bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproductive Life Events and Sexual Functioning in Women: Case Reports
Authors: Warnock Julia K. , Biggs C. Faye 
Published: August 2016

AbstractAre reproductive life events in women associated with an increased risk of sexual dysfunction? Female sexual dysfunction effects up to 40% of women in the United States between 18 and 59 years of age. Sexual dysfunction may be accompanied by fluctuations in gonadal hormone secretion, making women more vulnerable to sexual symptoms, especially during times of reproductive life events. Reproductive life events, such as the use of birth control pills, various phases of the menstrual cycles, postpartum and lactation states, and perimenopause, are highly correlated with changes in sex steroids. As an understanding of the role of sex steroids on sexual functioning is elucidated, clinicians will be able to offer more specific and effective treatment options for women during various phases of reproductive life. Several case studies are presented to illustrate the unique clinical considerations that a clinician must consider when treating the biologic component of female sexual dysfunction.
Adult ADHD and Comorbid Depressive Disorders: Diagnostic Challenges and Treatment Options
Authors: Goodman David 
Published: August 2016

Attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) are separately common mental health conditions that can have an adverse effect on a patient's quality of life if left untreated. These disorders frequently cooccur with one another, which can lead to increased patient suffering and diagnostic challenges for the treating clinician. In the United States adult population, epidemiological data show that the prevalence rate for MDD is 6.7%, while the ADHD prevalence rate in US adults is 4.4%. This epidemiological data represents the general population and likely underestimates the prevalence rates in clinic or practice patients. Examining the concurrent comorbid rate, if a patient has MDD, the likelihood of that patient also having ADHD is 18.6%; if the patient has ADHD, the likelihood of that patient having comorbid MDD is 9.4%. If the patient has dysthymia, the comorbid rate of ADHD is 12.8%, while those adults with ADHD have a comorbid rate of dysthymia of 22.6% (Slide 1).The diagnostic distinction between ADHD and MDD is a critical aspect of clinical evaluation that often presents challenges and confusion to the treating clinician (Slide 2). There are several factors that clinicians should consider in order to best distinguish these disorders, and ensure an accurate diagnosis—age of symptom onset, presenting symptoms, and family history of either disorder.Typically, ADHD presents first in children, whereas most mood disorders, specifically MDD, have their index case onset in adolescence. Although MDD and dysthymia is reported in childhood, the peak incidence occurs during the adolescent years. Thus, the age of onset becomes one diagnostic factor that can assist in distinguishing these two conditions.
Love and Attachment: The Psychobiology of Social Bonding
Authors: Stein Dan J. , Vythilingum Bavanisha 
Published: August 2016

ABSTRACTBasic animal studies and human imaging studies have contributed to our understanding of the psychobiology of love and attachment. There are overlaps and distinctions in the neuronal circuitry of maternal love, romantic love, and long-term attachment. In these circuits, important molecules, which have been demonstrated to play a role in the psychobiology of social bonding include dopamine, serotonin, opioids, oxytocin, and vasopressin. Particular genetic and environmental variations contribute to social-bonding phenotypes, consistent with an evolutionary perspective on the value of these behaviors. Advances in the psychobiology of social bonds have led to hypotheses about the pharmacotherapy of disorders of attachment.
Pathological Love: Impulsivity, Personality, and Romantic Relationship
Authors: Sophia Eglacy C. , Tavares Hermano , Berti Marina P. , Pereira Ana Paula , Lorena Andrea , Mello Cidália , Gorenstein Clarice , Zilberman Monica L. 
Published: August 2016

ABSTRACTIntroduction: Pathological love (PL)–behavior characterized by providing repetitive and uncontrolled care and attention to the partner in a romantic relationship–is a rarely studied condition, despite not being rare and causing suffering. This study aims at investigating impulsivity, personality, and characteristics related to the romantic relationship in this population.Methods: Eighty-nine individuals (50 with PL; 39 individuals with no psychiatric disorder) were compared regarding impulsivity, personality, type of attachment, satisfaction with romantic relationship, and love style.Results: Individuals with PL have higher levels of impulsivity (P<.001; Barratt Impulsiveness Scale), higher self-transcendence, that is, are more unconventional and hold sense of communion with a wider reality (P<.001; Temperament and Character Inventory) and keep dissatisfactory romantic relationships (P<.001; Adapted Relationship Assessment Scale).Conclusion: Individuals with PL present personality traits and relationship aspects that must be taken into account in devising assessment and therapeutic strategies for this population.
The Context of Genetic Testing in Clinical Psychiatric Practice
Authors: Mrazek David A. 
Published: August 2016

AbstractAlthough most patients with depression ultimately respond to antidepressant therapy, >50% have inadequate response to an individual antidepressant trial. The desire to avoid adverse drug reactions is common among patients, and is an important determinant of drug selection among psychiatrists. However, since the major classes of antidepressants and antipsychotics appear to be comparable in efficacy, clinicians have little basis for selecting the most effective agent for an individual patient. Pharmacogenetics, often described as the study of genetic variation that explains differential response to medication, represents an important new avenue toward improving treatment outcomes. Genetic variation in drug-metabolizing enzymes has been recognized for decades. The main focus of current psychiatric pharmacogenetic testing is on the cytochrome P450 (CYP) 2D6 and, to a somewhat lesser extent, on the 2C19 genes. Data suggest that poor metabolizer status can be associated with an increased risk of adverse drug reactions with certain medications, and that ultra-rapid metabolizers may require higher-than-usual doses to achieve a therapeutic response. The importance of CYP enzymes in the metabolism of several antidepressant and antipsychotic drugs suggest that genetic variation may aid in medication selection or dosing. Advances in pharmacogenetic research may facilitate the development of personalized medicine in which genetic information can inform drug selection, leading to optimal drug effectiveness and minimal drug toxicity.
History and Pathophysiology of ADHD
Authors: Donnelly Craig L. 
Published: August 2016

AbstractAttention-deficit/hyperactivity disorder (ADHD), once considered to be a childhood disorder, is diagnosed in ~7 million adults in the United States, as reported by The National Comorbidity Study. Although it is now recognized that ADHD often persists into adulthood, the current diagnostic criteria is geared toward symptom identification in children. Symptoms of inattention, impulsivity, and hyperactivity evolve over the life cycle and present differently in adults. Further complicating diagnosis is that ADHD is associated with multiple functional impairments and comorbid psychiatric disorders. The Multi-Modal Treatment Study of ADHD reported that only 32% of the study population had ADHD alone; 29% had ADHD plus oppositional defiant disorder and/or conduct disorder, 14% had ADHD plus anxiety or depression, and 25% had all three disorders. Optimal treatment utilizes a multi-modal approach including behavioral treatments combined with pharmacologic treatment strategies. Food and Drug Administration-approved medications for ADHD include the stimulants and nonstimulants, although tricyclic antidepressants and bupropion are also commonly used.In this monograph, Craig L. Donnelly, MD, reviews the history of ADHD and discusses the pathophysiologic progression of childhood symptoms into those commonly exhibited by adults. Next, Frederick W. Reimherr, MD, reviews comorbidity of ADHD and describes the Utah Criteria as a method of diagnosing adults through recollection of childhood problems. Finally, Joel L. Young, MD, reviews treatment approaches to adult ADHD and its comorbid conditions.
Resilience: Determinants, Measurement, and Treatment Responsiveness
Authors: Connor Kathryn M. , Zhang Wei 
Published: August 2016

AbstractIn human terms, resilience is an ability to cope with stress and varies with context, time, age, gender, and cultural origin. Resilience shifts the focus of psychological investigation onto increasing the positive rather than reducing the negative. Inquiry into resilience has evolved from descriptions of resilient qualities, to discovery of the process to attain resilience, to uncovering the motivation to reintegrate in a resilient manner. Much of the research on resilience has focused on children in settings such as family violence, extreme poverty, war, and natural disasters. A coherent pattern of characteristics associated with successful adaptation has emerged. Salient characteristics include commitment, dynamism, humor in the face of adversity, patience, optimism, faith, and altruism. As such, resilience may represent an important target of treatment in anxiety, depression, and stress reactions. Resilience can be quantified, but available measures need to be validated transculturally. There exist many possible determinants of resilience, including neurobiologic, genetic, temperament, and environmental influences. Resilience is modifiable on individual and cultural levels. Posttraumatic stress disorder is an example of a serious disorder associated with impaired stress coping that can improve with treatment.
Introduction-Neuroprotection: A Therapeutic Strategy to Prevent Deterioration Associated with Schizophrenia
Authors: Lieberman Jeffrey A. 
Published: August 2016

AbstractSchizophrenia is a neurodevelopmental disorder associated with persistent symptomatology, severe functional disability, and residual morbidity characteristic of neurodegenerative brain diseases. The illness begins with genetic susceptibility and generally expresses itself after puberty through subtle changes that begin during the prodromal stage. Symptoms get progressively worse and tend to become more resistant to treatment with each relapse. Evidence for a neuroprotective effect of some forms of early treatment is beginning to emerge. While the underlying mechanisms remain uncertain, atypical antipsychotics may counteract some of the progressive deteriorative effects by enhancing synaptic plasticity and cellular resilience. However, identifying and treating patients in the earliest disease states presents methodological challenges as there is no consensus on the best methods of intervention and differences in at-risk children are not readily detectable or substantial enough to predict which ones will develop schizophrenia.In this expert roundtable supplement, Jeffrey A. Lieberman, MD, reviews the historical context of progressive deterioration in schizophrenia. Next, Diana O. Perkins, MD, MPH, reviews some of the challenges to early identification of illness as well as the impact of early versus delayed treatment. Finally, L. Fredrik Jarskog, MD, focuses on the neurobiology of functional progression in schizophrenia as well as pharmacology and the potential for neuroprotection.
Special Considerations in Diagnosing and Treating Attention-Deficit/Hyperactivity Disorder
Authors: Wigal Sharon B. , Wigal Timothy L. 
Published: August 2016

AbstractAttention-deficit/hyperactivity disorder (ADHD) is a prevalent chronic condition that affects people of all ages, including young children, school-aged children, adolescents, and adults. Symptoms can be noted as early as preschool age, tend to progress into functional impairment and behavioral problems in later childhood, and typically persist into adulthood. Contrary to previous belief, the disorder does not resolve with puberty for the majority of children; rather, the symptoms are manifested differently throughout the lifecycle. Presentation in adults is heavily biased toward inattentive symptoms, which are less likely to draw notice than hyperactive or impulsive symptoms and may contribute to the underrecognition of ADHD in this patient population. Diagnosis is particularly difficult due in large part to the pronounced comorbidity of psychiatric disorders in this patient population. Identification may be even more difficult in adults than children as the diagnostic criteria are not as clear, adults have difficulty remembering symptoms prior to 7 years of age, and there is a high prevalence of comorbid psychiatric disorders in adults. Early identification and treatment of symptoms of ADHD in preschool-age children is essential to effective long-term management of the disorder. Both medication and behavioral treatments appear to alleviate the symptoms of ADHD, and evidence suggests that discontinuation of treatment leads to the reemergence of the condition. Efforts are currently continuing toward understanding the genetic underpinnings of ADHD.This expert review supplement will address the prevalence, comorbidity, treatment issues, and special considerations surrounding ADHD management throughout each stage of the lifecycle beginning with ADHD in preschool-aged children, continuing with school-aged children and adolescents, and ending with adulthood.
Factors That Impact Choice of Antidepressant Treatment in Medically Complex Patients
Authors: Dago Pedro Luis 
Published: August 2016

AbstractIn medically complex patients with multiple comorbid illnesses who require concomitant medications, selecting the optimal antidepressant (ie, low risk of adverse effects and/or pharmacokinetic interactions) for an individual patient is critical for positive long-term patient outcomes. The serotonin-norepinephrine reuptake inhibitors (SNRIs) are increasingly being used as first-line treatment for major depressive disorder (MDD) and may prove beneficial for treatment of medically complex patients. Thus, it is key for clinicians to evaluate the differences in the pharmacokinetic and tolerability profiles of the SNRI class of antidepressants, evaluating differences both within the class and compared with other antidepressants used to treat MDD.
The Neurobiology of Panic Disorder: Toward an Integrated Model
Authors: Stein Dan J. 
Published: August 2016

AbstractPanic disorder (PD) is a complex, multidimensional psychiatric disorder characterized by the presence of panic attacks as well as anticipatory anxiety and panic-related phobias (eg, agoraphobia). Although the etiology of this disabling disorder remains unclear, advances in basic neuroscience and in imaging studies have led to a greater understanding of the neurocircuitry and neurochemistry that are involved in modulating fear and anxiety and that are relevant to understanding PD. A preliminary integrated model can be outlined, but there is a need for additional research that cuts across genetic investigation, provocation studies, neuroimaging techniques, and treatment trials. As research continues and greater insight into the mechanisms underlying PD is achieved, additional treatment strategies may emerge.
The Role of Race and Ethnicity in Utilizing Atypical Antipsychotics
Authors: Nasrallah Henry A. 
Published: August 2016

Atypical antipsychotics have become widely accepted as the first-line standard of care in the treatment of psychotic disorders, such as schizophrenia and bipolar disorder, which occur in ethnically and racially diverse patients. Accumulating data indicate that ethnicity factors may impact the efficacy and safety of atypical antipsychotics. Given the increasingly heterogeneous ethnic and racial composition of the United States, it is important for practicing clinicians to understand how race and ethnicity may influence the pharmacotherapeutic use of atypical antipsychotics.The three articles in this supplement to CNS Spectrums, address how race and ethnicity may influence the efficacy, safety, tolerability, and dosing of atypical antipsychotics in today’s heterogeneous patient population.L. DiAnne Bradford, PhD, reviews the most recent advances in ethnopharmacology and how gender, race, and ethnicity can influence, through metabolic biotransformation, the pharmacokinetic and pharmacodynamic properties of atypical antipsychotics. Dr. Bradford will also review how antipsychotic-related adverse events may be associated with the differences in oxidative enzyme activity across ethnic and racial groups and how these factors should be given careful consideration in the management of patients of different ethnic/genetic profiles.David C. Henderson, MD, examines the emerging data that suggest metabolic differences among various racial and ethnic groups may predispose patients to serious medical complications, such as obesity, dyslipidemia, and diabetes mellitus. Dr. Henderson discusses the impact of these racial/ethnic metabolic differences when clinicians are prescribing atypical antipsychotics and also compares the risks of metabolic issues associated with specific agents within the class of atypical antipsychotics.
The Differential Diagnosis of Pseudobulbar Affect (PBA): Distinguishing PBA Among Disorders of Mood and Affect
Authors: Arciniegas David B. , Lauterbach Edward C. , Ginsberg David L. , Anderson Karen E. , Chow Tiffany W. , Flashman Laura A. , Hurley Robin A. , Kaufer Daniel I. , McAllister Thomas W. , Reeve Alison , Schiffer Randolph B. , Silver Jonathan M. 
Published: August 2016

AbstractThis monograph summarizes the proceedings of a roundtable meeting convened to discuss pseudobulbar affect (PBA). Two didactic lectures were presented, followed by a moderated discussion among 11 participants. Post-meeting manuscript development synthesized didactic- and discussion-based content and incorporated additional material from the neuroscience literature. A conceptual framework with which to distinguish between disorders of mood and affect is presented first, and disorders of affect regulation are then reviewed briefly. A detailed description of the most common of these disorders, PBA, is the focus of the remainder of the monograph. The prevalence, putative neuranatomic and neurochemical bases of PBA are reviewed, and current and emerging methods of evaluation and treatment of persons with PBA are discussed. The material presented in this monograph will help clinicians better recognize, diagnose, and treat PBA, and will form a foundation for understanding and interpreting future studies of this condition.
Defining and Diagnosing Involuntary Emotional Expression Disorder
Authors: Cummings Jeffrey L. , Arciniegas David B. , Brooks Benjamin R. , Herndon Robert M. , Lauterbach Edward C. , Pioro Erik P. , Robinson Robert G. , Scharre Douglas W. , Schiffer Randolph B. , Weintraub Daniel 
Published: August 2016

AbstractUncontrollable episodes of emotional expression occur in a variety of neurological conditions. This emotional disinhibition syndrome is characterized by episodes of crying or laughing that are unrelated to or out of proportion to the eliciting stimulus. This syndrome is common among patients with amyotrophic lateral sclerosis, multiple sclerosis, stroke, and traumatic brain injury and a variety of terms and definitions have been used to describe it. The confusing nomenclature has been a barrier to understanding, diagnosis, and treatment of this disorder. The authors propose a unifying term, involuntary emotional expression disorder (IEED), and provide diagnostic criteria for this disorder.
Introduction: An Overview of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Study
Authors: McEvoy Joseph P. 
Published: August 2016

In September 2005, the National Institute of Mental Health published phase 1 results of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, a large-scale, double-blind trial comparing the relative effectiveness of five antipsychotics used to treat patients with schizophrenia: perphenazine, a conventional antipsychotic that has been commercially available since the 1950s, and four atypical agents—olanzapine, quetiapine, risperidone, and ziprasidone—that were introduced in the 1990s. The broad intention of the CATIE study is to determine if the atypical agents used offer any demonstrable clinical and public health advantages over the conventional agents. Concerns over costs and side effects (eg, pronounced weight gain and lipid disturbances) associated with the newer, atypical antipsychotics, as well as doubts about superior efficacy relative to older, conventional agents, served as an impetus to the trial.The study design chosen for the CATIE study—that of a “large, simple” trial—sought to bypass the limitations of clinical studies that are conducted when pharmaceutical companies seek regulatory approval of a new medication. Studies done in pursuance of drug approval attempt to establish safety and efficacy in controlled clinical settings so as to determine if a drug works at all, and if its use entails specific side effects. Hence, they are typically placebo-controlled and short-term, enroll a small homogeneous population (eg, initially hospitalized patients with no psychiatric or medical comorbidities), forbid or restrict the use of concomitant medications, and take as their endpoints well-defined side effects and measures of core psychopathology. These restrictions heighten the risk that the study findings may not be widely applicable to patients outside the confines of the protocol.
Sexuality in Men and Women With Epilepsy
Authors: Harden Cynthia L. 
Published: August 2016

AbstractMost people with epilepsy maintain normal reproductive and sexual lives. However, a significant minority of women with epilepsy (20% to 30%) have some degree of sexual dysfunction, including problems with libido, arousal, and orgasm. Men with epilepsy are at risk for decreased sexual functioning, including sexual interest and sexual performance, at least in part because of increased sex hormone-binding globulin levels and lower bioactive testosterone levels, particularly in association with the use of enzyme-inducing antiepileptic drugs, such as phenytoin and carbamazepine. A decrease in bioactive testosterone levels probably has a significant effect on the sexuality of women with epilepsy as well. Antiepileptic drugs may also affect sexual function in women through alterations of serotonergic neurotransmission. Epilepsy itself appears to have the potential to affect sexual function. The amygdala is emerging as a brain structure with significant involvement in sexuality in patients with epilepsy, as shown by alterations in sexual functioning after temporal lobectomy. Preliminary evidence suggests that people with temporal lobe epilepsy have reduced genital blood flow in response to erotic stimulation; the etiology of this phenomenon is not well understood, but disruption of the limbic and frontal cortex by epileptic activity may be implicated. Psychosocial factors, including sexual anxiety and stigma associated with epilepsy, can also affect the sexual life of patients with epilepsy.