bluuebunny/crossref_metadata_2025 huggingface dataset:
A Question of Interpretation: The Roman Rota and the Theology of Marriage
Authors: Ofm Aidan McGrath
Published: August 2016

Judges need guidance if they are to apply the law in particular circumstances with an even hand. For Roman Catholics, Canon 19 of the 1983 Code of Canon Law provides this guidance by reference to the practice of the Roman Curia and by the constant opinion of learned authors. Useful as these supplementary sources are, they mean that judges have to trust that those responsible for making decisions in the Roman Curia and the learned authors have drawn their conclusions on a sound basis. This study considers what happened when a specific document was misunderstood in the Roman Catholic Church for almost four hundred years. The document, a letter from Pope Sixtus V to his Nuncio in Spain in 1587, responded to a specific query concerning the capacity for marriage of men who had been castrated. The interpretation of the letter defined the Roman Catholic Church's concept of marriage in general and its understanding of the impediment of impotence for four centuries. In the twentieth century, several Roman Catholic judges and canonists refused to take at face value the conclusions offered by other judges and learned authors, and decided to carry out their own analysis of the document in question. This resulted in a complete reversal of the way in which marriage cases were considered by the Apostolic Tribunal of the Roman Rota, and contributed to the emergence of a much richer and more integrated theology of marriage.
The Heathen Are Come Into Thine Inheritance: Reverter Of School Sites And The House Of Lords' Decision in Fraser v Canterbury Dbf
Authors: Richens Nick
Published: August 2016

On 27 October 2005 the House of Lords' decision in Fraser v Canterbury Diocesan Board of Finance (No 2)—referred to in this Comment as Fraser (No 2)—ended an audacious attempt by the Canterbury Diocese to eliminate the issue of reverter in the majority of school sites affected by it. The media, largely unable to comprehend the legal issues, announced that the decision would lose the Church a lot of money: ‘The widespread practice of selling school sites could prove to be a costly mistake’; ‘Defeat over sale of school land to cost Church millions’.
The Spirit of the Canon Law and its Application in England
Authors: Kemp Eric
Published: August 2016

The word Canon means a rule or norm and it was used at quite an early stage of the Church's history to denote both general principles governing the life of the Christian society and particular enactments of Christian assemblies. The subject matter of the canons is as wide as the life of the Church itself and consequently very varied in its nature. At one end of its range it is concerned with matters fundamental to the Church's existence such as the creeds and sacraments. At the other it deals with practical arrangements such as the ownership and use of buildings. At a recent conference with German Lutherans I was asked whether the canon law was jus divinum or jus humanum, and I felt bound to reply. ‘Both’, because of this wide range which stretches from revelation to convenience.
On Using the English Reports as a Source for Ecclesiastical Law: A Cautionary Tale
Authors: Smith Michael
Published: August 2016

‘One swallow docs not a summer make’ – so goes the old adage – and the object of this note is not to assert that reported cases are unreliable evidence. Its aim is to suggest that research must still extend beyond the printed evidence even for that period in history when collections of reported cases start to become freely available.
PREGNANCY ASSOCIATED HEPATOBILIARY DYSFUNCTION
Authors: KAUL ABHA , THILAGANATHAN BASKY , RAHMAN TONY
Published: August 2016

Physiological changes associated with pregnancy are well documented, the liver is no exception. Changes to maternal physiology during pregnancy can give rise to a change in liver function tests.
Prescribing Conventional Antipsychotics at Two Veterans Administration Hospitals: Are There Geographical Differences?
Authors: Masand Prakash S. , Arora Monica , Schwartz Thomas L. , Sharma Anil , Wang Xiaohong , Bhatia Subhash , Manjooran Jacob , Hardoby William , Virk Subhdeep , Kuhles Daniel J. , Agharkar Bhushan , Gupta Sanjay
Published: August 2016

The medical records of 110 patients receiving conventional antipsychotics at two geographically distinct Veterans Administration hospitals (Syracuse, New York and Omaha, Nebraska) were reviewed. The most common reasons for continuation of conventional antipsychotics were good response and patient or physician choice. Frequently, physicians did not discuss the reasons for continuing conventional antipsychotics or the availability of alternative therapies with their patients. Geographic differences in physicians' prescribing practices of conventional antipsychotics were apparent.
Pharmacologic Treatment of Schizophrenia: What the Future Holds
Authors: Tandon Rajiv , Jibson Michael D.
Published: August 2016

The advent of the newer “atypical” antipsychotics has revolutionized pharmacologic treatment of schizophrenia (SZ) and other psychotic disorders. In contrast to the first-generation conventional neuroleptics, these second-generation antipsychotic agents possess a broader spectrum of efficacy and cause fewer motor side effects such as extrapyramidal symptoms and tardive dyskinesia. Despite their substantial advantages, however, these second-generation agents also have significant limitations in terms of both efficacy and adverse effects. Several strategies to address these shortcomings are currently under study and some of these are likely to become part of our therapeutic armamentarium in the future. Current shortcomings in the pharmacologic treatment of SZ and strategies under investigation to address each of these deficiencies are reviewed. New formulations of existing medications and new antipsychotics under development are discussed. Developing adjunctive treatment strategies to address each of the major psychopathologic domains in SZ are summarized. The potential application of genetic information to treatment-matching in SZ is reviewed and likely refinements in the practice of evidence-based medicine in the pharmacotherapy of SZ are considered.
Overcoming Our Limits
Authors: Gorman Jack M.
Published: August 2016

There is an old joke that applies to the past–and only the past–of psychopharmacology: One dark night, a police officer notices a man furiously searching for something beneath a street lamp. “What are you looking for?“ he asks. The man replies, “My car keys. If I don't find them, I'll never get home.” “Well,” asks the police officer, “did you lose them here?” “No,” the man replies. “But this is the only place on the block that has any light.”

For example, once it was discovered that tricyclic antide pressants antagonize the presynaptic neuronal reuptake of norepinephrine (NE), the idea was put forth that the problem in depression is some abnormality in noradrenergic function. Some of the tricyclics, like desipramine and nortriptyline, are actually selective NE reuptake inhibitors. However, once it became apparent that selective serotonin (5-HT) reuptake inhibitors (SSRIs) are also effective in treating depression, consideration of the noradrenergic system suddenly disappeared from the literature, replaced by a new hypothesis that depression is caused by deficient serotonergic neurotransmission.
Adrenergic Pharmacology: Focus on the Central Nervous System
Authors: Pupo Andre S. , Minneman Kenneth P.
Published: August 2016

Norepinephrine and epinephrine are involved in the control of several important functions of the central nervous system (CNS), including sleep, arousal, mood, appetite, and autonomic outflow. Catecholamines control these functions through activation of a family of adrenergic receptors (ARs). The ARs are divided into three subfamilies (α1, α2, and β) based on their pharmacologic properties, signaling mechanisms, and structure. ARs in the CNS are targets for several therapeutic agents used in the treatment of depression, obesity, hypertension, and other diseases. Not much is known, however, about the role of specific AR sub-types in the actions of these drugs. In this paper, we provide an overview of adrenergic pharmacology in the CNS, focusing on the pharmacologic properties of subtype-selective AR agonists and antagonists, the accessibility of these drugs to the CNS, and the distribution of ARs in different areas of the brain.
Efficacy of Noradrenergic-Selective Agents in the Treatment of Neuropsychiatric Diseases
Authors: Kasper Siegfried F. , Resinger Eva
Published: August 2016

In recent years, a number of antidepressants with varying degrees of selectivity for the noradrenergic neurotransmitter system have become available. However, these agents represent a pharmacologically heterogeneous group and differ in terms of their precise side-effect profile and, possibly, their clinical efficacy. Bupropion, which is thought to act on both the dopamine and norepinephrine (NE) systems, has not been widely used as an antidepressant and has more recently been licensed as adjunctive therapy for smoking cessation. The serotonin-NE reuptake inhibitors venlafaxine and nefazodone, the noradrenergic and specific serotonergic antide-pressant mirtazapine, and the selective NE reuptake inhibitor reboxetine (the only truly NE-selective agent available) have all demonstrated efficacy in the treatment of depressive disorders. Evidence is now emerging for their use in the treatment of anxiety and panic disorders. There is some suggestion of a role for noradrenergic agents in other disorders, including attention-deficit/hyper-activity disorder and social phobia. The full range of disorders for which noradrenergic agents can be used remains to be seen and further research in this area is necessary.
Seizure Types, Epilepsy Syndromes, Etiology, and Diagnosis
Authors: Edwards Jonathan C.
Published: August 2016

The clinical manifestation of epileptic seizures may vary widely from patient to patient, depending on the region of the brain involved. Over the centuries, many seizure classific systems have been used, and the current most widely used classification system is that of the International League Against Epilepsy (ILAE). The ILAE system divides seizures into those of partial onset and those of generalized onset, depending on whether the initial clinical manifestations indicate that one cortical region or both hemispheres are involved at the onset of the seizure. Partial seizures are then divided into simple partial seizures, in which a fully conscious state is retained, or complex partial seizures, in which consciousness is impaired. A more recent classification system based purely on symptom features and signs has been proposed, and this system may provide advantages for localization, and especially for surgical evaluation. Epilepsy is a condition characterized by recurrent unprovoked seizures. Epilepsy may be idiopathic, cryptogenic, or symptomatic. Idiopathic epilepsies are generally genetic, and while man such syndromes have been described, advances in molecular genetics will undoubtedly reveal many more syndromes in near future. Cryptogenic epilepsies are those in which an underlying cause is suspected, but the etiology remains undetected. Epilepsies for which there is an underlying structural cause or major metabolic derangement are considered symptomatic. Common causes and diagnostic evaluation are described in this article.
Reproductive Dysfunction in Women With Epilepsy: Antiepileptic Drug Effects on Sex-Steroid Hormones
Authors: Morrell Martha J. , Flynn Kerry L. , Seale Cairn G. , Doñe Silvia , Paulson Amelia J. , Flaster Edith R. , Ferin Michel
Published: August 2016

Women with epilepsy are at risk for reproductive health dysfunction. Sex-steroid hormone abnormalities have been reported in women with epilepsy, but it has been difficult to determine whether these abnormalities are due to epilepsy-related hypothalamic-pituitary axis dysfunction, or to pharmacokinetic actions of antiepileptic drugs (AEDs). Sex-steroid hormones were evaluated in 84 reproductive-aged women with epilepsy receiving an AED in monotherapy, and in 20 nonepileptic controls. Estrone, free testosterone, and androstenedione were significantly lower in subjects receiving enzyme-inducing AEDs than in nonepileptic controls. Free testosterone was significantly elevated in subjects receiving valproate compared to nonepileptic controls. Subjects with epilepsy receiving gabapentin or lamotrigine were no different from the nonepileptic controls in any of the endocrine variables. Subjects with epilepsy who are receiving AEDs that alter cytochrome P450 enzymes are at risk for significant abnormalities in sex-steroid hormones. In contrast, subjects receiving AEDs that do not alter cytochrome P450 enzymes show no differences in sex-steroid hormones compared with nonepileptic controls. With new AEDs available that do not alter cytochrome P450 enzymes, physician selection of therapy should consider not only seizure control, but also potential effects on reproductive physiology.
Alternative, Complementary, or Not: Is Mainstream Medicine Ready for Herbal Medicine?
Authors: Gorman Jack M.
Published: August 2016

Proponents of herbal therapies frequently insist that traditional physicians must be made ready to accept so-called “alternative” or “complementary” treatments. In this month's issue of CNS Spectrums, two wonderful guest editors, Drs. Jonathan Davidson and Kathryn M. Connor, both of Duke University, help us turn that issue around. The real question for psychiatrists, neurologists, and neuroscientists is whether herbal treatments are ready for us.

Due in large part to recent Congressional mandates, dietary supplements, even when proposed to work for medical conditions like depression and generalized anxiety disorder, do not require approval in the United States by the Food and Drug Administration as pharmaceutical agents.
St. John's Wort:Clinical Status in Psychiatry
Authors: Meltzer-Brody Samantha E.
Published: August 2016

Depression and anxiety are among the top 10 health problems for which complementary and alternative therapies (CATs) are most frequently used, and medicinal herbs are among the most popular of these treatments. St. Johns wort(Hypericum perforaturn) is a perennial herb that has become a widely used depression therapy. Extracts of hypericum have shown affinity for receptors within multiple neurochemical systems. The primary active substance responsible for the antidepressant effect is not well defined, but most work has concentrated specifically on the hypericin and hyperforin components. Although hypericum has demonstrated significant antidepressant and antianxiety effects in multiple studies, there are several recent studies that do not support the previous evidence. In all reported studies, hypericum extracts have been well tolerated. In addition, new psychiatric uses for hypericum in obsessive-compulsive disorder, generalized anxiety disorder, menopausal symptoms, and alcohol dependence have been reported. Because patients are choosing to pursue CAT as a first-line therapy, psychiatrists will need to have a better understanding of phytomedicines used for treating depression and anxiety, and thus be better prepared to serve as effective allies of their patients.
ADHD: Current Questions and Research
Authors: Newcorn Jeffery
Published: August 2016

The past decade has seen an increased focus on the developmental trajectory of attention-deficit/hyperactivity disorder (ADHD), with the recognition that ADHD is, for many, a life-long condition akin to many other chronic illnesses. There has been an increase in the extent to which young children, adolescents, and adults receive a diagnosis of ADHD, yet there remain many poorly understood and controversial issues within the scientific community and the lay public. Do ADHD patients of different ages present with similar manifestations of the disorder, and if so, why was this not recognized for so long? Are there alternative clinical presentations among ADHD patients of different ages? What is the nature of comorbidity in ADHD over the course of development, and what are its functional consequences? How can we best measure and define ADHD, differentiating it from normal activity in young children, on the one hand, and other psychiatric disorders in older children and adults on the other? This is a key issue because ADHD has been a controversial diagnostic entity to many nonpsychiatrists because there is no one laboratory task that defines it. Most importantly, how do we understand issues related to risk and resilience in a longitudinal model, and can we identify factors that predict different clinical outcomes or pathways?
The Effect of Childhood Conduct Disorder and Cognitive Functioning on Adolescent Substance Use
Authors: Harty Seth C. , Thorn Nicole K. , Kalmar Jessica H. , Newcorn Jeffrey H. , Halperin Jeffrey M.
Published: August 2016

Objective: To assess the impact of childhood conduct disorder (CD) and intelligence quotient (IQ) on later substance use in adolescence.

Methods: Neuropsychological and structured diagnostic evaluations were initially administered to 32 children with disruptive behavior disorder when they were 7–11 years of age. They were then re-evaluated on average 6.7 years later using an array of interviews and rating scales with a focus on substance use.

Results: Early CD and IQ scores together accounted for a significant proportion of the variance in later substance use (R2=.248). In addition, there was a significant CD and Verbal IQ interaction (R2=.164) such that high Verbal IQ was linked to increased substance use in adolescents who had childhood CD.

Conclusion: These data indicate that the presence of conduct disorder may interact with high Verbal IQ during childhood in such a way as to predict later adolescent substance use in disruptive behavior disorder populations.
PMDD: Definition and Prevalence
Authors: Pearlstein Teri
Published: August 2016

Premenstrual dysphoric disorder (PMDD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as the presence of at least 5 of 11 symptoms with at least one of the symptoms being depressed mood, anxiety, affective lability, or irritability. The other symptoms include decreased interest in usual activities, poor concentration, fatigue, increased appetite, change in sleep, a sense of being overwhelmed or out of control, and physical symptoms such as breast tenderness. The symptoms must be present in the luteal (premenstrual) phase of the menstrual cycle, must resolve during the first few days of menses, and must have been present for at least 1 year. The symptoms should be severe enough to disrupt social and role functioning. The DSM-IV PMDD criteria include the recommendation that women prospectively rate their symptoms daily for two menstrual cycles to confirm the timing of the symptoms and the absence of a chronic underlying Axis I disorder. Many studies have identified irritability as the most frequently reported premenstrual symptom. It has been proposed that women with PMDD may comprise two subsets; one with predominant depressive symptoms, and another with predominant irritability.
Ever-Present Adverse Effects
Authors: Gorman Jack M.
Published: August 2016

With our emphasis on treatment-refractory depression, one cannot help but think about recent media coverage and regulatory events surrounding antide-pressant therapy. The current debate about the safety of antidepressant therapy for children and adolescents stands out in particular.

Recently, a pediatrician attending a symposium at the University of Pennsylvania asked me whether I thought that primary care pediatricians should continue to prescribe antidepressants for children with depression and anxiety disorder. As is now well known, data have emerged suggesting a link between selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and an increase in suicidal ideation involving children and adolescents during clinical trials. It is important to bear in mind that no actual suicides occurred and that some of the “suicidal acts” were far from lethal and, arguably, not suicidal. Nevertheless, overall ~1 in 50 children on active medication—significantly more than those on placebo—had new-onset suicidal ideation or actions. The effect was most noticeable for venlafaxine and paroxetine and least noticeable for fluoxetine. As all of these drugs block the presynaptic reuptake of serotonin, it is not clear if the differences among these medications are real.
Therapy of Treatment Resistant Depression: Focus on the Management of TRD with Atypical Antipsychotics
Authors: Klein Nikolas , Sacher Julia , Wallner Helene , Tauscher Johannes , Kasper Siegfried
Published: August 2016

Treatment-resistant depression (TRD) represents a significant challenge for physicians. About one third of patients with major depressive disorder fail to experience sufficient symptom improvement despite adequate treatment. Despite this high occurrence of TRD there was no general consensus on diagnosis criteria for TRD until 1997 when researchers proposed a model of defining and staging TRD. In 1999, others defined operational criteria for the definition of TRD. Treatment of TRD is commonly separated into pharmacologic and nonpharmacologic methods. This review gives a short overview of these two methods. The nonpharmacologic methods include psychotherapy, electroconvulsive therapy, and vagus nerve stimulation. Pharmacologic methods include switching to another antidepressant monotherapy, and augmentation or combination with two or more antidepressants or other agents. This review especially focuses on the augmentation of the antidepressant therapy with atypical antipsychotics.
The Role of Atypical Antipsychotics in Glucose/Insulin Dysregulation and the Evolving Role of the Psychiatrist in a New Era of Drug Treatment Options
Authors: Ferraioli Anthony , Shirley Kara Lee , David Panakkal
Published: August 2016

This article examines the issue of atypical antipsychotics, glucose/insulin, and other metabolic derangements (ie, metabolic syndrome), including a general introduction to the health, concerns of our patients, a review of the literature, possible mechanisms of antipsychotic induced glucose dysregulation, monitoring approaches, and management and prevention of metabolic syndrome. Literature review leads to mechanism hypotheses and risk estimations, leading to guidelines for monitoring and treatment. The patient population suffers from a higher degree of baseline metabolic dysregulation resulting in cardiovascular disease through components of the metabolic syndrome, and this risk increases with administration of atypical antipsychotic medication at different rates, depending on both drug and patient risk factors. The growing knowledge of mechanisms behind drug induced glucose/insulin and other metabolic dysregulation, as well as advances in pharmacogenomics, will help refine drug selection and monitoring for adverse, life-threatening metabolic effects.
Special Populations
Authors: Zohar Joseph , Fostick Leah , Black Donald W. , Lopez-Ibor Juan J.
Published: August 2016

Obsessive-compulsive disorder (OCD) is a formidable public health problem, rated by the World Health Organization as one of the top 20 most disabling diseases.The shame and secrecy associated with OCD, as well as the lack of recognition of its characteristic symptoms, particularly by primary care physicians, hinders appropriate diagnosis and treatment. Most adults with OCD report a late adolescent or early adulthood onset, yet OCD can occur throughout the life span. Pre-school children have been known to develop the disorder, as have elderly persons. OCD can cause considerable distress and disability; for example, children may fall behind in their education, and adults can become housebound. Comorbid psychiatric disorders have become an area of intense interest. Comorbid depression for example, is frequently the symptom that leads the individual to seek treatment. Patients with schizophrenia frequently develop obsessions and compulsions, and these symptoms are associated with a poorer outcome. The role of second-generation antipsychotics merits further study in the treatment of this subset of patients. An important step toward delineating specific subgroups within the OCD-schizophrenia axis may be the use of endophenotypic markers. Unfortunately, many patients with OCD will have a less than optimal treatment response. Poor treatment response is associated with serious social disability, but there are few clues to guide clinicians in predicting treatment response in patients with OCD, in terms of specific demographic variables, clinical symptoms, or the presence of comorbid psychiatric disorders.
Prodromal Schizophrenia: The Dilemma of Prediction and Early Intervention
Authors: Davidson Michael , Weiser Mark
Published: August 2016

The notion that subtle cognitive, emotional, behavioral, and functional deviations from norms are present in many individuals several years before a formal diagnosis of schizophrenia has been around for almost a century. This notion has been at the base of the developmental hypothesis of schizophrenia and has been the impetus for the use of cognition as an endophenotype for studying the illness. The recent enthusiasm for prodromal research derives from two unrelated and controversial claims: that short duration of untreated psychosis is associated with better prognosis and that novel antipsychotic drugs have a better safety profile, supposedly enabling early intervention at a relatively lower risk of side effects to the patient.

At the current level of knowledge, the risk-benefit assessment of prodromal interventions turns out to be an almost unsolvable conundrum. On one hand, the age of onset of psychosis and schizophrenia, early and mid-ado-lescence, coincides with the age at which life-long social and vocational characteristics are shaped. Any intervention that could produce even minimal delay in onset of active psychosis or ameliorate its early course might have a life-long impact. Therefore, the idea of prodromal intervention cannot be easily dismissed. On the other hand, in absence of accurate markers for imminent psychosis and strong data indicating that treatment during the prodromal phase is effective, exposing adolescents to the stigma associated with the illness and the adverse effects of antipsychotics has raised serious hesitations among many researchers and clinicians.
The Diagnosis and Assessment of Individuals Prodromal for Schizophrenic Psychosis
Authors: Addington Jean
Published: August 2016

Accurate identification of individuals in the earliest symptomatic stages of psychosis offers new hope for developing more effective treatment strategies. Recently, research clinics have been set up to identify and possibly treat individuals who are seen as being at ultra-high risk of developing a psychotic disorder. This article reviews and describes measures that are currently being used and further developed in order to determine both the diagnostic criteria for the prodromal state and the severity of these putatively prodromal symptoms.
Update on Alzheimer's Disease: One Hundred Years After Dr. Alois Alzheimer
Authors: Cummings Jeffrey L.
Published: August 2016

Alzheimer's disease was first described by Alois Alzheimer in 1906, and first appeared in the medical literature in 1907. The medical community has been ruminating about Alzheimer's disease for over 100 years, and only recently have Alzheimer's disease therapies begun to emerge. However, many vital questions remain, pertinent not only to physicians but to the public at large. For example, how likely is it that a particular individual will develop Alzheimer's disease? What can one do to avoid getting Alzheimer's disease? What are the current and promising treatments for Alzheimer's disease? While there are grey areas, the Alzheimer's disease field is beginning to find solid answers to these questions. There are risk factors that individuals can control, and emerging treatments are cause for optimism.
Advocating for People with Alzheimer's Disease and their Caregivers
Authors: Cherry Debra
Published: August 2016

Many efforts are being made to medically manage or eliminate Alzheimer's disease. Millions of family members, friends, and professionals are serving as caregivers for those with the disorder. These two efforts are important, but they are not enough. The public must also be educated in order to reduce the risk for Alzheimer's disease and related dementias in younger generations. These various goals can be accomplished through many different community-focused activities, including care and support for families; public awareness; community, patient, and professional education; research; and advocacy.
Evidence-Based Pharmacotherapy for Mood and Anxiety Disorders with Concurrent Alcoholism
Authors: Brady Kathleen T.
Published: August 2016

Co-occurring psychiatric and alcohol use disorders can have devastating personal and societal effects, yet little evidence exists to guide clinical treatment. In the face of scant data, individual practitioners must rely instead on professional experience and those limited practice guidelines that currently exist. The American Psychiatric Association (APA) advises that failure to treat a concurrent psychiatric disorder reduces the likelihood that the treatment for a substance use disorder (SUD) will be effective. Indeed, the effects of nontreatment were demonstrated in a prospective study assessing alcohol-dependent patients for 1 year following hospitalization for alcohol dependence, in which untreated depression was directly associated with a shorter time to first drink. The results also showed that among those patients with depression (Slide 1), taking antidepressants at the time of discharge increased the likelihood of an individual remaining abstinent during the follow-up period.
Prevention of Premature Mortality Among Patients with Schizophrenia: The Need for Primary Prevention Efforts in Cardiovascular Disease
Authors: Hennekens Charles H.
Published: August 2016

Patients with schizophrenia have a markedly reduced lifespan compared with the general population. In the United States today, patients with schizophrenia have an average life expectancy of ∼61 years, about 20% lower than that of the general population, in which life expectancy is ∼76 years.
Epidemiology, Impairments, and Differential Diagnosis in Adult ADHD:Introduction
Authors: Adler Lenard A.
Published: August 2016

In the mid-1970s, attention-deficit/hyperactivity disorder (ADHD) was still believed to be a childhood disorder that disappeared with the onset of adolescence. At this time, Wender studied a cohort of adults presenting with ADHD-like symptoms, all of whom had been diagnosed with ADHD in childhood. Wender prescribed psycho-stimulants, which successfully produced a response in the adults, thus fostering research into adult ADHD.
Perceptions of Efficacy, Safety, and Tolerability: Impact on Evaluating New Treatments
Authors: Kennedy Sidney
Published: August 2016

Efficacy, safety, and tolerability are primary parameters for evaluation of any pharmacologic treatment. However, in order to evaluate the effectiveness of a new treatment in everyday clinical practice, these parameters must be assessed in the context of a number of societal, patient, and methodological variables.
Fibromyalgia Syndrome: Diagnosis and Comorbidities
Authors: Natelson Benjamin H.
Published: August 2016

In 1990, The American College of Rheumatology laid out several sets of criteria for the diagnosis of fibromyalgia syndrome (FM). The first criterion required patients to report at least 3 months of widespread pain. Pain was considered widespread if it was present in four quadrants of the body—the right and left side as well as above and below the waist. Axial skeleton pain is also very commonly present in FM and is often considered a fifth “quadrant.” The second diagnostic criterion was widespread pain in response to a tender point examination. In this assessment the clinician presses on 18 specific areas with enough pressure to blanche his fingertip (∼4 kg). The patient's report of pain and not pressure on such testing in at least 11 of the tender points completes the requirements for the diagnosis of FM (Slide 1). Although these criteria were established to standardize patients for research studies, many physicians follow them for diagnostic purposes as well. However, these criteria must be viewed in the same context as the definition of hypertension (ie, blood pressures ≥140/90). Patients who do not quite attain these criteria should still be considered to have probable hypertension; and the same applies to FM. A patient who has three-quadrant pain and 9 tender points does not meet the criteria for FM, but the therapeutic approach to this patient is the same as it is for the patient with definitive FM.
From Childhood into Adulthood: The Changing Face of ADHD
Authors: Adler Lenard A.
Published: August 2016

How common is attention-deficit/hyperactivity disorder (ADHD), and does the prevalence change from adolescence to adulthood?

A number of studies have reviewed the persistence of attention-deficit/hyperactivity disorder (ADHD) from childhood into adolescence and adulthood as well as how the disorder changes over the lifespan of the illness. Recently, a metaanalysis found that the worldwide prevalence of childhood ADHD is ∼8%, and approximately two thirds of children with ADHD continue to have the disorder as adults. The National Comorbidity Survey is possibly the most comprehensive, up-to-date study examining the prevalence of community-based prevalence of adult ADHD; 4.4% of patients in that study were found to have ADHD. The prevalence of ADHD among adolescent patients seems to lie somewhere between the prevalence rates for children and adults.
Recognizing & Treating Comorbid ADHD in Adults with Depression
Authors: Manos Michael J.
Published: August 2016

The National Comorbidity Survey Replication by Kessler and colleagues found that of adult patients with major depressive disorder (MDD), 9.4% met Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised criteria for attention-deficit/hyperactivity disorder (ADHD). Among those with dysthymia, 22.6% also met criteria for ADHD. In addition, it is estimated that approximately a third of the United States population experiences MDD symptoms at any point in time. Kessler and colleagues also conducted a retrospective study on impairment of adults with ADHD and found that ADHD has a prevalence of ∼4.4% in the US adult population, which suggests that ∼9 million US adults may have ADHD.
Combination Treatments for Schizophrenia
Authors: Miller Alexander L.
Published: August 2016

Combination treatments, especially combinations of antipsychotics, are used frequently for schizophrenia, despite a paucity of evidence regarding their safety and efficacy. Because the literature basis is weak and expert recommendations are largely lacking, providers should be vigilant in documenting improved outcomes for patients thought to benefit from combination treatments. Target symptoms that have been studied include psychosis, cognitive deficits, and negative symptoms. The strongest evidence is for augmentation of clozapine with another antipsychotic or with electroconvulsive therapy for persistent positive symptoms. Combination treatments for cognitive deficits and negative symptoms are being actively investigated, but current evidence is insufficient to recommend available agents for these components of schizophrenia. It is important that appropriate monotherapies be given adequate trials before resorting to combination therapies.
A Profile of Obsessive-Compulsive Symptoms In Schizophrenia
Authors: Porto Linda , Bermanzohn Paul C. , Pollack Simcha , Morrissey Richard , Siris Samuel G.
Published: August 2016

Obsessive-compulsive (OC) symptoms and schizophrenia may present, as intertwined phenomena whose relationship remains poorly understood. The purpose of this paper is to provide a detailed phenomenological description of OC symptoms in schizophrenia.

Fifty long-term patients with chronic schizophrenia or schizoaffective disorder from a continuing day-treatment program were assessed using the Structured Clinical Interview for DSM-IV and the Yale-Brown Obsessive-Compulsive Scale symptom checklist. Forty-six percent (n=23) reported clinically significant OC symptoms. Twenty-six percent (n=13) met criteria for OCD, from which three subgroups emerged: (1) patients whose OCD was unrelated to their psychotic symptoms, (2) patients whose OCD was related to, but not restricted to, their psychotic symptoms, and (3) patients whose OC symptoms existed on a continuum with their psychosis. The last group tended to incorporate their OC symptoms into delusional beliefs during the active phase of illness and shift to OCD during full or partial remissions. Eight percent met all inclusion criteria for OCD, but their OC symptoms were better accounted for by their psychosis.

We conclude that these findings support previous clinical constructs that OCD and schizophrenia are not always dichotomous disorders, but may be interconnected.
Neuropsychopharmacology: Changing the Face of Psychotropic Drug Discovery
Authors: Leonard B. E.
Published: August 2016

This review speculates on the changes currently taking place in psychopharmacology that will alter the course of psychotropic drug discovery and application in the coming millennium. The importance of endocoids as causative agents in central nervous system diseases; the role of neuropeptides and “trace” amine transmitters; the impact of imaging methods in elucidating the mechanism of action of psychotropic drugs; gene therapy; and the new role of psychoneuroimmunology in drug discovery are predicted to have a major impact in both the research and development of new psychotropic drugs in the twenty-first century.
Detecting the Malingering of Seizures
Authors: Mendez Mario F.
Published: August 2016

We present the case report of a patient who manifested seizures due to malingering, and discuss the differential diagnosis. The characteristics typical of nonepileptic seizures not due to malingering and of seizures due to malingering are described. Methods of distinguishing nonepileptic seizures from epileptic seizures are outlined, and the differences between seizures due to malingering and other nonepileptic seizures are discussed.
Seizures and EEG Findings in Children With Autism Spectrum Disorder
Authors: Tuchman Roberto , Jayakar Prasanna , Yaylali Ilker , Villalobos Rafael
Published: August 2016

Autism spectrum disorder (ASD) is a neurobiological developmental symptom complex characterized by early onset of deficits in verbal and nonverbal communication skills, socio-communicative function, and repetitive behaviors. The well-documented increased frequency of seizures and abnormal electroencephalographic (EEG) findings in ASD support the concept that the central nervous system dysfunction has a neurobiological basis. We review the prevalence of seizures and EEG abnormalities in children with ASD and explore the possible clinical significance of this correlation.
The Neurology of Obsessive-Compulsive Disorder
Authors: Hymas Nigel
Published: August 2016

Over the last two decades, there has been a resurgence of interest in cerebral mechanisms underlying many psychiatric disorders. The changes in our understanding of the syndrome called obsessive-compulsive disorder (OCD) reflect this shift of perspective. Although OCD remains a syndrome that is quintessentially psychiatric, it has been increasingly recognized that it also has a neurological dimension that merits study in its own right, using the concepts and tools of clinical neurology.
Clinicians and Mental Health Policy: An Inside Perspective
Authors: Boorstin Robert
Published: August 2016

In Washington these days, there is no shortage of people willing to dispense advice about what clinicians can do to impact national mental health policy. The advice and comments that follow reflect one perspective, but it is not that of a psychiatrist, a psychopharmacologist, a nurse, a social worker, or a member of any medical profession. Rather, it is the view of one of the legions of Washington bureaucrats with fancy titles and delusions of grandeur. The difference is that this view happens to have a chemical basis—it comes from a person with a decade of experience dealing firsthand with both manic-depressive illness and mental health policy.
Low Platelet Monoamine Oxidase Activity in Sensation-Seeking Bullfighters
Authors: Carrasco José Luis , Sáiz-Ruiz Jerónimo , Díaz-Marsá Marina , César Jesús , López-Ibor Juan José
Published: August 2016

In this study, we attempt to demonstrate an association between low platelet monoamine oxidase (MAO) activity, as assessed by isotopic methods, and the stable behavioral pattern of sensation- and risk-seeking of professional bull-fighters. Sixteen professional bullfighters were studied and compared with a control group of 46 healthy control subjects who did not engage in risky jobs or activities. The group of bullfighters had significantly reduced platelet MAO activity compared with the control group (P<0.05). Bullfighters were shown to be significantly more extroverted and sensation-seeking than controls on various temperament scales. A predisposition to engage in risky activities (eg, bullfighting) and sensation-seeking could be partly conditioned by the presence of biological components of personality manifested by a significantly decreased platelet MAO activity.
Transcranial Magnetic Stimulation as a Probe and Potential Treatment in Obsessive-Compulsive Disorder
Authors: Greenberg Benjamin D. , Corá-Locatelli Gabriela , Wassermann Eric M. , Ziemann Ulf , Murphy Dennis L.
Published: August 2016

Transcranial magnetic stimulation (TMS), a relatively noninvasive probe of cortical function, permits new kinds of explorations of relationships between regional brain activity and symptomatology in obsessive-compulsive disorder (OCD). In TMS, a pulsed magnetic field affects activity in cerebral cortex underlying an electromagnetic coil placed on the scalp. Results of exploratory studies suggest that the single- or paired-pulse TMS techniques, and the newer repetitive method (rTMS), in which trains of stimuli are delivered at a given frequency, are potentially useful probes of cortical mechanisms involved in psychopathologic conditions, as in studies of motor, sensory, and cognitive physiology. For example, single-pulse TMS of motor cortex can produce muscle potentials or movement. Higher-frequency repetitive stimulation (rTMS) of occipital cortex can produce phosphenes or visual extinction, stimulation of Broca's area results in word-finding difficulties or speech arrest, and rTMS of prefrontal cortex affects verbal recall and other cognitive functions. Prefrontal rTMS can alter mood in healthy individuals. Both open and controlled clinical studies suggest that single-pulse TMS, and rTMS, may have antidepressant effects. Although the cerebral cortex is the only human brain structure subject to direct magnetic stimulation with current technology, TMS may influence activity in subcortical sites via their functional relationships with cortical areas. The effects of TMS on cortical excitability may depend on a combination of factors including coil design, stimulus frequency and intensity, and possibly the functional state of the cortex before stimulation.
Obsessive-Compulsive Disorder: Experimental Pharmacology
Authors: Marazziti Donatella
Published: August 2016

There is evidence supporting the presence of abnormalities in certain neurotransmitters, such as dopamine and noradrenaline, and in neuropeptides and other mechanisms, such as the immune system in patients with obsessive-compulsive disorder (OCD). However, the findings implicating serotonin (5-hydroxytryptamine [5-HT]) in the pathophysiology of OCD are increasing at a rate not found in any other psychiatric disorder. These abundant findings foster numerous complex questions that await answers. For example, which 5-HT receptor subtypes or other subcomponents of the 5-HT system are principally involved in OCD pathophysiology, and how do they interact with dysfunctions of other systems? In the search for answers to these critical questions, experimental pharmacology represents a key tool for approaching the complexity of the involvement of 5-HT in OCD, and also suggests new potential therapeutic targets. This article summarizes, in part, the presentations and the discussion of the symposium, “Experimental Pharmacology in OCD,” which was held during the Third International OCD Conference meeting in Madeira, Portugal, in September 1998.
Surgery for Psychiatric Disorders
Authors: Cosgrove G. Rees
Published: August 2016

The modern therapeutic approach to most psychiatric diseases involves a combination of well-supervised psychotherapy, pharmacotherapy, and electroconvulsive therapy. Patients who fail to adequately respond to these modern treatment methods and remain severely disabled may be considered for surgical intervention. Cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy are the most common psychosurgical procedures performed today, with response rates in the 35% to 65% range. Modern stereotactic techniques have reduced complication rates, but controversy remains regarding the optimal surgical procedure. The major psychiatric diagnostic categories that might respond to surgery include treatment-refractory major affective disorders, obsessive-compulsive disorder, and chronic anxiety states. Surgery should be considered as one part of an entire treatment plan and must be followed by an appropriate psychiatric rehabilitation program. It should only be carried out by an expert multidisciplinary team consisting of a neurologist a neurosurgeon, and a psychiatrist with experience in these disorders. Surgical intervention remains a reasonable therapeutic option for select patients with a disabling psychiatric disease and may be underutilized.
Dyskinesias Differentiate Autistic Disorder From Catatonia
Authors: Bras̆ić James Robert , Barnett Jacqueline Y. , Will Michael V. , Nadrich Robert H. , Sheitman Brian B. , Ahmad Raheela , Mendonça Maria de Fatima , Kaplan Diana , Brathwaite Carla
Published: August 2016

Autistic disorder and catatonia are neuropsychiatric syndromes defined by impairments in social interaction, communication, and restricted, stereotypical motor routines. Assessments of children with these disorders are typically restricted in scope by the patients' limited ability to comprehend directions. The authors performed systematic assessments of dyskinesias on six prepubertal boys with autistic disorder and mental retardation and on one adolescent male with catatonia to determine if this type of information could be routinely obtained. The boys with autistic disorder had more stereotypies and tics, a greater degree of akathisia and hyperactivity, and more compulsions than the adolescent with catatonia. Catatonia was associated with catalepsy and dystonic postures. The authors conclude that the diagnostic accuracy and specificity of neuropsychiatric syndromes may be enhanced by the systematic assessment of the dyskinesias associated with each condition.
Mood Disorders During Pregnancy and Lactation: Defining Issues of Exposure and Treatment
Authors: Stowe Zachary N. , Calhoun Kelley , Ramsey Clayton , Sadek Noha , Newport Jeffrey
Published: August 2016

Epidemiologic studies have consistently demonstrated a greater incidence of depressive disorders and anxiety among women. Many women experience these conditions during the reproductive years. The dramatic expanse of literature focusing on the use of medications often has failed to pay homage to the potential impact of the disorders. When considering the extant human and laboratory data on mental illness and stress during pregnancy and the postpartum period, it is evident that some degree of exposure (be it treatment or illness) always occurs. The primary goal of the risk-benefit assessment for the treatment of mental illness during these periods is to assist patients and their families in choosing the path of potential exposure that possesses the least risk for them. Once this decision is made, the goal is to limit the number of exposures for the fetus/neonate.