bluuebunny/crossref_metadata_2025 huggingface dataset:
Posttraumatic Stress Disorder, Supported Employment, and Outcomes in People with Severe Mental Illness
Authors: Mueser Kim T. , Essock Susan M. , Haines Michael , Wolfe Rosemarie , Xie Haiyi
Published: August 2016

Objective: To evaluate whether posttraumatic stress disorder (PTSD) is related to outcomes in persons with severe mental illness (SMI) participating in a study of vocatinal rehabilitation programs

Background: PTSD is a common comorbid disorder in people with SMI, but it is unknown whether PTSD interferes with the ability to benefit from rehabilitation programs such as supported employment.

Methods: The relationships between PTSD and symptoms, health, quality of life, and work outcomes was examined in 176 clients with SMI participating in a 2-year randomized controlled trial of three vocational rehabilitation programs: supported employment based on the Individual Placement and Support model, a psychosocial rehabilitation program based on transitional employment, and standard services.

Results: The overall rate of current PTSD in the sample was 16%. Compared with clients without PTSD, clients with PTSD had more severe psychiatric symptoms, worse reported health, lower self-esteem, and lower subjective quality of life. Clients with PTSD who participated in the Individual Placement and Support model (the most effective vocational model of the three studied) also had worse employment outcomes over the 2-year study period than clients without PTSD, with lower rates of compeitive work, fewer hours worked, and fewer wages earned. Employment outcomes did not differ between clients with PTSD versus without PTSD in the other two vocational rehabilitation approaches.

Conclusion: The findings suggest that PTSD may contribute to worse work outcomes in clients participating in supported employment programs. Effective treatment of these clients with PTSD may improve their ability to benefit from supported employment.
Prediction of Outcome from the Dartmouth Assertive Community Treatment Fidelity Scale
Authors: Bond Gary R. , Salyers Michelle P.
Published: August 2016

Background: Assertive community treatment (ACT) is an intensive and comprehensive treatment for clients with severe mental illness (SMI) who do not readily benefit from clinic-based services. Monitoring the implementation of such programs is critical, because better-implemented programs have been found to be effective in improving client outcomes.

Objective: We tested the hypothesis that fidelity to the ACT model would be positively correlated with improved client outcomes, as measured by reduction in psychiatric hospital use.

Methods: A scale measuring fidelity of program implementation, the Dartmouth ACT Scale, was examined in 10 newly formed ACT teams. Using the team as the unit of measure, the mean reduction in state hospital days for a 1-year period before and after program admission was calculated. Mean effect size in reduction in hospital days was used as the outcome measure in a correlational design.

Results: Pre/post comparisons showed a 43% reduction in hospital days for 317 clients (t=8.61, P<.001). The Pearson correlation between DACTS fidelity and reduction of state hospitaldays was .49, P=.08, one-tailed.

Conclusion: Several possible reasons are offered for why the study hypothesis was not confirmed. However, even if predictive validity of the Dartmouth ACT Scale is limited, it continues to be a useful tool for program monitoring and for providing corrective feedback.
Development of Subtype Selective GABAAModulators
Authors: Dawson Gerard R. , Collinson Neil , Atack John R.
Published: August 2016

Drugs modulating γ-aminobutyric acid (GABA) transmission via the benzodiazepine (BZ) site on the γ-aminobutyric acid type A (GABAA) receptor have been in widespread use for more than 40 years to treat anxiety, epilepsy, and sleep disorders. These drugs have been shown to be safe, well tolerated, and effective although the mechanism by they produce a myriad of pharmacologic effects remains elusive. In recent years it has been discovered that, although the GABAAreceptor is widely distributed in the brain, the substructure and composition of the receptor differs from between brain regions. Termed “GABAAreceptor subtypes” their discovery leads to speculation that different subtypes may mediate specific effects of BZs such as anxiety or sedation. The phenotypic analysis of transgenic knock-in and knock-out mice in which particular GABAAreceptors were rendered insensitive to the effects of BZ while others were unaffected confirmed this speculation. Subsequently, subtype-specific GABAAligands were developed that, for example, retained the anxiolytic effects of BZs but were devoid of their sedative effects. Therefore, it may be possible to develop effective anxiolytic compounds that have a much reduced side-effect profile compared with existing drugs.
Issues in the Psychopharmacologic Assessment and Treatment of the Orthodox Jewish Patient
Authors: Feinberg S. Shalom
Published: August 2016

As with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.
Gabapentin and Lamotrigine: Novel Treatments for Mood and Anxiety Disorders
Authors: Pollack Mark H. , Scott Erin L.
Published: August 2016

Clinical experience and systematic inquiry demonstrate that many patients with mood and anxiety disorders remain symptomatic despite standard interventions. These observations have prompted the search for alternative pharmacotherapeutic treatment options. Anticonvulsants, including valproic acid and carbamazepine, have demonstrated benefit for a number of psychiatric conditions. Recently, clinical and research attention has focused on the use of the new anticonvulsants gabapentin and lamotrigine as alternatives to standard pharmacotherapies for the treatment of mood and anxiety disorders. This paper reviews the experience to date with these agents in the treatment of psychiatric conditions. Gabapentin demonstrates promise for the treatment of panic and generalized anxiety, while both gabapentin and lamotrigine appear useful as mood stabilizers in the treatment of bipolar disorder.
Genetic Anticipation in Portuguese Families With Bipolar Mood Disorder
Authors: Macedo Antonio , Azevedo M. Helena , Coelho Isabel , Dourado Ana , Valente Jose , Pato Michele T. , Soares Maria João , Kennedy James L. , Macciardi Fabio , Pato Carlos N.
Published: August 2016

Genetic anticipation refers to an inheritance pattern within a pedigree showing a decrease in age of onset or an increase in disease severity or both in successive generations. This phenomenon has become the focus of important research in schizophrenia and bipolar mood disorder. The results to date have been controversial and far from conclusive. To attempt to resolve some of the earlier findings, we compared age at onset and disease severity between two generations in 24 Portuguese families ascertained for genetic linkage studies of bipolar mood disorder. There was a significant decrease in age of onset (P<. 00001) and increase in frequency of episodes (P<.0001)from the first to the second generation. This difference was significant under each of the four data-sampling schemes, one of which excluded probands. The second generation experienced onset 12.4 to 15.9 years earlier and illness 2.3 to 2.6 times more severe than did the first generation. We found no evidence for a specific effect in anticipation related to the transmitting parent's sex. Results of the present study, analyzed carefully for a variety of possible biases, suggest evidence for genetic anticipation in these Portuguese bipolar families.
Psychotherapy of Depression: Current Status, Future Directions
Authors: Thase Michael E.
Published: August 2016

This article reviews recent studies of psychotherapy for treatment of depression. There is evidence that cognitive behavioral and interpersonal therapies are useful treatments for depressed outpatients, roughly comparable to antidepressant pharmacotherapy. Pharmacotherapy and psychotherapy do not, however, necessarily treat the same patients and there is emerging evidence of a neurobiological “boundary” that may delimit therapy response. Psychotherapy plus pharmacotherapy combinations appear particularly useful for outpatients with more severe, recurrent depressions. Depression-focused psychotherapy may also provide an important alternative to an indefinite course of maintenance pharmacotherapy for patients at high risk for recurrence.
Treatment Issues During Pregnancy and Lactation
Authors: Baugh Claudia L. , Stowe Zachary N.
Published: August 2016

The lifetime incidence of mood disorders is twice as great in women compared with men, with the highest risk occurring during the childbearing years. The management of mental illness during pregnancy and lactation is a particularly complex clinical situation. The cornerstone of such a clinical decision is a completion of an assessment of the risks of the illness vs the risks of treatment. The following article reviews the factors influencing infant outcome and outlines the essential elements of the process of determining risk for the use of psychotropics in women during pregnancy and lactation. As the available data rapidly change, the facets of the risk benefit assessment are consistent and often the issue of specific medication is decided by prior history and exposure.
Dementia and the Neurovirulence of HIV-1
Authors: Shapshak Paul , Fujimura Robert K. , Srivastava Ashok , Goodkin Karl
Published: August 2016

Infection with human immunodeficiency virus type 1 (HIV-1 ) leads rapidly to infection of the brain and subsequent neuropsychological impairment, including subclinical impairment, minor cognitive-motor disorder, and HIV-1–associated dementia (HAD). This article reviews HAD and the factors involved in its pathogenesis; the effectiveness of antiretroviral therapy; the prevalence of HIV-1 and subtypes; and the role of chemokines and cytokines as the capstones associated with neuropathology due to inflammation.
Brain Imaging in Catatonia: Current Findings and a Pathophysiologic Model
Authors: Northoff Georg
Published: August 2016

Karl Ludwig Kahlbaum originally described catatonia as a psychomotor disease that encompassed motor, affective, and behavioral symptoms. In the beginning of the 20th century, catatonia was considered to be the motoric manifestation of schizophrenia; therefore, neuropathologic research mostly focused on neuroanatomic substrates (ie, the basal ganglia underlying the generation of movements). Even though some alterations were found in basal ganglia, the findings in these subcortical structures are not consistent. Recently, there has been a reemergence of interest into researching catatonia. Brain imaging studies have shown major and specific alterations in a right hemispheric neural network that includes the medial and lateral orbitofrontal and posterior parietal cortex. This neural network may be abnormally modulated by altered functional interactions between γ-aminobutyric acid (GABA)-ergic and glutamatergic transmission. This may account for the interrelationship among motor, emotional, and behavioral alterations observed in both clinical phenomenology and the subjective experiences of patients with catatonia. Such functional interrelationships should be explored in further detail in catatonia, which may also serve as a paradigmatic model for the investigation of psychomotor and brain function in general.
Insight in Body Dysmorphic Disorder with and Without Comorbid Obsessive-Compulsive Disorder
Authors: Marazziti Donatella , Giannotti Daniele , Catena Mario , Carlini Marina , Dell'Osso Bernardo , Presta Silvio , Pfanner Chiara , Mungai Francesco , Dell'Osso Liliana
Published: August 2016

Introduction: The aim of this study was to compare the level of insight in patients with body dysmorphic disorder (BDD) with and without comorbid obsessive-compulsive disorder (OCD), and to measure its possible relationships with clinical features.

Methods: Thirty outpatients affected by BDD, according to Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria, of whom 18 were also suffering from OCD, were included in the study. Clinical assessment was carried out by means of the Yale-Brown Obsessive-Compulsive Scale modified for BDD and a specially designed OCD Questionnaire. The level of insight was measured by means of the score at item 11 of the Yale-Brown Obsessive-Compulsive Scale modified for BDD.

Results: The insight resulted to be excellent in four cases, good in four, fair in five, poor in 15 and absent in two. Significant and positive correlations were observed between the level of insight and the following items: resistance to thoughts and to activities as well as to time spent on activities and control on activities related to the defect. The insight was significantly lower in patients affected by both BDD and OCD.

Conclusion: The findings indicate that the majority of BDD patients in this study, and especially those with comorbid OCD, have a low degree of insight that is significantly correlated to symptoms specific of the disorder.
Obsessive-Compulsive Disorder With and Without Tic Disorder:A Comparative Study From India
Authors: Jaisoorya T.S. , Reddy Y.C. Janardhan , Srinath S. , Thennarasu K.
Published: August 2016

Introduction:Evidence from phenomenological, family, genetic, and treatment studies from Western centers have suggested that tic-related obsessive-compulsive disorder (OCD) could be different from non-tic-related OCD. This study from India investigated the differences in OCD with and without tics, with respect to sociode-mographics, symptom profile, and comorbidity, including obsessive-compulsive spectrum disorders, to examine whether the clinical profile of tic-related OCD is similar to that reported previously.

Methods:Fifty subjects with OCD and tics (chronic motor tics and Tourette syndrome) were compared with 141 OCD subjects without tics.

Results:Subjects having OCD with tics tended to be males, and had an earlier onset of illness. They had more of symmetry/aggressive and religious obsessions, and cleaning, ordering/arranging, hoarding, and repeating compulsions and were associated with trichotillomania and hypochondraisis. Stepwise backward (Wald) regression analysis showed that an early age of onset, male gender, aggressive obsessions, cleaning compulsions, and trichotillomania were significantly associated with tic-related OCD.

Conclusion:The findings of this study from India are broadly similar to those reported previously from the West indicating the universality of differences in tic- and non-tic-related OCD. Our findings also support the existing evidence that tics contribute to the heterogeneity of OCD.
Efficacy and Tolerability of Long-Term, Open-Label, Mixed Amphetamine Salts Extended Release in Adolescents With ADHD
Authors: Spencer Thomas J. , Biederman Joseph , Wilens Timothy E.
Published: August 2016

Objective

Assess long-term tolerability and efficacy of once-daily mixed amphetamine salts extended release (MAS XR) for attention-deficit/hyperactivity disorder (ADHD) in adolescents (13–17 years of age).

Methods

Efficacy of MAS XR (10–60 mg/day) in 138 adolescents with ADHD was assessed in a 6-month, openlabel, extension study following participation in a 4-week, randomized, placebo-controlled trial of MAS XR. Efficacy was based on ADHD Rating Scale-IV (ADHD-RS-IV) scores and Clinical Global Impressions-Improvement (CGI-I) ratings at end point. Tolerability was based on reported adverse events, physical and laboratory examintions, vital signs, and electrocardiographic measures.

Findings

Patients exhibited sustained improvement in ADHD symptoms in this 6-month, open-label study of MAS XR 10–60 mg/day. End point ADHD-RS-IV total score was significantly decreased from baseline (-7.9; P<.0001); similar decreases were seen for hyperactivity/impulsivity (-4.0; P<.0001) and indttentiveness (-3.8; P<.0001). Based on CGI-I ratings, 60.9% of patients were very much/much improved, 33.3% were unchanged, 5.8% were much worse, and 0% were very much worse. The most common adverse events related to MAS XR were anorexia (24.6%), weight loss (24.6%), headache (14.5%), and nervousness (13.0%).

Conclusion

Long-term MAS XR therapy is generally well tolerated and exerts sustained control of ADHD symptoms in otherwise healthy adolescents.
Short- and Long-Term Cardiovascular Effects of Mixed Amphetamine Salts Extended-Release in Adolescents With ADHD
Authors: Wilens Timothy E. , Spencer Thomas J. , Biederman Joseph
Published: August 2016

Objective

Assess cardiovascular effects of once-daily mixed amphetamine salts extended release (MAS XR) in adolescents (13–17 years of age) with attention-deficit/hyperactivity disorder (ADHD).

Methods

Blood pressure (BP), pulse, and electrocardiograms were assessed in 327 healthy subjects during a 4-week, randomized, double-blind, placebo-controlled, forced dose-titration study. Placebo (n=69) or once-daily MAS XR(10, 20, 30, or 40 mg) was administered to subjects ≤75 kg (n=233); 50- and 60-mg MAS XR was administered to subjects >75 kg (n=25). One hundred thirty-eight subjects participated in a 6-month, open-label extension study.

Findings

Changes in BP and QTcB (Bazett's formula) intervals at 4 weeks with MAS XR were not significantly different from the placebo group. Pulse increased by 5.0 and 8.5 bpm after 3 weeks with MAS XR 20 and 50 mg/day, respectively (P≤.002). After 6 months of open-label MAS XR treatment, mean increases in systolic BP (1.7 mm Hg; P=.0252) and pulse (4.4 bpm; P<.0001) were statistically, but not clinically, significant diastolic BP was not significantly changed (0.6 mm Hg) A decrease in QTcB interval (-4.6±19.9 msec) was statistically (P=.009), but not clinically, significant. There were no serious cardiovascular adverse events.

Conclusion

Cardiovascular effects of short- and long-term MAS XR treatment (≤60 mg/day) were minimal in otherwise healthy adolescents with ADHD.
Behavioral and Neuropsychiatric Outcomes in Alzheimer's Disease
Authors: Cummings Jeffrey L.
Published: August 2016

Behavioral and psychological symptoms of dementia pose significant challenges in the management of patients with Alzheimer's disease. Neuropsychiatric symptoms are associated with cognitive decline, highly impaired activities of daily living, and frontal lobe pathology. Moreover, behavioral and psychological symptoms can diminish patient quality of life, increase caregiver distress, and accelerate nursing home placement. Although these symptoms are often associated with the later stages of Alzheimer's disease, a high percentage of individuals with mild cognitive impairment or mild Alzheimer's report symptoms as well. This article provides an overview of behavioral and neuropsychiatric symptoms associated with Alzheimer's disease and discusses nonpharmacologic and pharmacologic approaches to the management of such symptoms. For patients with severe behavioral and psychological symptoms of dementia, pychotropic agents may be warranted, whereas approved therapies for Alzheimer's, including cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine, may be appropriate in less severe cases.
Angioedema and Maculopapular Eruptions Associated with Carbamazepine Administration
Authors: Elias Alby , Madhusoodanan Subramoniam , Pudukkadan David , Antony James T.
Published: August 2016

Cutaneous rashes and eruptions can be caused by many medications, including carbamazepine. The presentation can be varied depending on severity. Cutaneous eruptions occur in 3% of individuals administered carbamazepine. Angioedema, a rare side effect of carbamazepine, involves vascular leakage in dermis and subcutis mediated by immunoglobulin E and/or bradykinins. Angioedema is more common in females and in the third decade of life. We report the case of a 27-year-old Indian woman who developed maculopapular rash and angioedema secondary to carbamazepine administration. The patient responded successfully to withdrawal of the drug and treatment with antihistamines. Due to the potentially life-threatening complications of this condition and the increasing use of anticonvulsants in the treatment of mood disorders, psychiatrists must be aware of the diagnosis and treatment of this condition.
Beauty and the Beast: Psychobiologic and Evolutionary Perspectives on Body Dysmorphic Disorder
Authors: Stein Dan J. , Carey Paul D. , Warwick James
Published: August 2016

Body dysmorphic disorder (BDD) is characterized by preoccupation with a defect in appearance. Concepts of beauty play a particularly crucial role in humans' mental and social life, and may have specific psychobiologic and evolutionary underpinnings. In particular, there is a growing literature on the neurocircuitry underpinning the body schema, body image and facial expression processing, and aesthetic and symmetry judgments. Speculatively, disruptions in cognitive-affective processes relevant to judgments about physical beauty lead to BDD.
Syndrome of Inappropriate Antidiuretic Hormone Associated with Escitalopram Therapy
Authors: Nirmalani Anjali , Stock Saundra L. , Catalano Glenn
Published: August 2016

Escitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent compound. Side effects are not generally serious and include headache, diarrhea, and nausea. While hyponatremia and the syndrome of inappropriate antidiuretic hormone (SIADH) have been associated with treatment with other SSRIs, there has only been one case of escitalopram-induced SIADH reported in the literature to date. We now report another case of a patient who developed SIADH after being treated with escitalopram for 4 weeks. The patient's hyponatremia improved following the discontinuation of escitalopram. Clinicians should be aware of this uncommon but significant side effect of SSRIs and monitor high-risk patients for the development of SIADH.
The Standard of Care in Suicide Risk Assessment:An Elusive Concept
Authors: Simon Robert I. , Shuman Daniel W.
Published: August 2016

Suicide risk assessment is now a core competency requirement in the residency training of psychiatrists.The purpose of suicide risk assessment is to identify modifiable or treatable acute, high-risk suicide factors, and available protective factors that inform patient treatment and safety management.The standard of care varies according to state statutory definitions. Heretofore, most states adopted an average physician or “ordinarily employed standard.” Currently, more states are adopting a “reasonable, prudent physician” standard. No single source or authority defines the standard of care for suicide risk assessment. Evidence-based psychiatry can inform clinicians' suicide risk assessments. Carefully documented risk assessments will assist the courts in evaluating clinicians' decision-making process.
Clinical Assessment of Suicide Risk in Depressive Disorder
Authors: Coryell William H.
Published: August 2016

Efforts to identify clinical risk factors for complete suicide through the follow-up of depressed patients have yielded relatively few robust predictors. Those identified by at least three studies are (in order of decreasing frequency) suicidal plans/attempts, male sex, being single or living alone, inpatient status, and hopelessness. Because the best established of these predictors has only modest sensitivity and specificity, the need for other robust tools is clear. A rich body of research has identified two biological risk factors for suicide in depressive disorder: hypothalamicpituitary-adrenal axis hyperactivity and deficits in serotonin function. Moreover, there is now considerable evidence that the dexamethasone suppression test and measures of serum cholesterol concentrations, respectively, may provide a clinically useful reflection of these two mechanisms. Observations that these measures appear to be additive, both with each other and with other clinical risk factors, indicate that a substantial improvement in the clinician's ability to assess suicide risk is possible.
Warriors Versus Worriers: The Role of COMT Gene Variants
Authors: Stein Dan J. , Newman Timothy K. , Savitz Jonathan , Ramesar Rajkumar
Published: August 2016

Behavioral phenotypes are generally complex, reflecting the action of multiple different genes. Nevertheless, there is growing evidence that key gene variants can alter activity within specific neuronal circuits and, therefore, influence particular cognitive-affective phenomena. One example is the catechol-O-methyltransferase (COMT) gene, which has a common variant at codon 158. Those with valine (Val158) alleles have increased greater COMT activity and lower prefrontal extracellular dopamine compared with those with the methionine (Met158) substitution. Val158 alleles may be associated with an advantage in the processing of aversive stimuli (warrior strategy), while Met158 alleles may be associated with an advantage in memory and attention tasks (worrier strategy). Under conditions of increased dopamine release (eg, stress), individuals with Val158 alleles may have improved dopaminergic transmission and better performance. while individuals with Met158 alleles may have less efficient neurotransmission and worse performance. Some evidence suggests that Val158 alleles are associated with schizophrenia, while Met158 alleles are associated with anxiety.
A Pilot Survey of Inmate Preferences for On-Site, Visiting Consultant, and Telemedicine Psychiatric Services
Authors: Tucker William , Olfson Mark , Simring Steven , Goodman William , Bienenfeld Scott
Published: August 2016

Objective

To assess inmate preferences for in-prison mental health services, outside psychiatric consultants, and telemedicine psychiatric consultation for 16 mental health services.

Methods

Structured interviews were conducted of the service modality preferences of 28 inmates who received psychiatric telemedicine consultations in NewYork State Department of Corrections facilities.

Results

For five of the 16 mental health services assessed, a significantly larger proportion of inmates preferred delivery of mental services by their on-site mental health team to an outside psychiatric consultant, whether visiting or using telemedicine. For another eight services, inmate preferences were approximately equal. For three services (treatment progress, evaluation of childhood sexual abuse, and sexual concerns), inmates reported a trend toward preference for out-side consultation (visiting and telemedicine combined). For no service did inmates prefer telemedicine to a visiting consultant.

Conclusion

Although inmates prefer the use of on-site mental health professionals for many mental health services, some inmates prefer visiting or telemedicine consultants for the evaluation of safety and sexual issues. Because telemedicine is efficient and readily available, its role in these areas requires further evaluation.
Novel Therapeutics for Schizophrenia: Targeting Glycine Modulation of NMDA Glutamate Receptors
Authors: Stahl Stephen M.
Published: August 2016

Currently, a major hypothesis for the pathophysiology of schizophrenia proposes that numerous risk factors converge on the N-methyl-D-aspartate (NMDA) receptor for the neurotransmitter glutamate, resulting in neurodevelopmental abnormalities at glutamate synapses and hypofunction of NMDA receptors.This hypothesis was presented in a previous “Trends in Psychopharmacology” column. Novel treatments are now in development that can theoretically boost the function of NMDA receptors by enhancing actions at the glycine co-transmitter site of this receptor complex. Early studies already indicate that this may lead to improvement in negative and cognitive symptoms of schizophrenia, especially when added as augmenting agents to atypical antipsychotics.
Psychiatric Comorbidity in 36 Adults with Mitochondrial Cytopathies
Authors: Fattal Omar , Link Jessica , Quinn Kathleen , Cohen Bruce H. , Franco Kathleen
Published: August 2016

Introduction:

Mitochondria are intracellular organelles involved in adenosine triphosphate production. The literature has established the presence of mitochondrial dysfunction in some subjects with psychiatric disorders. Also, there are multiple reports of patients with mitochondrial dysfunction who have various psychiatric disorders. Although the literature on mitochondrial dysfunction and its relation to psychiatric disorders is growing, there remain many unanswered questions.

Objective:

To review subjects with mitochondrial cytopathies for prevalence of psychiatric comorbidity.

Methods:

For this study, 36 adults were interviewed. The Mini International Neuropsychiatric Interview and the Short-Form 36 Health Survey, version 1 were used.

Results:

Lifetime diagnoses included 54% major depressive disorder, 17% bipolar disorder, and 11% panic disorder. These prevalence rates are compared with the general population and subjects with cancer and epilepsy. Subjects with a comorbid psychiatric diagnosis were older (P=.05), had more hospital admissions (P=.02), more medical conditions (P=.01), and lower quality of life (P=.01) than subjects with mitochondrial disease alone.

Conclusion:

Clinicians caring for persons with mitochondrial cytopathies should note the high prevalence of psychiatric problems. Also, this comorbidity might have etiological and therapeutic implications.
An Open-Label Trial of Divalproex Extended-Release in the Treatment of Borderline Personality Disorder
Authors: Simeon Daphne , Baker Bryann , Chaplin William , Braun Ashley , Hollander Eric
Published: August 2016

Introduction:

Borderline personality disorder (BPD) is associated with several symptoms, including impulsivity, aggression, and intense unstable affect, which can be targeted with anticonvulsant agents. Divalproex extended-release (ER) is used widely in clinical practice, which leads to the question of its efficacy and tolerability in treating BPD.

Methods:

This study assessed the efficacy and tolerability of divalproex ER in 20 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD via a 12-week openlabel trial. Primary outcome measures included the Clinical Global Impression–Improvement (CGI-I) scale and the Global Assessment Scale. Secondary outcome measures assessed aggression (Aggression Questionnaire, Overt Aggression Scale-Modified); affective disturbance (Affective Intensity Measure, Affective Lability Scale); dissociation (Dissociative Experiences Scale); and general psychopathology (Symptom-Checklist 90–Revised).

Results:

Thirteen subjects were male and seven were female with a mean age of 37.0±11.3 years. Treatment was associated with statistically significant improvement on the CGI-I, the Global Assessment Scale, the Overt Aggression Scale–Modified irritability subscale, and the Aggression Questionnaire. A trend toward significant improvement was observed on the Affective Intensity Measure. Seven out of 10 completers (70%) were treatment responders, with an endpoint CGI-I of 2 (much improved) or 1 (very much improved). There was no significant decline in affective lability or in dissociation. One participant discontinued treatment due to adverse events.

Conclusion:

These findings support that divalproex ER is an efficacious and well-tolerated pharmacologic agent for BPD, with the additional advantage of single daily dosing at bedtime. Placebo-controlled trials are needed for replication.
Neural Dysfunction in Postpartum Depression: An fMRI Pilot Study
Authors: Silverman Michael E. , Loudon Holly , Safier Michal , Protopopescu Xenia , Leiter Gila , Liu Xun , Goldstein Martin
Published: August 2016

Introduction:

With ∼4 million births each year in the United States, an estimated 760,000 women annually suffer from a clinically significant postpartum depressive illness. Yet even though the relationship between psychiatric disorders and the postpartum period has been documented since the time of Hippocrates, fewer than half of all these cases are recognized.

Objective:

Because postpartum depression (PPD), the most common complication of childbearing, remains poorly characterized, and its etiology remains unclear, we attempted to address a critical gap in the mechanistic understanding of PPD by probing its systems-level neuropathophysiology, in the context of a specific neurobiological model of fronto-limbic-striatal function.

Methods:

Using emotionally valenced word probes, with linguistic semantic specificity within an integrated functional magnetic resonance imaging (fMRI) protocol, we investigated emotional processing, behavioral regulation, and their interaction (functions of clinical relevance to PPD), in the context of fronto-limbic-striatal function.

Results:

We observed attenuated activity in posterior orbitofrontal cortex for negative versus neutral stimuli with greater PPD symptomatology, increased amygdala activity in response to negative words in those without PPD symptomotology, and attenuated striatum activation to positive word conditions with greater PPD symptomotology.

Conclusion:

Identifying the functional neuroanatomical profile of brain systems involved in the regulation of emotion and behavior in the postpartum period will not only assist in determining whether the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric diagnostic specifier of PPD has an associated, unique, functional neuroanatomical profile, but a neurobiological characterization in relation to asymptomatic (postpartum nondepressed) control subjects, will also increase our understanding of the affective disorder spectrum, shed additional light on the possible mechanism(s) responsible for PPD and provide a necessary foundation for the development of more targeted, biologically based diagnostic and therapeutic strategies for PPD.
Somnambulism Induced by Quetiapine: Two Case Reports and a Review of the Literature
Authors: Hafeez Zeba Hasan , Kalinowski Constance M.
Published: August 2016

Somnambulism, a previously unreported side effect of quetiapine, is described in two cases. Both cases involved individuals who had no prior or family history of somnambulism and had attention-deficit/hyperactivity disorder. The possible significance of this will also be discussed. Somnambulism is a common parasomnia that reflects an impairment in the normal mechanisms of arousal from sleep in which motor behaviors are activated without full consciousness. Motor behaviors are initiated during deep non-rapid eye movement or slow-wave sleep (stages 3-4), and may be limited to relatively simple manifestations, such as sitting up, fumbling with objects or bedclothes, or mumbling.
Considerations for Inpatient Versus Outpatient Treatment with Antipsychotics
Authors: Henderson David C.
Published: August 2016

The general goals for recovery of patients with schizophrenia are relatively simple: to improve patients' functioning, enable them to return to work or school, and allow them resume normal lives. However, there are differences between inpatient and outpatient treatment as it relates to some of these goals. For example, a hospitalized patient who has just suffered an acute episode may not be able to realistically meet the abovementioned goals. In such cases, clinicians must try to meet more feasible goals: moving patients from an acute episode to remission, reducing symptoms, improving function, and achieving stability outside of the hospital (Slide 1). This road to recovery involves two phases of treatment, inpatient and outpatient, which differ in their pursuit of patient stability. This discussion will touch on some of the differences between inpatient and outpatient treatment as it relates to acute goals and successful long-term treatment.
Obsessive-Compulsive Spectrum Phenomena and the DSM-V Developmental Process
Authors: Hollander Eric
Published: August 2016

Several of this month's articles and interviews touch on themes that relate to spectrum phenomena as well as the Diagnostic and Statistical Manual of Mental Disorders developmental process.

First, Darrel A. Regier, MD, MPH, director of the Division of Research at American Psychiatric Association, discusses, in an interview with CNS Spectrums, the developmental process for DSM-V. He emphasizes the use of dimensional measures to determine both thresholds for disorders, and to assess response to treatments. He also highlights a focus on spectra of disorders that cut across traditional diagnostic boundaries as one way to deal with issues of comorbidity. Finally, he discusses new approaches to the five DSM axes, and the need to link together the DSM and International Classification of Diseases processes. Three other articles in this issue also clearly relate to these obsessive-compulsive spectra issues.

For example, Leonardo F. Fontenelle, MD, PhD, describes how, although much attention has been paid to patients who lack insight into their obsessional beliefs, less importance has been given to individuals with obsessive-compulsive disorder (OCD) who display perceptual disturbances typically found in psychotic disorders, including schizophrenia, schizoaffective disorders, or mood disorders with psychotic features. The authors call attention to a phenomenon that has been neglected in the psychiatric literature (ie, the occurrence of hallucinations and related phenomena in patients with OCD). They describe five patients with OCD with hallucinations in several different sensory modalities, including the auditory, the visual, the tactile, the olfactory, and the cenesthetic modalities, and suggest that further psychopathological research should clarify the clinical significance of hallucinations among patients with OCD.
Auditory, Visual, Tactile, Olfactory, and Bodily Hallucinations in Patients with Obsessive-Compulsive Disorder
Authors: Fontenelle Leonardo F. , Lopes Angélica P. , Borges Manuela C. , Pacheco Paula G. , Nascimento Antonio L. , Versiani Marcio
Published: August 2016

Although much attention has been paid to patients who lack insight into their obsessional beliefs, less importance has been given to individuals with obsessive-compulsive disorder (OCD) who display perceptual disturbances typically found in psychotic disorders, including schizophrenia, schizoaffective disorders, or mood disorders with psychotic features. We would like to call the attention to a phenomenon that has been neglected in the psychiatric literature: the occurrence of hallucinations and related phenomena in patients with OCD. In this case report, we describe five clinical vignettes of patients with OCD with hallucinations in several different sensory modalities, including the auditory, the visual, the tactile, the olfactory, and the cenesthetic ones. Further psychopathological research should clarify the clinical significance of hallucinations among patients with OCD.
Neuropsychological Characteristics and Personality Traits in Pathological Gambling
Authors: Forbush Kelsie T. , Shaw Martha , Graeber Margarita A. , Hovick Lauren , Meyer Vanessa J. , Moser David J. , Bayless John , Watson David , Black Donald W.
Published: August 2016

Introduction:

Pathological gambling disorder (PG) has been associated with fronto-temporal dysfunction and maladaptive personality traits, such as impulsivity and novelty seeking. The purpose of this study was to examine the predictive variance of neuropsychological and personality characteristics in PG.

Methods:

Persons with PG (n=25) and a comparison group (n=34) were administered a battery of neuropsychological tests, the Temperament and Character Inventory, and the Barratt Impulsiveness Scale. Subjects with PG had evidence of fronto-temporal dysfunction as assessed by the Stroop, Wisconsin Card Sorting Test-64, Wechsler Adult Intelligence Scale Letter-Number Sequencing, Controlled Oral Word Association Test, and Boston Diagnostic Aphasia Examination Animal Naming Test.

Results:

Subjects with PG also had impaired decision making on the Iowa Gambling Task. PG subjects had elevated levels of impulsivity, novelty seeking, and harm avoidance, and lower levels of self-directedness and cooperativeness. Logistic regression analyses indicated that neuropsychological variables did not add significant incremental variance over personality traits in predicting PG (Block χ2=5.19, P=.074), while personality variables added significant incremental variance over neuropsychological traits in predicting PG (Block χ2=25.13, P<.001).

Conclusion:

These results suggest that personality traits are better predictors than neuropsychological characteristics of whether someone has PG.
Cognitive-Affective Neuroscience of Somatization Disorder and Functional Somatic Syndromes: Reconceptualizing The Triad of Depression-Anxiety-Somatic Symptoms
Authors: Stein Dan J. , Muller Jacqueline
Published: August 2016

Somatization disorder is a somatoform disorder that overlaps with a number of functional somatic syndromes and has high comorbidity with major depression and anxiety disorders. Proposals have been made for revising the category of somatoform disorders, for simplifying the criteria for somatization disorder, and for emphasizing the unitary nature of the functional somatic syndromes in future classifications. A review of the cognitive-affective neuroscience of somatization disorder and related conditions suggests that overlapping psychobiological mechanisms mediate depression, anxiety, and somatization symptoms. Particular genes and environments may contribute to determining whether symptoms are predominantly depressive, anxious, or somatic, and there are perhaps also overlaps and distinctions in the distal evolutionary mechanisms that produce these symptoms.
Current Status of Cannabis Treatment of Multiple Sclerosis with an Illustrative Case Presentation of a Patient with MS, Complex Vocal Tics, Paroxysmal Dystonia, and Marijuana Dependence Treated with Dronabinol
Authors: Deutsch Stephen I. , Rosse Richard B. , Connor Julie M. , Burket Jessica A. , Murphy Mary E. , Fox Fiona J.
Published: August 2016

Pain, spasticity, tremor, spasms, poor sleep quality, and bladder and bowel dysfunction, among other symptoms, contribute significantly to the disability and impaired quality of life of many patients with multiple sclerosis (MS). Motor symptoms referable to the basal ganglia, especially paroxysmal dystonia, occur rarely and contribute to the experience of distress. A substantial percentage of patients with MS report subjective benefit from what is often illicit abuse of extracts of the Cannabis sativa plant; the main cannabinoids include delta-9-tetrahydrocannabinol (Δ9-THC) and cannabidiol. Clinical trials of cannabis plant extracts and synthetic Δ9-THC provide support for therapeutic benefit on at least some patient self-report measures. An illustrative case is presented of a 52-year-old woman with MS, paroxysmal dystonia, complex vocal tics, and marijuana dependence. The patient was started on an empirical trial of dronabinol, an encapsulated form of synthetic Δ9-THC that is usually prescribed as an adjunctive medication for patients undergoing cancer chemotherapy. The patient reported a dramatic reduction of craving and illicit use; she did not experience the “high” on the prescribed medication. She also reported an improvement in the quality of her sleep with diminished awakenings during the night, decreased vocalizations, and the tension associated with their emission, decreased anxiety and a decreased frequency of paroxysmal dystonia.
Varenicline-Induced Mixed Mood and Psychotic Episode in a Patient with a Past History of Depression
Authors: Pumariega Andres J. , Nelson Robert , Rotenberg Larry
Published: August 2016

Varenicline is a promising agent with demonstrated efficacy in the promotion of smoking cessation. However, from the time of initial trials, it has been associated with significant psychiatric adverse effects. We describe a case where mixed mood and psychotic disturbance developed in an individual with a history of depression and a family history of bipolar disorder. Based on this case, we hypothesize a possible mechanism of action for these adverse effects and preventive measures that could be undertaken in its effective use.
Challenges in the Implementation of Manualized Psychotherapy in Combat-related PTSD
Authors: Linden Maria , Golier Julia
Published: August 2016

Mr. F is a 60-year-old Caucasian, married, unemployed male who presented to the outpatient department of the Veterans Administration (VA) ∼10 months ago with a chief complaint of sleep difficulties. Approximately 12 years ago he had been diagnosed with posttraumatic stress disorder (PTSD) and a major depressive episode (MDE). He received very little treatment, either medication or therapy, at that time. He presented after being followed in a Veteran's Center for weekly to biweekly supportive therapy with a counselor for ∼6 months. He had gone to the Veteran's Center due to the encouragement of his wife. She had noted that he was becoming increasingly irritable and isolative at home and she had asked him to seek help for his anger and irritability. An event occurred in which he broke a chair after watching war-related news coverage and that made her insist that he present for treatment.
STEPPS: Systems Training for Emotional Predictability and Problem Solving in Women Offenders with Borderline Personality Disorder in Prison—A Pilot Study
Authors: Black Donald W. , Blum Nancee , Eichinger Leanne , McCormick Brett , Allen Jeff , Sieleni Bruce
Published: August 2016

Introduction:

An uncontrolled pilot study of SystemsTraining for Emotional Predictability and Problem Solving (STEPPS) was conducted with incarcerated women offenders. STEPPS is a promising new cognitive-behavioral group treatment for persons with borderline personality disorder (BPD).

Methods:

Twelve women offenders withDiagnostic and Statistical Manual of Mental Disorders, Fourth EditionBPD were enrolled in the 20-week program at an Iowa prison. Efficacy assessments included the Borderline Evaluation of Severity overTime, the Positive and Negative Affectivity Scale, and the Beck Depression Inventory. Data were collected at baseline, and weeks 4, 8, 12, 16, and 20. A prison therapist was trained to deliver the STEPPS program.

Results:

The 12 volunteers had a mean age of 34.8±8.5 years. Two women discontinued early because they were released from prison; the others attended all sessions. The analysis showed significant improvements in BPD-related symptoms, negative affectivity, and depression. The Borderline Evaluation of Severity over Time total score was highly significant at week 20 (P=.009), indicating overall improvement in BPD-related symptoms. Effect sizes for the efficacy measures were moderate to large. The prison therapist showed excellent adherence to the model.

Conclusion:

This study demonstrated the successful implementation of the STEPPS program in a women's prison. Participants achieved “real-world” benefits, including a reduction in the negative thoughts and behaviors associated with BPD, negative affectivity, and depression. Implications of the findings are discussed.