bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

ABSTRACTWomen 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

ABSTRACTDepression 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.
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

ABSTRACTObjective: 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.
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

ABSTRACTTreatment-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

ABSTRACTThis 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

AbstractObsessive-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

ABSTRACTAccurate 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.
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.
Combination Treatments for Schizophrenia
Authors: Miller Alexander L. 
Published: August 2016

ABSTRACTCombination 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

AbstractObsessive-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

AbstractThis 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

AbstractWe 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

AbstractAutism 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

AbstractOver 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.
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

AbstractIn 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.
Obsessive-Compulsive Disorder: Experimental Pharmacology
Authors: Marazziti Donatella 
Published: August 2016

AbstractThere 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

AbstractThe 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

AbstractAutistic 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.