bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of LY354740, a Novel Glutamatergic Metabotropic Agonist, on Nonhuman Primate Hypothalamic-Pituitary-Adrenal Axis and Noradrenergic Function
Authors: Coplan Jeremy D. , Mathew Sanjay J. , Smith Eric L.P. , Trost Ronald C. , Scharf Bruce A. , Martinez Jose , Gorman Jack M. , Monn James A. , Schoepp Darryle D. , Rosenblum Leonard A.
Published: August 2016

The search for novel anxiolytics and antidepressants has focused on compounds with the potential to reduce excessive hypothalamic-pituitary-adrenal (HPA) axis activity. L-glutamate, an excitatory neurotransmitter ubiquitously present within the central nervous system, conceivably plays an important role in activating the neural sites involved in stress modulation. Deactivation of the HPA axis by glutamatergic neurotransmission modulation may represent a novel therapeutic approach. Accordingly, the acute intravenous effects of the novel metabotropic (mGlu2/3) agonist LY354740 were tested on bonnet macaques (Macaca radiata) undergoing acute infusions of yohimbine, a noradrenergic stimulant. Dependent measures were the magnitude of the increase of plasma cortisol and plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) customarily elicited by yohimbine. Next, the effects of 6 weeks of chronic oral administration of LY354740 on baseline (postcapture) plasma cortisol and MHPG levels in comparison to the identical measure in untreated controls were assessed. Subjects chronically treated with LY354740 received yohimbine infusions which were compared to yohimbine infusions and saline infusions in non-LY354740-treated subjects. Preliminary evidence supports the view that acute LY354740 infusion resulted in a marked diminution of yohimbine-induced stress response, as manifest by a substantial attenuation of cortisol and MHPG response observed in comparison to the saline-treated yohimbine condition. Chronic oral administration of LY354740 led to postcapture baseline cortisol levels which were markedly reduced (∼50%) in comparison to untreated control subjects; however, there were no significant parallel differences in MHPG levels. Yohimbine infusions elicited an increase in cortisol and MHPG levels in both LY354740-treated and non-LY354740-treated subjects, in comparison to declines in cortisol values observed following vehicle infusions (group X time interaction; P<.0001). Chronic LY354740-treated subjects failed to achieve cortisol levels comparable in range to those of untreated subjects primarily because of their low baseline cortisol levels. In contrast, despite equivalent baselines, yohimbine-induced MHPG values were increased overall in the chronically treated group compared to the saline and yohimbine-alone groups. Thus, LY354740 markedly reduced the acute corticoid and noradrenergic response elicited by yohimbine infusion. Chronic administration of LY354740 appears to present a safe and effective mechanism to markedly down-modulate the HPA axis while retaining noradrenergic responsivity.
Long-Term Cardiovascular Effects of Mixed Amphetamine Salts Extended Release in Adults With ADHD
Authors: Weisler Richard H. , Biederman Joseph , Spencer Thomas J. , Wilens Timothy E.
Published: August 2016

Objective: To assess long-term cardiovascular effects of mixed amphetamine salts extended release (MAS XR) in adults with attention-deficit/hyperactivity disorder (ADHD) combined subtype.

Methods: 223 otherwise healthy adults (≥18 years of age) with ADHD combined subtype were exposed to ≤24 months of MAS XR (20–60 mg/day). Resting sitting diastolic blood pressure (DBP) and systolic blood pressur (SBP) and pulse were measured at baseline and weekly, then monthly during long-term treatment. Twelve-lead electrocardiograms were obtained at screening/baseline, weekly, then at 3-and 6-month intervals up to 24 months.

Findings: With MAS XR 20–60 mg/day, mean changes in DBP (1.3±9.2 mm Hg; P=.O42), SBP (2.3±12.5 mmHg; P=.OO6), and pulse (2.1±13.4 bpm; P=.019) were small and not clinically significant. A clinically insignificant increase in QTcB (corrected by Bazett's formula) interval (7.2 msec; P<.001) was observed at 24 months. No subject exhibited QTcB interval >480 msec (QTcF [corrected by Fridericia's formula] >454 msec). Seven subjects discontinued due to a car-diovascular adverse event (hypertension, n=5, palpitation/tachycardia, n=2); none of these events was reported as serious. Few subjects with normal baseline vital signs (using approved parameters at the time of study initiation) exhibited clinically significant abnormalities at end point; several subjects with borderline baseline values exhibited shifts to abnormal values during MAS XR therapy.

Conclusion: Cardiovascular effects of long-term MAS XR (≤60 mg/day) were minimal in otherwise healthy adults with ADHD. Nevertheless, vital signs should be monitored prior to and during treatment with any stimulant.
Addressing Inadequacies in the Care of Patients with Schizophrenia and Bipolar Disorder
Authors: Vogel-Scibilia Suzanne
Published: August 2016

Physicians treating patients with serious mental illness need to overcome a number of hurdles to ensure that appropriate health care is provided to these often underserved patients. The Community Mental Health Act of 1963 established community mental health centers (CMHCs) that provide patients with access to psychiatric care, with the unintended consequence of separating mental health care from physical care. CMHCs do not always have adequate resources to screen, monitor, and treat cardiovascular disease (CVD): they lack sufficient funding, have limited staff, and often do not have laboratory facilities for monitoring lipids and blood glucose.
Conclusion: Summary and Recommendations
Authors: Newcomer John W. , Nasrallah Henry A. , McIntyre Roger S. , Hennekens Charles H. , Vogel-Scibilia Suzanne
Published: August 2016

Cardiovascular disease (CVD) remains the number one cause of death in the United States and most developed countries and is expected to remain so for much of this century. Rates of obesity have increased 2–4-fold over the last 2 decades in the US and this condition is linked with early development of hypertension, hyperlipidemia, diabetes, and atherosclerosis. The prevalence of diabetes is also increasing, and the rise of diabetes in young people 18–29 years of age was 40% in the period between 1990 and 2001. The World Heart Federation (WHF) has estimated that CVD will become the number one cause of death in the world by 2020, surpassing infectious disease in developing countries. Metabolic disorders are on the rise in general. However, as highlighted in the discussions presented in this supplement, patients with serious mental illness appear to represent a special population who are particularly vulnerable, with rates that surpass the general population.
The Epidemiology of Adult ADHD
Authors: Spencer Thomas J.
Published: August 2016

Until recently, little was known about the epidemiology of attention-deficit/hyperactivity disorder (ADHD) in adults. Bottom-up studies following children with ADHD into adolescence had shown variable rates of persistence, some of which depended on the definitions used. The traditional diagnosis was complicated by the introduction of theDiagnostic and Statistical Manual of Mental Disorders, Third Edition, which stated that ADHD could be diagnosed with inattentive symptoms alone. This resulted in diagnostic inconsistency as earlier investigations demanded the presence of hyperactivity while others did not. Diagnosis also depended on the site, the cohort, whether interviews versus rating scales were employed, and whether the subject or their parent were the source of information.
Introduction and Clinical Presentations
Authors: O'Reardon John P.
Published: August 2016

Treatment-resistant depression (TRD) may be defined, both pragmatically and clinically, as the failure of an episode of major depression to respond fully to the adequate administration of a treatment that is known to be effective (Slide 1). It is important for the clinician, in terms of not inadvertently reinforcing stigma, to bear in mind, as the definition indicates, that it is the disease state or episode of depression that is treatment resistant, and not the patient, per se. The treatment that has failed must be a valid one and must also have been delivered effectively before one can conclude that this episode of major depression is resistant to any particular level of treatment.
Augmentation Strategies
Authors: Thase Michael E.
Published: August 2016

When patients do not respond to an initial course of antidepressant treatment, clinicians may opt for a number of alternatives. First, re-evaluating the diagnosis to make sure that no comorbidities were missed, and that the diagnosis of major depressive disorder (MDD) is accurate, particularly with respect to recognition of clinical features that might suggest previously unrecognized bipolarity or psychotic features. Secondly, clinicians should ensure that the patient has adhered to the recommended medication. When finally reaching the point of certainty or near certainty that the patient has not benefited from a truly adequate course of treatment lasting ≥8 weeks, the next major considerations usually are to either switch antidepressants or to augment the original choice of treatments. Lastly, selection of the most appropriate “next choice” strategy should take into account the tolerability of and degree of improvement observed with the initial antidepressant medications. Many clinicians prefer to switch patients who have poorer tolerability and minimal symptom improvement and try to augment therapy when the initial antidepressant has been well tolerated and resulted in some degree of symptom improvement.
Switching Antidepressants vs. Conventional Augmentation Strategies
Authors: Papakostas George I.
Published: August 2016

Antidepressants have been available since the 1950s, when the monoamine oxidase inhibitors were first discovered. Since then, our armamentarium of antidepressants has progressively expanded with the discovery of the tricyclic antidepressants (TCAs) in the 1960s, the selective serotonin reuptake inhibitors (SSRIs) in the 1980s, and, subsequently, the serotonin norepinephrine reuptake inhibitors (SNRIs), and other agents possessing a diverse mechanism of action including buproprion, and mirtazapine.
ADHD in Adults — A Familiar Disease with Unfamiliar Challenges
Authors: Faraone Stephen V.
Published: August 2016

What exactly is known today about the impact of the adult form of attention-deficit/hyperactivity disorder (ADHD) in society?:

In a recent study to examine the societal impact of attention-deficit/hyperactivity disorder (ADHD), 500 patients diagnosed with ADHD and 501 participants with no substantial signs or symptoms of ADHD were studied. Subjects were asked several questions about their quality of life, employment, job satisfaction, and other aspects of their well-being and functionality. Income, which is an important marker for the degree of productivity for an individual in society, was also assessed. ADHD can profoundly affect the performance of individuals in the workplace (Slide 1), and this study found that having ADHD reduced an individual's income by an average of ∼$10,000 per year. If that loss of income is extrapolated to all adults in the United States who have ADHD, it suggests that the economy is losing around $70 billion a year to $115 billion a year in productivity, as measured by loss of income. The range was broad because different models with varying assumptions were applied to project income loss over time. Nevertheless, based on these numbers, it is reasonable to estimate that the population is losing ∼$100 billion annually in productivity due to ADHD.

Income loss was found at all levels of education, but it was greatest among patients who had advanced degrees of education; so it seems that the disease may have a more pronounced impact on income among those in the higher income brackets.
Altered Immune Function In Autism
Authors: Delgiudice-Asch Gina , Hollander Eric
Published: August 2016

Recent studies of the pathogenesis of autism have suggested that this disorder may have an autoimmune basis in some patients. Observations have been made regarding cellular and humoral immune dysfunction, abnormalities associated with the complement system and major histocompatibility complex gene expression, differences in soluble mediators of the immune response, and the presence of antibrain and antimyelin autoantibodies. In this article, we review these experimental and clinical observations, and examine preliminary efforts using immunomodulatory therapies to treat autism.
Cognitive Impairment in Schizophrenia and Implications of Atypical Neuroleptic Treatment
Authors: Harvey Philip D. , Keefe Richard S. E.
Published: August 2016

Cognitive impairment is considered a central feature of schizophrenia. Many aspects of cognition are impaired in schizophrenia. Careful evaluation of the relationship between cognitive impairment and the other symptoms of schizophrenia has revealed several important findings. In this article, we discuss these findings, the effects of typical neuroleptic therapy on cognitive impairment, and important issues to address in cognitive enhancement studies in schizophrenia.
Molecular Biology and Psychiatry: New Methodologies and Techniques
Authors: Marracci Silvia , Marazziti Donatella , Ori Michela , Nardi Irma
Published: August 2016

Molecular biology techniques are used widely in the study of central nervous system structures and functions. The possibilities offered by such methodologies are attracting an increasing number of researchers for their versatility and for their promise to permit the investigation of different proteins, step by step, from gene transcription to posttranscriptional processes. Of particular interest is the study of the enzymes responsible for the synthesis and catabolism of neurotransmitters, as well as neuroreceptors.

Today, a general knowledge of such methods and of how they can be used in CNS studies is fundamental for psychiatrists, even if not directly involved in basic research, since it can be easily predicted that the next century will be characterized by an increasing application of these approaches to biological psychiatry. In this article, we describe gene expression methods and the aim of gene expression studies. We also present some general information on the various steps and techniques used for different purposes in biological psychiatry.
A Selective Pattern of Neuropsychological Dysfunction in Patients With Panic Disorder-Agoraphobia
Authors: Toni Cristina , Cappa Stefano , Perugi Giulio , Boldrini Maura , Frare Franco , Pedri Simone , Medda Pierpaolo , Cassano Giovanni B.
Published: August 2016

The neuropsychological performance of 19 unmedicated patients with panic disorder (PD) was compared with 15 age- and education-matched control subjects. The test results indicate a selective pattern of neuropsychological dysfunctions in patients with PD, suggestive of an involvement of the right frontal and temporoparietal brain areas.
Is Lifetime Separation Anxiety a Manifestation of Panic Spectrum?
Authors: Fagiolini Andrea , Shear M. Katherine , Cassano Giovanni B. , Frank Ellen
Published: August 2016

Separation anxiety has long been of interest in psychiatry. The term refers to both a phenomenon of normal psychological development and to the symptoms of a common childhood psychiatric disorder, classified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and the International Statistical Classification of Diseases and Related Health Problems, Tenth Edition (ICD 10), as separation anxiety disorder. Available epidemiological studies suggest a prevalence rate of this disorder of about 4%. Treatment studies using cognitive behavioral therapy and/or medication are reported in the literature. There is also evidence that symptoms of separation anxiety may occur in adulthood, though this is far less widely known. We consider childhood and adult separation anxiety to be a component of panic spectrum, described in other papers of this issue.

A small and somewhat confusing literature addresses the question of outcome of childhood separation anxiety disorder, with support for a weak association between childhood separation anxiety and adult panic disorder. We believe there is a suggestion of a stronger association of the childhood condition with persistence of a similar syndrome of adult separation anxiety. Symptoms of adult separation anxiety may be a manifestation of panic spectrum, as we suggest. Such symptoms may represent a separate, specific clinical entity, or symptomatic separation anxiety may occur as a manifestation of a range of Axis I disorders, and may respond to treatment of these disorders. In any case, we urge researchers and clinicians to begin to attend to the possibility that adult psychiatric patients may suffer from clinically significant symptoms of adult separation anxiety.
The Role of 5-HT1B/1D Receptors in the Treatment of Migraine
Authors: Waeber Christian
Published: August 2016

Of all known neurotransmitters, 5-HT is the one most frequently mentioned in the pathophysiology of migraine. This review focuses on the relationship between the efficacy of sumatriptan and other migraine agents and their effects on specific 5-HT receptors in rodent models. These agents are seen to have effects on vascular constriction and the release of vasoactive and inflammatory peptides from trigeminovascular sensory neurons. Specific subtypes of the 5-HT1 receptors appear to mediate these effects.
Pharmacology of 5-HT1AReceptors: Critical Aspects
Authors: Borsini Franco
Published: August 2016

Myriad difficulties exist in analyzing the pharmacology of the serotonin 1A (5-HT1A) receptor. The receptor may demonstrate a different activity depending on the tissue or species used for analysis, the agent used, laboratory conditions, and differences between in vitro and in vivo effects of compounds. Affinity for 5-HT receptors also varies widely, presenting difficulties in drawing definitive conclusions on affinity values for various compounds. At least two possibilities exist to explain the diversity of pharmacology of 5-HT receptors. First, it is possible that different 5-HT1Areceptor subtypes exist. Second, the 5-HT1Areceptors may play a far more complex role than previously believed.
Psychogenic Cough and Laryngeal Tics Involving Cough: A Case Report and Review of the Literature
Authors: Gómez-Gil Esther , Sanz Pilar , Toro Josep , de Pablo Joan , Cirera Esteban
Published: August 2016

We present the case of a 27-year-old man treated unsuccessfully for 1 year for chronic cough, who was thought to suffer from psychogenic cough. Vocal tic was suspected by a liaison psychiatry service, and treatment with low-dose haloperidol was successful. This case suggests that more attention to tic syndromes is needed before qualifying persistent idiopathic cough as psychogenic.
WCA Recommendations for the Long-Term Treatment of Posttraumatic Stress Disorder
Authors: Stein Dan J. , Bandelow Borwin , Hollander Eric , Nutt David J. , Okasha Ahmed , Pollack Mark H. , Swinson Richard P. , Zohar Joseph
Published: August 2016

Posttraumatic stress disorder (PTSD) is a common and disabling condition. In addition to combat-related PTSD, the disorder occurs in civilians exposed to severe traumatic events, with the community prevalence rate for the combined populations reaching as high as 12%. If left untreated, PTSD may continue for years after the stressor event, resulting in severe functional and emotional impairment and a dramatic reduction in quality of life, with negative economic consequences for both the sufferer and society as a whole. Although PTSD is often overlooked, diagnosis is relatively straight-forward once a triggering stressor event and the triad of persistent symptoms—reexperiencing the traumatic event, avoiding stimuli associated with the trauma, and hyperarousal—have been identified. However, comorbid conditions of anxiety and depression frequently hamper accurate diagnosis. Treatment for PTSD includes psychotherapy and pharmacotherapy. The latter includes selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase inhibitors. Only SSRls have been proven effective and safe in long-term randomized controlled trials. Current guidelines from the Expert Consensus Panel for PTSD recommend treatment of chronic PTSD for a minimum of 12–24 months.
Neurobiological Models of Attention-Deficit/Hyperactivity Disorder: A Brief Review of the Empirical Evidence
Authors: Schulz Kurt P. , Himelstein Jessica , Halperin Jeffrey M. , Newcorn Jeffrey H.
Published: August 2016

Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric disorder characterized by inattention, impulsivity, and overactivity that begins in childhood. While considerable research has focused on the neurobiological substrates of this disorder, the specific nature of the brain dysfunction in ADHD has remained elusive. However, early data from pharmacological treatment studies, as well as from basic research in animals and humans, initially led several investigators to develop neurobiological models of ADHD. These models of ADHD and more recent evidence from neuropsychological, neuroimaging, neurochemical, and genetic research are briefly reviewed. While not completely consistent, the empirical data suggest that dysfunction in prefrontal-striatal neural circuits, as well as in brain stem catecholamine systems that innervate these circuits, may underlie the executive function deficits in ADHD.
Recent Developments in the Neuroendocrinology of Posttraumatic Stress Disorder
Authors: Yehuda Rachel
Published: August 2016

In 1980, the diagnosis of posttraumatic stress disorder (PTSD) was established to recognize that exposure to events such as rape, physical assault, torture, or combat can leave long-lasting psychological scars in persons who undergo these experiences. The intention of the diagnosis was to acknowledge that exposure to a traumatic event was a sufficient explanation for the occurrence of longterm psychological problems. Prior to this formulation, stressful events were thought to precipitate symptoms that would resolve over time. The symptoms manifested by persons following adverse events were characterized as transient adjustment reactions. Longerterm symptoms were considered to be a reflection of underlying neurosis, rather than stress exposure per se.

The diagnosis of PTSD provided a paradigm for acknowledging that exposure to devastating trauma can produce symptoms that can be quite severe and chronic in nature. Although many of the symptoms of PTSD were similar to those that occur in other anxiety or mood disorders, the hallmark of PTSD appeared to be a preoccupation with the traumatic event and a resultant set of behavioral changes that occurred because of attempts to avoid reminders of the event.
The Obsessive Compulsive Spectrum: A Survey of 800 Practitioners
Authors: Hollander Eric , Twersky Rebecca , Bienstock Carol
Published: August 2016

The obsessive-compulsive (OC) spectrum is a group of related disorders that appear to share symptomatology, neurobiology, and treatment response with obsessive-compulsive disorder. To collect data on the appreciation of the OC spectrum concept among clinicians, 800 participants completed a questionnaire to help determine their understanding and appreciation of this concept, at a workshop on the OC spectrum.
Circadian Rhythm Sleep Disorders as a Possible Side Effect of Fluvoxamine
Authors: Hermesh Haggai , Lemberg Hadas , Abadi Judith , Dagan Yaron
Published: August 2016

Sleep problems, day somnolence, and fatigue as a result of psychotropic drugs are very common. Psychiatrists usually consider these effects a result of insomnia and treat them by prescribing sleeping pills or other benzodiazepine agents.

We describe here 10 cases of circadian rhythm sleep disorders (CRSD)—and not merely insomnia—as a possible side effect of fluvoxamine (FVA). Two other serotonin reuptake inhibitors, fluoxetine and clomipramine, did not induce CRSD in any of these 10 patients. We speculate that FVA-induced CRSD is caused by the effect of FVA on serotonin and melatonin levels in the central nervous system.

CRSD as a side effect of FVA can be treated by replacing the suspected FVA or adding melatonin to a beneficial FVA treatment. Thus, it is important to be aware of possible iatrogenic CRSD in order to treat appropriately. Prospective studies are needed to confirm our observation and to study the influence of other psychotropic drugs on sleep-wake schedule.
The Consequences of Uncontrolled Epilepsy
Authors: Sperling Michael R.
Published: August 2016

The consequences of epilepsy can be quite severe and include shortened lifespan, excessive bodily injury, neuropsychological and psychiatric impairment, and social disability. There is evidence that seizures cause brain injury, including neuronal death and physiological dysfunction. Mortality rates are 4—7 times higher in people with medically refractory seizures, and injury rates are substantial, ranging from one per 20 person-years to as much as one per 3 person-years. Quality of life is impaired in epilepsy, and relates to seizure control. Psychosocial disabilities, including lower social interaction with reduced marriage rates and reduced employment levels, are more common in people with refractory seizures. Complete seizure control is desirable, since seizures potentially constitute a serious threat to health and well-being. Therefore, satisfactory seizure control should be defined as having no seizures. Treatment should be directed to preventing seizures whenever possible and achieving control early in the course of illness. The risks of uncontrolled seizures outweigh the risks of aggressive medical or surgical therapy.
The “Prodromal” Patient: Both Symptomatic and At-Risk
Authors: Woods Scott W. , Miller Tandy J. , McGlashan Thomas H.
Published: August 2016

This article discusses conceptual issues relevant to the prospective diagnosis of the schizophrenic prodrome. Recent efforts to diagnose these patients with operational criteria based on current symptoms are reviewed. Symptomatic patients so identified appear to be treatment-seeking and to have mild cognitive impairments. In addition to being currently symptomatic, these patients are imminently at risk for progression of illness and development of schizophrenia. Data from three international centers suggest that this risk is approximately 40% over the next year of follow-up if untreated. The implications of the reviewed data for the appropriateness of the term “prodromal” and for treatment/prevention research for these patients are discussed.
Trichotillomania in a Schizophrenia Patient
Authors: Kähkönen Seppo
Published: August 2016

Comorbidity of trichotillomania with different psychiatric disorders is common. However, until recently there have been no reports of trichotillomania in schizophrenia patients. In this article, the case of a female schizophrenia patient with trichotillomania is reported. Her schizophren was being treated with risperidone. Citalopram was later administered as an augmentation to risperidone. This combination therapy presented a partial response of trichotillo mania without exacerbating schizophrenia symptoms.
Presence of Irritability During Depressive Episodes in Bipolar Disorder
Authors: Deckersbach Thilo , Perlis Roy H. , Frankle W. Gordon , Gray Stephen M. , Grandin Louisa , Dougherty Darin D. , Nierenberg Andrew A. , Sachs Gary S.
Published: August 2016

Background:This study examined the prevalence of irritability in patients with bipolar I disorder during an episode ofDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)major depression who do not meet criteria for a mixed episode.

Method:A chart review of 111 patients with bipolar I disorder treated at the Massachusetts General Hospital Bipolar Clinic between 1998 and 2000 identified 34 patients who met criteria for aDSM-IVmajor depressive episode in the absence of (1) mood elevation and/or (2) irritability associated with any additional above thresholdDSM-IVsymptoms of mania. Data gathered from the charts utilized prospective ratings made routinely at each clinic visit using the Clinical Monitoring Form (CMF), a structured assessment instrument which includes modified versions of the mood modules of the Structured Clinical Interview forDSM-IV.Data from these 34 patients were reviewed to determine the presence of irritability.

Results:The frequency of abnormal irritability in these 34 patients followed a bimodal distribution: 26% of the patients showed abnormal irritability ≥75% of the time, compared with 68% of the patients with abnormal irritabihty ≤30% of the time. Of the high-irritability patients, psychomotor agitation was rated as definitely present to a significant degree in 44%. Talkativeness and distractibility were rated present but subthreshold in one patient each. All other symptoms ofDSM-IVmania were absent.

Conclusion:Approximately 25% of patients with bipolar I disorder who meet criteria for aDSM-IVmajor depressive episode also experienced substantial irritability in the absence of associated symptoms of mania. Our results suggest that abnormal irritability is not limited to mania or mixed states.
Trail Making and Olfaction in Schizophrenia: Implications for Processing Speed
Authors: Goudsmit Nora , Wolitzky Rachel , Seckinger Regine Anna , Corcoran Cheryl , Stanford Arielle , Rosenfield Paul , Goetz Ray , Malaspina Dolores
Published: August 2016

Background:

Previous research has established a relationship between smell identification deficits (SID) and particular aspects of cognitive function among patients with schizophrenia.

Objective:

To expand the extant literature, we examined the relationship between SID and the Trail Making Test to determine if processing speed is related to SID.

Methods:

Our sample included 60 inpatients from the New York State Psychiatric Institute's Schizophrenia Research Unit. We considered age, deficit syndrome, verbai intelligence quotient, and education in our analyses due to their documented relationship to smell identification ability.

Results:

Trails A errors and Trails A seconds accounted for a significant amount of the variance in University of Pennsylvania Smell Identification Test scores in a regression analysis (R2=.10, P=.008 and R2=.05, P=.04).

Conclusion:

Linking neurocognition to smell identification deficits may prove to be an essential marker for schizophrenia research.
Family Psychoeducation as an Evidence-Based Practice
Authors: Murray-Swank Aaron B. , Dixon Lisa
Published: August 2016

Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia and bipolar disorder. Over 30 randomized clinical trials demonstrated that psychoeducation programs reduce relapse, improve symptomatic recovery, and enhance psychosocial and family outcomes. Recent work supports family psychoeducation strategies for other disorders, including major depression, obsessive-compulsive disorder, and borderline personality disorder. This review summarizes the research evidence supporting prominent models of family psychoeducation. Professional and peer-led family education programs are also reviewed and differentiated from family psychoeducation. Directions for future research studies to enhance the evidence base and inform treatment recommendations are proposed. Finally, strategies for implementation of family psychoeducation in routine clinical practice are discussed.
Implementing Evidence-Based Psychosocial Practices: Lessons Learned from Statewide Implementation of Two Practices
Authors: Moser Lorna L. , DeLuca Natalie L. , Bond Gary R. , Rollins Angela L.
Published: August 2016

Objective: As part of this national project, we examined barriers and strategies to implementation of two evidence-based practices (EBPs) in Indiana.

Background: Despite many advances in the knowledge base regarding mental health treatment, the implementation of EBPs in real-world setting remains poorly understood. The National EBP Project is a multi-state study of factors influencing implementation of EBPs.

Methods: Over a 15-month period we observed eight assertive community treatment (ACT) programs and six integrated dual disorders treatment (IDDT) programs and noted pertinent actions taken by the state mental health agency influencing implementation. We created a database containing summaries of monthly visits to each program and interviews with key leaders. Using this database and clinical impressions, we rated barriers and strategies at each site on seven factors: Attitudes, Mastery, Leadership, Staffing, Policies, Workflow, and Program Monitoring.

Results: At the site level, the most frequently observed barriers were in the areas of leadership, staffing and policies for ACT, and mastery and leadership for IDDT. Overall, barriers were more evident for IDDT than for ACT. Strategies were less frequently noted but generally paralleled the areas noted for barriers. However, our central finding was that ACT was generally more successfully implemented than IDDT throughout the state, and that this difference could be traced in large part to state-level factors relating to historical preparation for the practice, establishment of standards, formation of a technical assistance center, and funding.

Conclusion: In this case study, both state-level and site-specific factors influenced success of implementation of EBPs. To address these factors, the field needs systematic strategies to anticipate and overcome these barriers if full implementation is to be realized.
Lamotrigine in Psychiatry: Pharmacology and Therapeutics
Authors: Jefferson James W.
Published: August 2016

Following the introduction of lamotrigine in 1994 as a treatment for epilepsy in the United States, the drug has seen progressively greater application in psychiatry, particularly as a treatment for bipolar disorder. This review critically evaluates the support for lamotrigine use across a broad range of psychiatric disorders as well as discuss its pharmacology, side-effect profile, and interactions with other medications.
Lamotrigine Augmentation Strategy for Patients with Treatment-Resistant Depression
Authors: Gutierrez Rosben L. , McKercher Ruth , Galea Jason , Jamison Katrina L.
Published: August 2016

Objective:

To investigate if lamotrigine added to an antidepressant regimen reduces the symptoms of major depression in treatment-resistant patients.

Introduction:

Charts were retrospectively reviewed for 34 patients (36–63 years of age) with major depressive disorder who received lamotrigine augmentation to the antidepressant regimen for treatment-resistant depression (TRD). Data collection occurred at baseline and at an average of 30 (Time 2), 78 (Time 3), 167 (Time 6), and 356 days (Time 12), thereafter, using a “Medication Visit by MD” scale for collection of target symptom data at each timepoint.

Results:

Following the addition of lamotrigine to the antidepressant regimen (mean dose of 43, 63, and 113 mg/day for Time 3, Time 6, and Time 12, respectively), a statistically significant reduction of scores was shown as early as Time 2 for target symptoms of depressed mood, loss of interest, anxiety, irritability, (low) energy, and cognitive impairment. The difference from baseline remained statistically significant at Time 3, Time 6, and Time 12 (with the exception of irritability, which was not statistically significant at Time 6). “Patient's response” also reflected statistically significant improvement at each time period compared with baseline. The most common side effect reported and reason for discontinuation was tiredness.

Discussion:

Because TRD is a clinical condition that can present with severe and disabling symptoms, many clinicians are faced with an urgent need to find relief for their patients. Trying to achieve symptom improvement in a timely manner during a medication change can be challenging and difficult. This can be managed by an augmentation strategy using a psychotropic add-on to an existing medication regimen. Our results show the benefits of lamotrigine augmentation to an antidepressant regimen. Prospective, controlled clinical trials with larger sample size are needed to confirm our results.

Conclusion:

In this retrospective chart review, augmentation with lamotrigine was a tolerable and efficacious strategy for treating patients with TRD.
Metabolic and Endocrine Disturbances in Psychiatric Disorders:A Multidisciplinary Approach to Appropriate Atypical Antipsychotic Utilization
Authors: Masand Prakash S. , Culpepper Larry , Henderson David , Lee Scott , Littrell Kimberly , Newcomer John W. , Rasgon Natalie
Published: August 2016

Patients with psychiatric disorders have an increased rate of cardiovascular morbidity and mortality compared with the general population. Metabolic issues such as weight gain, dyslipidemia, diabetes mellitus, diabetic ketoacidosis, and pancreatitis have been reported with the use of antipsychotic agents. Although atypical antipsychotics have not been linked directly to the development of metabolic syndrome, these medications have been shown to increase risk factors that can lead to metabolic and endocrine disturbances. Therefore, clinicians should provide ongoing monitoring for patients who are being treated for psychiatric disorders with these agents. According to the 2004 Consensus Report on Antipsychotics, screening measures should include baseline and follow-up monitoring of personal/family histories, weight (body mass index), waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile.
The Role of Estrogen Therapy in Postpartum Psychiatric Disorders: An Update
Authors: Gentile Salvatore
Published: August 2016

Objectives:

The aim of this review is to assess and summarize the existing literature data about the efficacy of estrogen replacement therapy (ERT) in preventing and treating postpartum psychiatric disorders.

Methods:

An extensive and unrestrictive computerized search (from 1970 to June 2005) on MEDLINE/PubMed, TOXNET, EMBASE, and Cochrane Databases was conducted with the following search terms: estradiol, estrogen-treatment, hormonal treatment, therapy, postpartum depression, postnatal depression, puerperal depression, postpartum blues, postpartum psychosis, lactation, and breastfeeding.

Results:

In assessing available literature information about the role of ERT in preventing and treating puerperal psychiatric diseases, all reviewed studies were found to suffer from severe methodological limitations.

Conclusion:

Well-designed and strictly focused multicenter trials are warranted in order to firmly establish the effectiveness of ERT in puerperal psychiatric disorders.
Posttraumatic Stress Disorder in Medically Ill Patients: What is Known, What Needs to be Determined, and Why is it Important?
Authors: Shemesh Eyal , Stuber Margaret L.
Published: August 2016

Can a medical illness or its treatment qualify as an emotionally traumatic event and can it cause posttraumatic stress disorder symptoms? If so, can the view of a medical illness as a traumatic experience enhance our ability to understand patients' adjustment to illness and their emotional reactions to it? Is it important to identify posttraumatic symptoms and try to address them in medically ill patients? These questions form the backbone for this review. Because many questions remain unanswered (or the answers are not definitive yet), we concisely summarize the issues and present our own view of the most pressing questions for further research.
The Medical Traumatic Stress Toolkit
Authors: Stuber Margaret L. , Schneider Stephanie , Kassam-Adams Nancy , Kazak Anne E. , Saxe Glenn
Published: August 2016

Children and their parents who are exposed to medical life-threat due to illness or injury are at risk for developing symptoms of posttraumatic stress. However, the prevention, detection, and treatment needed are often not available in the acute care settings of the hospital. The National Child Traumatic Stress Network and the Substance Abuse and Mental Health Services Administration have created a set of materials for use by hospital health providers and families that is available for download free from the National Child Traumatic Stress Network website, www.nctsn.org.
How Life Imitates Tourette Syndrome: Reflections of an Afflicted Neuroscientist
Authors: Hollenbeck Peter
Published: August 2016

It is just 3 or 4 weeks after my diagnosis of Tourette syndrome (TS). I have been slowly and conscientiously titrating upward the dose of medication prescribed by my neurologist, waiting skeptically, but not without hope, for some amelioration of my tics. A typical scientist/patient, I have downloaded all available information about this drug from the Internet and have been recalculating the increasing dose in mg/kg body weight every few days. Today I have ducked out of my lab and am doing a very hard training run along the Muddy River in Boston, gearing up for my 21st year of spring and summer races, when I am caught unprepared by a flash of insight. I am speeding along the path with a smoothness and crispness of rhythm that I have seldom felt—maybe just one of those rare great days?—when it occurs to me that I am taking a good deep breath every four strides, in-and-out without fail, every four strides. And only at that moment do I realize that I have always suffered from “skipping” breaths, even on the hardest runs, and have always taken it for granted. Indeed, I have always assumed that all other runners' breathing is as ragged as my own. But now—how remarkable!—I am not missing a single precious breath. This, I realize, is because my phonic tic is gone. So my teammates and competitors must have never missed those breaths, not a single one, because they don't have TS!
The Psychiatry of Tourette Syndrome
Authors: Walkup John T.
Published: August 2016

Tourette syndrome (TS) has been conceptualized as a psychological problem, a neurological problem, and more recently a neurobehavioral problem. Each conceptual model has had an impact on how persons with TS view themselves and how practitioners view individuals with TS, as well as an impact on what both clinicians and patients expect from diagnosis and treatment. This article reviews the common comorbid psychiatric disorders and their relationship to TS, and discusses how the evolving conceptions of TS have impacted psychologically on persons with tics and TS, as well as on the providers who treat them.
The Role of the Mental Health Professional in the Assessment and Management of Irritable Bowel Syndrome
Authors: Gaynes Bradley N. , Drossman Douglas A.
Published: August 2016

Irritable bowel syndrome (IBS), a condition common in the health-care setting, can be especially challenging to manage for both the referring physician and the psychiatrist. Much of this difficulty arises from the understanding and treatment of the disorder from a disease-based biomedical approach rather than a biopsychosocial model. The latter model offers a more effective method to understand the development and clinical expression of IBS, and as a result, directly informs subsequent management. This article defines and describes the epidemiology of IBS, reviews its pathophysiology, identifies the role of psychosocial factors using a biopsychosocial model of IBS, and clarifies the role of the mental health professional in its management. IBS management involves identifying psychiatric comorbidities, assessing the patient's perspective of the role of psychosocial factors, offering psychotherapy directed toward adaptive coping mechanisms, providing psychotropic medication consultation, and engaging in ongoing collaboration with the referring physician.
The Symptoms of Depression in Endocrine Disorders
Authors: Hutto Burton
Published: August 2016

Many endocrine disorders present with symptoms of depression, thus differentiating primary depressive disorders from such endocrine conditions can be challenging. Awareness of the typical clinical picture of endocrine disorders is of primary importance. This article discusses a variety of common and uncommon endocrine disorders and the symptomatology that might suggest a depressive illness, and reviews literature on how endocrinopathies can mimic depression. Emphasis is also placed on the role that stress can play in the pathogenesis of endocrine disorders. Psychiatrists should be familiar with the range of presenting symptoms for endocrine disorders, and they should not rely on the presence or absence of stressors to guide their differential diagnosis between depression and endocrine disorder.
The Genetics of Obsessive-Compulsive Disorder: An Immunologic Perspective
Authors: Rapaport Mark Hyman , McAllister Cathy G.
Published: August 2016

This article presents a rationale for the hypothesis that an autoimmune mechanism might be involved in the pathogenesis of some forms of obsessive-compulsive aborder (OCO). Existing clinical studies suggesting that some individuals with OCD may have an autoimmune-mediated disorder are briefly summarized. A case example where intravenous immunoglobulin G has been successfully used to treat an adult with OCD spectrum disorder is presented. Preclinical data demonstrating that fragments from the group Αβ hemolytic streptococcus cell wall M proteins can generate antibodies that bind to rat and human tissue are also presented.
Psychiatric and Psychological Aspects of Chronic Pain
Authors: Greenfield Daniel P.
Published: August 2016

To gain a better understanding and a more complete assessment of chronic pain syndrome, the psychosocial, psychological, psychodynamic, and psychiatric aspects of this condition should be included in patient evaluation. As illustrated in the two case studies presented, this approach leads to clearer recognition of the biological and psychosocial needs of patients, and allows for more effective treatment measures to be taken.
Cognitive Features of Social Phobia
Authors: Rowa Karen , Antony Martin M. , Swinson Richard P.
Published: August 2016

New cognitive models of social phobia have been developed based, in part, on a growing number of studies suggesting that people with social phobia process information related to social threat differently than people who are not socially anxious and, in some cases, differently than individuals with other anxiety disorders. In addition to providing an overview of recent models of social phobia, this paper reviews the research literature to date on the following aspects of cognition in social phobia: attention, memory, attributions and appraisals, imagery and perspective, and perfectionism.
Psychosocial Treatments for Social Phobia
Authors: Masia Carrie L. , Schneier Franklin R.
Published: August 2016

Increasing recognition of the prevalence and impairment associated with social phobia has spurred the development of effective psychosocial treatments for this disorder. Exposure-based interventions have the most empirical support. This article applies the tripartite model of anxiety to social phobia, describes state-of-the-art psychosocial treatments, and highlights studies on the comparative and combined efficacy of psychological and pharmacologic treatments. Clinical issues related to treatment implementation, limitations of extant psychosocial interventions, and suggestions for future research are also discussed.
Clinical Management of Alcohol Withdrawal
Authors: Myrick Hugh , Anton Raymond F.
Published: August 2016

It has been well known for a number of years that abrupt withdrawal from alcohol following chronic use is associated with adverse consequences, ranging from mild tremors to withdrawal seizures. The overall purposes of treating alcohol withdrawal (AW) are to relieve patient discomfort, to prevent the development of more serious withdrawal symptoms, and to initiate long-term alcohol rehabilitation. Several areas of controversy exist in the clinical management of AW, including the optimal treatment setting, the need for pharmacologic management, and the most appropriate agent to prescribe when medication is deemed necessary. This article reviews the clinical features, general management, and treatment of AW.