global, Treatment Usage Patterns (millions), 2004–2011 60 Table 38: Antidepressants Market, Panic Disorder, Global, Treatment Usage Patterns (millions), 2011–2018 61 Table 39: Antidepressants Market, Panic Disorder, Global, Market Segmentation by Geography ($m), 2004–2011 63 Table 40: Antidepressants Market, Panic Disorder, Global, Market Segmentation by Geography ($m), 2011–2018 63 Table 41: Antidepressants Market, Global, Revenues by Geography ($bn), 2004–2011 66 Table 42: Antidepressants Market, Global, Revenues by Geography ($bn), 2011–2018 67 Table 43: Antidepressants Market, The US, Revenue ($bn), 2004–2011 68 Table 44: Antidepressants Market, The US, Revenue Forecast ($bn), 2011–2018 68 Table 45: Antidepressants Market, The US, Annual Cost of Therapy ($), 2004–2011 69 Table 46: Antidepressants Market, The US, Annual Cost of Therapy ($), 2011–2018 69 Table 47: Antidepressants Market, The US, Treatment Usage Patterns (millions), 2004–2011 70 Table 48: Antidepressants Market, The US, Treatment Usage Patterns (millions), 2011–2018 70 Table 49: Antidepressants Market, EU5, Revenue ($bn), 2004–2011 72 Table 50: Antidepressants Market, EU5, Revenue Forecast ($bn), 2011–2018 72 Table 51: Antidepressants Market, EU5, Annual Cost of Therapy ($), 2004–2011 73 Table 52: Antidepressants Market, EU5, Annual Cost of Therapy ($), 2011–2018 73 Table 53: Antidepressants Market, EU5, Treatment Usage Patterns (millions), 2004–2011 74 Table 54: Antidepressants Market, EU5, Treatment Usage Patterns (millions), 2011–2018 74 Table 55: Antidepressants Market, Japan, Revenue ($m), 2004–2011 76 Table 56: Antidepressants Market, Japan, Revenue ($m), 2011–2018 76 Table 57: Antidepressants Market, Japan, Annual Cost of Therapy ($), 2004–2011 77 Table 58: Antidepressants Market, Japan, Annual Cost of Therapy ($), 2011–2018 77 Table 59: Antidepressants Market, Japan, Treatment Usage Patterns (millions), 2004–2011 78 Table 60: Antidepressants Market, Japan, Treatment Usage Patterns (millions), 2011–2018 78 Table 61: Antidepressants Market, Pipeline, 2012 79 Table 62: Lundbeck, Antidepressant Pipeline Products, 2011 87 Table 63: AstraZeneca, Antidepressants Pipeline, 2011 89 Table 64: Eli Lilly and Company, Antidepressants Pipeline, 2011 90 Table 65: Forest Laboratories, MDD, Pipeline Products, 2011 91 1.2 List of Figures Figure 1: Antidepressants Market, Global, Revenue ($bn), 2004–2018 21 Figure 2: Antidepressants Market, Global, Annual Cost of Therapy ($), 2004–2018 23 Figure 3: Antidepressants Market, Global, Therapeutic Usage Patterns (millions), 2004–2018 24 Figure 4: Antidepressants Market, MDD, Global, Revenue ($bn), 2004–2018 30 Figure 5: Antidepressants Market, MDD, Global, Annual Cost of Therapy ($), 2004–2018 31 Figure 6: Antidepressants Market, MDD, Global, Treatment Usage Patterns (millions), 2004–2018 32 Figure 7: Antidepressants Market, MDD, Global, Market Segmentation by Geography ($bn), 2004–2018 34 Figure 8: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Revenue ($bn), 2004–2018 39 Figure 9: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Annual Cost of Therapy ($), 2004–2018 40 Figure 10: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Treatment Usage Patterns (millions), 2004–2018 41 Figure 11: Antidepressants Market, Obsessive-Compulsive Disorder, Global, Market Segmentation by Geography ($m), 2004–2018 43 Figure 12: Antidepressants Market, Generalized Anxiety Disorder, Global, Revenue ($bn), 2004–2018 47 Figure 13: Antidepressants Market, Generalized Anxiety Disorder, Global, Annual Cost of Therapy ($), 2004–2018 48 Figure 14: Antidepressants Market, Generalized Anxiety Disorder, Global, Treatment Usage Patterns (millions), 2004–2018 50 Figure 15: Antidepressants Market, Generalized Anxiety Disorder, Global, Market Segmentation by Geography ($m), 2004–2018 52 Figure 16: Antidepressants Market, Panic Disorder, Global, Revenue ($m), 2004–2018 58 Figure 17: Antidepressants Market, Panic Disorder, Global, Annual Cost of Therapy ($), 2004–2018 59 Figure 18: Antidepressants Market, Panic Disorder, Global, Treatment Usage Patterns (millions), 2004–2018 60 Figure 19: Antidepressants Market, Panic Disorder, Global, Market Segmentation by Geography ($m), 2004–2018 63 Figure 20: Antidepressants Market, Global, Revenues by Geography ($bn), 2004–2018 66 Figure 21: Antidepressants Market, The US, Revenue ($bn), 2004–2018 68 Figure 22: Antidepressants Market, The US, Annual Cost of Therapy ($), 2004–2018 69 Figure 23: Antidepressants Market, The US, Treatment Usage Patterns (millions), 2004–2018 70 Figure 24: Antidepressants Market, EU5, Revenue ($bn), 2004–2018 72 Figure 25: Antidepressants Market, EU5, Annual Cost of Therapy ($), 2004–2018 73 Figure 26: Antidepressants Market, EU5, Treatment Usage Patterns (millions), 2004–2018 74 Figure 27: Antidepressants Market, Japan, Revenue ($m), 2004–2018 75 Figure 28: Antidepressants Market, Japan, Annual Cost of Therapy ($), 2004–2018 76 Figure 29: Antidepressants Market, Japan, Treatment Usage Patterns (millions), 2004–2018 77 Figure 30: Antidepressants Market, SWOT Analysis, Lundbeck, 2011 88 Figure 31: Antidepressants Market, SWOT Analysis, AstraZeneca, 2011 89 Figure 32: Antidepressants Market, SWOT Analysis, Eli Lilly and Company, 2011 90 Figure 33: Antidepressants Market, SWOT Analysis, Forest Laboratories, 2011 91 Figure 34: Antidepressants Market, SWOT Analysis, Pfizer Inc., 2011 93 Figure 35: Antidepressants Market, SWOT Analysis, GlaxoSmithKline, 2011 94 Figure 36: Antidepressants Market, SWOT Analysis, Bristol-Myers Squibb, 2011 95 Figure 37: GBI Research Market Forecasting Model 109 Companies mentioned H. Lundbeck AstraZeneca Eli Lilly and Company Forest Laboratories Pfizer Inc. GlaxoSmithKline Bristol-Myers Squibb Company To order this report: Drug_and_Medication Industry: Antidepressants Market to 2018 – Despite Safety Concerns, Selective Serotonin Re-uptake Inhibitors (SSRIs) Continue to Dominate in the Absence of Effective Therapeutic Alternatives __________________________ Contact Nicolas: nicolasbombourg@reportlinker.com US: (805)-652-2626 Intl: +1 805-652-2626

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Obsessive hoarding: “It’s the biggest nightmare”

By Denise Crosby
dcrosby@stmedianetwork.com

October 25, 2012 5:54PM

Dave Skeberdis sorts through some of his belongings on the front porch of his Aurora home on Wednesday, October 24, 2012. The city of Aurora has deemed the residence unsuitable for habitation after discovering it had mold spore counts twice to 15 times normal levels. | Jeff Cagle~For Sun-Times Media

Breakout

Breakout text.






Updated: October 26, 2012 2:44AM

At first, Dave Skeberdis seemed eager to put a face on the condition called compulsive hoarding.

He even described himself as “a hoarder” to the media after the city of Aurora deemed his property unfit for habitation upon discovering hundreds of birds in his garbage-filled home.

“I am obsessed,” the 57-year-old IT technician admitted, after indicating he’d cooperate with the city in its efforts to clean up his townhome on Shadybrook Lane. But after meeting with officials, he changed his mind because of the almost $14,000 bill he’d be stuck with — forcing the city on Wednesday to seek an emergency court order to clean the place up because of the health threat it posed to the community.

Skeberdis also back-pedaled on the description of himself as a hoarder, saying the term — like the number of birds in his home — had been greatly exaggerated. Instead, he said, “I just let things get out of control.”

Bill Scheibe Jr., who’s been following the Aurora headlines closely from his Joliet home, isn’t surprised at this response. The former sports columnist and editor for The Herald-News had warned his intensely proud mother that someday she’d be found dead under piles of rubbish in her Worth home — with TV cameras planted outside her door when they removed her body. But his scare tactics did little to convince the 72-year-old woman, who also had more 40 cats in her home, that she needed help.

In February, his prediction — TV cameras and screamy headlines included — came true.

Yet, “If you would have called her a hoarder, she would have spit on you,” said Scheibe, who would meet his mother in the driveway when visiting because of the conditions inside her home.

Despite the popularity of reality shows about the compulsive hoarding, experts say relatively little is known about the disorder. According to Dr. David Leader, head of Dreyer Medical Center’s Psychiatry Department, “there’s not a huge amount of literature out there,” in part “because so many hoarders hide from us” due to the shame involved.

Although it has long been considered a dimension of obsessive compulsive disorder, Leader says that attitude has begun to shift in the past couple years. Obsessive hoarding is currently being considered as a diagnosis all its own in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the official book of the American Psychiatric Association.

Hoarding knows no social or economic boundaries, say experts. It can start in childhood but doesn’t become severe until adulthood. It runs in families and frequently accompanies depression, social anxiety, bipolar disorder or impulse control. At its center is not so much collecting or saving things, Leader says, as it is the fear of throwing something away.

“Think about how you don’t want to throw out old checkbooks or income tax statements because you think you might need them someday,” he said, “then manifest that a hundred or a thousand times.”

Animal hoarders, Leader added, truly love the creatures they collect and don’t realize the harm they are doing. Those who struggle with OH rarely have insight into the reality of their problem, which makes them much harder to treat than OCD.

The city of Aurora deals with hoarding cases infrequently, maybe one every couple of years, said spokesman Kevin Stahr. The Property Standards Division is in charge of getting the property cleaned up for the safety and well-being of the neighborhood. In extreme cases, officials also reach out to health service experts for assistance.

Animal hoarders are treated differently from standard hoarders because there are ordinances related to the care and treatment of animals, he said. If the city comes across a case, the homeowner is referred to a mental health expert. That’s particularly important if animals are involved because there is such an emotional attachment.

“It is a balance when these situations occur for several factors,” Stahr added. “We have to work with the homeowner to see how we can assist them, check the safety of any animals in the home, and to ensure the well-being of the impacted neighborhood.”

A couple years before his mother’s death, Scheibe said the village of Worth tried to work with Margareta after neighbors complained about the garbage in her yard. But nothing ever changed, he said, and his mom even changed her will “because she thought I was the one who turned her in.”

Scheibe said he watched his mother, who grew up in impoverished post-World War II Germany, gradually develop more hoarding tendencies as he became a teen. But it wasn’t until his father suffered a stroke in the mid-’90s and eventually developed dementia that the problem spiraled out of control. His father died on Christmas Eve 2010; and after Margareta’s body was found a couple months later, Scheibe said he had a difficult time searching for his father’s urn under the mounds of rubbish.

These are not pleasant memories for the Joliet man. But he’s more than willing to talk about his personal hell because of the need to put more faces on this problem.

“It’s the biggest nightmare you can imagine,” said Scheibe. “I feel bad for anyone who has to deal with it, including neighbors and the city of Aurora, who are left to clean up the mess.”

Scheibe compares the problem to heroin and meth: It spirals so quickly out of control with a dismal success rate even after the problem is addressed. And like those two deadly drugs, “we are just now starting to talk about how bad it is.”

While Kane County “is years ahead” of other places because of its mental health court, Leader agrees more can be done to facilitate training of mental health, social services, public health and housing, police and fire officials.

“It’s hard to get them help,” he said. “There is more acceptance, but we are not there yet.”