bluuebunny/crossref_metadata_2025 huggingface dataset:
The Quest for a Classic: Wang Yi and the Exegetical Prehistory of his Commentary to the Songs of Chu
Authors: Schimmelpfennig Michael
Published: August 2016

With the publication of Madman of Chu: A Myth of Loyalty and Dissent in 1980, Laurence Schneider established the view that the controversy over Qu Yuan between various erudites during the Han dynasty was a dispute between adherents and opponents about the question of what the Chu minister and poet stood for. The present study challenges this view by demonstrating that, aside from the so-called biographies by Sima Qian and Liu Xiang, all other contributions to the debate represent readings of the Li sao. Once this is understood, each contribution to the debate can not only be seen in its own light but it can also be examined in its relation to the section and sentence commentary by Wang Yi written in the second century C.E. The understanding of the controversy as a discourse of rather varied interpretations of the Li sao enables us to regard the Chuci zhangju by Wang Yi as a commentary that stood at the end of this controversy that lasted more than three centuries. It also enables us to see that the controversy rested on a particular set of premises, especially the question of the literary status of the Li sao and its author. The final thesis resulting from the present study is that the main reason for the lasting influence of Wang Yi's commentary together with the fact that it remained unchallenged until the twelfth century is that it was built on a sound and varied exegetical foundation, namely the controversy on the Li sao during the Han.

The first part of this article examines the contributions to the controversy by Jia Yi (201–165), Liu An (?178–122), Sima Qian (145–?86), Liu Xiang (79–8), Yang Xiong (53 B.C.E-18 C.E.), Liang Song (?–83 C.E.) and Ban Gu (32–92) in chronological order. The second part juxtaposes their works with the commentary of Wang Yi in order to understand how the Eastern Han commentator employed the contributions of his predecessors and how he reacted to them.
Wrought Metal-Working Prior to Middle Shang (?)—A Problem in Archaeological and Art-Historical Research Approaches
Authors: Barnard Noel
Published: August 2016

The existence of certain types of Lung-shan pottery vessels and early Shang bronzes based upon supposed wrought metal prototypes continues to lead some scholars to the conclusion that these cultures had knowledge of sheet metal, smithy techniques. An analysis of such features as the tubular spout, projecting ledges, imitation “rivets,” and imitation folded rims leads to the conclusion that their presence is accounted for either by the versatility of the Neolithic potters, by the requirements of metal casting techniques, or by decorative considerations; it need not, and frequently cannot, be explained in terms of sheet metal prototypes. The article also considers the nature and significance of various cold metal working techniques, such as annealing. In the view of the wrought-metal advocates, these techniques would have had to have been discarded and forgotten by the early Chinese metal workers in favor of direct casting in piece-mold assemblies. This is highly unlikely.
Gender Differences in the Granting of Behavioural Autonomy to Adolescents
Authors: Farnill Douglas
Published: August 2016

A recent article in this Journal, Hudson et al. (1986) published age norms for adolescent autonomy. The reported norms were the same for boys and girls. In our research, reported in the present article, we found that the gender of the child is a significant variable in opinions about when adolescents ought be permitted autonomy. We suggest that null findings about gender effects may be due to the inadvertent evocation of an ideology of sex equality, masking the effects of gender. Except for the gender differences, our results strongly support the previously published norms and add to the fund of information available.
Irlen Lenses: An Appraisal
Authors: Winter Sam
Published: August 2016

An experiment was conducted to indentify and analyse any positive effects of lrlen lenses upon visual perceptual performance of children previously diagnosed as Scotopic Sensitive. Pupils performed a letter identification visual search task under lrlen lens, Untinted lens, Plain Grey lens and No lens conditions. No condition was associated with superior performance on the task. Nevertheless, several children reported that untinted or plain grey lenses helped them perform the task. The study provides no evidence to suggest that lrlen lenses improve visual performance.
Ethics and the Role of Law
Authors: Habgood John
Published: August 2016

I was once sitting knee-to-knee with a woolsack full of judges at the State Opening of Parliament, and I asked them how far they were concerned with ethical issues in their work. They said “not at all”; such issues were the task of jurisprudence, not of legal practitioners. But I believe that ethics are bound up with the actual practice of the law and I want to point to three ways in which they interact.
The Governing Body of the Church in Wales Recent Legislation
Authors: Watkin Thomas Glyn
Published: August 2016

At its April meeting, the Governing Body considered a varied agenda, including three items of legal interest. These were: firstly, an amendment relating to the size and composition of the membership of the Representative Body of the Church in Wales; secondly, the second reading of a bill to amend the canon law of the Church in Wales relating to clerical disabilities, and, thirdly, a motion seeking to render retired clerics ineligible for membership of Parochial Church Councils within the province.
The Nordic and Baltic Churches
Authors: Hill Christopher
Published: August 2016

In October 1992 representatives of the British and Irish Anglican Churches, together with their counterparts from the Nordic and Baltic Lutheran Churches signed an historic agreement near Porvoo in Finland which, if accepted by all these churches, will bring about their closer communion. The Porvoo Common Statement and a supporting dossier of Essays on Church and Ministry in Northern Europe were published in 1993 (Together in Mission and Ministry, Church House Publishing, London). The Porvoo Common Statement is now being considered by the General Synod which will be asked to accept a core Joint Declaration. This begins by a mutual acknowledgement of each other's churches as part of the One, Holy, Catholic and Apostolic Church. A second acknowledgement follows concerning the mutual presence of the Word of God and the Sacraments of baptism and the eucharist;then acknowledgements of the common confession of the apostolic faith and the ministry as both an instrument of grace and as having Christ's commission.
European Perspectives on Ecclesiastical Law and Religious Education
Authors: McClean David
Published: August 2016

In February 1988 a group of German, Italian and Spanish scholars, principally professors of ecclesiastical law, met on the politically if not theologically neutral ground of Geneva to consider the creation of a European body linking scholars working in this field in the various member States of the European Community.
State Finance For European Churches
Authors: McClean David
Published: August 2016

In the January 1990 issue of the Journal, Professor McClean gave some account of the first meeting of the European Consortium for Church and State Research and of the position as to State support for Religious Education in the countries of the European Community. This article, based on his contribution to the March Conference of the Society, looks at the wider question of State Finance for the Churches, their ministry and worship.
Outrageous Behaviour—A Postscript
Authors: Jones T. Hughie
Published: August 2016

In his interesting article on order and disorder in church, Paul Barber citedAbrahams and Orsv.Cavey. The case is also cited by others writing on related matters. It has both social and legal aspects which it was not germane to Barber's purpose to develop, and this note is intended to remind readers of an event which may have attracted their attention and interest at the time.
Laissez-Faire Liturgy?
Authors: Lloyd Trevor
Published: August 2016

‘Where the Spirit of the Lord is, there is liberty.’

‘The rigidity imposed on the BCP through being enforced by Act of Parliament is against the nature of worship and the practice of Church law. This rigidity contributed a good deal to the separation of Independents from the Church of England in the seventeenth century and of the Methodists in the eighteenth. Again, towards the end of the nineteenth century, when enforcement to a great extent broke down, a situation arose in which many of the directions of the Prayer Book were disregarded without permission or protest from authority.”
How We Got to Where We Are: The Development of the Clergyman's Role
Authors: Russell Anthony
Published: August 2016

The church declares and witnesses to a changeless God beyond the confines of time and space. However, at the same time the church responds to change in the same way as other social institutions, and it is impossible to understand the Church of England without reference to its history.
Church Discipline and the Regulation of Membership in the Mormon Church
Authors: Gedicks Frederick Mark
Published: August 2016

The Church of Jesus Christ of Latter-day Saints, more commonly known as the ‘LDS’ or ‘Mormon’ Church, regulates its membership by means of a system that recalls the Old Testament far more than the modern West. All important decisions relating to joining and leaving the church are invested in the inspired discretion of local priesthood authorities who are governed by general standards rather than rules that have the character of law.
Religiously Affiliated Schools in America and Italy
Authors: Madera Adelaide
Published: August 2016

The aim of this paper is to make a comparison between the legal status of religiously affiliated schools in America and those in Italy, taking into account the difference between the two legal systems in which these institutions operate, and the different understanding of Church-State relations (separatism in the USA, Church-State Agreements in Italy). First, the study examines the different juridical legal structures offered by the two legal systems to religious organisations to manage secular works and protect their property. Secondly it examines the problem of the access of religiously affiliated schools to the public funding necessary for these institutions to continue to develop their mission: in both legal systems religiously affiliated schools are constitutionally denied direct access to public funding, but some forms of indirect access have been gradually admitted. Thirdly, the article examines new perspectives opened by recent statutes (in Italy) and decisions (in the USA) that are altering the traditional relationship between public/private and religious/secular which are going to offer a new, more equal role to religiously affiliated schools in both systems, preserving their spiritual identity and ethos.
Theological Reflections on the Place of the Sacred in Society
Authors: Inge John
Published: August 2016

This paper attempts an overview of currents of theological thinking on the place of the sacred in society. It considers the long tradition of active engagement between Church and State, which derives its authority from the New Testament and can be traced through St Augustine and Anglican Divines to the present day. Having examined contemporary arguments of those who question the propriety of such an arrangement it concludes that it remains theologically justifiable. The paper then turns to the particular question of the Establishment of the Church of England and engages both with those who support it and those who are in favour of disestablishment. It observes that Establishment functions at various levels in English society and, whilst acknowledging and welcoming the fact that its form will continue to change, argues that it offers distinct advantages to both Church and State. In a country where seventy-one per cent of the population professes itself to be Christian it gives the state legitimacy by reminding the latter that all authority derives from God and ensures that Christian influence for the maintenance of a just and peaceful society remains strong. Establishment reminds the Church that it has a responsibility to the whole nation, not just those who regularly attend its churches, and protects the mission and ministry of the Church throughout the parishes of the land.
Doctrine, Conservation and Aesthetic Judgment in the Court of Ecclesiastical Causes Reserved
Authors: Harte J. D. C.
Published: August 2016

The faculty jurisdiction of the Church of England is the core of what remains as a distinctive system of Church Law in England. It serves inter alia to safeguard the national heritage of parish churches and it is the reason why ecclesiastical buildings in use generally are immune from listed building control under secular planning law. The faculty jurisdiction still provides a model for regulating the conservation of buildings of historic and aesthetic interest and their contents which can be compared favourably with listed building control.
Aripiprazole for Patients with Schizophrenia and Schizoaffective Disorder: An Open-Label, Randomized, Study Versus Haloperidol
Authors: de Oliveira Irismar Reis , Elkis Hélio , Gattaz Wagner Farid , Chaves Ana Cristina , de Sena Eduardo Pondé , e Souza Fabio Gomes de Matos , Campos João Alberto , Bueno João Romildo , e Silva Jorge Alberto Costa , Louzã Mário Rodrigues , de Abreu Paulo Belmonte
Published: August 2016

Introduction: Aripiprazole, a dopamine D2 receptor partial agonist, has also partial agonist activity at serotonin (5-HT)1A receptors and antagonist activity at 5-HT2A receptors.

Methods: In this 8-week, multicenter, randomized, parallel-group, open-label, flexible-dose study, patients diagnosed with schizophrenia or schizoaffective disorder were randomized to aripiprazole 15–30 mg/day or haloperidol 10–15 mg/day.

Results: Patients treated with both aripiprazole and haloperidol improved from baseline in Positive and Negative Syndrome Scale total, positive, and negative scores as well as in Clinical Global Impressions scores (all P<.001). At the end of the study, the percentage of patients classified as responders—according to ≥40% reduction in the Positive and Negative Syndrome Scale negative subscale score—was significantly higher in the aripiprazole group (20%) than in the haloperidol group (0%) (P<.05). Additionally, a higher number of patients receiving haloperidol required more anticholinergic medications (P<.001) than aripiprazole-treated patients, whereas more aripiprazole (45.5%) than haloperidol-treated patients (12.9%) required benzodiazepines (P=.002). At endpoint, rates of preference of medication were higher in the aripiprazole group (63.2%) than in the haloperidol group (21.7%), as expressed by patients and caregivers (P=.001).

Conclusion: Aripiprazole and haloperidol had similar efficacy in terms of reduction of overall psychopathology. Although aripiprazole has been demonstrated to be superior concerning negative symptoms and in terms of tolerability (extrapyramidal symptoms) and preferred by patients and caregivers than haloperidol, significantly more aripiprazole-treated patients required benzodiazepines.
Neuroimaging Studies in Tourette Syndrome
Authors: Wright Christopher I. , Peterson Bradley S. , Rauch Scott L.
Published: August 2016

Tourette syndrome (TS) is a complex neurobehavioral disorder principally characterized by motor and vocal tics. However, features of obsessive-compulsive and attention-deficit/hyperactivity disorders are often present. The basal ganglia and associated brain structures have been implicated in the pathophysiology of TS, as well as in these related conditions. Specifically, it is believed that the neuroanatomically and functionally defined basal ganglia thalamocortical loops are involved in TS. These loops are composed of a sequence of connections originating in the cortex and passing in series through the striatum (caudate and putamen), globus pallidus, and thalamus before returning to the cortical areas of origin. This review concentrates on the neuroimaging findings in Ts, particularly as they relate to alterations in components of the basal ganglia thalamocortical circuits. These neuroimaging data suggest that the major abnormalities in TS involve striatal or cortical dysfunction, as well as dysfunction of dopaminergic systems that regulate basas ganglia neurotransmission.
Neuropathology in Tourette Syndrome
Authors: Swerdlow Neal R. , Young Anne B.
Published: August 2016

The unique clinical presentation of Tourette syndrome (TS) and its symptomatic response to dopamine antagonists are widely cited as evidence for the central role of the limbic-motor interface in the pathophysiology of TS. Nonetheless, the true neuropathology of TS remains elusive, even though significant advances have been made in understanding complex interconnected circuitries within the limbic system and basal ganglia. Neuropathologic and neuroimaging studies—plagued by small samples, clinical heterogeneity, and a number of interpretative problems—are generally supportive of pathology within the orbitofrontal cortex, striatum, and their efferent projections in TS. The specific patterns of abnormalities vary widely across these studies, clouding attempts to define a unifying neuropathology for this disorder. Converging yet circumstantial evidence for frontal cortical, and basal ganglia pathology in TS comes also from studies infields ranging from neuroimmunology to neuropsychology, and from the clinical overlap between TS and disorders such as obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, and Sydenhams chorea. As a “model” neuropsychiatric disorder, TS has stimulated advances in several areas of neurobiology research, yet we still await a real understanding of its pathophysiology in order to move from empirically driven therapeutics to the development of targeted effective treatments.
Anxieties Over the Diagnostic and Statistical Manual of Mental Disorders
Authors: Trimble Michael
Published: August 2016

Rumor has it that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) is on the way. Apart from giving the American Psychiatric Association an enormous financial boost, this should be an opportunity to improve on some of the terrible intellectual lapses of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Revised (DSM-IV-R), to bring DSM and the International Classification of Diseases (ICD) schemes closer together, and to expand on biological and other markers as diagnostic components in the classificatory process. It is hoped that more than the first of these possibilities will be realized.

Since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, (DSM-III), the DSM manuals have brought a measure of good sense to clinical practice and have improved communication among researchers, so that at least in theory schizophrenia is similar on both sides of the Atlantic, and most probably is similar on both coasts of the United States. The slavish adherence to listed criteria has developed a sense of renewed interest in phenomenology of a practical kind, and exclusion criteria mean that not all individuals who visit a psychiatrist's office can be guaranteed a diagnosis. The distinction between Axis 1 and Axis 2 categories and the removal of any psychoanalytic taints was a stunning acceptance of Jaspers pace Freud.
Vagus Nerve Stimulation and Lennox-Gastaut Syndrome: A Review of the Literature and Data From the VNS Patient Registry
Authors: Karceski Steven
Published: August 2016

Lennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy that is usually refractory to medical management. When medications fail, alternative therapies are considered. Among these are two surgical options: corpus callosotomy and vagus nerve stimulation (VNS). Safety and efficacy are two important factors to consider when selecting an appropriate treatment. VNS is safer than callosotomy, but its efficacy is more difficult to assess. Available studies evaluate its effectiveness using a mixed population of patients (some with prior epilepsy surgery), a multitude of VNS settings, and variable endpoints. To estimate the efficacy of VNS in patients with LGS, a review of the medical literature and the VNS Patient Registry was performed. Within the limits of this type of study, the results showed that VNS appears equally as effective as callosotomy. Because VNS has a lower potential for adverse events, these results suggest that VNS should be considered first in appropriately selected patient.
The Use of Valerian in Neuropsychiatry
Authors: Krystal Andrew D. , Ressler Ilana
Published: August 2016

Valerian is a medicinal agent deriving from the plant Valeriana officinalis L. We reviewed the available literature on the use of valerian preparations in the treatment of neuropsychiatric disorders. Preclinical studies suggest that valerian has sedative and muscle-relaxant effects. Few clinical trials with valerian have been carried out in conditions other than insomnia. The insomnia studies have methodologic shortcomings but suggest that some preparations lead to significant subjective improvement in sleep complaints with remarkably few side effects. Furthermore, some evidence indicates that valerian preparations may have a mechanism of action and clinical characteristics that differ from the benzodiazepine-related sedative/hypnotics, making them more suitable for long-term use. If this safety profile and the plant's sedative/hypnotic efficacy are confirmed in double-blind, placebo-controlled trials with carefully and consistently prepared valerian compounds, then those compounds would fill an important and presently unfilled niche in the treatment of insomnia.
Trauma and PTSD in Adolescent Girls
Authors: Cloitre Marylene
Published: August 2016

The diagnosis for posttraumatic stress disorder (PTSD) requires that onset be initiated by a negative life event. The event is considered capable of producing PTSD if it creates a threat to the person's physical integrity and produces a reaction of shock and horror. The traumatic events most frequently described in the research literature are combat and rape. These events are well known to produce the three symptom clusters that comprise PTSD and include: (A) re-experiencing symptoms, such as nightmares, sudden unbidden intrusive images and thoughts of the event, and flashbacks; (B) symptoms classified as avoidance, including efforts to avoid thoughts and feelings related to the event, sense of foreshortened future, and emotional numbing; and (C) symptoms of hyperarousal, such as hypervigilance and exaggerated startle response.

The nature of PTSD, particularly that it emerges from significantly disturbing life experiences, may contribute to the limited inquiry about the presence of the disorder among youths. It is difficult to consider that children and teenagers are exposed to terrible events such as physical assault, rape, and mass violence, which frequently lead to sustained psychiatric problems. However, the reality is that children and adolescents experience more violence than adults and that PTSD appears among youth at a rate equivalent to that of adults.
Anxiety During Pregnancy and Postpartum
Authors: Altemus Margaret
Published: August 2016

Perinatal depression is widely considered to be a major public health problem. Anxiety disorders are also common among women of childbearing years, but the course and consequences of anxiety during pregnancy have not yet been established.

Almost all studies of the prevalence and consequences of perinatal anxiety have used questionnaire measures of anxiety. Unlike the Edinburgh Postnatal Depression Scale, questionnaire measures of anxiety symptoms have not been validated for pregnant or postpartum patients, thus it is unclear to what degree these measures are detecting anxiety versus typical physical symptoms associated with pregnancy and infant care. For example, many items on the Beck Anxiety Inventory, including difficulty breathing, facial flushing, unsteadiness, light headedness, sweating, and indigestion, commonly occur during pregnancy. In a study of >8,000 women, more women scored above a cut-off score on the anxiety subscale of the Crown-Crisp Index during weeks 18 and 32 of pregnancy compared to 8 weeks and 8 months postpartum. Three studies have administered selected modules from the Structured Clinical Interview to postpartum women. All three studies found that >50% of women with postpartum anxiety disorders were not depressed and that anxiety disorders were at least as common postpartum as major depression. Antenatal anxiety was associated with an increased risk of postpartum depression, even after controlling for antenatal depression.
Stress, Peer Affiliation, and Transforming Growth Factor-β1 in Differentially Reared Primates
Authors: Smith Eric L.P. , Batuman Olcay A. , Coplan Jeremy D. , Rosenblum Leonard A.
Published: August 2016

A bidirectional regulatory interaction between the central nervous system and the immune system is largely provided by cytokines and their specific receptors, which are expressed by cells of both systems. Transforming growth factor-β1 (TGF-β1), produced by glial cells and lymphocytes and regulated by steroid hormones, is one such cytokine. In the current study, we examined the relationship between TGF-β1 and peer affiliation in bonnet macaques (Macaca radiata) either reared normally or exposed as infants to conditions in which their mothers faced fluctuating requirements for food procurement (variable foraging demand [VFD]). Rearing under VFD conditions has been previously shown to produce dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in these animals. Serum levels of TGF-β1 after exposure to a moderate stressor had no correlation with peer affiliation under baseline conditions (r=.07), but were highly correlated with affiliation after subsequent challenge with a fear stimulus (r=.62). Affiliation after the fear stimulus also was inversely correlated with baseline levels of affiliation (r=−.71). These data suggest that changes in peripheral TGF-β1 may be reflective of latent behavioral and biochemical propensities possibly related to affect. Further examination of the effects of early adversity will improve our understanding of the relationship between the HPA axis and immune function.
Hypothalamic-Pituitary-Adrenal Axis Function and the Metabolic Syndrome X of Obesity
Authors: Gohil Baiju C. , Rosenblum Leonard A. , Coplan Jeremy D. , Kral John G.
Published: August 2016

Obesity has negative health consequences related to fat distribution, particularly the central or visceral accumulation of fat. The major complications associated with visceral obesity, termed the “Metabolic Syndrome of Obesity,” or “Syndrome X,” are type II diabetes, hypertension, and dyslipidemia. As with certain mood disorders, the syndrome may be a consequence of neuroendocrine perturbations typically associated with chronic stress. Our work with bonnet macaque monkeys provides an animal model for the relationship between early stress, behavioral and hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and Syndrome X. During their infant's first half-year, mothers face a variable foraging demand (VFD), in which ample food varies unpredictably in the difficulty of its acquisition, and the offspring show persistent abnormalities in systems known to modulate stress and affective regulation. Early work on the bonnet macaque noted the emergence of a sample of spontaneously obese subjects as they matured. Using the VFD model, the current study showed that there was a clear relationship between early cerebrospinal fluid corticotropin-releasing factor levels and subsequently measured body mass index, supporting the hypotheses regarding the interactive roles of early experience and HPA axis dysregulation in the ontogeny of both metabolic and mood disorders.
A Review of the Treatment for Refractory Obsessive-Compulsive Disorder: From Medicine to Deep Brain Stimulation
Authors: Husted David S. , Shapira Nathan A.
Published: August 2016

This article provides an overview of the etiology, epidemiology, and first-line treatment options for obsessive-compulsive disorder (OCD). The subject of treatment-resistant and treatment-refractory OCD is the discussed, including a definition of these often-debated terms, and the latest treatment options delineated. This includes a review of the latest research concerning the pharmacological agents that have been studied as monotherapy or augmenting agents for the treatment of OCD, the use of experimental medications and procedures, treatment with reversible, minimally invasive procedure, such as vagal nerve stimulation and transcranial magnetic stimulation, invasive but the potentially reversible deep brain stimulation, and irreversible lesioning with ablative psychosurgery. A discussion of the role of psychotherapy in the treatment of OCD is also included.
Bipolar Disorders: Special Diagnostic and Treatment Considerations in Women
Authors: McElroy Susan L.
Published: August 2016

Bipolar disorder in women presents special diagnostic and treatment challenges to the clinician. The presentation of female bipolar may resemble depressive disorders, comorbid Axis I disorders, Axis II personality disorders, behavioral dysregulation, or general medical disorders; thus, it is critically important for clinicians to assess for a history of hypomania or mania when determining diagnosis in any woman presenting with psychological symptoms. Several gender differences may exist in the epidemiology and symptomatology of bipolar disorder, and each must be kept in mind during assessment. Rapid cycling and mixed states have been associated with female gender and may present diagnostic challenges as each often presents as major depression. Symptoms of postpartum psychosis tend to differ from the symptoms typically seen in bipolar mania; therefore, if postpartum psychosis is actually a manifestation of bipolar disorder, accurate diagnosis depends upon a knowledge of these differences. Special treatment considerations for bipolar disorder in women involve interactions between the illness and the female reproductive cycle. A risk of fetal malformation exists when some mood-stabilizing agents are used during conception and/or during the first trimester of pregnancy. Neurobehavioral teratogenicity and neonatal toxicity is also possible. Careful treatment management is necessary to reduce the risks to the fetus/infant and to effectively manage bipolar disorder in the mother. In treating women with bipolar disorder, clinicians should discuss the issue of pregnancy and associated risks of treatment versus no treatment with every patient of reproductive age. Further studies are needed on gestational timing and exposure to mood-stabilizing agents, especially newer agents recently approved or currently being considered for the treatment of bipolar disorder.
From Obsessive-Compulsive Spectrum to Obsessive-Compulsive Disorders: The Cape Town Consensus Statement
Authors: Zohar Joseph
Published: August 2016

In awareness of recent developments and upcoming future changes in the conceptualization of obsessive-compulsive disorders (OCDs), a group of 14 experts with specific experience in this area decided that a consensus statement on the present and future of OCD is timely. The group, with their long-term interest and productivity in the area of OCD, met with the specific aim of providing a global perspective. Ten countries from four continents were represented in this 2-day consensus meeting.

The meeting took place in Cape Town on February 27–28, 2006. The participants were asked to prepare and submit a relevant presentation before the meeting in order to enrich the discussion. Six presentations reviewed the following aspects of OCD: diagnosis, epidemiology, neurobiology, treatment, special populations, and pediatric OCD. A draft consensus was prepared, based on the presentations, recent consensus statements, evidence-based guidelines, and the ensuing discussions.
New Dimensions in the OCD Spectrum: Autism, Pathologic Gambling, and Compulsive Buying
Authors: Wong Cheryl M. , Hollander Eric
Published: August 2016

The obsessive-compulsive spectrum can be divided into two subclusters: disorders of impulsivity and neurologic disorders (Figure 1). This article examines autism (from the neurologic cluster) and pathologic gambling and compulsive shopping (from the impulse side of the spectrum). These three disorders are major mental health problems, impacting on society, the affected individuals, and their families. In addition, these three disorders are underrecognized and underdiagnosed. In this article, we outline and review the phenomenology, psychopathology, and treatment options of these three disorders.
Treatment of Adult ADHD and Comorbid Depression
Authors: Spencer Thomas J.
Published: August 2016

As a general principle, separate treatments are often needed for attention-deficit/hyperactivity disorder (ADHD) and comorbid psychiatric disorders. There are few treatments for mood disorders that also treat ADHD, and vice versa. This discussion will review the literature on agents that are effective for both disorders, or that may potentially be combined. Physicians must bear in mind that none of these agents is approved by the Food and Drug Administration for the treatment of comorbid ADHD and depression.
Dosing Atypical Antipsychotics
Authors: Cutler Andrew , Ball Sara , Stahl Stephen M.
Published: August 2016

The task of prescribing, dosing, and switching antipsychotics is generally characterized by a process of trial and error, often resulting in suffering from side effects and/or lack of response while searching for the optimum treatment. Clinical trials often inaccurately predict optimum doses and titration schedules, leaving prescribers without precise guidance for how to use newer therapies in clinical practice. A tremendous amount of individual response variability further complicates the task of effectively dosing antipsychotics.
Co-morbidity in Adults with ADHD
Authors: Newcorn Jeffrey H.
Published: August 2016

Attention-deficit/hyperactivity disorder (ADHD) is highly co-morbid across the life span. However, co-morbidity is not uniform across time; individual co-morbid conditions tend to occur at different times developmentally, with rates often reflecting lifetime occurrence (Slide 1). In addition to changes in the rates of co-morbidity, the nature of co-morbidity may also differ in late adolescence/adulthood, when co-morbid conditions can be especially impairing (eg, antisocial disorder, substance use disorder [SUD], more severe mood disorders).
Medical Mimics and Differential Diagnosis in Adult ADHD
Authors: Stein Mark A.
Published: August 2016

When performing a diagnostic evaluation for an adult patient with possible adult attention-deficit/hyperactivity disorder (ADHD), clinicians must pay particular attention to possible mimics. ADHD mimics are conditions responsible for the symptoms or impairments that superficially resemble, and may be confused with ADHD. These mimics may produce symptoms and impairments similar to those seen in adults with ADHD, but differ in etiology, course, or response to treatment of ADHD. When evaluating someone for ADHD, clinicians should first rule out the possibility of medical, psychiatric, and social mimics of ADHD.
Gender, Age, and the Risk of Insomnia
Authors: Zee Phyllis
Published: August 2016

While insomnia is common among men and women and across all age groups, older adults and women experience markedly increased risk for this disorder. Insomnia complaints in adults ≥65 years of age are very common. Foley and colleagues demonstrated in a study of 9,282 older adults (mean age of 74) an insomnia prevalence rate of ∼60%.

Approximately 57% of older adults have sleep complaints (Slide 1). Most of these are associated with comorbid conditions including depressed mood, respiratory problems, or poor physical health. The healthiest members of this population have far fewer sleep complaints.
New Directions in the Pharmacologic Treatment of Insomnia
Authors: Neubauer David
Published: August 2016

Because a multitude of factors contribute to insomnia, the context of treatment can greatly impact treatment efficacy. Major depression or congestive heart failure, for example, can contribute to insomnia, and treatment of those conditions should exert a positive effect on insomnia symptoms. On the other hand, the treatment of other conditions, such as the use of selective serotonin reuptake inhibitors antidepressants, may have a negative effect on the quality of sleep. Clinicians, therefore, need to take a versatile, multifaceted approach for each patient when treating insomnia.
Major Depressive Disorder: Barriers to Treatment
Authors: Nierenberg Andrew
Published: August 2016

There are a variety of barriers to major depressive disorder (MDD) treatment which may impede access to professional help and prevent best patient outcome. These barriers include the heterogeneity of MDD, societal factors, and clinician-patient relationship as well as issues of concordance, compliance, and adherence.
Use of Decision Support Tools for Treatment Algorithms
Authors: Trivedi Madhukar H.
Published: August 2016

Major depressive disorder (MDD) is a highly prevalent, debilitating disorder that is often chronic, recurrent, and costly, with the economic burden in the United States for the year 2000 exceeding $83 billion. Recent data from the National Comorbidity Survey Replication (NCS-R) indicate that MDD has a lifetime prevalence of 16.2% and a 12-month prevalence of 6.6% in the US. Among those reporting at least one episode of MDD in the previous 12 months, mean episode duration was 16 weeks. Roughly 60% of patients experienced role impairment that was “severe” or “very severe,” and nearly 80% reported comorbid disorders as defined by theDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition, with MDD only rarely being primary. Although 51.6% of patients with MDD received health care treatment for the illness, treatment was “adequate,” as defined by the Agency for Health Care Policy and Research and the American Psychiatric Association guidelines (ie, ≥4 outpatient visits with any type of physician for pharmacotherapy that included use of either an antidepressant or a mood stabilizer for ≥30 days or ≥8 outpatient visits with any professional in the specialty mental health sector for psychotherapy lasting a mean of ≥30 visits) in 41.9% of treated cases. Only 21.6% of all MDD patients in the NCS-R, therefore, received minimal guideline-level treatment.
Clinical Management of Major Depressive Disorder
Authors: Mignon Laurence , Stahl Stephen M.
Published: August 2016

The World Health Organization estimates that depression is the fourth leading cause of disability worldwide with a lifetime prevalence of ∼15% to 20%. While the antidepressants currently on the market will be effective in most patients, a significant number of patients will experience residual symptoms, treatment-resistance, and relapse. The recent Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study has shed some light on the reality of antidepressant treatment. At first, only one-third of patients on citalopram monotherapy remitted. The other two-thirds who failed to remit saw their likelihood of remission decrease with each successive trial of another antidepressant monotherapy. Thus, after four successive monotherapies were tried over the course of one year, (ie, after four treatments each lasting 12 weeks), only two-thirds of patients achieved remission (Figure 1). Besides this poor prognosis, the patients who required more treatment cycles to get better also had a higher likelihood of relapsing. Once patients reach that point, they are considered treatment-resistant.
Dosage and Administration Issues of Antipsychotic Agents (and Adjunctive Medicines) in the Acute Stabilization of Psychoses
Authors: Chengappa K. N. Roy
Published: August 2016

There are several options and approaches available to practicing psychiatrists for the pharmacologic management of acute psychotic episodes that present in emergency room settings. This article focuses on the first hours and days of such episodes, the goals of treatment, and comparison of the “old favorites,” such as combination haloperidol and lorazepam (in liquid, tablet or injectable formulations), with the newer second-generation antipsychotic agents, such as olanzapine, ziprasidone, risperidone, quetiapine, or aripiprazole, which are available in different formulations. The speed of titration to an effective target dose for these newer agents are addressed as well.
Rethinking the Treatment Paradigm for Bipolar Depression: The Importance of Long-Term Management
Authors: Baldassano Claudia F. , Ballas Christos A. , O'Reardon John P.
Published: August 2016

The need for long-term management of bipolar disorder is evident. Bipolar patients spend more time depressed than manic; however, few agents used for maintenance therapy of bipolar disorder have demonstrated good efficacy in delaying relapse into depression. This article provides a comprehensive review of open-label and randomized, controlled studies examining prophylactic efficacy in bipolar disorder, especially bipolar depression. Lithium, considered the gold standard for bipolar disorder maintenance therapy may be more effective in delaying manic relapse than in delaying depressive relapse. Evidence for the efficacy of divalproex and carbamazepine in delaying depressive relapse is yet to be fully elucidated. Lamotrigine has demonstrated efficacy in delaying time to depressive relapse. Unpublished studies show ohnzapine's efficacy in preventing manic recurrence, while its efficacy in preventing depressive recunence is yet to be proven. As patients with bipohr disorder are prone to experiencing depressive episodes, more attention needs to be focused on preventing depressive relapse. To date, three agents—lithium, lamotrigine, and olanzapine—have been shown to have prophylactic benefits in treating this highly recunent disorder.
Effective Dosing and Dose Equivalency of Second-Generation Antipsychotic Medications
Authors: Buckley Peter F.
Published: August 2016

Dosing patterns with second-generation antipsychotic medications (SGAs) are dynamic, with some SGAs surpassing current recommendations while others are declining in dose since their initial regulatory guidelines. Pertinent recent studies and available pharmacoepidemiologic reports, information, and expert consenses are reviewed herein to illuminate current thinking on the topic of dosing with SGAs. There is a need for fixed-dose studies of each SGA. Additionally, dosing should be a primary consideration when designing and subsequently interpreting comparative studies between SGAs.
The Future of Biological Psychiatry
Authors: Van Praag H. M.
Published: August 2016

Progress in biological psychiatry is contingent upon progress in neurobiology and progress in research of proper characterization and assessment of abnormal behavior. Advances in neurobiology are rapid and steady; however, advances are few and far between in psychopathology. In many ways, developments over the past two decades run counter to what I believe to be diagnostic pre-requisites for fruitful biological research in psychiatry. I presume this to be a major reason why thus far biology has made no significant contributions to the diagnoses of mental disorders.

For progress to occur in biological psychiatry, the traditional diagnostic philosophies and attitudes must be reevaluated and alternative diagnostic approaches put into practice. This and the diagnostic method of functional psychopathology are reviewed in this article, with a focus on how the functional psychopathological approach could contribute to the advancement of the diagnostic process in psychiatry, and the opportunities it provides for biological psychiatric research.
Recognizing and Treating Nonmotor Disorders Associated with Parkinson's Disease
Authors: Stacy Mark
Published: August 2016

Recognizing the nonmotor symptoms associated with Parkinson's disease (PD) is necessary to determine effective treatment regimens and achieve patients' maximum mobility, as well as enhance their quality of life. The Unified Parkinson's Disease Rating Scale (UPDRS) is a useful tool for the clinician in evaluating the entire patient. In this article, the nonmotor disorders related to PD are reviewed, with specific attention to the first and last sections of the UPDRS, which cover mentation and complications of therapy, respectively. Various treatment regimens for these nonmotor symptoms are presented. Other autonomic nervous system symptoms associated with PD, which are not assessed in the UPDRS, are also discussed.
Serotonergic and Noradrenergic Function in Pathological Gambling
Authors: DeCaria Concetta M. , Begaz Tomer , Hollander Eric
Published: August 2016

Research on pathological gambling has begun to demonstrate the significant pathophysiologic role of several neurotransmitter systems in this disorder. Challenge studies with various pharmacologic agents have suggested the importance of potential dysregulation of the serotonergic system in pathological gambling, as this system is linked to dysfunction in behavioral initiation and inhibition. In addition, the noradrenergic system has been associated with mediation of arousal, increases of which are manifested by pathological gamblers. The interactions between these and other neurotransmitter systems, as well as the similarities between pathological gambling and other behavioral disorders, may provide important clues for pharmacologic intervention.
Reconceptualization of Behavior Therapy for Obsessive-Compulsive Disorder from a Learning and Neurochemical Perspective
Authors: Neziroglu Fugen , Hsia Curtis
Published: August 2016

The etiology and treatment of obsessive-compulsive disorder has been explained from a social learning and neurobiological model. In this article a third model is proposed: the biobehavioral model, which encompasses a learning and neurochemical viewpoint. The authors suggest that behavior therapy and medications may operate in the same manner and that behavior therapy may need to be reconceptualized. Animal and human research supporting the interaction of behavioral change and neurochemical processes is presented. The authors also posit that urges precede anxiety and that compulsions are performed in response to the anxiety. Also, obsessions are viewed as secondary to compulsions. The mechanism of how behavior and cognitive-behavioral therapy may produce neurochemical changes is discussed.
Adenylyl Cyclase Activity and Mood Disorders: Preliminary Data in Human Brain Postmortem
Authors: Palego Lionella , Giromella Annalisa , Mazzoni Maria Rosa , Naccarato Antonio Giuseppe , Marazziti Donatella
Published: August 2016

During the past decade, an increasing interest has been shifted from the study of neuroreceptors to their links with second-messenger pathways. In the present article, we shall briefly review the methodological tools for evaluating adenylyl cyclase activity in several human brain and peripheral models, as well as the studies suggesting its involvement in the pathophysiology of mood disorders. We shall present also some preliminary data obtained in our laboratory providing evidence for the measurement of serotonin-sensitive adenylyl cyclase activity in human brain postmortem.