bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applications for Magnetic Resonance Imaging in Bipolar Disorder
Authors: Renshaw Perry F. 
Published: August 2016

AbstractBipolar disorder is a prevalent psychiatric disorder with a high rate of misdiagnosis and evidence of degenerative progression. Research indicates that the interval between bipolar episodes decreases steadily until the patient settles into a relatively frequent course of mania and depression. Various imaging techniques have been used in the understanding of the brain pathology underlying bipolar disorder through identification of patterns consistent with disruption of the normal brain activity in bipolar patients. These techniques have demonstrated evidence of abnormalities in the structure and function of the prefrontal cortex. In addition, the cerebellar vermis, which serves as an error-detection function to modulate the iterative network, appears to shrink with recurrent episodes. Functional imaging demonstrates that the anterior limbic network is overactivated and overresponsive in patients with bipolar disorder. In many patients, those deficits are often compensated for by activation of other brain areas. Ultimately, when the compensation fails, expression of bipolar symptoms arise. Using magnetic resonance spectroscopy, simple models can be constructed based on the hypothesis that mitochondrial function may be impaired in bipolar disorder. There is also increasing evidence that psychotropic medications can affect specific brain regions that are thought to be involved in the pathogenesis of psychiatric disorders. Glutamate levels appear to be elevated in untreated patients with bipolar disorder, which may cause glutamatergic neurotoxicity and negative therapeutic implications. Further advances in brain imaging may contribute to the improvement of available therapies and the understanding which treatments will be most suitable for specific patients.
The Nature of Insomnia
Authors: Roth Thomas 
Published: August 2016

AbstractInsomnia is a disorder characterized by chronic sleep disturbance associated with daytime disability or distress, such as memory impairment and fatigue, that occurs despite adequate opportunity for sleep. Insomnia may present as difficulty falling/staying asleep or as sleep that is nonrestorative. Studies show a strong correlation between insomnia and impaired quality of life. Pain conditions and depression are commonly associated with insomnia, either as secondary or comorbid conditions. In addition, a greater incidence of anxiety, alcohol and drug dependence, and cardiovascular disease is found in people with insomnia. Data indicate insomnia results from over-engaged arousal systems. Insomnia patients experience increased metabolic rate, body temperature, and heart rate, and elevated levels of norepinephrine and catecholamines. Pharmacologic options for the treatment of insomnia include benzodiazepine hypnotics, a selective melatonin receptor agonist, and sedating antidepressants. However, insomnia may be best treated with cognitive-behavioral therapy and instruction in good sleep hygiene, either alone or in concert with pharmacologic agents. Studies on the effects of insomnia treatment use variable methodologies or do not publish negative results, and there are currently no studies of treatment focusing on morbidity. Further research is necessary to better understand the effects of insomnia therapies on medical and psychiatric disorders.In this Clinical Information Supplement, Thomas Roth, PhD, describes the nature of insomnia and its pathophysiology. Next, Andrew D. Krystal, MD, MS, reviews morbidities associated with insomnia. Finally, Joseph A. Lieberman III, MD, MPH, provides an overview of therapeutics utilized in patients with insomnia, including behavioral therapies and pharmacologic options.
Introduction
Authors: Klein Donald , O'Brien Charles P. 
Published: August 2016

AbstractPharmacoepidemiology, the study of the effects of drugs in large numbers of people, is a relatively new discipline that applies the methods of epidemiology to clinical pharmacology. Premarketing clinical trials remain the only way to scientifically determine whether a drug is causally effective, yet these trials do not provide information that allows for estimates about rare, late, or off-label toxicities associated with the drug in question. Increasing concern about common and debilitating adverse effects of medications has highlighted the need for enhanced postmarketing surveillance to follow up on clinical trials. There is a further concern regarding the broader issue of the risk-benefit ratio of certain medications. Computerized databases are a good source of information on which to lay the foundations of postmarketing research. A system of cross-linked computerized medical records may better enable researchers and physicians to realistically monitor postmarketing safety and incorporate monitoring benefits. The same research could also elucidate the net public health effect of regulatory decisions. The Veterans Affairs database in the United States and PHARMO in the Netherlands may represent good models on which to base future postmarketing surveillance studies.In this expert roundtable supplement, Brian L. Strom, MD, provides an overview of the appropriate use of large computer databases in pharmacoepidemiology studies. Philip Wang, MD, DrPH, discusses the advantages of pharmacoepidemiologic studies over clinical trials in correctly detecting drug safety issues. Francesca Cunningham, PharmD, reviews a large computer database that is currently in use within the VA healthcare system, and Ron M.C. Herings, PharmD, PhD, discusses the development of the PHARMO system in the Netherlands.
Neuroprotection: A New Strategy in the Treatment of Schizophrenia
Authors: Lieberman Jeffrey A. , Buckley Peter F. , Perkins Diana O. 
Published: August 2016

AbstractIntervention in the progression of schizophrenia is an effort not just to deter psychosis but also to protect the brain from physiologic deterioration. Neurodegeneration is believed to result from neurochemical dysregulation during the onset of schizophrenia. Deterioration accrued over recurring psychotic episodes causes cumulative loss of cell processes, loss of gray matter volume, and apoptosis. Neurodegeneration ultimately results in persistent symptomology and functional impairment. Functional decline occurs early in the course of schizophrenia, and the symptoms that emerge during the prodromal stage may derail the normal adolescent neurodevelopment. Both first-episode psychosis and the prodrome may be opportunities to forestall neurodegeneration. Unfortunately, people with schizophrenia often experience a long duration of untreated psychosis. Treatment of first-episode psychosis with antipsychotic agents shows robust response. However, early-stage patients have very high rates of medication noncompliance. Treatment in the prodrome may offer the best chance to delay the onset of illness, mitigate its severity after onset, or even prevent onset of symptoms entirely. Nonpharmacologic treatments during the prodrome, such as education, treatment for substance use, and cognitive-behavioral therapy, are low-risk interventions that are potentially beneficial. Pharmacologic interventions during the prodrome are also effective in delaying onset of illness, but carry the risk of adversely affecting patients who are false positives for prodromal schizophrenia.In this Expert Roundtable Supplement, Jeffrey A. Lieberman, MD, provides an overview of the neurobiological basis of neurodegeneration and the concept of neuroprotection. Next, Peter F. Buckley, MD, reviews the importance of first-episode psychosis, including duration of untreated illness and medication adherence. Finally, Diana O. Perkins, MD, MPH, reviews treatment strategies for prodromal schizophrenia.
Somatic Symptoms of Depression and Anxiety in the Western Pacific Region: Questions and Answers
Authors: Clarke David M. , Hatim Ahmad , Ho Brian , Pan Jiyang , Ng Chee , Oh Kang-Seob , Wenyuan Wu , Ki-Yan Mak 
Published: August 2016

It is a commonly held belief among mental health care providers that patients from the Western Pacific region with major depressive disorder (MDD) and anxiety disorders disproportionately present with somatic symptoms as opposed to emotional symptoms. Cultural norms, such as the stigma associated with psychiatric disorders, may lead members of this population to ignore the emotional aspects of these disorders or deny the presence of psychological symptoms. Empirical support is provided by the lower prevalence of these disorders in some Western Pacific nations in relation to the rest of the world. For example, MDD rates in India (9%), Japan (2%), China (2% to 4%), Malaysia (8%) and Australia (3%) are generally lower than rates in the United States (16%) and worldwide (10%). These discrepancies may be the result of missed diagnoses. Misdiagnosis is related to the increased somatization of MDD symptoms in these populations. As defined by the WHO, the Western Pacific region consists of 37 countries with a total population of 1.8 billion people (1.3 billion in China alone) with diverse cultural backgrounds and demographic profiles, which makes the issue of cultural effects on MDD diagnosis more complex.Patients with MDD or anxiety disorders worldwide often present with somatic symptoms, which frequently accompany psychological symptoms. For example, in a recent report of pooled data from Canada, scores on the Somatic Symptoms Inventory, the 17-item Hamilton Rating Scale for Depression (HAM-D17), and the Hamilton Rating Scale for Anxiety (HAM-A) were used to evaluate the association between somatic symptoms and MDD. Of the 2,191 patients randomly enrolled in the study, 78% reported moderate-to-severe fatigue and weakness. Painful physical symptoms commonly occur in patients with anxiety disorders as well. In a European study, painful physical symptoms were reported by 28% of those without anxiety disorders and 45% of those with anxiety disorders.
Pharmacologic Treatment of Panic Disorder
Authors: Stevens Julie C. , Pollack Mark H. 
Published: August 2016

AbstractPanic disorder, frequently complicated by agoraphobia in the clinical setting, is a relatively common disorder that is associated with significant morbid burden and dysfunction in affected individuals. PD treatment is focused on the reduction of panic attacks, avoidance behavior, and anticipatory anxiety, as well as the resolution of comorbid conditions, with the goal of normalizing function and improving overall quality of life. Antidepressants, including the selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors, as well as benzodiazepines, are commonly used as primary pharmacotherapies for the treatment of PD, with a variety of other novel interventions potentially useful as well, to optimize treatment outcome.
Adding Cognitive-Behavioral Therapy to Pharmacotherapy for Panic Disorder: Issues and Strategies
Authors: Otto Michael W. , Powers Mark , Smits Jasper A. J. 
Published: August 2016

AbstractDespite ample evidence of the efficacy of cognitive-behavioral therapy (CBT) for the treatment of patients with panic disorder (PD), dissemination of this evidence is proceeding slowly. This article highlights some of the issues surrounding the dissemination of CBT for PD and suggests strategies for integrating CBT with pharmacotherapy. Treatment principles, with attention to the modification of CBT protocols for use in a brief-contact format, are reviewed. The principles and application of exposure interventions are discussed for both in vivo (situational) and interoceptive (feared anxiety sensations) exposure, with emphasis on the learning of safety in the context of feared sensations of anxiety. Contextual factors that may affect the success of exposure interventions and cognitive and informational interventions are also discussed.
New Approaches in Managing Chronic Insomnia
Authors: Neubauer David N. 
Published: August 2016

ABSTRACTDespite a high prevalence in the United States, insomnia remains underdiagnosed and undertreated. Extensive research has identified several factors that contribute to the inadequate treatment of insomnia, including the failure of patients to report insomnia to physicians, limited physician training, and physician misconceptions about the risks associated with hypnotic medications. To achieve optimal patient outcomes, physicians differentiate acute from chronic insomnia and distinguish primary insomnia from sleep disorders that occur with comorbid conditions, most notably psychiatric illnesses such as circadian rhythm disturbances. In addition, they utilize sleep hygiene measures, behavioral therapy, and/or pharmacologic medications to improve sleep problems in patients with insomnia. Newer nonbenzodiazepine receptor agonists are effective with fewer side effects than older benzodiazepine agonists; however, in 2005 a National Institutes of Health panel on chronic insomnia management indicated that clinical trials are needed to establish the long-term benefits of the newer drugs. Since 2005, data from clinical trials lasting 6 months to 1 year have been published for hypnotics including eszopiclone, zaleplon, and zolpidem extended-release. As the result of potentially altered dosing and monitoring, elderly patients require special consideration.
Nonstimulants and Emerging Treatments in Adults with ADHD
Authors: Newcorn Jeffrey H. 
Published: August 2016

AbstractTreatment of attention-deficit/hyperactivity disorder (ADHD) may positively impact the neurobiology of adult patients with ADHD. Treatment may also minimize impairment from core symptoms and may alter the course of co-morbid disorders such as depression and substance use disorder. However, much of the information on stimulant use in adult ADHD comes from studies conducted in children, and it remains unclear whether there is a difference between children and adults when it comes to the side effects and tolerability of ADHD treatments. It is known that clinical presentation differs between adults and children, with adults demonstrating a higher percentage of mood disorders. Current treatments for adult ADHD include psychosocial therapies and pharmacologic therapies, the latter of which include the stimulants d-methylphenidate extended release (XR), OROS methylphenidate, lisdexamfetamine, and mixed amphetamine salts XR; and the nonstimulant atomoxetine, a selective norepinephrine reuptake inhibitor. There is need for additional study of treatment strategies for adult ADHD. Although all classes of ADHD medications are approved in adults, there are fewer approved formulations for adults than for children. Efficacy in adults is more subjective than in children, which may affect how efficacy rates for adult treatments are calculated. Adults also present a greater diversion risk than children. In addition, there are several new and emerging medication treatments worth considering.This Expert Roundtable Supplement represents part 2 of a 3-part supplement series on adult ADHD led by Lenard A. Adler, MD. In this activity, Thomas J. Spencer, MD, discusses the neurobiology and genetics of adult ADHD; Mark A. Stein, PhD, discusses stimulant therapy; and Jeffrey H. Newcorn, MD, reviews nonstimulants and psychosocial treatments
The Medical Treatment of Obsessive-Compulsive Disorder and Anxiety
Authors: Bandelow Borwin 
Published: August 2016

AbstractSelective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy treatments for obsessive-compulsive disorder (OCD). Clomipramine is effective in OCD but associated with more adverse events. Typically, higher doses of antidepressants are required for OCD. Up to 50% of patients do not respond to initial treatment of OCD. Treatment options for nonresponders include augmentation of antidepressants with atypical antipsychotics, among other strategies. First-line treatments for anxiety disorders include SSRIs, serotonin norepinephrine reuptake inhibitors, and pregabalin. Tricyclic antidepressants are equally effective as SSRIs, but are less well tolerated. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of dependency and tolerance. Other treatment options include irreversible and reversible monoamine oxidase inhibitors, the atypical antipsychotic quetiapine, and other medications. Cognitive-behavioral therapy has been sufficiently investigated in controlled studies of OCD and anxiety disorders and is recommended alone or in combination with the above medications.
Self-Help and Internet-Guided Interventions in Depression and Anxiety Disorders: A Systematic Review of Meta-Analyses
Authors: Hof Edith van‘t , Cuijpers Pim , Stein Dan J. 
Published: August 2016

AbstractThere is a growing database of research on self-help and Internet-guided interventions in the treatment of common mental disorders, and a number of meta-analyses have now been published. This article provides a systematic review of meta-analyses on the efficacy of self-help interventions, including Internet-guided therapy, for depression and anxiety disorders. Searches were conducted in PubMed, PsychINFO, EMBASE, and the Cochrane database for statistical meta-analyses of randomized, controlled trials of self-help or Internet-guided interventions for depression or anxiety disorders published in English. Reference lists were also used to find additional studies. Effect sizes were tabulated; 13 meta-analyses reported medium to large effect sizes for self-help interventions. Studies included in the meta-analyses differed in samples, type of self-help (eg, computer-aided, Internet-guided), control conditions, and study design. The meta-analyses indicate that self-help methods are effective in a range of different disorders, including depression and anxiety disorders. Most meta-analyses found relatively large effect sizes for self-help treatments, independent of the type of self-help, and comparable to effect sizes for face-to-face treatments. However, further research is needed to optimize the use of self-help methods.
The Role of Non-Pharmacologic Approaches in the Management of Fibromyalgia
Authors: Williams David A. 
Published: August 2016

The optimal management of fibromyalgia (FM) is comprised of both pharmacologic and nonpharmacologic approaches. This multidimensional approach is preferred given that FM is not only a pain condition, but involves a number of other symptoms as is reflected in the new clinical criteria being developed by Wolfe and colleagues. Proper management of FM should be informed through multidimensional assessment of the clinically relevant domains described previously in this supplement. Pharmacologic and nonpharmacologic approaches work together to provide the broadest possible coverage of these domains, minimize the impact of each domain on functioning and well-being, and facilitate long-term adaptations to one's lifestyle.The use of nonpharmacologic strategies in the management of FM has varying levels of evidence. The strongest evidence currently exists for aerobic exercise, cognitive-behavioral therapy (CBT), and for patient education or self-management. Moderate evidence exists for strength training, acupuncture, hypnotherapy, and biofeedback modalities. Weaker evidence exists for manual massage therapy. Currently, there is no evidence of long-term benefit for tender point injections or flexibility exercise modalities, although these options may be beneficial in the short term. This article will focus on the three areas that have the strongest evidence base: patient education, exercise, and CBT.Educational programs are typically offered in the context of primary care or in specialty practices. In their simplest form, these programs try to dispel myths about FM and provide patients with the most up-to-date knowledge about the condition.
Comparing Expenditures in Depressed Patients Treated with Venlafaxine ER and SSRIs
Authors: Sloan Diane M. , LeLorier Jacques 
Published: August 2016

AbstractDepression is a chronic illness whose true costs to society are unclear. The costs associated with depression are direct (drugs and treatment), indirect (absenteeism and loss of productivity), and intangible (quality of life). Direct costs are usually easy to quantify. Indirect costs often test the ingenuity of researchers whose results are, at best, crude approximations. Intangible costs are elusive and may never be measured with any degree of accuracy. To compound matters further, many patients with depression have never been diagnosed, which complicates the cost accounting analysis of depression from a societal perspective. What is clear is that the worldwide costs of depression are climbing The overall costs of treating depression attributable to drug therapy are modest. The appropriate choice of antidepressant therapy is likely to be the product that provides the highest effectiveness in terms of overall costs. As a result, it is important that prescribers have an idea of the benefit derived from the cost of drugs, and how the cost effectiveness of different drugs compare.Previous studies of antidepressant cost effectiveness have suggested that the use of venlafaxine, which costs more than generic selective serotonin reuptake inhibitors (SSRIs), may be no more costly when total costs (eg, how many drugs were prescribed, how many medical or emergency room visits patients had, and how often they were hospitalized) are calculated. The objectives of this retrospective, populationbased, database study were to identify patient characteristics and factors associated with the choice of antidepressant in order to assess differences in persistence, healthcare utilization, and direct medical costs associated with venlafaxine and SSRI pharmacotherapy.Study results indicated that in this real-world setting, medical costs were similar among depressive patients treated with venlafaxine and SSRIs. The higher purchase price of venlafaxine was balanced by cost savings due to fewer hospitalizations and fewer outpatient medical visits. Differences in drug treatment may also partially explicate the observed differences in average direct medical costs between venlafaxine and SSRIs.
Recognizing and Effectively Treating Depression
Authors: Lecrubier Yves 
Published: August 2016

AbstractIn 2004, more people died in Europe from suicide than from road accidents. The lifetime prevalence of major depression is 20% for women and 10% for men. Depression is a leading cause of disability and decreased quality of life. In spite of this, numerous studies have shown that only ~50% of depressed patients are recognized as such in primary care. In a recent international survey of everyday management of depression we observed that only ~15% of patients became symptom-free following treatment. In spite of this low level of remission primary care physicians and psychiatrist only rarely increased the dose of antidepressant or switched to another medication as unanimously recommended by different guidelines. Numerous studies have demonstrated the importance of maintaining treatment for ≥6 months after remission is obtained in order to prevent relapse and recurrence. However, a recent study reported that only 19% of a cohort of patients in primary care continued treatment for 6 months as recommended. Antidepressants can be very effective but only when used correctly at adequate doses and for a sufficient duration. Although new improved antidepressants are obviously desirable, a greater recognition of depression and its treatment by the correct use of currently available antidepressant drugs could greatly improve the management of this major public health problem.