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Bottemanne H, Arnould A, Najar A, Delaigue F, Serresse L, Joly L, Mouchabac S. [Combination of ketamine and esketamine with Exposure and Response Prevention (ERP) therapy for Obsessive-Compulsive Disorder]. L'ENCEPHALE 2023; 49:304-311. [PMID: 37095049 DOI: 10.1016/j.encep.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 04/26/2023]
Abstract
Obsessive-Compulsive Disorder (OCD), characterized by the combination of obsession and compulsion, is a clinical and therapeutic challenge. Many patients with OCD do not respond to first-line treatments such as serotonin selective reuptake inhibitors (SSRIs) and exposure and response prevention psychotherapy (ERP). For these resistant patients, some preliminary studies have shown that ketamine, a non-selective glutamatergic NMDA receptors antagonist, could improve the obsessive symptoms. A number of these studies have also suggested that the combination of ketamine with ERP psychotherapy may jointly potentiate the effectiveness of ketamine and ERP. In this paper, we present the existing data on the combined use of ketamine with ERP psychotherapy for OCD. We suggest that modulation of NMDA receptor activity and glutamatergic signaling by ketamine may promote the therapeutic mechanisms involved in ERP such as fear extinction and brain plasticity mechanisms. Finally, we propose a ketamine-augmented ERP psychotherapy (KAP-ERP) protocol in OCD, and we present the limitations associated with its application in clinical practice.
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Affiliation(s)
- Hugo Bottemanne
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/Inserm, Paris, France; Sorbonne University, Department of Philosophy, SND Research Unit, UMR 8011, CNRS, Paris, France; Department of Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Alice Arnould
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Amaury Najar
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fanny Delaigue
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Laure Serresse
- Sorbonne University, Unité Mobile d'Accompagnement et de Soins Palliatifs, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Lucie Joly
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/Inserm, Paris, France; Department of Psychiatry, Saint Antoine Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphane Mouchabac
- Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/Inserm, Paris, France; Department of Psychiatry, Saint Antoine Hospital, Sorbonne University, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Choi KY. Valproate Adjuvant Cognitive Behavioral Therapy in Panic Disorder Patients With Comorbid Bipolar Disorder: Case Series and Review of the Literature. Psychiatry Investig 2022; 19:614-625. [PMID: 36059050 PMCID: PMC9441465 DOI: 10.30773/pi.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/28/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022] Open
Abstract
Anxiety disorders are the most common comorbid psychiatric disorders in patients with bipolar disorder. Managing anxiety symptoms in comorbid conditions is challenging and has received little research interest. The findings from preclinical research on fear conditioning, an animal model of anxiety disorder, have suggested that memory reconsolidation updating (exposure-based therapy) combined with valproate might facilitate the amelioration of fear memories. Here, three cases of successful amelioration of agoraphobia and panic symptoms through valproate adjuvant therapy for cognitive behavioral therapy in patients who failed to respond to two to three consecutive standard pharmacotherapy trials over several years are described. To the best of the author's knowledge, this is the first attempt to combine CBT with valproate in patients with panic disorder, agoraphobia, and comorbid bipolar disorder. Additionally, the background preclinical research on this combination therapy based on the reconsolidation-updating mechanism, the inhibition of histone deacetylase 2, and critical period reopening, off-label use of valproate in panic disorder, plasticity-augmented psychotherapy, and how to combine valproate with CBT is discussed.
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Affiliation(s)
- Kwang-Yeon Choi
- Department of Psychiatry, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Republic of Korea
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Park SC, Kim YK. A Novel Bio-Psychosocial-Behavioral Treatment Model of Panic Disorder. Psychiatry Investig 2019; 16:4-15. [PMID: 30301303 PMCID: PMC6354044 DOI: 10.30773/pi.2018.08.21.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022] Open
Abstract
To conceptualize a novel bio-psychosocial-behavioral treatment model of panic disorder (PD), it is necessary to completely integrate behavioral, psychophysiological, neurobiological, and genetic data. Molecular genetic research on PD is specifically focused on neurotransmitters, including serotonin, neuropeptides, glucocorticoids, and neurotrophins. Although pharmacological interventions for PD are currently available, the need for more effective, faster-acting, and more tolerable pharmacological interventions is unmet. Thus, glutamatergic receptor modulators, orexin receptor antagonists, corticotrophin-releasing factor 1 receptor antagonists, and other novel mechanism-based anti-panic therapeutics have been proposed. Research on the neural correlates of PD is focused on the dysfunctional "cross-talk" between emotional drive (limbic structure) and cognitive inhibition (prefrontal cortex) and the fear circuit, which includes the amygdala-hippocampus-prefrontal axis. The neural perspective regarding PD supports the idea that cognitive-behavioral therapy normalizes alterations in top-down cognitive processing, including increased threat expectancy and attention to threat. Consistent with the concept of "personalized medicine," it is speculated that Research Domain Criteria can enlighten further treatments targeting dysfunctions underlying PD more precisely and provide us with better definitions of moderators used to identify subgroups according to different responses to treatment. Structuring of the "negative valence systems" domain, which includes fear/anxiety, is required to define PD. Therefore, targeting glutamate- and orexin-related molecular mechanisms associated with the fear circuit, which includes the amygdala-hippocampus-prefrontal cortex axis, is required to define a novel bio-psychosocial-behavioral treatment model of PD.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital, Busan, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Ansan Hospital, Ansan, Republic of Korea
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An Integrated Bio-psycho-social Approach to Psychiatric Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:331-340. [PMID: 31705503 DOI: 10.1007/978-981-32-9721-0_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The biopsychosocial approach is a model of eclecticism, which consists of multidisciplinary academic fields, reacting against the "neuroscientification" of psychiatry. The biopsychosocial approach was proposed by George Engel following Adolf Meyer's psychobiological and Roy R. Ginker's eclectic approach to psychiatry. Although the use of the biopsychosocial approach is increasing, it has several limitations: First, specific practices cannot be guided by the biopsychosocial approach because it is considered to be "boundless psychiatry." Second, unlike an initial intention, the symptomatic use of psychotropic medications may be justified by the biopsychosocial approach. Third, the economic forces to enhance biological psychiatry cannot be hindered by the biopsychosocial approach. Hence, to overcome the limitations of the current biopsychosocial approach, potential new paradigms including evolutionary psychiatry, pragmatism, integrationism, and pluralism have been proposed. Above all, Eric Kandel presented the link between neuroscience and psychiatry from the perspective of integrationism. In accordance with integrationism and/or pluralism, based on the paradigm shift of the theoretical construct from chemical imbalance to dysfunctional circuit, next-generation treatments for mental disorders have been proposed by Thomas Insel. Thus, a more integrated biopsychosocial approach to managing psychiatric disorders including schizophrenia and panic disorder may be proposed.
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Howe EG. New Ways to Cut through Ethical Gordian Knots. THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017284257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kim YK. Can we cope with treatment refractoriness in psychiatric disorders? Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:101-2. [PMID: 27345157 DOI: 10.1016/j.pnpbp.2016.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Republic of Korea.
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