bluuebunny/crossref_metadata_2025 huggingface dataset:
The Ecclesiastical Law Centre At Middle Temple Library
Authors: Edgell Janet
Published: August 2016

‘The Ecclesiastical Courts date from 1076, but it is certain that at no time in their long history have they been as busy as they are today. Most of their work arises out of applications for faculties to make alterations in churches, their contents or churchyards. The majority of cases are dealt with without a hearing and in Chambers, but an increasing number have to be decided after a full hearing in Open Court. Most Ecclesiastical Court Judgments are not reported; yet many of them are of considerable interest and together they create a body of Ecclesiastical Law. To meet an undoubted need, the Honourable Society of the Middle Temple has been glad to receive from the Ecclesiastical Judges’ Association transcripts of Judgments, to copy, bind and index them and to make them available for reading and, if desired, copying within the Inn's Library. If provided with copies of future Judgments, the Library will treat them in the same way.’
The Commom Law of the Anglican Communion
Authors: Doe Norman
Published: August 2016

The aim of this short paper is to examine whether and how canon law might be acknowledged as one of the instruments of Anglican unity. First, the study proposes that there are principles of canon law recognised by churches. These are rooted in the canonical tradition shared by churches of the catholic and apostolic tradition. Secondly, the following proposes that the profound similarities between Anglican legal systems indicate, as a matter of descriptive fact, what Anglicans share in common juridically. Together, the principles of canon law and the similarities between Anglican legal systems represent the common law of the Anglican Communion. Thirdly, the study addresses some methodological issues raised in ascertaining and formulating the canonical principles of the Anglicanhis commune. Finally, it suggests some reasons and justifications for an acknowledgement of the Anglican common law.
The General Synod of the Church of Ireland
Authors: Davey Michael
Published: August 2016

Anyone who liked liturgy would have loved Church of Ireland General Synod 2002. There were no less than nine liturgical Bills for consideration. These included traditional and modern forms of marriage service together with a form of prayer and dedication after a civil marriage. It was emphasised in the introduction to this latter Bill that the object was not to provide a service of blessing such as used to be suggested for divorced couples who used not to have access to the marriage service, but to deal with occasions where, for various reasons, couples would undergo a civil ceremony first.
Doctrine and Discipline
Authors: Hope David
Published: August 2016

In a concluding article as co-patron of the Ecclesiastical Law Society,1 the Most Reverend and Right Honourable Dr David Hope offers a reflection on his personal experiences of the interplay between doctrine and discipline encountered during his period of office as Archbishop of York. He focuses on censures of deprivation and disqulification under section 55 of the Ecclesiastical Jurisdiction Measure 1963; deposition appeals; summary revocation of clerical licences; and the Lambeth and Bishopthorpe Register.
Multifunctional Drugs: A Novel Concept for Psychopharmacology
Authors: Stahl Stephen M.
Published: August 2016

Beginning this month and appearing periodically in future columns, “Trends in Psychopharmacology” will cover a new concept and hot topic in the field, namely, that of “multifunctional drugs.” The concept is presented in overview here. Future installments will cover specific drugs in greater depth. Multifunctional drugs include those agents with more than one putative therapeutic mechanism of action.
The Neuroscience of the Tourette Syndrome Spectrum
Authors: Hollander Eric
Published: August 2016

This is the second installment of a double issue on Tourette syndrome (TS) for CNS Spectrums. This issue highlights recent research findings in the field and provides a state-of-the art update on the relationship between TS and obsessive-compulsive disorder (OCD), as well as on the genetics, functional imaging and neurocircuitry, and neuropathology of TS.

I would again like to express my appreciation to the guest editor of this superb issue—Neal Swerdlow, MD, PhD, associate professor of psychiatry at University of California, San Diego, and scientific director of the Tourette Syndrome Association (TSA)—as well as Sue Levi-Pearl of the TSA.

The issue begins with a first-person account of TS by Major League baseball player Jim Eisenreich. His .300 lifetime batting average in professional baseball is a reflection of the superior focus he achieves in sports. In his work as a spokesman on behalf of TS, he serves as a role model, and his work will certainly help to raise awareness about TS so that others may avoid his experience of a 17-year gap between onset of symptoms and correct diagnosis.
Cardiovascular Side Effects of Novel Antipsychotics
Authors: Gupta Sanjay , Masand Prakash S. , Kothari Ashok J.
Published: August 2016

Since the introduction of clozapine, several novel antipsychotic agents have been introduced and more are in Phase II/III studies. Because these agents are used clinically as first-line treatment, we need to be more familiar with their side-effect profiles. This manuscript reviews the cardiovascular side effects of currently available novel antipsychotics. The medications reviewed include clozapine, risperidone, olanzapine, quetiapine, and ziprasidone. Guidelines are suggested for the use of these medications in clinical practice.
Nonepileptic Seizures: An Overview
Authors: Barry John J.
Published: August 2016

Since before the time of Charcot, nonepileptic seizures (NES) have intrigued and perplexed physicians. With the advent of the electroencephalogram, particularly with the addition of continuous video monitoring, the diagnosis of NES has received increasing evaluation. Characteristic historical features and clinical signs of NES, coupled with new diagnostic techniques, have progressively refined our understanding of the disorder. The treatment of patients who have NES has received much less attention and the prognosis of these patients illustrates the need for a more comprehensive, systematic, and validated intervention. These issues are discussed with an emphasis on the need for future research.
Adolescent Outcome of ADHD: Impact of Childhood Conduct and Anxiety Disorders
Authors: Newcorn Jeffrey H. , Miller Scott R. , Ivanova Iliyan , Schulz Kurt P. , Kalmar Jessica , Marks David J. , Halperin Jeffrey M.
Published: August 2016

Objective: This study examines the impact of comorbidity of attention-deficit/hyperactivity disorder (ADHD) with disruptive and anxiety disorders in childhood on clinical course and outcome. We consider the relative contribution of each comorbid symptom constellation, and also their interaction, to assess the following questions: (1) Does early comorbidity with conduct disorder (CD) and anxiety disorders define specific developmental trajectories?; (2) Is comorbid anxiety disorders in childhood continuous with anxiety disorders in adolescence?; (3) Does comorbid anxiety disorders mitigate the negative behavioral outcome of youth with ADHD?; and (4) Is there an interaction between comorbid CD and anxiety disorders, when they occur simultaneously, that predicts a different outcome than either comorbid condition alone?

Method: Thirty-two 15- to 18-year-old adolescent males, diagnosed with ADHD between 7 and 11 years of age, were re-evaluated for assessment of adolescent outcome 4.3–9.2 years later. Hierarchical regression analyses were run with each of the eight Child Behavior Checklist and Youth Self-Report problem scales, and the four anxiety symptom subscales of the Multidimensional Anxiety Scale for Children serving as outcome variables.

Results: Findings indicate that comorbid CD at baseline predicteds parent reports of behavior problems in adolescence, while comorbid anxiety disorders in childhood predicted youth reports of anxiety and social problems. Anxiety disorders without CD did not predict poor behavioral outcome. Children with both comorbid CD and anxiety disorder had the highest levels of parent-rated symptoms on follow up. In particular, adolescent social problems were best predicted by the combination of comorbid CD and anxiety disorder in childhood.

Conclusion: These data provide evidence that children with ADHD plus anxiety disorder do in fact have anxiety disorders, and that the combination of anxiety disorder and CD predicts a more rather than less severe course.
Glutamate—Hypothalamic-Pituitary-Adrenal Axis Interactions: Implications for Mood and Anxiety Disorders
Authors: Mathew Sanjay J. , Coplan Jeremy D. , Smith Eric L.P. , Schoepp Darryle D. , Rosenblum Leonard A. , Gorman Jack M.
Published: August 2016

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is a pathologic feature of certain mood and anxiety disorders that results in the increased production and secretion of corticotropin-releasing factor. There is increasing preclinical evidence that glutamate, an excitatory amino acid, plays an important role in the regulation of the HPA axis. Activation of glutamatergic projections to limbic structures such as the amygdala and brainstem structures such as the nucleus tractus solitarius is implicated in the stress response. There are laboratory and clinical suggestions that glutamatergic N-methyl-D-aspartate (NMDA) receptor antagonists function as antidepressants, and that chronic antidepressant treatments have a significant impact on NMDA receptor function. Clinical investigations of glutamate antagonists in patients with mood and anxiety disorders are in their infancy, with a few reports suggesting the presence of mood-elevating properties. Ultimately, HPA axis modulators, serotonin-enhancing agents, and glutamate antagonists might serve to increase neurotropic factors in key brain regions for affective and anxiety regulation, providing a putative final common pathway.
Evaluating the New Antiepileptic Drugs: Balancing Benefits and Adverse Effects
Authors: Privitera Michael D. , Bergey Gregory K. , Smith Michael C. , Ginsberg David L.
Published: August 2016

Eight new antiepileptic drugs (AEDs) have been introduced since 1993 and clinicians are now faced with a complex array of treatment choices. In evaluating the newly available drugs, it is important to analyze the different aspects of these agents. Some of the more important characteristics to be aware of are efficacy, adverse effects, pharmacokinetics, and mechanisms of action.

One of the factors complicating treatment choice is the absence of comparative head-to-head clinical trials between the new AEDs. While in some cases it is possible to draw conclusions from the results of randomized, controlled trials that have tested medications against placebo or older drugs, often physicians have to rely on open-label data or personal experiences in selecting the right medications for specific cases.

Trends suggest that the new AEDs are more efficacious compared to the older AEDs, but the major potential benefits of the new drugs are their better safety, tolerability, and cognitive profiles and more desirable pharmacokinetics.

It is obvious that there is a need to redefine the concept of “successful” treatment of epilepsy. Patients need to be individually evaluated and, in addition to controlling seizures, tolerability should be taken into consideration in finding the most appropriate treatment regimen.
Therapeutic Alternatives for Difficult-to-Treat Depression: A Narrative Review of the State of the Evidence
Authors: Thase Michael E.
Published: August 2016

Despite the large number of depressed patients who do not respond to first-line antidepressants, the evidence base of alternate strategies is quite thin. In this article, a simple 5-stage system for categorizing treatment-resistant depression (TRD) is described and the evidence pertaining to the major strategies currently utilized is summarized using four grades, ranging from D (case reports only) to A (multiple positive placebo-controlled trials). It is concluded that the level of evidence supporting many of the contemporary strategies used for TRD (eg, combinations of antidepressants and augmentation with medications such as pindolol, buspirone, or modafinil) is scanty at best. Even the fundamental question concerning “to augment or to switch” is not answerable with available data. It is noted that the best-documented treatments (ie, lithium augmentation, switching to a monoamine oxidase inhibitor, and electroconvulsive therapy) are among the least utilized. This state of affairs will improve with completion of the studies of Systematic Treatment Alternatives to Relieve Depression, a large multicenter study of difficult-to-treat depression funded by the National Institute of Mental Health. There is a need for greater collaboration among academicians and organizations, such as the American Psychiatric Association, the National Institute of Mental Health, and the pharmaceutical industry, to ensure that sufficient research is conducted so that clinician's choices for patients with TRD can be guided by empirical evidence.
Clinical Experience with Aripiprazole Treatment in Ten Elderly Patients with Schizophrenia or Schizoaffective Disorder: Retrospective Case Studies
Authors: Madhusoodanan Subramoniam , Brenner Ronald , Gupta Sanjay , Reddy Harsha , Bogunovic Olivera
Published: August 2016

Background: Clinical trials of aripiprazole, a recentl Food and Drug Administration-approved atypical antipsychotic, included elderly patients, but more data are needed on the effects of aripiprazole in this population, especially those with comorbid medical illnesses.

Objective: To assess the response and safety of aripiprazole treatment in elderly patients with phrenia or schizoaffective disorder.

Method: Data was obtained by retrospective review of medical records. Aripiprazole was used to treat 10 elderly hospitalized patients between 62 and 85 years of age who manifested signs of psychosis related to schizophrenia or schizoaffective disorder. All patients had been treated previously with atypical and classic antipsychotics. Response was assessed by clinical observation of patients' behavior and Clinical Global Impression Scale assigned retrospectively.

Results: Seven patients responded to treatment, two did not respond, and one had a partial response. The mean Clinical Global Impression Scale scores improved from 6 (severely ill) at baseline to 2.3 (much improved) at discharge. Treatment was discontinued in the two patients who did not respond. Of the seven patients who responded, four presented with positive symptoms and showed significant improvement while three presented with positive and negative symptoms and both symptoms improved significantly. Four patients had preexisting extrapyramidal symptoms (EPS) and these symptoms decreased in three patients. In addition, two patients were able to discontinue antiparkinson medications. One patient who had severe tardive dyskinesia showed significant improvement in the dyskinetic symptoms. Four patients showed postural hypotension (without clinical symptoms) which resolved over time without treatment. Six patients showed a mean weight loss of 5.2 lbs. No adverse consequences occurred when divalproex sodium, carbamazepine, clonazepam or citalopram were given concurrently.

Conclusion: The reduction of both positive and negative symptoms of schizophrenia and the lack of significant EPS, tardive dyskinesia, sedation, weight gain, anticholinergic effects, and QTc prolongation gives preliminary indication that aripiprazole may be a safe and effective medication for elderly patients with schizophrenia or schizoaffective disorder.
An Interim Analysis of the Quality of Life, Effectiveness, Safety, and Tolerability (QU.E.S.T.) Evaluation of Mixed Amphetamine Salts Extended Release in Adults With ADHD
Authors: Goodman David W. , Ginsberg Lawrence , Weisler Richard H. , Cutler Andrew J. , Hodgkins Paul
Published: August 2016

Objective: Evaluate safety and efficacy of mixed amphetamine salts extended release (MAS XR) in adults with attention-deficit/hyperactivity disorder (ADHD).

Methods: 10-week interim analysis of the Quality of life, Effectiveness, Safety, and Tolerability (QU.E.S.T.) trial, an ongoing, 30-week, open-label, multicenter investigation of once-daily MAS XR (10–60 mg/day) in adults (≥18 years of age) with ADHD in community practice settings.

Findings: With up to 10 weeks of open-label MAS XR 10 to 60 mg/day (final visit mean dose: 37.2 mg/day), 725 adults exhibited rapid, sustained improvement in ADHD symptoms. At end point, significant decreases from baseline were seen in ADHD Rating Scale IV total scores (-19.8±11.6; P<.0001), hyperactivity/impulsivity subscak (-8.1±6.1; P<.0001), and inattentive subscale (-11.6±6.7; P<.0001). Most subjects (74.4%) were rated as very much/much improved. Based on the 36- item Short Form Health Survey (version 2), significant improvements in quality of life were seen in the domains of general health, physical and mental health, vitality, and social, emotional and physical role functioning (P<.0001). Few subjects (6.9%) withdrew due to adverse events; the most common MAS XR-related adverse events were decreased appetite and dry mouth (19.2% each), insomnia (17.8%), and headache (16.8%).

Conclusion: In adults with ADHD, MAS XR treatment is generally safe and demonstrates significant improvement in ADHD symptoms and related quality of life.
Neurobiology of Obsessive-Compulsive Disorder:Serotonin and Beyond
Authors: Westenberg Herman G.M. , Fineberg Naomi A. , Denys Damiaan
Published: August 2016

The evidence for the involvement of the serotonergic system in the pathogenesis of obsessive-compulsive disorder (OCD) is circumstantial at best, despite being the focus for most pathophysiological research over the last 2 decades. This hypothesis was initially motivated by the observed differential efficacy of selective serotonin reuptake inhibitors in alleviating OCD symptoms. Direct evidence that serotonergic perturbations are implicated in the pathophysiology of OCD is still sparse. There is growing evidence, from both preclinical and clinical studies, that the dopamine system may also be involved in the pathogenesis of OCD, and that dopaminergic and serotonergic pathways play a role in the genesis and maintenance of obsessive-compulsive symptoms. The complex interactions between both systems, the phenotypic heterogeneity of the disorder, and the limitations of the available tests to probe both systems, make it as yet impossible to draw firm conclusions as to how these systems are implicated. Further studies with more selective pharmacologic agents and neurocognitive probes in humans, studies using deep brain stimulation in combination with neuroimaging, and the development of better animal models for OCD may further our understanding of this disabling condition.
Consensus Statement
Authors: Zohar Joseph , Hollander Eric , Stein Dan J. , Westenberg Herman G. M. , Westenberg Herman G. M. ,   Cape Town Consensus Group
Published: August 2016

Over the last 25 years, the perception of obsessive-compulsive disorder (OCD) has changed; where once it was seen as a rare refractory disorder, it is now viewed as a fairly prevalent, but treatable, medical condition responding to two main therapeutic strategies—serotonin reuptake inhibitors (SRIs) and cognitive-behavioral therapy (CBT). Given the emergence of new results with SRIs, more data on the role of augmentation strategies with second-generation antipsychotics, and recent genetic and neuroimaging findings with potential for advancing the understanding of the pathogenesis of OCD, it was thought appropriate to revisit OCD in order to identify key developments in this field and examine how they might be translated into the clinical arena.This consensus statement is the product of the International Anxiety Disorders Conference that took place in Cape Town in February 2006, and is referred to as the Cape Town Consensus (CTC).
Obsessive-Compulsive Disorder, Body Dysmorphic Disorder, and Hypochondriasis: Three Variations on a Theme
Authors: Josephson Stephen C. , Hollander Eric , Fallon Brian , Stein Dan J.
Published: August 2016

Background:

Exaggerated illness and appearance concerns and related compulsive behaviors are seen in the psychiatric disorders of hypochondriasis (HYP), body dysmorphic disorder (BDD), and obsessive-compulsive disorder (OCD). It has been argued that these conditions may cluster in clinical samples and that our current categorical diagnostic policies, which assume independence of these disorders, are arbitrary and fail to capture the dimensional nature of these disorders.

Methods:

We present retrospective clinical data on 21 randomly selected patients who presented with symptoms that involved anxiety about illness and appearance and who were evaluated for cognitive-behavioral treatment or pharmacotherapy. We also review the symptoms, associated features, and response to treatment of three patients from the sample who were each diagnosed with all three of these disorders (HYP, BDD, and OCD).

Results:

Three patients met criteria for HYP, BDD, and OCD, and the other 18 patients met criteria for at least two of the above conditions. The most frequently reported source of anxiety had to do with one's hair. Nine out of the 12 patients treated with behavioral therapy were considered to be responders, and the one treated solely with medication was “very much improved.” Of the eight treated with a combination of behavioral therapy and medication, five were judged to be responders.

Conclusions:

Overlap in phenomenology, associated features, and treatment response suggests that these three disorders may be difficult to distinguish from each other and that a “cluster analysis” model may prove helpful in evaluating clinical samples.
Severity of Obsessive-Compulsive Symptoms is Related to Self-Directedness Character Trait in Obsessive-Compulsive Disorder
Authors: Cruz-Fuentes Carlos , Blas Claudia , Gonzalez Laura , Camarena Beatriz , Nicolini Humberto
Published: August 2016

Objective:

The present study examined the psychobiological Temperament and Character model of personality on obsessive-compulsive disorder (OCD) patients, as well as the relation of temperament and/or character dimensions on the severity of obsessive-compubive symptoms.

Methods:

Fifty-four subjects diagnosed with OCD, were assessed with the Temperament and Character Inventory, the Yale-Brown Obsessive-Compulsive scale and the Hamilton Rating Scales for depression and anxiety.

Results:

Compared with controls, OCD subjects displayed increased harm avoidance and lower self-directedness and cooperativeness. Low self-directedness and high Hamilton depression scores were associated with increased severity of obsessive-compulsive symptoms.

Conclusions:

The Temperament and Character profile of OCD patients characterized in the present stud personality model and can be linked to some of their behavioral features. Furthermore, our data provides support of the influence that some personality traits may have on the severity of OCD symptoms.
Pharmacotherapy of ADHD in Adults
Authors: Wilens Timothy E.
Published: August 2016

There is a complex overlap between major depressive disorder (MDD) and attention-deficit/hyperactivity disorder (ADHD). The different therapeutic options for adult ADHD mirror those used for children with ADHD. Both stimulant and nonstimulant medications are used to treat the disorder.
Introduction:Cardiovascular Disease and Metabolic Risk Factors in Patients with Mental Illness
Authors: Newcomer John W.
Published: August 2016

According to the National Comorbidity Study Replication, >25% of people in the United States have some type of mental illness. The prevalence of serious mental illness has been estimated at 6.2%. Patients with severe and persistent mental illness have significantly reduced life expectancy relative to the general population. On average, pooled populations of public sector inpatients and outpatients die 25–30 years earlier than unaffected individuals in the general population, according to recent data from multiple states in the US. Schizophrenia and bipolar disorder together account for ∼23,000 deaths and >20 million life-years of disability worldwide each year. The most common cause of mortality in these individuals is cardiovascular disease (CVD), not, as might be assumed, suicide (Figure 1). Heart disease and stroke are the most common causes of death in patients with serious mental illness, accounting for ∼40% of deaths, underlying the dramatically decreased life expectancy in these patients.
Adherence with Antidepressant Therapy and Successful Patient Self-Management
Authors: Lin Elizabeth H.B.
Published: August 2016

Until recently, depression was considered an acute, self-remitting illness of limited duration. However, it is increasingly recognized as a chronic, relapsing, or recurrent illness in most patients, imposing a substantial burden on the individual and society. Research has demonstrated an association between depression and impaired psychosocial functioning, reduced productivity and life satisfaction, excess health care utilization, increased reporting of medically unexplained medical symptoms, comorbidity with other psychiatric illnesses, and suicide. It is more prevalent in patients with common chronic medical conditions, such as obstructive pulmonary disease, hypertension, diabetes, stroke, coronary artery disease, asthma, and chronic pain. In addition to its association with medical morbidity and mortality, depression has a negative impact on self-care behaviors, including medication adherence, in patients with chronic medical illnesses, and in health-related behaviors such as exercise, smoking, and weight control. As a consequence, it is a major barrier to effective care of chronic medical illnesses.
Pharmacologic Mood Destabilization: Case Vignettes
Authors: Swann Alan C.
Published: August 2016

Bipolar disorder is an illness characterized by inherent mood instability that produces a predisposition to depressive, hypomanic, or manic episodes. This predisposition to affective episodes, rather than the episodes themselves (which can have many causes), is arguably the hallmark of bipolar disorder.

Most episodes of bipolar disorder, including the first episode, are depressive. This exposes an inherent flaw in our nosological system, which requires a manic or hypomanic episode for diagnosis of bipolar disorder. Treatment of a depressive episode in undiagnosed bipolar disorder can entail the use of medications that were developed to treat a different disorder (major depressive illness) and that may have mood-destabilizing or activating properties.
The Effects of TMS on Animal Models of Depression, β-Adrenergic Receptors, and Brain Monoamines
Authors: Belmaker R.H. , Grisaru Nimrod , Ben-Shahar Dorit , Klein Ehud
Published: August 2016

In initial studies using animal models of depression, we primarily focused on the similarities of transcranial magnetic stimulation (TMS) to electroconvulsive therapy (ECT). However, our investigations show that TMS has its own, unique, potentially diagnostic and therapeutic effects, distinct from those of ECT. These effects need further exploration in animal and clinical studies.
Implications of Kindling And Quenching For the Possible Frequency Dependence Of rTMS
Authors: Post R. M. , Kimbrell T. , Frye M. , George M. , McCann U. , Little J. , Dunn R. , Li H. , Weiss S.R.B.
Published: August 2016

Kindling involves repeated administration of brief high-frequency electrophysiological stimulation of the brain at initially subthreshold intensities that eventually evoke full-blown seizures. It has thus been used not only as a model of epileptogenesis, but of long-term neuronal memory. Quenching is a phenomenon that utilizes low-frequency stimulation for much longer periods of time (eg, 1 Hz for 15 minutes), and appears to exert preventive effects on the development of kindling and inhibit the manifestation of full-blown kindled seizures by markedly increasing the amygdala afterdischarge and seizure threshold. (See also “Kindling and Quenching: Conceptual Implications for rTMS,” by Weiss and Post, page 32). The parameters of kindling and quenching with intracerebral stimulation of the amygdala in vivo are highly similar to those achieved in vitro in hippocampai slice preparations for inducing long-term potentiation (LTP) and longterm depression (LTD), respectively. These neuroplastic changes are relatively long lasting and appear reversible at the level of synaptic function with either LTD or LTP capable of countering the effects of the other.
Competency Evaluations on the Psychiatric Consultation Service
Authors: Masand Prakash , Vasavada Tarak , Nasra George
Published: August 2016

The authors retrospectively reviewed the charts of all patients seen by the Psychiatric Consultation Service at their institution between January 1, 1989 to December 31, 1992. A total of 94 patients were evaluated for competency (study group). These were compared with 88 diagnostically matched patients (control group) who were assessed for reasons other than competency during the same time period. Patients in the study group were more likely to be black, less likely to be prescribed psychotropics, and more likely to be consulted upon later on during the course of their hospitalization. Among patients assessed for competency (study group) those patients judged to be incompetent were more likely to be older, have organic mental disorders (OMD), be prescribed psychotropics, and have longer hospital stays. Amongst patients in the study group, geriatric patients (> 60) when compared with nongeriatric patients were more likely to be female, Caucasian, and have OMD and multiple medical illnesses.
The Role of Serotonin in Autism-Spectrum Disorders
Authors: Potenza Marc N. , Mcdougle Christopher J.
Published: August 2016

While the etiologies of pervasive developmental disorders (PDDs) appear complicated, multifactorial, and relatively poorly understood research over the last 30 to 40 years has implicated certain neurochemicals in the pathophysiology of these diseases. From these studies, a great deal of evidence has emerged supporting a role for serotonergic dysfunction in individuals with autism and related disorders. Recent clinical trials of drugs influencing serotonergic systems have demonstrated promising effects in children, adolescents, and adults with PDDs.
Progress in the Neurobiology of Autism
Authors: Rapin Isabelle
Published: August 2016

To date, research regarding the neurobiological basis of autism has produced only the most preliminary of data. Although some advances have been made, the need for more definitive knowledge is crucial to more fully understand and treat this disorder.

In this review, the autistic spectrum is discussed in terms of its defining symptoms. These symptoms are explained based on current understanding, and the need for more information regarding the bases of these abnormalities is noted. The critical needs of research are discussed, with an emphasis on areas in urgent need of analysis.
Autism, Serotonin, and the Cerebellum: Might There Be a Connection?
Authors: Marazziti Donatella , Nardi Irma , Cassano Giovanni B.
Published: August 2016

Although the precise etiological nature of autism—the most common development disorder—remains elusive, two main biological factors have been suggested. One is related to a possible neurochemical dysfunction at the level of the serotonergic system; the other underlines the presence of neuroanatomical abnormalities in different areas, in particular, in the cerebellum.

The authors propose a unifying hypothesis linking serotonin (5-hydroxytryptamine, or 5-HT) to the cerebellum on the basis of the observation of a specific 5-HT receptor subtype, 5-HT5A, in this area. The 5-HT5A receptors may be involved in the pathophysiology of autism, and perhaps, in autism-related disorders, since they are mainly expressed in Purkinje's cells. Future studies with specific drugs that interact with 5-HT5A receptors should permit the testing of this hypothesis through the evaluation of the receptors themselves in autopsied brain samples or in vivo by positron emission tomography. Theoretically, such compounds might prove effective in the treatment of autism.
Trichotillomania–A Search for Answers
Authors: O'Sullivan Richard L. , Keuthen Nancy J.
Published: August 2016

As defined by the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV), trichotillomania (TTM) is a complex syndrome of distressing, often uncontrolled, urge-driven hair pulling. Generally under-diagnosed, it is known to afflict approximately 1–2% of the population. Historically, the morbidity and psychosocial sequelae associated with this disorder have been seriously minimized. Clinical intervention remains a challenge with conflicting documentation of treatment efficacy and often-reported treatment relapse.

The dedication of an entire issue of CNS Spectrums to this disorder highlights the recent recognition of the clinical importance and scientific complexity of this condition. As guest editors of this issue, we welcome the opportunity to educate clinicians, clinical researchers, and basic scientists regarding current perspectives and challenges inherent in this disorder. It is our hope that these papers will encourage our professional audience to think critically about this condition, empirically study it, and work to improve the suffering of those afflicted with it. Furthermore, it should serve as a resource for hair pullers and their families, in conjunction with the soon-to-be-released American Psychiatric Association text, Trichotillomania: Current Developments.
The Neurobiology of Trichotillomania
Authors: Stein Dan J. , O'Sullivan Richard L. , van Heerden Barend , Seedat Soraya , Niehaus Dana
Published: August 2016

The neurobiology of trichotillomania (TTM) has only recently received attention from the neuropsychiatrie community, and the number of studies in this area is limited. Nevertheless, there is tentative support for the hypothesis that serotonergic, dopaminergic, and opioid systems mediate hair-pulling symptoms, and that corticostriatal circuits also play a role. An understanding of the neurobiology of TTM may be of value not only for the treatment of this disorder, but also for other stereotypic behaviors.
Altered CSF 5-HIAA Disposition in Pathologic Male Gamblers
Authors: Nordin Conny , Eklundh Thomas
Published: August 2016

Previous reports concerning the cerebrospinal fluid (CSF) of pathologic gamblers have described disturbed norepinephrine and dopamine (but not serotonin) functioning in the central nervous system. We analyzed neurotransmitter metabolites in two consecutive 6-mL samples of CSF obtained from 10 pathologic male gamblers punctured at the L4-5 level following 8 hours of fasting along with strict bed rest. Data were compared with those for healthy male controls. In conformity with findings in healthy male controls, we found gradients in CSF 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA), but not 4-hydroxy-3-methoxyphenyl glycol (HMPG). Expressing the CSF concentrations as nmol x L-1 x min-1 of tapping time (an estimate of the mass flow through the needle), the levels of 5-HIAA and HMPG (but not HVA) were found to be significantly lower in gamblers. Levels of 5-HIAA and HVA showed a significant correlation in gamblers but not in healthy controls. Taking tapping time into account, the CSF levels of HMPG and 5-HIAA were significantly lower in gamblers. We concluded that, in light of previous CSF findings of disturbed norepinephrine and dopamine function, altered indolamine function cannot be fully ruled out.
Randomized Controlled Trial of Yogic Meditation Techniques for Patients With Obsessive-Compulsive Disorder
Authors: Shannahoff-Khalsa David S. , Ray Leslie E. , Levine Saul , Gallen Christopher C. , Schwartz Barry J. , Sidorowich John J.
Published: August 2016

The objective of this study was to compare efficacy of two meditation protocols for treating patients with obsessive-compulsive disorder (OCD). Patients were randomized to two groups—matched for sex, age, and medication status—and blinded to the comparison protocol. They were told the trial would last for 12 months, unless one protocol proved to be more efficacious. If so, groups would merge, and the group that received the less efficacious treatment would also be afforded 12 months of the more effective one. The study was conducted at Children's Hospital, San Diego, Calif. Patients were selected according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria and recruited by advertisements and referral. At baseline, Group 1 included 11 adults and 1 adolescent, and Group 2 included 10 adults. Group 1 employed a kundalini yoga meditation protocol and Group 2 employed the Relaxation Response plus Mindfulness Meditation technique. Baseline and 3-month interval testing was conducted using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Symptoms Checklist-90-Revised Obsessive Compulsive (SCL-90-R OC) and Global Severity Index (SCL-90-R GSI) scales, Profile of Moods scale (POMS), Perceived Stress Scale (PSS), and Purpose in Life (PIL) test. Seven adults in each group completed 3 months of therapy. At 3 months, Group 1 demonstrated greater improvements (Student's independent groups t-test) on the Y-BOCS, SCL-90-R OC and GSI scales, and POMS, and greater but nonsignificant improvements on the PSS and PIL test. An intent-to-treat analysis (Y-BOCS) for the baseline and 3-month tests showed that only Group 1 improved. Within-group statistics (Students paired t-tests) showed that Group 1 significantly improved on all six scales, but Group 2 had no improvements. Groups were merged for an additional year using Group 1 techniques. At 15 months, the final group (N=11) improved 71%, 62%, 66%, 74%, 39%, and 23%, respectively, on the Y-BOCS, SCL-90-R OC SCL-90-R GSI, POMS, PSS, and PIL; P<0.003 (analysis of variance). This study demonstrates that kundalini yoga techniques are effective in the treatment of OCD.
WCA Recommendations for the Long-Term Treatment of Obsessive-Compulsive Disorder in Adults
Authors: Greist John H. , Bandelow Borwin , Hollander Eric , Marazziti Donatella , Montgomery Stuart A. , Nutt David J. , Okasha Ahmed , Swinson Richard P. , Zohar Joseph
Published: August 2016

What are the latest psychotherapeutic and pharmacotherapeutic treatment recommendations for obsessive-compulsive disorder (OCD)? OCD is a relatively common disorder with a lifetime prevalence of ~2% in the general population. It often has an early onset, usually in childhood or adolescence, and frequently becomes chronic and disabling if left untreated. High associated healthcare utilization and costs, and reduced productivity resulting in loss of earning, pose a huge economic burden to OCD patients and their families, employers, and society. OCD is characterized by the presence of obsessions and compulsions that are time-consuming, cause marked distress, or significantly interfere with a person's functioning. Most patients with OCD experience symptoms throughout their lives and benefit from long-term treatment. Both psychotherapy and pharmacotherapy are recommended, either alone or in combination, for the treatment of OCD. Cognitive-behavioral therapy is the psychotherapy of choice. Pharmacologic treatment options include the tricyclic antidepressant clomipramine and the selective serotonin reuptake inhibitors (SSRIs) citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. These have all shown benefit in acute treatment trials; clomipramine, fluvoxamine, fluoxetine, and sertraline have also demonstrated benefit in long-term treatment trials (at least 24 weeks), and clomipramine, sertraline, and fluvoxamine have United States Food and Drug Administration approvals for use in children and adolescents. Available treatment guidelines recommend first-line use of an SSR1 (ie, fluoxetine, fluvoxamine, paroxetine, sertraline, or citalopram) in preference to clomipramine, due to the latter's less favorable adverse-event profile. Further, pharmacotherapy for a minimum of 1–2 years is recommended before very gradual withdrawal may be considered.
WCA Recommendations for the Long-Term Treatment of Social Phobia
Authors: Van Ameringen Michael , Allgulander Christer , Bandelow Borwin , Greist John H. , Hollander Eric , Montgomery Stuart A. , Nutt David J. , Okasha Ahmed , Pollack Mark H. , Stein Dan J. , Swinson Richard P.
Published: August 2016

What is the best approach for treating patients with social phobia (social anxiety disorder) over the long term? Social phobia is the most common anxiety disorder, with reported prevalence rates of up to 18.7%. Social phobia is characterized by a marked and persistent fear of being observed or evaluated by others in social performance or interaction situations and is associated with physical, cognitive, and behavioral (ie, avoidance) symptoms. The onset of social phobia typically occurs in childhood or adolescence and the clinical course, if left untreated, is usually chronic, unremitting, and associated with significant functional impairment. Social phobia exhibits a high degree of comorbidity with other psychiatric disorders, including mood disorders, anxiety disorders, and substance abuse/dependence. Few people with social phobia seek professional help despite the existence of beneficial treatment approaches. The efficacy, tolerability, and safety of the selective serotonin reuptake inhibitors (SSRIs), evidenced in randomized clinical trials, support these agents as first-line treatment. The benzodiazepine clonazepam and certain monoamine oxidase inhibitors (representing both reversible and nonreversible inhibitors) may also be of benefit. Treatment of social phobia may need to be continued for several months to consolidate response and achieve full remission. The SSRIs have shown benefit in longterm treatment trials, while long-term treatment data from clinical studies of clonazepam are limited but support the drug's efficacy. There is also evidence for the effectiveness of exposure-based strategies of cognitive-behavioral therapy, and controlled studies suggest that the effects of treatment are generally maintained at long-term follow-up. In light of the chronicity and disability associated with social phobia, as well as the high relapse rate after short-term therapy, it is recommended that effective treatment be continued for at least 12 months.
The Predominantly Inattentive Subtype of Attention-Deficit/Hyperactivity Disorder
Authors: Solanto Mary V.
Published: August 2016

The predominantly inattentive (IN) subtype of attention-deficit/hyperactivity disorder (ADHD) is a recently defined condition that is often overlooked by professionals and is still not completely understood. Characterized by symptoms of inattentiveness, such as distractibility, failure to complete work, forgetfulness, and disorganization, the IN subtype differs from the more commonly recognized combined (CB) subtype of ADHD in that symptoms of hyper activity and impulsivity are absent or minimal. Large-scale epidemiologic studies suggest that the IN subtype is at least as prevalent as the CB subtype, and is at least as likely to be associated with academic and/or social impairment. Diagnosis of the IN subtype, however, may be more challenging because in addition to inattentiveness, other symptoms, including learning problems, depression, and anxiety, may also present without externalizing behaviors. Several studies have shown that compared with the CB subtype, the IN subtype has a later age of onset and referral, a relatively larger proportion of affected females, and is much less likely to be associated with symptoms of oppositional defiant disorder or conduct disorder. Research is currently under way to examine the cognitive characteristics of the IN subtype and its genetic and neurobiologic underpinnings, as well as to evaluate the effectiveness of pharmacotherapy and other treatments.
Uncomplicated and Comorbid Obsessive-Compulsive Disorder in an Epidemiologic Sample
Authors: Hollander Eric , Greenwald Steven , Neville David , Johnson Jim , Hornig Christopher D. , Weissman Myrna M.
Published: August 2016

This study investigates lifetime prevalence rates, demographic characteristics, childhood conduct disorder and adult antisocial features, suicide attempts, and cognitive impairment in individuals with obsessive-compulsive disorder (OCD) uncomplicated by or comorbid with any other psychiatric disorder. The data are from the NIMH Epidemiological Catchment Area (ECA) study, and the current analyses compared subjects with uncomplicated OCD (no history of any other lifetime psychiatric disorder) comorbid OCD (with any other lifetime disorder), other lifetime psychiatric disorders, and no lifetime psychiatric disorders across these variables. OCD in its uncomplicated and comorbid form had significantly higher rates of childhood conduct symptoms, adult antisocial personality disorder problems, and of suicide attempts than did no or other disorders. Comorbid OCD subjects had higher rates of mild cognitive impairment on the Mini-Mental Status Exam than did subjects with other disorders. These findings suggest that a subgroup of OCD patients may have impulsive features, including childhood conduct disorder symptoms and an increased rate of suicide attempts; wider clinical attention to these outcomes is needed.
Cognitive-Behavioral Therapy and Integrated Approaches in the Treatment of Obsessive-Compulsive Disorder
Authors: Hohagen Fritz
Published: August 2016

Obsessive-compulsive disorder (OCD) has long been considered a treatment-refractory mental condition. Neither pharmacologic nor psychodynamic therapy has been proven to treat OCD effectively. Yet the prognosis for OCD has changed dramatically in recent years with the introduction of behavior therapy and the use of selective serotonin reuptake inhibitors (SSRIs). Many studies have shown that behavior therapy, especially exposure with response prevention, and SSRIs reduce obsessive-compulsive symptoms significantly. Still, many unanswered questions—including the role of cognitive therapy in the treatment of OCD, exposure therapy vs multimodal behavioral therapy, individual versus group therapy, outcome predictors in adults, adolescents, and children, and the role of combination treatment using an SSRI and cognitive-behavioral therapy—remain. This article will explore these issues as well as suggest directions for further research into OCD.
Emotions, Brain Development, and Psychopathologic Vulnerability
Authors: Galderisi Silvana , Mucci Armida
Published: August 2016

Emotional reactivity in infancy and early childhood may play a role in the regulation of brain plasticity and hemispheric organization, which has possible implications vulnerability to psychopathology. Empiric findings demonstrate the role of attachment patterns in emotional reactivity modulation and limbic circuitry shaping.
Sexual Addiction and Compulsion: Recognition, Treatment, and Recovery
Authors: Carnes Patrick J.
Published: August 2016

The management of patients with compulsive sexual behavior requires an understanding of the profile of the sexually compulsive or addicted patient. This article summarizes patient characteristics and their implications for treatment. Data from a study of the recovery of 957 patients who had problematic, sexually excessive behavior are presented. Spanning 5 years, the study shows six distinct stages patients experienced and the clinical activities that were most useful to them. A trajectory of a typical diagnosis and treatment path is provided, as well as important resources for physicians and patients.