351
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Visser RM, Lau-Zhu A, Henson RN, Holmes EA. Multiple memory systems, multiple time points: how science can inform treatment to control the expression of unwanted emotional memories. Philos Trans R Soc Lond B Biol Sci 2018; 373:20170209. [PMID: 29352036 PMCID: PMC5790835 DOI: 10.1098/rstb.2017.0209] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 01/04/2023] Open
Abstract
Memories that have strong emotions associated with them are particularly resilient to forgetting. This is not necessarily problematic, however some aspects of memory can be. In particular, the involuntary expression of those memories, e.g. intrusive memories after trauma, are core to certain psychological disorders. Since the beginning of this century, research using animal models shows that it is possible to change the underlying memory, for example by interfering with its consolidation or reconsolidation. While the idea of targeting maladaptive memories is promising for the treatment of stress and anxiety disorders, a direct application of the procedures used in non-human animals to humans in clinical settings is not straightforward. In translational research, more attention needs to be paid to specifying what aspect of memory (i) can be modified and (ii) should be modified. This requires a clear conceptualization of what aspect of memory is being targeted, and how different memory expressions may map onto clinical symptoms. Furthermore, memory processes are dynamic, so procedural details concerning timing are crucial when implementing a treatment and when assessing its effectiveness. To target emotional memory in its full complexity, including its malleability, science cannot rely on a single method, species or paradigm. Rather, a constructive dialogue is needed between multiple levels of research, all the way 'from mice to mental health'.This article is part of a discussion meeting issue 'Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.
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Affiliation(s)
- Renée M Visser
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Alex Lau-Zhu
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard N Henson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
- Karolinska Institutet, Division of Psychology, Department of Clinical Neuroscience, Stockholm, Sweden
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352
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de Graaff LF, Honig A, van Pampus MG, Stramrood CAI. Preventing post-traumatic stress disorder following childbirth and traumatic birth experiences: a systematic review. Acta Obstet Gynecol Scand 2018; 97:648-656. [PMID: 29336486 DOI: 10.1111/aogs.13291] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 12/30/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Between 9 and 44% of women experience giving birth as traumatic, and 3% of women develop a post-traumatic stress disorder following childbirth. Knowledge on risk factors is abundant, but studies on treatment are limited. This study aimed to present an overview of means to prevent traumatic birth experiences and childbirth-related post-traumatic stress disorder. MATERIAL AND METHODS Major databases [Cochrane; Embase; PsycINFO; PubMed (Medline)] were searched using combinations of the key words and their synonyms. RESULTS After screening titles and abstracts and reading 135 full-text articles, 13 studies were included. All evaluated secondary prevention, and none primary prevention. Interventions included debriefing, structured psychological interventions, expressive writing interventions, encouraging skin-to-skin contact with healthy newborns immediately postpartum and holding or seeing the newborn after stillbirth. The large heterogeneity of study characteristics precluded pooling of data. The writing interventions to express feelings appeared to be effective in prevention. A psychological intervention including elements of exposure and psycho-education seemed to lead to fewer post-traumatic stress disorder symptoms in women who delivered via emergency cesarean section. CONCLUSIONS No research has been done on primary prevention of traumatic childbirth. Research on secondary prevention of traumatic childbirth and post-traumatic stress disorder following delivery provides insufficient evidence that the described interventions are effective in unselected groups of women. In certain subgroups, results are inhomogeneous.
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Affiliation(s)
- Lisanne F de Graaff
- Department of Obstetrics and Gynecology, OLVG Hospital, Amsterdam, Netherlands
| | - Adriaan Honig
- Department of Obstetrics and Gynecology, OLVG Hospital, Amsterdam, Netherlands.,VU University Medical Center, Amsterdam, Netherlands
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353
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van Rooij AJ, Ferguson CJ, Colder Carras M, Kardefelt-Winther D, Shi J, Aarseth E, Bean AM, Bergmark KH, Brus A, Coulson M, Deleuze J, Dullur P, Dunkels E, Edman J, Elson M, Etchells PJ, Fiskaali A, Granic I, Jansz J, Karlsen F, Kaye LK, Kirsh B, Lieberoth A, Markey P, Mills KL, Nielsen RKL, Orben A, Poulsen A, Prause N, Prax P, Quandt T, Schimmenti A, Starcevic V, Stutman G, Turner NE, van Looy J, Przybylski AK. A weak scientific basis for gaming disorder: Let us err on the side of caution. J Behav Addict 2018; 7:1-9. [PMID: 29529886 PMCID: PMC6035022 DOI: 10.1556/2006.7.2018.19] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/12/2018] [Indexed: 11/19/2022] Open
Abstract
We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.
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Affiliation(s)
- Antonius J. van Rooij
- Department of Children & Risky Behavior, Trimbos Institute, Utrecht, The Netherlands
| | | | - Michelle Colder Carras
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jing Shi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Espen Aarseth
- Center for Computer Games Research, IT University of Copenhagen, Copenhagen, Denmark
| | - Anthony M. Bean
- Department of Psychology, Framingham State University, Framingham, MA, USA
| | | | - Anne Brus
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Mark Coulson
- Department of Psychology, Middlesex University, London, UK
| | - Jory Deleuze
- Department of Psychology, Université Catholique de Louvain (UCL), Louvain, Belgium
| | - Pravin Dullur
- School of medicine, Western Sydney University, Penrith, NSW, Australia
| | - Elza Dunkels
- Department of Applied Educational Science, Umeå University, Umeå, Sweden
| | - Johan Edman
- Department of Criminology, Stockholm University, Stockholm, Sweden
| | - Malte Elson
- Psychology of Human Technology Interaction Group, Ruhr University Bochum, Bochum, Germany
| | | | - Anne Fiskaali
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Isabela Granic
- Developmental Psychopathology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Jeroen Jansz
- Department of Media and Communication, ERMeCC, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Faltin Karlsen
- Westerdals Department of Film and Media, Kristiania University College, Oslo, Norway
| | - Linda K. Kaye
- Department of Psychology, Edge Hill University, Ormskirk, UK
| | - Bonnie Kirsh
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Andreas Lieberoth
- Department of Educational Psychology, Danish School of Education, Aarhus University, Aarhus, Denmark
| | - Patrick Markey
- Department of Psychology, Villanova University, Villanova, PA, USA
| | | | | | - Amy Orben
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Arne Poulsen
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | | | - Patrick Prax
- Department of Game Design, Uppsala University, Visby, Sweden
| | - Thorsten Quandt
- Department of Communication, University of Münster, Münster, Germany
| | - Adriano Schimmenti
- Department of Human and Social Sciences, UKE – Kore University of Enna, Enna, Italy
| | - Vladan Starcevic
- Discipline of Psychiatry, University of Sydney, Sydney, Australia
| | | | - Nigel E. Turner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jan van Looy
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
| | - Andrew K. Przybylski
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Internet Institute, University of Oxford, Oxford, UK
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354
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Abstract
This paper aims to understand the DSM-5 through situating it within the context of the historical development of the DSM series. When one looks at the sets of diagnostic criteria, the DSM-5 is strikingly similar to the DSM-IV. I argue that at this level the DSM has become 'locked-in' and difficult to change. At the same time, at the structural, or conceptual, level there have been radical changes, for example in the definition of 'mental disorder', in the role of theory and of values, and in the abandonment of the multiaxial approach to diagnosis. The way that the DSM-5 was constructed means that the overall conceptual framework of the classification only barely constrains the sets of diagnostic criteria it contains.
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355
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Nobili A, Krashia P, Cordella A, La Barbera L, Dell'Acqua MC, Caruso A, Pignataro A, Marino R, Sciarra F, Biamonte F, Scattoni ML, Ammassari-Teule M, Cecconi F, Berretta N, Keller F, Mercuri NB, D'Amelio M. Ambra1 Shapes Hippocampal Inhibition/Excitation Balance: Role in Neurodevelopmental Disorders. Mol Neurobiol 2018; 55:7921-7940. [PMID: 29488136 PMCID: PMC6132777 DOI: 10.1007/s12035-018-0911-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/15/2018] [Indexed: 01/04/2023]
Abstract
Imbalances between excitatory and inhibitory synaptic transmission cause brain network dysfunction and are central to the pathogenesis of neurodevelopmental disorders. Parvalbumin interneurons are highly implicated in this imbalance. Here, we probed the social behavior and hippocampal function of mice carrying a haploinsufficiency for Ambra1, a pro-autophagic gene crucial for brain development. We show that heterozygous Ambra1 mice (Ambra+/−) are characterized by loss of hippocampal parvalbumin interneurons, decreases in the inhibition/excitation ratio, and altered social behaviors that are solely restricted to the female gender. Loss of parvalbumin interneurons in Ambra1+/− females is further linked to reductions of the inhibitory drive onto principal neurons and alterations in network oscillatory activity, CA1 synaptic plasticity, and pyramidal neuron spine density. Parvalbumin interneuron loss is underlined by increased apoptosis during the embryonic development of progenitor neurons in the medial ganglionic eminence. Together, these findings identify an Ambra1-dependent mechanism that drives inhibition/excitation imbalance in the hippocampus, contributing to abnormal brain activity reminiscent of neurodevelopmental disorders.
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Affiliation(s)
- Annalisa Nobili
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy.,Department of Medicine, University Campus-Biomedico, 00128, Rome, Italy
| | - Paraskevi Krashia
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy. .,Department of Systems Medicine, University of Rome 'Tor Vergata', 00133, Rome, Italy.
| | - Alberto Cordella
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', 00133, Rome, Italy
| | - Livia La Barbera
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', 00133, Rome, Italy
| | - Maria Concetta Dell'Acqua
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy.,Department of Medicine, University Campus-Biomedico, 00128, Rome, Italy
| | - Angela Caruso
- Research Coordination and Support Service, Istituto Superiore di Sanità (ISS), 00161, Rome, Italy
| | - Annabella Pignataro
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy.,Institute of Cell Biology and Neurobiology (IBCN), National Research Council (CNR), 00143, Rome, Italy
| | - Ramona Marino
- Department of Medicine, University Campus-Biomedico, 00128, Rome, Italy
| | - Francesca Sciarra
- Department of Medicine, University Campus-Biomedico, 00128, Rome, Italy
| | - Filippo Biamonte
- Institute of Histology and Embryology, "A. Gemelli" Faculty of Medicine, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità (ISS), 00161, Rome, Italy
| | - Martine Ammassari-Teule
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy.,Institute of Cell Biology and Neurobiology (IBCN), National Research Council (CNR), 00143, Rome, Italy
| | - Francesco Cecconi
- Department of Biology, University of Rome 'Tor Vergata', 00133, Rome, Italy.,Cell Stress and Survival Group, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark.,Department of Pediatric Hematology and Oncology, IRCSS Bambino Gesu Children's Hospital, 00165, Rome, Italy
| | - Nicola Berretta
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy
| | - Flavio Keller
- Department of Medicine, University Campus-Biomedico, 00128, Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy.,Department of Systems Medicine, University of Rome 'Tor Vergata', 00133, Rome, Italy
| | - Marcello D'Amelio
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00143, Rome, Italy. .,Department of Medicine, University Campus-Biomedico, 00128, Rome, Italy.
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356
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Mutoh T, Mutoh T, Tsubone H, Takada M, Doumura M, Ihara M, Shimomura H, Taki Y, Ihara M. Impact of serial gait analyses on long-term outcome of hippotherapy in children and adolescents with cerebral palsy. Complement Ther Clin Pract 2018; 30:19-23. [DOI: 10.1016/j.ctcp.2017.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/22/2017] [Accepted: 11/07/2017] [Indexed: 02/03/2023]
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357
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Dakanalis A, Colmegna F, Zanetti MA, Di Giacomo E, Riva G, Clerici M. Evaluation of the DSM-5 Severity Specifier for Bulimia Nervosa in Treatment-Seeking Youth. Child Psychiatry Hum Dev 2018; 49:137-145. [PMID: 28510006 DOI: 10.1007/s10578-017-0735-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A new severity specifier for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (e.g., laxative misuse, self-induced vomiting, fasting, diuretic misuse, and excessive exercise), has been added to the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a means of addressing variability and heterogeneity in the severity of the disorder. While existing research provides support for the DSM-5 severity specifier for BN in adult patients, evidence for its validity and clinical utility in youth is currently lacking. To address this gap, data from 272 treatment-seeking adolescents with DSM-5 BN (94.2% female, M age = 15.3 years, SD 1.7) were analysed to examine whether these patients, sub-grouped based on the DSM-5 severity definitions, would show meaningful differences in a broad range of clinical variables and demographic and physical characteristics. Analyses revealed that participants categorized with mild, moderate, severe, and extreme severity of BN significantly differed from each other in 15 variables regarding eating disorder pathological features and putative maintenance factors (i.e., core low self-esteem, perfectionism, social appearance anxiety, body surveillance, and mood intolerance), health-related quality of life and comorbid psychiatric (i.e., affective and anxiety) disorders (large effect sizes). Between-group differences in demographics, body mass index, or age-of-BN onset were not observed. Collectively, our findings provide support for the utility of the frequency of inappropriate weight compensatory behaviours as a severity indicator for BN and suggest that age-at-onset of BN is probably more disorder- than severity-dependent. Implications for future research are outlined.
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Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | | | | | - Ester Di Giacomo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.,Department of Mental Health, San Gerardo Hospital, Monza, Italy
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358
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Novelle MG, Diéguez C. Food Addiction and Binge Eating: Lessons Learned from Animal Models. Nutrients 2018; 10:E71. [PMID: 29324652 PMCID: PMC5793299 DOI: 10.3390/nu10010071] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/26/2017] [Accepted: 01/09/2018] [Indexed: 01/10/2023] Open
Abstract
The feeding process is required for basic life, influenced by environment cues and tightly regulated according to demands of the internal milieu by regulatory brain circuits. Although eating behaviour cannot be considered "addictive" under normal circumstances, people can become "addicted" to this behaviour, similarly to how some people are addicted to drugs. The symptoms, cravings and causes of "eating addiction" are remarkably similar to those experienced by drug addicts, and both drug-seeking behaviour as eating addiction share the same neural pathways. However, while the drug addiction process has been highly characterised, eating addiction is a nascent field. In fact, there is still a great controversy over the concept of "food addiction". This review aims to summarize the most relevant animal models of "eating addictive behaviour", emphasising binge eating disorder, that could help us to understand the neurobiological mechanisms hidden under this behaviour, and to improve the psychotherapy and pharmacological treatment in patients suffering from these pathologies.
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Affiliation(s)
- Marta G Novelle
- Department of Physiology, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela-Instituto de Investigación Sanitaria (IDIS), CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 15786 Santiago de Compostela, Spain.
| | - Carlos Diéguez
- Department of Physiology, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela-Instituto de Investigación Sanitaria (IDIS), CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 15786 Santiago de Compostela, Spain.
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359
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Sperandeo R, Monda V, Messina G, Carotenuto M, Maldonato NM, Moretto E, Leone E, De Luca V, Monda M, Messina A. Brain functional integration: an epidemiologic study on stress-producing dissociative phenomena. Neuropsychiatr Dis Treat 2018; 14:11-19. [PMID: 29296086 PMCID: PMC5741075 DOI: 10.2147/ndt.s146250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Dissociative phenomena are common among psychiatric patients; the presence of these symptoms can worsen the prognosis, increasing the severity of their clinical conditions and exposing them to increased risk of suicidal behavior. Personality disorders as long duration stressful experiences may support the development of dissociative phenomena. In 933 psychiatric outpatients consecutively recruited, presence of dissociative phenomena was identified with the Dissociative Experience Scale (DES). Dissociative phenomena were significantly more severe in the group of people with mental disorders and/or personality disorders. All psychopathologic traits detected with the symptom checklist-90-revised had a significant correlation with the total score on the DES. Using total DES score as the dependent variable, a linear regression model was constructed. Mental and personality disorders which were associated with greater severity of dissociative phenomena on analysis of variance were included as predictors; scores from the nine scales of symptom checklist-90-revised, significantly correlated to total DES score, were used as covariates. The model consisted of seven explanatory variables (four factors and three covariates) explaining 82% of variance. The four significant factors were the presence of borderline and narcissistic personality disorder, substance abuse disorders and psychotic disorders. Significant covariates were psychopathologic traits of anger, psychoticism and obsessiveness. This study, confirming Janet's theory, explains that, mental disorders and psychopathologic experiences of patients can configure the chronic stress condition that produces functional damage to the adaptive executive system. The symptoms of dissociative depersonalization/derealization and dissociative amnesia can be explained, in large part, through their current and previous psychopathologic experiences.
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Affiliation(s)
- Raffaele Sperandeo
- Department of Human Sciences, Università Della, Basilicata.,School of Integrated Gestaltic Psychotherapy, Torre Annunziata
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia
| | - Marco Carotenuto
- Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Nelson Mauro Maldonato
- Department of Human Sciences, Università Della, Basilicata.,School of Integrated Gestaltic Psychotherapy, Torre Annunziata
| | - Enrico Moretto
- Department of Human Sciences, Università Della, Basilicata.,School of Integrated Gestaltic Psychotherapy, Torre Annunziata
| | - Elena Leone
- Department of Human Sciences, Università Della, Basilicata.,School of Integrated Gestaltic Psychotherapy, Torre Annunziata
| | - Vincenzo De Luca
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples
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360
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Abstract
BACKGROUND Masked depression is often misdiagnosed due to the predominance of somatic symptoms and is further complicated by lack of awareness among doctors. AIM The present survey was conducted to gather the views of psychiatrists and nonpsychiatrists regarding presentation and management aspects of masked depression. This may help in unmasking this condition and facilitate early identification and appropriate management of patients presenting with this condition. MATERIALS AND METHODS This questionnaire-based survey was conducted as an interview through computer-aided telephonic interview among 300 doctors (150 psychiatrists and 150 nonpsychiatrists) across India. RESULTS Both psychiatrists and nonpsychiatrists reported a high prevalence of somatic symptoms among patients with masked depression. Nonpsychiatrists (44%) more often than psychiatrists (20%) noted chronic pain in the majority of patients with masked depression. Psychiatrists (31%) more often than nonpsychiatrists (9%) noted lack of concentration in the majority of patients with masked depression. Sexual dysfunction among young patients and noncompliance to therapy for chronic illness were considered as potential predictors of masked depression. There was a general agreement among psychiatrists and nonpsychiatrists that medical liaising is beneficial for the management of patients with masked depression. CONCLUSION Both psychiatrists and nonpsychiatrists agree that somatic symptoms are commonly encountered in patients with masked depression. However, these somatic symptoms are often interpreted as physical illness rather than as an entity of depression which creates an unmet need in terms of managing masked depression, especially by nonpsychiatrists.
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Affiliation(s)
| | - Akshata Mane
- Pfizer Ltd (Medical), Mumbai, Maharashtra, India
| | | | - Ganesh Uchit
- Pfizer Ltd (Medical), Mumbai, Maharashtra, India
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361
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Therapeutic Particularities with Depot Medications in Schizophrenia. CURRENT HEALTH SCIENCES JOURNAL 2018; 44:322-325. [PMID: 30647956 PMCID: PMC6311213 DOI: 10.12865/chsj.44.03.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022]
Abstract
Schizophrenia is a neurodegenerative disease with personality degradation, changes in behavior, cognition, affective disorder and reduced socio-professional insertion. Early diagnosis is necessary and maintenance is ensured by antipsychotic treatment and for non-compliant patients there is an alternative to depot medication that greatly improves therapeutic adherence. The study presents the case of a 43-year-old patient diagnosed with paranoid schizophrenia using the Diagnostic and Statistical Manual of Mental Disorders V-TR criteria that showed a favorable evolution under depot treatment.
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362
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Abstract
OBJECTIVE Gambling is a commonplace phenomenon, existing along a continuum from occasional gambling to functionally impairing gambling disorder. The internet may act as a conduit for some gambling behaviors. The impact of problematic internet use on clinical and cognitive features relevant to gambling has received little research attention. METHODS A total of 206 adults aged 18-30 years who gamble at least five times per year were recruited from the general community and undertook detailed clinical and cognitive assessments. Problematic internet use was defined using a total score of 5 or more on Young's Diagnostic Questionnaire (YDQ). Linear regression was employed to evaluate the relative contribution of addictive-related, impulsive-related, and compulsive-related measures in predicting YDQ total scores in gamblers. RESULTS Gamblers with problematic internet use (18% of the sample) reported lower quality of life, lower self-esteem, elevated rates of intermittent explosive disorder, gambling disorder symptoms, attention deficit hyperactivity disorder (ADHD) symptoms, antisocial personality disorder, and posttraumatic stress disorder (PTSD), as well as relative deficits in decision making and spatial working memory. In linear regression, the extent of problematic internet use was most significantly associated with increased gambling disorder symptoms and increased ADHD symptoms. CONCLUSIONS Problematic internet use in gamblers is associated with worse quality of life, more problem/pathological gambling symptoms, more psychiatric morbidities, and select cognitive impairment. Refinement of the definition of problematic internet use and exploration of its clinical and cognitive associations are likely to be highly relevant to the treatment of problematic gambling.
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363
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Dakanalis A, Bartoli F, Caslini M, Crocamo C, Zanetti MA, Riva G, Clerici M, Carrà G. Validity and clinical utility of the DSM-5 severity specifier for bulimia nervosa: results from a multisite sample of patients who received evidence-based treatment. Eur Arch Psychiatry Clin Neurosci 2017; 267:823-829. [PMID: 27435722 DOI: 10.1007/s00406-016-0712-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023]
Abstract
A new "severity specifier" for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (IWCBs), was added to the DSM-5 as a means of documenting heterogeneity and variability in the severity of the disorder. Yet, evidence for its validity in clinical populations, including prognostic significance for treatment outcome, is currently lacking. Existing data from 281 treatment-seeking patients with DSM-5 BN, who received the best available treatment for their disorder (manual-based cognitive behavioural therapy; CBT) in an outpatient setting, were re-analysed to examine whether these patients subgrouped based on the DSM-5 severity levels would show meaningful and consistent differences on (a) a range of clinical variables assessed at pre-treatment and (b) post-treatment abstinence from IWCBs. Results highlight that the mild, moderate, severe, and extreme severity groups were statistically distinguishable on 22 variables assessed at pre-treatment regarding eating disorder pathological features, maintenance factors of BN, associated (current) and lifetime psychopathology, social maladjustment and illness-specific functional impairment, and abstinence outcome. Mood intolerance, a maintenance factor of BN but external to eating disorder pathological features (typically addressed within CBT), emerged as the primary clinical variable distinguishing the severity groups showing a differential treatment response. Overall, the findings speak to the concurrent and predictive validity of the new DSM-5 severity criterion for BN and are important because a common benchmark informing patients, clinicians, and researchers about severity of the disorder and allowing severity fluctuation and patient's progress to be tracked does not exist so far. Implications for future research are outlined.
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Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, P.Za Botta 11, 27100, Pavia, Italy. .,Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Francesco Bartoli
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Manuela Caslini
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Maria Assunta Zanetti
- Department of Brain and Behavioral Sciences, University of Pavia, P.Za Botta 11, 27100, Pavia, Italy
| | - Giuseppe Riva
- Department of Psychology, Catholic University, Largo Gemelli 1, 20123, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Via Ariosto 13, 20145, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.,Division of Psychiatry, Faculty of Brain Sciences, University College of London, Gower Street, London, WC1E 6BT, UK
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364
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Côté SM, Orri M, Brendgen M, Vitaro F, Boivin M, Japel C, Séguin JR, Geoffroy MC, Rouquette A, Falissard B, Tremblay RE. Psychometric properties of the Mental Health and Social Inadaptation Assessment for Adolescents (MIA) in a population-based sample. Int J Methods Psychiatr Res 2017; 26. [PMID: 28449235 PMCID: PMC5724652 DOI: 10.1002/mpr.1566] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/20/2017] [Accepted: 02/23/2017] [Indexed: 11/12/2022] Open
Abstract
We report on the psychometric properties of the Mental Health and Social Inadaptation Assessment for Adolescents (MIA), a self-report instrument for quantifying the frequency of mental health and psychosocial adaptation problems using a dimensional approach and based on the DSM-5. The instrument includes 113 questions, takes 20-25 minutes to answer, and covers the past 12 months. A population-based cohort of adolescents (n = 1443, age = 15 years; 48% males) rated the frequency at which they experienced symptoms of Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder, Oppositional Defiant Disorder, Depression, Generalized Anxiety, Social Phobia, Eating Disorders (i.e. DSM disorders), Self-harm, Delinquency, Psychopathy as well as social adaptation problems (e.g. aggression). They also rated interference with functioning in four contexts (family, friends, school, daily life). Reliability analyses indicated good to excellent internal consistency for most scales (alpha = 0.70-0.97) except Psychopathy (alpha = 0.46). The hypothesized structure of the instrument showed acceptable fit according to confirmatory factor analysis (CFA) [Chi-square (4155) = 9776.2, p = 0.000; Chi-square/DF = 2.35; root mean square error of approximation (RMSEA) = 0.031; Comparative Fit Index (CFI) = 0.864], and good convergent and discriminant validity according to multitrait-multimethods analysis. This initial study showed adequate internal validity and reliability of the MIA. Our findings open the way for further studies investigating other validity aspects, which are necessary before recommending the wide use of the MIA in research and clinical settings.
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Affiliation(s)
- Sylvana M Côté
- Department of Social and Preventive Medicine, University of Montreal, Canada.,Bordeaux Population Health Research Centre, INSERM U1219 and University of Bordeaux, Bordeaux, France
| | - Massimiliano Orri
- Bordeaux Population Health Research Centre, INSERM U1219 and University of Bordeaux, Bordeaux, France
| | - Mara Brendgen
- Psychology Department, University of Quebec in Montreal, Montreal, Canada
| | - Frank Vitaro
- School of Psychoeducation, University of Montreal, Canada
| | - Michel Boivin
- School of Psychology, Laval University, Canada and Tomsk State University, Russia
| | - Christa Japel
- School of Education, University of Quebec, Montreal, Canada
| | - Jean R Séguin
- Psychiatry Department, University of Montreal, Canada
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University; Douglas Mental Health University Institute, Montréal, Québec, Canada
| | | | - Bruno Falissard
- CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, France
| | - Richard E Tremblay
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
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365
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Veras AB, Cougo S, Meira F, Peixoto C, Barros JA, Nardi AE, Malaspina D, Poyurovsky M, Kahn JP. Schizophrenia dissection by five anxiety and depressive subtype comorbidities: Clinical implications and evolutionary perspective. Psychiatry Res 2017; 257:172-178. [PMID: 28763736 DOI: 10.1016/j.psychres.2017.07.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/07/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
Twenty patients with DSM5 schizophrenia were comprehensively and formally assessed by an experienced psychiatrist. All subjects were assessed for: positive and negative psychotic symptoms; social anxiety; panic anxiety; obsessive compulsive disorder, atypical depression; major depression; suicide risk; and global assessment of functioning. Different profiles of clinical presentation and symptom evolution emerged for patients with schizophrenia who had co-morbid depression (15%), OCD (15%), panic or limited symptom attacks (55%) and social anxiety (5%). At least eighty percent of the sample had one or more of these co-morbidities. Summing up, the data support our previous finding that panic is highly prevalent in Schizophrenia with Auditory Hallucinations (>73% here, versus 100% before), and panic was paroxysmally concurrent with voice onset. Moreover, characteristic clinical findings may help point clinicians to five specific co-morbidity psychosis subtypes. Moreover, co-morbidity dissection of psychotic diagnoses recalls and parallels the historical psychopharmacologic dissection of non-psychotic anxiety and depressive subtypes diagnoses. Larger studies should further test and explore these preliminary findings.
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Affiliation(s)
- André B Veras
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (LabPR/UFRJ), Rio de Janeiro, Brazil; Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil; Department of Psychiatry and Environmental Medicine, New York University Medical Center, New York, NY, USA.
| | - Simone Cougo
- Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil
| | - Fernanda Meira
- Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil
| | - Clayton Peixoto
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (LabPR/UFRJ), Rio de Janeiro, Brazil; Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil
| | - Jorge A Barros
- Translational Research Group on Mental Health (GPTranSMe), Dom Bosco Catholic University, Campo Grande, Brazil
| | - Antonio E Nardi
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (LabPR/UFRJ), Rio de Janeiro, Brazil
| | - Dolores Malaspina
- Department of Psychiatry and Environmental Medicine, New York University Medical Center, New York, NY, USA
| | - Michael Poyurovsky
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Jeffrey P Kahn
- Department of Psychiatry, Weill-Cornell Medical College, New York, NY, USA
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366
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McKenzie K, Martin L, Ouellette-Kuntz H. Needles in the haystack: Using open-text fields to identify persons with intellectual and developmental disabilities in administrative home care data. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 69:85-95. [PMID: 28841496 DOI: 10.1016/j.ridd.2017.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/29/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Use of administrative health data to study populations of interest is becoming more common. Identifying individuals with intellectual and developmental disabilities (IDD) in existing databases can be challenging due to inconsistent definitions and terminologies of IDD over time and across sectors, and the inability to rely on etiologies of IDD as they are frequently unknown. AIMS To identify diagnoses related to IDD in an administrative database and create a cohort of persons with IDD. METHODS Open-text diagnostic entries related to IDD were identified in an Ontario home care database (2003-2015) and coded as being either acceptable (e.g. Down syndrome) or ambiguous (e.g. intellectually challenged). The cognitive and functional skills of the resulting groups were compared using logistic regressions and standardized differences, and their age distributions were compared to that of the general home care population. RESULTS Just under 1% of the home care population had a diagnostic entry related to IDD. Ambiguous terms were most commonly used (61%), and this group tended to be older and less impaired than the group with more acceptable terms used to describe their IDD. CONCLUSIONS Open-text diagnostic variables in administrative health records can be used to identify and study individuals with IDD. IMPLICATIONS Future work is needed to educate assessors on the importance of using standard, accepted terminology when recording diagnoses related to IDD.
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Affiliation(s)
- Katherine McKenzie
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7 B 5E1, Canada.
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7 B 5E1, Canada.
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences, Queen's University & Ongwanada, 191 Portsmouth Avenue, Kingston, Ontario, Kingston, K7 M 8A6, Canada.
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367
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Parellada M, Gomez-Vallejo S, Burdeus M, Arango C. Developmental Differences Between Schizophrenia and Bipolar Disorder. Schizophr Bull 2017; 43:1176-1189. [PMID: 29045744 PMCID: PMC5737496 DOI: 10.1093/schbul/sbx126] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Ample evidence supports a neurodevelopmental origin in some cases of schizophrenia (SZ). More inconsistent information is available for bipolar disorder (BD). We herein review studies with a focus on premorbid (adjustment and functionality) and early developmental milestones that include both SZ and BD patients. A search was performed in the PubMed electronic database, retrieving 619 abstracts; 30 were ultimately included in this systematic review. Eight prospective cohorts, 15 retrospective studies, and 7 studies based on national registries. Psychomotor developmental deviations and general adjustment problems characterize the childhood of subjects later diagnosed with SZ or BD; they are more marked in those later diagnosed with SZ vs BD, earlier onset vs later onset, and psychotic vs nonpsychotic disorders. Cognitive impairment follows a linear risk trend for SZ and a U-shaped trend for BD. Social isolation and visuoperceptual/reading anomalies more frequently antecede SZ. Pervasive developmental disorders increase the risk for both SZ and BD, more so in cases with normal intelligence. The predictive risk of each isolated developmental marker is low, but a significant percentage of subjects with SZ and a minority of adults with BD showed signs of premorbid abnormalities in childhood. The great limitation is still the lack of studies comparing SZ and BD that include psychotic and nonpsychotic bipolar cases separately. There are many cases, even in childhood/adolescent SZ, where no premorbid anomalies are found, and immunological disorders or other etiologies should be searched for. At least in cases with clear neurodevelopmental markers, rare genetic variants should be investigated.
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Affiliation(s)
- Mara Parellada
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain,IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain,To whom correspondence should be addressed; Mara Parellada, Hospital General Universitario Gregorio Marañón, Ibiza 43, Madrid 28009, Spain; tel: +34-91-5868133, fax: +34-91-4265004, e-mail:
| | - Sandra Gomez-Vallejo
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Monica Burdeus
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain,IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
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368
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Kogan CS, Paterniti S. The True North Strong and Free? Opportunities for Improving Canadian Mental Health Care and Education by Adopting the WHO's ICD-11 Classification. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:690-696. [PMID: 28662590 PMCID: PMC5638190 DOI: 10.1177/0706743717717253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Cary S Kogan
- 1 School of Psychology, University of Ottawa, Ottawa, Ontario.,2 Institute of Mental Health Research, Ottawa, Ontario
| | - Sabrina Paterniti
- 2 Institute of Mental Health Research, Ottawa, Ontario.,3 Royal Ottawa Mental Health Centre, Ottawa, Ontario.,4 Department of Psychiatry, University of Ottawa, Ottawa, Ontario
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369
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Makushkin EV, Oskolkova SN, Fastovtsov GA. [Psychiatry of the future: multidimensionality of the problems of modern psychiatry and development of classification systems]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:118-123. [PMID: 28884728 DOI: 10.17116/jnevro201711781118-123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The success and achievements in the area of neurosciences due to the development of neuroimaging, neurochemical and genome studies provide tasks for psychiatry determined by the necessity to develop new classifications of mental diseases, primarily ICD-11, specify clinical diagnostic criteria and rethink the essence of some mental disorders. In spite of the multiple direction of scientific opinions on the discussed issues, the development of modern psychiatry is characterized by intensive search of biological background of psychiatric disorders and elaboration of effective approaches to the diagnosis and treatment of mental diseases, including medical rehabilitation of patients.
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Affiliation(s)
- E V Makushkin
- Serbsky Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - S N Oskolkova
- Serbsky Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - G A Fastovtsov
- Serbsky Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia
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370
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Chaumette B, Kebir O, Krebs MO. [Genetics and epigenetics of schizophrenia and other psychoses]. Biol Aujourdhui 2017; 211:69-82. [PMID: 28682228 DOI: 10.1051/jbio/2017015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 06/07/2023]
Abstract
Schizophrenia and other psychoses are categorical psychiatric diagnoses corresponding to frequent and heterogeneous disorders. Their physiopathology still remains largely unknown despite numerous recent advances. In particular, the last decade has identified different types of genetic variants, thanks to emergence of high-throughput methods. These methods allow both the identification of rare variants with a large effect such as punctual mutations or copy-number variants and the identification of frequent variants with a limited effect such as polymorphisms. Many impacted genes have been identified showing a very high genetic heterogeneity of psychoses. These genes are overrepresented in synaptic and neurotransmission pathways. Only a small fraction of psychoses could be easily explained by genetics but this screening in clinical practice is important as it can lead to therapeutic challenge or genetic counselling. Nowadays, it is clear that the pathophysiology of the psychoses can only be understood by an integrative approach taking into account the interaction between genes and environment. This interaction could be mediated by the epigenome defined as the modification of gene expression without changes in DNA sequence. Epigenome is stable but could be modified by environmental factors. Several epigenetic mechanisms have been studied in psychosis, in particular the DNA methylation, the modification of histones and the microRNA. All of these mechanisms are under regulation by genetic factors and variants in these epigenetic-involved genes and cofactors have been also associated with schizophrenia. Thus, pathophysiology of psychosis is complex and morestudiesare needed before definitive conclusions. Altogether, the recent advances in the genetics and epigenetics of psychosis are promising and could open the way to a recategorization of these disorders as well as the identification of new therapeutic targets.
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Affiliation(s)
- Boris Chaumette
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Oussama Kebir
- INSERM, U894, Laboratoire "Physiopathologie des maladies psychiatriques", Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, 102-108 rue de la Santé, 75014 Paris, France Institut de Psychiatrie-GDR 3557, Centre Hospitalier Sainte-Anne, Paris, France
| | - Marie-Odile Krebs
- INSERM, U894, Laboratoire "Physiopathologie des maladies psychiatriques", Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, 102-108 rue de la Santé, 75014 Paris, France Institut de Psychiatrie-GDR 3557, Centre Hospitalier Sainte-Anne, Paris, France
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371
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Rosli R, Tan MP, Gray WK, Subramanian P, Mohd Hairi NN, Chin AV. How Can We Best Screen for Cognitive Impairment in Malaysia? A Pilot of the IDEA Cognitive Screen and Picture-Based Memory Impairment Scale and Comparison of Criterion Validity with the Mini Mental State Examination. Clin Gerontol 2017; 40:249-257. [PMID: 28459304 DOI: 10.1080/07317115.2017.1311978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To pilot two new cognitive screening tools for use in an urban Malaysian population and to compare their criterion validity against a gold standard, the well-established Mini-Mental State Examination (MMSE). METHODS The IDEA cognitive screen, Picture-based Memory Impairment Scale (PMIS), and MMSE were administered to a convenience sample of elderly (≥ 65 years) from the community and outpatient clinics at an urban teaching hospital. Consensus diagnosis was performed by two geriatricians blinded to PMIS and IDEA cognitive screen scores using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) clinical criteria. The MMSE performance was used as a reference. RESULTS The study enrolled 66 participants, with a median age of 78.5 years (interquartile range [IQR], 72.5-83.0) years and 11.0 median years of education (IQR, 9.0-13.0). Forty-three (65.2%) were female, and 32 (48.4%) were Chinese. The area under the receiver operating characteristic (AUROC) curve values were .962 (IDEA cognitive screen), .970 (PMIS), and .935 (MMSE). The optimal cutoff values for sensitivity and specificity were: IDEA cognitive screen: ≤ 11, 90.9% and 89.7%; PMIS: ≤ 6, 97.3% and 69.0%; and MMSE: ≤ 23, 84.6% and 76.0%. Although the sample size was small, multivariable logistic regression modelling suggested that all three screen scores did not appear to be educationally biased. CONCLUSION The IDEA and PMIS tools are potentially valid screening tools for dementia in urban Malaysia, and perform at least as well as the MMSE. Further work on larger representative, cohorts is needed to further assess the psychometric properties. CLINICAL IMPLICATIONS Study provides alternative screening tools for dementia for both non-specialists and specialists.
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Affiliation(s)
| | - Maw Pin Tan
- a University of Malaya , Kuala Lumpur , Malaysia
| | - William K Gray
- b Northumbria Healthcare NHS Foundation Trust , North Tyneside General Hospital , UK
| | | | | | - Ai-Vyrn Chin
- a University of Malaya , Kuala Lumpur , Malaysia
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372
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Cattane N, Rossi R, Lanfredi M, Cattaneo A. Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms. BMC Psychiatry 2017; 17:221. [PMID: 28619017 PMCID: PMC5472954 DOI: 10.1186/s12888-017-1383-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/06/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND According to several studies, the onset of the Borderline Personality Disorder (BPD) depends on the combination between genetic and environmental factors (GxE), in particular between biological vulnerabilities and the exposure to traumatic experiences during childhood. We have searched for studies reporting possible alterations in several biological processes and brain morphological features in relation to childhood trauma experiences and to BPD. We have also looked for epigenetic mechanisms as they could be mediators of the effects of childhood trauma in BPD vulnerability. DISCUSSION We prove the role of alterations in Hypothalamic-Pituitary-Adrenal (HPA) axis, in neurotrasmission, in the endogenous opioid system and in neuroplasticity in the childhood trauma-associated vulnerability to develop BPD; we also confirm the presence of morphological changes in several BPD brain areas and in particular in those involved in stress response. Not so many studies are available on epigenetic changes in BPD patients, although these mechanisms are widely investigated in relation to stress-related disorders. A better comprehension of the biological and epigenetic mechanisms, affected by childhood trauma and altered in BPD patients, could allow to identify "at high risk" subjects and to prevent or minimize the development of the disease later in life.
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Affiliation(s)
- Nadia Cattane
- grid.419422.8Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Roberta Rossi
- grid.419422.8Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Mariangela Lanfredi
- grid.419422.8Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio - Fatebenefratelli, via Pilastroni 4, Brescia, Italy. .,Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK. .,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK.
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373
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Machado PP, Grilo CM, Crosby RD. Evaluation of the DSM-5 Severity Indicator for Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2017; 25:221-223. [PMID: 28402070 PMCID: PMC8674740 DOI: 10.1002/erv.2508] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/03/2017] [Accepted: 02/12/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study tested the new DSM-5 severity criterion for anorexia nervosa (AN) based on proposed body mass index (BMI) cut-points. METHOD Participants were a clinical sample of 201 treatment-seeking patients diagnosed with DSM-5 AN in Portugal. Participants were categorised based on DSM-5 severity levels and were compared on demographic and clinical variables assessed with the Eating Disorder Examination-Questionnaire. RESULTS Based on DSM-5 severity definitions for AN, 73 (36.3%) participants were categorised as mild (≥17.0 BMI), 40 (19.9%) as moderate (16-16.99 BMI), 30 (14.9%) as severe (15-15.99 BMI) and 58 (28.9%) as extreme (<15 BMI). The severity groups did not differ significantly in age or gender. Analyses comparing the severity groups on measures of eating-disorder psychopathology revealed no significant differences on the Eating Disorder Examination-Questionnaire global or subscale scores. The groups also did not differ significantly on the frequency of binge eating or purging episodes within the past 28 days. CONCLUSIONS Our findings, in this clinical sample of patients with AN in Portugal, provide no evidence for the new DSM-5 severity ratings based on BMI level. Further research on the validity of the DSM-5 specifiers is needed and should test additional clinical or functional variables and especially prognostic utility for course and outcome across eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Paulo P.P. Machado
- Psychotherapy and Psychopathology Research Unit, CIPsi, School of Psychology, University of Minho, Portugal
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, and the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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374
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Dakanalis A, Riva G, Serino S, Colmegna F, Clerici M. Classifying Adults with Binge Eating Disorder Based on Severity Levels. EUROPEAN EATING DISORDERS REVIEW 2017; 25:268-274. [DOI: 10.1002/erv.2518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/18/2017] [Accepted: 03/20/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Antonios Dakanalis
- University of Milan-Bicocca, Milan/Monza and University of Pavia; Pavia Italy
| | - Giuseppe Riva
- Istituto Auxologico Italiano; Milan and Catholic University; Milan Italy
| | | | | | - Massimo Clerici
- University of Milan-Bicocca, Milan/Monza and San Gerardo Hospital; Monza Italy
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375
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Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample. Eat Weight Disord 2017; 22:161-167. [PMID: 27650858 DOI: 10.1007/s40519-016-0324-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study tested the new DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors in a treatment-seeking sample. METHODS Participants were 345 adults with DSM-5 BN presenting for treatment. They were sub-grouped based on DSM-5 severity levels and compared on a range of variables of clinical interest and demographics. RESULTS Based on DSM-5 severity definitions, 27.2 % of the sample was categorized with mild, 26.1 % with moderate, 24.9 % with severe, and 21.8 % with extreme severity of BN. Analyses revealed that the four (mild, moderate, severe, and extreme) severity groups of BN significantly differed from each other in eating disordered and body-related attitudes and behaviors, factors involved in the maintenance process of the disorder, comorbid psychiatric disorders, psychological distress, and psychosocial impairment (medium-to-large effect sizes). No significant between-group differences were observed in demographics, body mass index, or at the age when BN first occurred, lending some credence to recent suggestions that age-at-onset of BN may be more a disorder- than a severity-dependent variable. CONCLUSIONS Collectively, our findings provide support for the severity indicator for BN introduced in the DSM-5 as a means of addressing heterogeneity and variability in the severity of the disorder.
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376
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Vrijens D, Berghmans B, Nieman F, van Os J, van Koeveringe G, Leue C. Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions-A cross sectional cohort study at a Pelvic Care Centre. Neurourol Urodyn 2017; 36:1816-1823. [DOI: 10.1002/nau.23186] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/12/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Desiree Vrijens
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Bary Berghmans
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Fred Nieman
- Department of Clinical Epidemiology and Medical Technology Assessment; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON; Maastricht University Medical Centre; Maastricht The Netherlands
- King's Health Partners, Institute of Psychiatry; King's College London; London United Kingdom
- MeHNS, Research School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - Gommert van Koeveringe
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
- MeHNS, Research School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - Carsten Leue
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON; Maastricht University Medical Centre; Maastricht The Netherlands
- MeHNS, Research School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
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377
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Pai A, Suris AM, North CS. Posttraumatic Stress Disorder in the DSM-5: Controversy, Change, and Conceptual Considerations. Behav Sci (Basel) 2017; 7:bs7010007. [PMID: 28208816 PMCID: PMC5371751 DOI: 10.3390/bs7010007] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 01/27/2017] [Accepted: 02/03/2017] [Indexed: 01/30/2023] Open
Abstract
The criteria for posttraumatic stress disorder PTSD have changed considerably with the newest edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Changes to the diagnostic criteria from the DSM-IV to DSM-5 include: the relocation of PTSD from the anxiety disorders category to a new diagnostic category named “Trauma and Stressor-related Disorders”, the elimination of the subjective component to the definition of trauma, the explication and tightening of the definitions of trauma and exposure to it, the increase and rearrangement of the symptoms criteria, and changes in additional criteria and specifiers. This article will explore the nosology of the current diagnosis of PTSD by reviewing the changes made to the diagnostic criteria for PTSD in the DSM-5 and discuss how these changes influence the conceptualization of PTSD.
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Affiliation(s)
- Anushka Pai
- VA North Texas Health Care System, 4500 S. Lancaster Road, 116A, Dallas, TX 75216, USA.
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8828, USA.
| | - Alina M Suris
- VA North Texas Health Care System, 4500 S. Lancaster Road, 116A, Dallas, TX 75216, USA.
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8828, USA.
| | - Carol S North
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8828, USA.
- Metrocare Services, Dallas, TX 75247-4914, USA.
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378
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He Y, Jin X, Wang J, Meng M, Hou Z, Tian W, Li Y, Wang W, Wei Y, Wang Y, Meng H, Lu X, Chen Z, Fu L. Umbilical cord-derived mesenchymal stem cell transplantation for treating elderly vascular dementia. Cell Tissue Bank 2017; 18:53-59. [DOI: 10.1007/s10561-017-9609-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/13/2017] [Indexed: 02/06/2023]
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379
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Franklin CL, Walton JL, Cuccurullo LA, Raines A, Ball J, Vaught A, Chambliss JL, Maieritsch KP. Examining potential overlap of DSM-5 PTSD criteria D and E. Psychiatry Res 2016; 246:250-254. [PMID: 27723523 DOI: 10.1016/j.psychres.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/28/2016] [Accepted: 10/02/2016] [Indexed: 11/27/2022]
Abstract
The Diagnostic and Statistical Manual, Fifth Edition-5 (DSM-5) has adopted a four-factor symptom model for Posttraumatic Stress Disorder (PTSD) that includes new symptom additions in criterion D (D2, D3, D4), negative alterations in cognition and mood. This article examines potential overlapping endorsement of these symptoms amongst one another and with the behavioral symptoms within PTSD criterion E (E1 and E3; alterations in arousal and reactivity), through the lenses of cognitive-behavioral theory. Responses of veteran participants (N=320) completing the PTSD Checklist-5 were used to determine overlap in symptom reporting. We conducted a series of direct logistic regressions to determine the predictive ability of meeting the criterion D or E symptoms based on endorsement of the target D symptoms (D2, D3, D4). Results suggest that the new cognitive and emotional symptoms of criterion D have significant overlapping content, and that thought-related symptoms are often endorsed in conjunction with their behavioral counterpoint (D2/E3; D4/E1). Our results suggest that DSM-5 criterion D symptoms may not be central to the diagnostic structure of PTSD. These symptoms add complexity and difficulty to diagnosing PTSD without adding much unique content.
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Affiliation(s)
- C Laurel Franklin
- Southeast Louisiana Veterans Health Care System, 3500 Canal Street, New Orleans, LA 70119, USA; Tulane University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1430 Tulane Avenue, New Orleans, LA 70112, USA; South Central VA MIRECC, 3500 Canal Street, New Orleans, LA 70119, USA.
| | - Jessica L Walton
- Southeast Louisiana Veterans Health Care System, 3500 Canal Street, New Orleans, LA 70119, USA; South Central VA MIRECC, 3500 Canal Street, New Orleans, LA 70119, USA
| | - Lisa-Ann Cuccurullo
- Southeast Louisiana Veterans Health Care System, 3500 Canal Street, New Orleans, LA 70119, USA; South Central VA MIRECC, 3500 Canal Street, New Orleans, LA 70119, USA
| | - Amanda Raines
- Southeast Louisiana Veterans Health Care System, 3500 Canal Street, New Orleans, LA 70119, USA; South Central VA MIRECC, 3500 Canal Street, New Orleans, LA 70119, USA
| | - Jaqueline Ball
- Southeast Louisiana Veterans Health Care System, 3500 Canal Street, New Orleans, LA 70119, USA
| | - Amanda Vaught
- Southeast Louisiana Veterans Health Care System, 3500 Canal Street, New Orleans, LA 70119, USA
| | - Jessica L Chambliss
- Southeast Louisiana Veterans Health Care System, 3500 Canal Street, New Orleans, LA 70119, USA
| | - Kelly P Maieritsch
- Edward Hines Jr. VA Hospital, 5000 S. Fifth Street, Hines, IL 60141, USA
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380
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Anticevic A, Schleifer C, Youngsun TC. Emotional and cognitive dysregulation in schizophrenia and depression: understanding common and distinct behavioral and neural mechanisms. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26869843 PMCID: PMC4734880 DOI: 10.31887/dcns.2015.17.4/aanticevic] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Emerging behavioral and neuroimaging studies in schizophrenia (SCZ) and major depressive disorder (MD) are mapping mechanisms of co-occurring and distinct affective disturbances across these disorders. This constitutes a critical goal towards developing rationally guided therapies for upstream neural pathways that contribute to comorbid symptoms across disorders. We highlight the current state of the art in our understanding of emotional dysregulation in SCZ versus MD by focusing on broad domains of behavioral function that can map onto underlying neural systems, namely deficits in hedonics, anticipatory behaviors, computations underlying value and effort, and effortful goal-directed behaviors needed to pursue rewarding outcomes. We highlight unique disturbances in each disorder that may involve dissociable neural systems, but also possible interactions between affect and cognition in MD versus SCZ. Finally, we review computational and translational approaches that offer mechanistic insight into how cellular-level disruptions can lead to complex affective disturbances, informing development of therapies across MD and SCZ.
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Affiliation(s)
- Alan Anticevic
- Department of Psychiatry, Yale University School of Medicine; Interdepartmental Neuroscience Program, Yale University; NIAAA Center for the Translational Neuroscience of Alcoholism; Department of Psychology, Yale University; Division of Neurocognition, Neurogenetics & Neurocomputation, Yale University School of Medicine (Alan Anticevic) - New Haven, Connecticut, USA
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381
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McLennan JD. Understanding attention deficit hyperactivity disorder as a continuum. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:979-982. [PMID: 27965331 PMCID: PMC5154646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To review research findings that consider whether attention deficit hyperactivity disorder (ADHD) is a discrete entity or whether it is more consistent with an extreme end-of-trait distribution in the population and to then grapple with the potential clinical implications. QUALITY OF EVIDENCE Peer-reviewed publications in the past 5 years, drawing from diverse fields (taxonomy, epidemiology, genetics, neurobiology, and neuropsychology), were identified through searches in MEDLINE and PsycINFO. MAIN MESSAGE Accumulating research findings are most consistent with a predominately dimensional rather than a qualitatively distinct existence for ADHD. This does not negate the clinical needs of those who have substantial ADHD symptom clusters, nor the risks that such symptoms entail. However, the lack of discontinuity in the distribution of such traits in the population creates great uncertainty as to what thresholds should prompt explicit intervention. CONCLUSION The implications of this pattern of findings might include the need to de-emphasize categorical conceptualizations of ADHD, produce evidence to better inform risk-benefit ratios of interventions along a spectrum of symptom and functional severity, and more coherently triage and arrange service delivery on the basis of symptom and functional severity rather than artificial diagnostic categorizations.
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Affiliation(s)
- John D McLennan
- Child psychiatrist at the Children's Hospital of Eastern Ontario in Ottawa, a scientist at the Children's Hospital of Eastern Ontario Research Institute, Research Chair in Child & Adolescent Psychiatry at the University of Ottawa, and Adjunct Associate Professor at the University of Calgary in Alberta.
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382
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Grewal R, Haghighi M, Huang S, Smith AG, Cao C, Lin X, Lee DC, Teten N, Hill AM, Selenica MLB. Identifying biomarkers of dementia prevalent among amnestic mild cognitively impaired ethnic female patients. ALZHEIMERS RESEARCH & THERAPY 2016; 8:43. [PMID: 27756387 PMCID: PMC5067885 DOI: 10.1186/s13195-016-0211-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/13/2016] [Indexed: 12/22/2022]
Abstract
Background There is a need to investigate biomarkers that are indicative of the progression of dementia in ethnic patient populations. The disparity of information in these populations has been the focus of many clinical and academic centers, including ours, to contribute to a higher success rate in clinical trials. In this study, we have investigated plasma biomarkers in amnestic mild cognitively impaired (aMCI) female patient cohorts in the context of ethnicity and cognitive status. Method A panel of 12 biomarkers involved in the progression of brain pathology, inflammation, and cardiovascular disorders were investigated in female cohorts of African American, Hispanic, and White aMCI patients. Both biochemical and algorithmic analyses were applied to correlate biomarker levels measured during the early stages of the disease for each ethnicity. Results We report elevated plasma Aβ40, Aβ42, YKL-40, and cystatin C levels in the Hispanic cohort at early aMCI status. In addition, elevated plasma Aβ40 levels were associated with the aMCI status in both White and African American patient cohorts by the decision tree algorithm. Eotaxin-1 levels, as determined by the decision tree algorithm and biochemically measured total tau levels, were associated with the aMCI status in the African American cohort. Conclusions Overall, our data displayed novel differences in the plasma biomarkers of the aMCI female cohorts where the plasma levels of several biomarkers distinguished between each ethnicity at an early aMCI stage. Identification of these plasma biomarkers encourages new areas of investigation among aMCI ethnic populations, including larger patient cohorts and longitudinal study designs. Electronic supplementary material The online version of this article (doi:10.1186/s13195-016-0211-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rinko Grewal
- Byrd Alzheimer's Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL, 33613, USA.,Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Mona Haghighi
- Department of Industrial and Systems Engineering, University of Washington, 3900 Northeast Stevens Way, Seattle, WA, 98195, USA
| | - Shuai Huang
- Department of Industrial and Systems Engineering, University of Washington, 3900 Northeast Stevens Way, Seattle, WA, 98195, USA.,School of Aging Studies, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA
| | - Amanda G Smith
- Byrd Alzheimer's Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL, 33613, USA.,Department of Psychiatry and Behavioral Medicine, College of Medicine, University of South Florida, 3515 E Fletcher Ave, Tampa, FL, 33613, USA
| | - Chuanhai Cao
- Byrd Alzheimer's Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL, 33613, USA.,Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Xiaoyang Lin
- Byrd Alzheimer's Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL, 33613, USA.,Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Daniel C Lee
- Byrd Alzheimer's Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL, 33613, USA.,Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Nancy Teten
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Angela M Hill
- Byrd Alzheimer's Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL, 33613, USA.,Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Maj-Linda B Selenica
- Byrd Alzheimer's Institute, University of South Florida, 4001 E. Fletcher Ave, Tampa, FL, 33613, USA. .,Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA.
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383
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Porcu M, Balestrieri A, Siotto P, Lucatelli P, Anzidei M, Suri JS, Zaccagna F, Argiolas GM, Saba L. Clinical neuroimaging markers of response to treatment in mood disorders. Neurosci Lett 2016; 669:43-54. [PMID: 27737806 DOI: 10.1016/j.neulet.2016.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 09/01/2016] [Accepted: 10/06/2016] [Indexed: 12/22/2022]
Abstract
Mood disorders (MD) are important and frequent psychiatric illness. The management of patients affected by these conditions represents an important factor of disability as well as a significant social and economic burden. The "in-vivo" studies can help researchers to understand the first developmental events of the pathology and to identify the molecular and non-molecular targets of therapies. However, they have strong limitations due to the fact that human brain circuitry can not be reproduced in animal models. In addition, these neural pathways are difficult to be selectively studied with the modern imaging (such as Magnetic Resonance and Positron Emitted Tomography/Computed Tomography) and non-imaging (such as electroencephalography, magnetoencephalography, transcranial magnetic stimulation and evoked potentials) methods. In comparison with other methods, the "in-vivo" imaging investigations have higher temporal and spatial resolution compared to the "in-vivo" non-imaging techniques. All these factors make difficult to fully understand the aetiology and pathophysiology of these disorders, and consequently hinder the analysis of the effects of pharmacological and non-pharmacological therapies, which have been demonstrated effective in clinical settings. In this review, we will focus our attention on the current state of the art of imaging in the assessment of treatment efficacy in MD. We will analyse briefly the actual classification of MD; then we will focus on the "in vivo" imaging methods used in research and clinical activity, the current knowledge about the neural models at the base of MD. Finally the last part of the review will focus on the analysis of the main markers of response to treatment.
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Affiliation(s)
- Michele Porcu
- Department of Radiology, AOU of Cagliari, SS 554 Monserrato, CA, Italy
| | | | - Paolo Siotto
- Department of Radiology, AOB Azienda Ospedaliera Brotzu, CA, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Michele Anzidei
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Jasjit S Suri
- Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA; Electrical Engineering Department, Idaho State University (Aff.), Pocatello, ID, USA
| | - Fulvio Zaccagna
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | | | - Luca Saba
- Department of Radiology, AOU of Cagliari, SS 554 Monserrato, CA, Italy.
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384
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Okuda M, Liu W, Cisewski JA, Segura L, Storr CL, Martins SS. Gambling Disorder and Minority Populations: Prevalence and Risk Factors. CURRENT ADDICTION REPORTS 2016; 3:280-292. [PMID: 28824833 PMCID: PMC5560497 DOI: 10.1007/s40429-016-0108-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Previous studies demonstrate disparities in health and health services including gambling disorders (GD) among ethnic and racial minority groups. In this review, we summarize studies examining the prevalence of GD across different ethnic and racial minorities. RECENT FINDINGS We describe the sociodemographic subgroup variations at heightened risk for GD and factors associated with GD in racial and ethnic minority groups including gambling availability, comorbid substance use, psychiatric conditions, stress, acculturation, and differences in cultural values and cognitions. We found that research of GD among minority groups is scant, and the prevalence of GD among these groups is at a magnitude of concern. SUMMARY Racial and ethnic minority status in it of itself is not a risk factor for GD but may be a proxy for underlying potential risk factors. The need for prevention and treatment programs for different cultural group remains unmet.
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Affiliation(s)
- Mayumi Okuda
- Department of Psychiatry, Columbia University, 710 West 168th Street, 12 Floor, New York, NY 10032, USA
| | - Weiwei Liu
- NORC at the University of Chicago, 4350 East-west Highway, Bethesda, MD 20814, USA
| | - Jodi A Cisewski
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Luis Segura
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Carla L Storr
- Center for Health Outcomes Research, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
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385
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Docherty M, Boxer P, Huesmann LR, O'Brien M, Bushman BJ. Exploring Primary and Secondary Variants of Psychopathy in Adolescents in Detention and in the Community. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2016; 45:564-578. [PMID: 25602443 PMCID: PMC7219566 DOI: 10.1080/15374416.2014.979934] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The current study aims to ascertain how different variants of callous-unemotional traits differ in their psychopathology, exposure to aggression and violence, and aggressive and violent behavior. If secondary/distressed variants (high in callous-unemotional traits and high in anxiety) and primary/traditional variants (high in callous-unemotional traits and low in anxiety) differ along these dimensions, it may speak to their different etiologies, treatment needs (e.g., trauma focused), and responsiveness to treatment. The current sample consisted of 799 adolescents from high schools (n = 419) and juvenile detention centers (n = 380). Participants were interviewed regarding their callous-unemotional traits, psychopathology, exposure to aggression and violence, and aggressive and violent behavior. Parents/guardians and teachers/staff members also reported on participants' callous-unemotional traits and aggressive and violent behavior. A model-based cluster analysis indicated that there were four clusters in the data set, based on callous-unemotional traits and anxiety: a nonvariant cluster, a primary/traditional callous-unemotional cluster, a secondary/distressed callous-unemotional cluster, and a "fearful" cluster. Secondary/distressed variants of psychopathy exhibited significantly greater symptoms of depression and psychoticism, more exposure to low level aggression and neighborhood violence, and more aggressive and violent behavior, as compared to the other clusters. Adolescents with callous-unemotional traits might not be a homogeneous group, but rather may differ in attitudes, behaviors, and exposure to risk, therefore differing in their treatment needs and responsiveness.
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Affiliation(s)
| | - Paul Boxer
- b Department of Psychology and School of Criminal Justice , Rutgers University
- c Research Center for Group Dynamics, Institute for Social Research , The University of Michigan
| | - L Rowell Huesmann
- c Research Center for Group Dynamics, Institute for Social Research , The University of Michigan
- d Departments of Psychology and Communication Studies , The University of Michigan
| | - Maureen O'Brien
- e Institute for Social Research , The University of Michigan
| | - Brad J Bushman
- f School of Communication and Department of Psychology , The Ohio State University
- g Department of Communication Science , VU University Amsterdam
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386
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Forbush KT, Siew CSQ, Vitevitch MS. Application of network analysis to identify interactive systems of eating disorder psychopathology. Psychol Med 2016; 46:2667-2677. [PMID: 27387196 DOI: 10.1017/s003329171600012x] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Traditional approaches for the classification of eating disorders (EDs) attribute symptoms to an underlying, latent disease entity. The network approach is an alternative model in which mental disorders are represented as networks of interacting, self-reinforcing symptoms. This project was the first to use network analysis to identify interconnected systems of ED symptoms. METHOD Adult participants (n = 143; 77.6% women) with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ED were recruited from the community to take part in a larger ongoing longitudinal study. The Structured Clinical Interview for DSM Disorders (SCID-I) was used to establish diagnoses. An undirected network of ED symptoms was created using items from the Eating Pathology Symptoms Inventory (EPSI) and the R package qgraph. RESULTS Body checking emerged as the strongest and most important single symptom in the entire network by having the shortest average distance to other symptoms in the network, and by being the most frequent symptom on the path between any two other symptoms. Feeling the need to exercise every day and two symptoms assessing dietary restraint/restricting emerged as 'key players', such that their removal from the network resulted in maximal fracturing of the network into smaller components. CONCLUSIONS Although cognitive-behavioral therapy for EDs focuses on reducing body checking to promote recovery, our data indicate that amplified efforts to address body checking may produce stronger (and more enduring) effects. Finally, results of the 'key players analysis' suggested that targeting interventions at these key nodes might prevent or slow the cascade of symptoms through the 'network' of ED psychopathology.
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Affiliation(s)
- K T Forbush
- Department of Psychology,University of Kansas,Lawrence,KS 66045,USA
| | - C S Q Siew
- Department of Psychology,University of Kansas,Lawrence,KS 66045,USA
| | - M S Vitevitch
- Department of Psychology,University of Kansas,Lawrence,KS 66045,USA
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387
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Sheen YJ, Sheu WHH. Association between hypoglycemia and dementia in patients with type 2 diabetes. Diabetes Res Clin Pract 2016; 116:279-87. [PMID: 27321346 DOI: 10.1016/j.diabres.2016.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 03/17/2016] [Accepted: 04/14/2016] [Indexed: 12/27/2022]
Abstract
In addition to increased risks of macrovascular and microvascular complications, patients with type 2 diabetes mellitus (T2DM) usually also are at increased risk for cognitive impairment and dementia. Hypoglycemia, a common consequence of diabetes treatment, is considered an independent risk factor for dementia in patients with T2DM. Hypoglycemia and dementia are clinically underestimated and are related to poor outcomes; thus, they may compromise the life expectancy of patients with T2DM. Epidemiological evidence of hypoglycemia-associated cognitive decline and dementia is highly varied. Acute, severe hypoglycemic episodes induce chronic subclinical brain damage, cognitive decline, and subsequent dementia. However, the effects of recurrent moderate hypoglycemia on cognitive decline and dementia remain largely uninvestigated. Poor glycemic control (including fluctuation of hemoglobin A1C [HbA1c] and glucose values) and the viscous circle of bidirectional associations between dementia and hypoglycemia may be clinically relevant. The possible pathophysiological hypotheses include post-hypoglycemic neuronal damage, inflammatory processes, coagulation defects, endothelial abnormalities, and synaptic dysfunction of hippocampal neurons during hypoglycemia episodes. This article reviews previous findings, provides insight into the detection of groups at high risk of hypoglycemia-associated dementia, and proposes specific strategies to minimize the potential burdens associated with hypoglycemia-related neurocognitive disorders in patients with T2DM.
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Affiliation(s)
- Yi-Jing Sheen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, No. 199 Section 1, Sanmin Road, Taichung 403, Taiwan
| | - Wayne H H Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung 407, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Medical Technology, National Chung-Hsing University, Taichung, Taiwan.
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388
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Fiorillo A, Sampogna G, Del Vecchio V, Luciano M, Ambrosini A, Stanghellini G. Education in Psychopathology in Europe: Results from a Survey in 32 Countries. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:242-248. [PMID: 25895631 DOI: 10.1007/s40596-015-0333-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 03/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of the present paper is to assess the current status of training on psychopathology in Europe and to identify the unmet needs of training on psychopathology. METHODS An online survey was carried out during the period July-December 2013. Forty-one representatives of early career psychiatrists of their national associations were invited to participate. Each respondent was asked to provide the collective feedback of the association rather than that of any of its individual officer or member. RESULTS Thirty-two associations returned the questionnaire out of the 41 contacted (response rate, 78%). All respondents recognized psychopathology as a core component of training in psychiatry. According to respondents, the primary aims of psychopathology are (a) to assess psychiatric symptoms (47%), (b) to understand patients' abnormal experiences (33%), and (c) to make nosographical diagnosis (20%). A formal training course in psychopathology is available in 29 out of the 32 surveyed countries. In most countries, (a) there is not a defined number of hours dedicated to psychopathology, (b) teaching is mainly theoretical, and (c) a structured training on psychometric tools is missing. At the end of the training, about half of trainees is not satisfied with received training in psychopathology. CONCLUSIONS According to European early career psychiatrists, there is the need to rethink training in psychopathology, which should be at the heart of training in psychiatry and the key element of psychiatric practice. Education in psychopathology is affected by several unmet needs, such as lack of appropriate training in the use of psychometric instruments, lack of supervision, and lack of practical skills.
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389
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Carriero C, Dellino M, Campanelli FD, Licchelli M, Loverro G. Psychosexual Assessment of Transgender Individuals during the Sex Reassignment Process: Sexual Desire, Activity, and Satisfaction. Health (London) 2016. [DOI: 10.4236/health.2016.811111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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390
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The motor way: Clinical implications of understanding and shaping actions with the motor system in autism and drug addiction. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2015; 16:191-206. [DOI: 10.3758/s13415-015-0399-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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391
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Mun HS, Lipina TV, Roder JC. Ultrasonic Vocalizations in Mice During Exploratory Behavior are Context-Dependent. Front Behav Neurosci 2015; 9:316. [PMID: 26696847 PMCID: PMC4674556 DOI: 10.3389/fnbeh.2015.00316] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/08/2015] [Indexed: 11/13/2022] Open
Abstract
While rat ultrasonic vocalizations (USVs) are known to vary with anticipation of an aversive vs. positive stimulus, little is known about USVs in adult mice in relation to behaviors. We recorded the calls of adult C57BL/6J male mice under different environmental conditions by exposing mice to both novel and familiar environments that varied in stress intensity through the addition of bright light or shallow water. In general, mouse USVs were significantly more frequent and of longer duration in novel environments. Particularly, mice in dimly-lit novel environments performed more USVs while exhibiting unsupported rearing and walking behavior, and these calls were mostly at high frequency. In contrast, mice exhibited more low frequency USVs when engaging in supported rearing behavior in novel environments. These findings are consistent with data from rats suggesting that low-frequency calls are made under aversive conditions and high-frequency calls occur in non-stressful conditions. Our findings increase understanding of acoustic signals associated with exploratory behaviors relevant to cognitive and motivational aspects of behavior.
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Affiliation(s)
- Ho-Suk Mun
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital Toronto, ON, Canada ; Department of Molecular Genetics, University of Toronto Toronto, ON, Canada
| | - Tatiana V Lipina
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital Toronto, ON, Canada ; Federal State Budgetary Scientific Institution, Scientific Research Institute of Physiology and Basic Medicine Novosibirsk, Russia
| | - John C Roder
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital Toronto, ON, Canada ; Department of Molecular Genetics, University of Toronto Toronto, ON, Canada ; Institute of Medical Science, University of Toronto Toronto, ON, Canada ; Department of Physiology, University of Toronto Toronto, ON, Canada
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392
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Bhad R, Lal R, Balhara YPS. Disorders Related to Use of Psychoactive Substances in DSM-5: Changes and Challenges. Indian J Psychol Med 2015; 37:470-2. [PMID: 26702188 PMCID: PMC4676222 DOI: 10.4103/0253-7176.168613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In the most recent edition of Diagnostic and Statistical Manual (DSM) that is DSM-5 many modifications have been made in substance use disorder section. These include changes in terminology; sections and categories; diagnostic criteria; threshold for diagnosis; severity; and specifier. Additionally, there have been certain additions and omissions from the earlier version. Critical evaluation of the changes made to the section on disorders related to use of psychoactive substances in India context has not been published so far. The current paper presents a critique of the changes made to the substance use disorder section in DSM-5. The rationale for these changes put forth by DSM-5 work group on substance related disorders have been discussed. Additionally, attempt has been made to highlight the possible future challenges consequent to the current nosological revision for substance use disorder category. Overall DSM-5 seems to be promising in fulfilling its goal of DSM-ICD harmonisation and movement towards an internationally compatible and practical diagnostic system for mental health disorders. It has increased the scope of addiction by inclusion of behavioural addiction. It has also tried to balance the categorical and dimensional approach to diagnosis. However, the real test of this newer edition of one of the most commonly used nosological systems will be during clinical care and research. This will help address the debatable issues regarding the changes that DSM-5 brings with it.
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Affiliation(s)
- Roshan Bhad
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lal
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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393
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Strong T. Diagnoses, Relational Processes and Resourceful Dialogs: Tensions for Families and Family Therapy. FAMILY PROCESS 2015; 54:518-532. [PMID: 25683581 DOI: 10.1111/famp.12140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), given its psychiatric focus on mental disorders in individuals, presents families and family therapists with challenges. Despite considerable controversies over its adoption, the DSM-5 extends a process of standardizing a language for human and relational concerns. No longer a diagnostic language of professionals alone, its use is medicalizing how mental health funders and administrators, as well as clients, respond to human concerns. For family therapists who practice systemically, particularly from poststructuralist and strengths-based orientations, many tensions can follow when use of the DSM-5 is expected by mental health administrators and funders, or by clients who present concerns about themselves or a diagnosed family member. In this paper, I explore how such DSM-5 related tensions might be recognized, navigated, and negotiated in the practice of family therapy with clients, and with administrators and funders.
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Affiliation(s)
- Tom Strong
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
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394
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Evaluation of the DSM-5 severity indicator for binge eating disorder in a clinical sample. Behav Res Ther 2015; 71:110-4. [PMID: 26114779 DOI: 10.1016/j.brat.2015.05.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study tested the new DSM-5 severity criterion for binge eating disorder (BED) based on frequency of binge-eating in a clinical sample. This study also tested overvaluation of shape/weight as an alternative severity specifier. METHOD Participants were 834 treatment-seeking adults diagnosed with DSM-5 BED using semi-structured diagnostic and eating-disorder interviews. Participants sub-grouped based on DSM-5 severity levels and on overvaluation of shape/weight were compared on demographic and clinical variables. RESULTS Based on DSM-5 severity definitions, 331 (39.7%) participants were categorized as mild, 395 (47.5%) as moderate, 83 (10.0%) as severe, and 25 (3.0%) as extreme. Analyses comparing three (mild, moderate, and severe/extreme) severity groups revealed no significant differences in demographic variables or body mass index (BMI). Analyses revealed significantly higher eating-disorder psychopathology in the severe/extreme than moderate and mild groups and higher depression in moderate and severe/extreme groups than the mild group; effect sizes were small. Participants characterized with overvaluation (N = 449; 54%) versus without overvaluation (N = 384; 46%) did not differ significantly in age, sex, BMI, or binge-eating frequency, but had significantly greater eating-disorder psychopathology and depression. The robustly greater eating-disorder psychopathology and depression levels (medium-to-large effect sizes) in the overvaluation group was observed without attenuation of effect sizes after adjusting for ethnicity/race and binge-eating severity/frequency. CONCLUSIONS Our findings provide support for overvaluation of shape/weight as a severity specifier for BED as it provides stronger information about the severity of homogeneous groupings of patients than the DSM-5 rating based on binge-eating.
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395
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Abstract
Apresentamos o quadro clínico nomeado Psicopatia autística infantil por Hans Asperger no contexto de sua descoberta, e na atualidade. Relacionamos essa síndrome com o Autismo infantil precoce de Leo Kanner, caracterizado na mesma época. Discutimos a ignorância do trabalho de Asperger pelos pesquisadores até a década de 1980.
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396
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Legleye S, Guignard R, Richard JB, Ludwig K, Pabst A, Beck F. Properties of the Cannabis Abuse Screening Test (CAST) in the general population. Int J Methods Psychiatr Res 2015; 24:170-83. [PMID: 26077195 PMCID: PMC6878564 DOI: 10.1002/mpr.1465] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/01/2014] [Accepted: 01/06/2015] [Indexed: 11/05/2022] Open
Abstract
This paper explores the DSM-IV latent structure of cannabis users (especially its invariance towards gender and age) and assesses the psychometric properties of the Cannabis Abuse Screening Test (CAST) by confrontation with the theoretical diagnoses [dependence and cannabis use disorders (CUD)] and the latent class structure of the DSM-IV. The random sample comprised 550 French cannabis smokers aged 15-62 years interviewed by telephone. DSM-IV diagnoses were assessed with the Munich Composite International Diagnostic Interview. Internal structures of both instruments were assessed using factor analysis and latent class analysis. Optimal CAST cutoffs were determined by sensitivity, specificity and area under the receiver operating curve (AUC). CAST and DSM-IV were unidimensional (Cronbach's α = 0.742 and 0.752, respectively), although a two-factor solution showed a better fit for the CAST. CAST cutoffs for screening CUD and dependence were three (AUC = 0.851) and five (AUC = 0.868), respectively. DSM-IV latent class structure varied only marginally in age and gender. Three classes of cannabis smokers were determined, ordered along a continuum of symptoms: non-symptomatic (61.1%), moderate (32.9%) and severe (6.0%). CAST cutoff scores for screening moderate/severe and severe were, respectively, three (AUC = 0.869) and eight (AUC = 0.952). Results are compared to those obtained in previous CAST studies and discussed in line with the DSM-5.
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Affiliation(s)
- Stéphane Legleye
- National Institute for Demographic Studies (INED), Paris, France.,Inserm, U669, University Paris-Sud and University Paris Descartes, Paris, France.,University Paris XI, Paris, France
| | - Romain Guignard
- French Institute for Health Promotion and Health Education (INPES), Saint-Denis, France
| | - Jean-Baptiste Richard
- French Institute for Health Promotion and Health Education (INPES), Saint-Denis, France
| | - Kraus Ludwig
- Institut für Therapieforschung (IFT), Munich, Germany.,Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden
| | | | - François Beck
- French Institute for Health Promotion and Health Education (INPES), Saint-Denis, France.,Cermes3 - Equipe Cesames, Centre de Recherche Médecine, Sciences, Santé, Santé Mentale, Société, René Descartes Paris V University, Paris, France
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397
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Loke YJ, Hannan AJ, Craig JM. The Role of Epigenetic Change in Autism Spectrum Disorders. Front Neurol 2015; 6:107. [PMID: 26074864 PMCID: PMC4443738 DOI: 10.3389/fneur.2015.00107] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/28/2015] [Indexed: 12/14/2022] Open
Abstract
Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental disorders characterized by problems with social communication, social interaction, and repetitive or restricted behaviors. ASD are comorbid with other disorders including attention deficit hyperactivity disorder, epilepsy, Rett syndrome, and Fragile X syndrome. Neither the genetic nor the environmental components have been characterized well enough to aid diagnosis or treatment of non-syndromic ASD. However, genome-wide association studies have amassed evidence suggesting involvement of hundreds of genes and a variety of associated genetic pathways. Recently, investigators have turned to epigenetics, a prime mediator of environmental effects on genomes and phenotype, to characterize changes in ASD that constitute a molecular level on top of DNA sequence. Though in their infancy, such studies have the potential to increase our understanding of the etiology of ASD and may assist in the development of biomarkers for its prediction, diagnosis, prognosis, and eventually in its prevention and intervention. This review focuses on the first few epigenome-wide association studies of ASD and discusses future directions.
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Affiliation(s)
- Yuk Jing Loke
- Murdoch Childrens Research Institute, Royal Children's Hospital and Department of Paediatrics, University of Melbourne , Parkville, VIC , Australia
| | - Anthony John Hannan
- Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health, The University of Melbourne , Parkville, VIC , Australia
| | - Jeffrey Mark Craig
- Murdoch Childrens Research Institute, Royal Children's Hospital and Department of Paediatrics, University of Melbourne , Parkville, VIC , Australia
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398
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Angermeyer MC, Millier A, Rémuzat C, Refaï T, Schomerus G, Toumi M. Continuum beliefs and attitudes towards people with mental illness: Results from a national survey in France. Int J Soc Psychiatry 2015; 61:297-303. [PMID: 25061023 DOI: 10.1177/0020764014543312] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Whether mental disorders should be considered as categorical or dimensional has found increasing attention among mental health professionals. Only little is known about what the public thinks about this issue. AIMS First, to assess how prevalent the belief in a continuum of symptoms from mental health to mental illness is among the general public. Second, to examine how continuum beliefs are associated with attitudes towards people with mental disorder. METHODS In 2012, an on-line survey was conducted in France (N = 1,600). After the presentation of a case-vignette depicting a person with either schizophrenia or depression, belief in a continuum of symptoms, emotional reactions and desire for social distance related to the person in the vignette were assessed. RESULTS While 58.2% of respondents agreed in a symptom continuum for depression, this percentage was only 28.5% for schizophrenia. In both disorders, continuum beliefs were associated with more pro-social reactions and less desire for social distance. Only in schizophrenia, there was an inverse relationship with the expression of anger. CONCLUSIONS There is increasing evidence of an association between continuum beliefs and positive attitudes towards people with mental illness. Information on the continuous nature of psychopathological phenomena may usefully be included in anti-stigma messages.
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Affiliation(s)
- Matthias C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | | | | | - Georg Schomerus
- Department of Psychiatry, University of Greifswald, Greifswald, Germany HELIOS Hanseklinikum Stralsund, Stralsund, Germany
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399
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Millan MJ, Goodwin GM, Meyer-Lindenberg A, Ove Ögren S. Learning from the past and looking to the future: Emerging perspectives for improving the treatment of psychiatric disorders. Eur Neuropsychopharmacol 2015; 25:599-656. [PMID: 25836356 DOI: 10.1016/j.euroneuro.2015.01.016] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/28/2015] [Indexed: 02/06/2023]
Abstract
Modern neuropsychopharmacology commenced in the 1950s with the serendipitous discovery of first-generation antipsychotics and antidepressants which were therapeutically effective yet had marked adverse effects. Today, a broader palette of safer and better-tolerated agents is available for helping people that suffer from schizophrenia, depression and other psychiatric disorders, while complementary approaches like psychotherapy also have important roles to play in their treatment, both alone and in association with medication. Nonetheless, despite considerable efforts, current management is still only partially effective, and highly-prevalent psychiatric disorders of the brain continue to represent a huge personal and socio-economic burden. The lack of success in discovering more effective pharmacotherapy has contributed, together with many other factors, to a relative disengagement by pharmaceutical firms from neuropsychiatry. Nonetheless, interest remains high, and partnerships are proliferating with academic centres which are increasingly integrating drug discovery and translational research into their traditional activities. This is, then, a time of transition and an opportune moment to thoroughly survey the field. Accordingly, the present paper, first, chronicles the discovery and development of psychotropic agents, focusing in particular on their mechanisms of action and therapeutic utility, and how problems faced were eventually overcome. Second, it discusses the lessons learned from past successes and failures, and how they are being applied to promote future progress. Third, it comprehensively surveys emerging strategies that are (1), improving our understanding of the diagnosis and classification of psychiatric disorders; (2), deepening knowledge of their underlying risk factors and pathophysiological substrates; (3), refining cellular and animal models for discovery and validation of novel therapeutic agents; (4), improving the design and outcome of clinical trials; (5), moving towards reliable biomarkers of patient subpopulations and medication efficacy and (6), promoting collaborative approaches to innovation by uniting key partners from the regulators, industry and academia to patients. Notwithstanding the challenges ahead, the many changes and ideas articulated herein provide new hope and something of a framework for progress towards the improved prevention and relief of psychiatric and other CNS disorders, an urgent mission for our Century.
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Affiliation(s)
- Mark J Millan
- Pole for Innovation in Neurosciences, IDR Servier, 125 chemin de ronde, 78290 Croissy sur Seine, France.
| | - Guy M Goodwin
- University Department of Psychiatry, Oxford University, Warneford Hospital, Oxford OX3 7JX, England, UK
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, D-68159 Mannheim, Germany
| | - Sven Ove Ögren
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, S-17177 Stockholm, Sweden
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400
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Oathes DJ, Hilt LM, Nitschke JB. Affective neural responses modulated by serotonin transporter genotype in clinical anxiety and depression. PLoS One 2015; 10:e0115820. [PMID: 25675343 PMCID: PMC4344476 DOI: 10.1371/journal.pone.0115820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 12/02/2014] [Indexed: 12/16/2022] Open
Abstract
Serotonin transporter gene variants are known to interact with stressful life experiences to increase chances of developing affective symptoms, and these same variants have been shown to influence amygdala reactivity to affective stimuli in non-psychiatric populations. The impact of these gene variants on affective neurocircuitry in anxiety and mood disorders has been studied less extensively. Utilizing a triallelic assay (5-HTTLPR and rs25531) to assess genetic variation linked with altered serotonin signaling, this fMRI study investigated genetic influences on amygdala and anterior insula activity in 50 generalized anxiety disorder patients, 26 of whom also met DSM-IV criteria for social anxiety disorder and/or major depressive disorder, and 39 healthy comparison subjects. A Group x Genotype interaction was observed for both the amygdala and anterior insula in a paradigm designed to elicit responses in these brain areas during the anticipation of and response to aversive pictures. Patients who are S/L(G) carriers showed less activity than their L(A)/L(A) counterparts in both regions and less activity than S/L(G) healthy comparison subjects in the amygdala. Moreover, patients with greater insula responses reported higher levels of intolerance of uncertainty, an association that was particularly pronounced for patients with two LA alleles. A genotype effect was not established in healthy controls. These findings link the serotonin transporter gene to affective circuitry findings in anxiety and depression psychopathology and further suggest that its impact on patients may be different from effects typically observed in healthy populations.
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Affiliation(s)
- Desmond J. Oathes
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | - Lori M. Hilt
- Department of Psychology, Lawrence University, Appleton, WI, United States of America
| | - Jack B. Nitschke
- Departments of Psychiatry and Psychology, University of Wisconsin-Madison, Madison, WI, United States of America
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