Gardner, David M
There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses. Therefore, the development of competencies in psychotropic prescribing needs to be approached as a long-term, practice-based learning commitment. Proposed are the abilities and knowledge components necessary for safe and effective use of psychotropics. Typical challenges in prescribing for chronic and recurrent illnesses include highly variable responses and tolerability, drug interactions, and adverse effects that can be serious, irreversible, and even fatal. Prescribing psychotropics is further complicated by negative public and professional reports and growing patient concerns about the quality of care, and questions about the efficacy, safety, and addictive risks of psychotropics. Increased efforts are needed to enhance clinical training and knowledge in psychopharmacology among trainees and practising clinicians, with more comprehensive and sustained attention to the assessment of individual patients, and greater reliance on patient education and collaboration. Improved competence in psychotropic prescribing should lead to more informed, thoughtful, and better-targeted applications as one component of more comprehensive clinical care.
Zisook, Sidney; Balon, Richard; Benjamin, Sheldon; Beresin, Eugene; Goldberg, David A.; Jibson, Michael D.; Thrall, Grace
Objective: As part of an effort to improve psychopharmacology training in psychiatric residency programs, a committee of residency training directors and associate directors adapted an introductory schizophrenia presentation from the American Society of Clinical Psychopharmacology's Model Psychopharmacology Curriculum to develop a multimodal,…
Ponterotto, Joseph G.
Presents basic information on psychopharmacology and discusses the major antipsychotic, antidepressant, anti-anxiety, and lithium salt medications used with adults. The importance and implications of psychopharmacology for the counseling profession are highlighted. (Author)
Georgiopoulos, Anna M.; Huffman, Jeff C.
Objective: To describe our experience of learning clinical psychopharmacology during residency, in order to assist educators planning psychopharmacology curricula. Methods: We describe how psychopharmacology teaching was structured in our program, dividing our experience into two phases, early residency (PGY-I and PGY-II) and late residency…
The renewal of the philosophical debate in psychiatry is one exciting news of recent years. However, its use in psychopharmacology may be problematic, ranging from self-confinement into the realm of values (which leaves the evidence-based domain unchallenged) to complete rejection of scientific evidence. In this paper philosophy is conceived as a conceptual audit of clinical psychopharmacology. Its function is to criticise the epistemological and methodological problems of current neopositivist, ingenuously realist and evidence-servant psychiatry from within the scientific stance and with the aim of aiding psychopharmacologists in practicing a more self-aware, critical and possibly useful clinical practice. Three examples are discussed to suggest that psychopharmacological practice needs conceptual clarification. At the diagnostic level it is shown that the crisis of the current diagnostic system and the problem of comorbidity strongly influence psychopharmacological results, new conceptualizations more respondent to the psychopharmacological requirements being needed. Heterogeneity of research samples, lack of specificity of psychotropic drugs, difficult generalizability of results, need of a phenomenological study of drug-induced psychopathological changes are discussed herein. At the methodological level the merits and limits of evidence-based practice are considered, arguing that clinicians should know the best available evidence but that guidelines should not be constrictive (due to several methodological biases and rhetorical tricks of which the clinician should be aware, sometimes respondent to extra-scientific, economical requests). At the epistemological level it is shown that the clinical stance is shaped by implicit philosophical beliefs about the mind/body problem (reductionism, dualism, interactionism, pragmatism), and that philosophy can aid physicians to be more aware of their beliefs in order to choose the most useful view and to practice coherently
The marketing of selective serotonin reuptake inhibitors in the psychopharmacological industry presents a serious moral problem for the corporate model of medicine. In this paper I examine ethical issues relating to the efficacy and safety of these drugs. Pharmaceutical companies have a moral obligation to disclose all information in their possession bearing on the true risks and benefits of their drugs. Only then can patients make fully informed decisions about their treatment.
Dubovsky, Steven L.
Objective: To review the current status of psychopharmacology education for medical students, residents, and practitioners in psychiatry and other specialties. Methods: A search of the MEDLINE and PsychInfo data bases was conducted using four keywords: pharmacology, psychopharmacology, teaching, and student. Additional references were obtained…
Research in psychopharmacology began around 1950 with the description of antipsychotic effect of chlorpromazine followed shortly later with the mechanism of action of antidepressants. In these initial phases, pharmacy industry was open to knowledge and made efforts tending to the development to new drugs that showed efficacy and good safety profiles. In parallel development of theories attempting to find the etiology of psychiatric disorders acquired impulse. This review summarizes the new drugs for the treatment of psychiatric disorders currently under development and also presents a short list of the main biomarkers proposed for the diagnosis or the comprehension of the etiopathogeny in Psychiatry. Several questions arose when brain structures, biochemical pathways, proteins and genes began to be identified in the search for a better comprehension of etiopathogeny of mental disorders. Pharmaceutical industry virtually moved away from this field of research. Epistemological and methodological obstacles in psychopharmacological investigation together with the lack of priority given by industry to this field allow us to predict few advances for the treatment in Psychiatry in the short term.
Dilallo, John J.; Weiss, Gony
The use of motivational interviewing strategies in the practice of adolescent psychopharmacology is described. Motivational interviewing is an efficient and collaborative style of clinical interaction and this helps adolescent patients to integrate their psychiatric difficulties into a more resilient identity.
Thekdi, Seema M; Trinidad, Antolin; Roth, Andrew
Depression, anxiety, delirium, and other psychiatric symptoms are highly prevalent in the cancer setting, and pharmacological intervention is an important component in the overall psychosocial care of the patient. Psychopharmacology is also used as a primary or adjuvant treatment for the management of cancer-related symptoms stemming from the disease itself and/or its treatment, including sleep disturbance, loss of appetite, neuropathic pain, nausea, fatigue, and hot flashes. Psychiatrists, oncologists, and palliative care physicians working as members of a multidisciplinary team have the opportunity to target multiple symptoms that negatively affect a patient's quality of life with the strategic use of psychotropic medications when deemed appropriate. This article aims to review the indications for use of antidepressants, psychostimulants, anxiolytics, antipsychotics, and mood stabilizers in oncology. An updated review of the relevant literature is discussed and referenced in each section.
Tsai, L Y
Autism is a neurobiological disorder. The core clinical features of autism include impairment in social interaction, impairments in verbal and nonverbal communication, and restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. Autism often has coexisting neuropsychiatric disorders, including seizure disorders, attention deficit hyperactivity disorder, affective disorders, anxiety disorder, obsessive-compulsive disorder, and Tourette disorder. No etiology-based treatment modality has been developed to cure individuals with autism. However, comprehensive intervention, including parental counseling, behavior modification, special education in a highly structured environment, sensory integration training, speech therapy, social skill training, and medication, has demonstrated significant treatment effects in many individuals with autism. Findings from preliminary studies of major neurotransmitters and other neurochemical agents strongly suggest that neurochemical factors play a major role in autism. The findings also provide the rationale for psychopharmacotherapy in individuals with autism. This article reviews studies of neurochemical systems and related psychopharmacological research in autism and related neuropsychiatric disorders. Clinical indications for pharmacotherapy are described, and uses of various medications are suggested. This article also discusses new avenues of investigation that may lead to the development of more effective medication treatments in persons with autism.
Wall, Christopher A; Croarkin, Paul E; Swintak, Cosima; Koplin, Brett A
This article provides an overview of where psychiatric pharmacogenomic testing stands as an emerging clinical tool in modern psychotropic prescribing practice, specifically in the pediatric population. This practical discussion is organized around the state of psychiatric pharmacogenomics research when choosing psychopharmacologic interventions in the most commonly encountered mental illnesses in youth. As with the rest of the topics on psychopharmacology for children and adolescents in this publication, a clinical vignette is presented, this one highlighting a clinical case of a 16 year old genotyped during hospitalization for recalcitrant depression.
Zisook, Sidney; Benjamin, Sheldon; Balon, Richard; Glick, Ira; Louie, Alan; Moutier, Christine; Moyer, Trenton; Santos, Cynthia; Servis, Mark
Objective: This article reviews methods used to teach psychopharmacology to psychiatry residents that utilize principles of adult learning, enlist active participation of residents, and provide faculty with skills to seek, analyze, and use new information over the course of their careers. Methods: The pros and cons of five "nonlecture" methods of…
Schmied, Lori A; Steinberg, Hannah; Sykes, Elizabeth A B
The role of experimental psychology in the development of psychopharmacology has largely been ignored in recent historical accounts. In this article the authors attempt to redress that gap by outlining work in early experimental psychology that contributed significantly to the field. While psychiatrists focused on the therapeutic nature of drugs or their mimicry of psychopathology, experimental psychologists used psychoactive drugs as tools to study individual differences in normal behavior as well as to develop methodologies using behavior to study mechanisms of drug action. Experimental work by Kraepelin, Rivers, and Hollingworth was particularly important in establishing drug-screening protocols still used today. Research on nitrous oxide and on the effects of drug combinations is discussed to illustrate the importance of experimental psychology to psychopharmacology.
Kaplan, Gabriel; McCracken, James T
At present, no evidence-based effective pharmacologic options are available for treating the core deficits of autism spectrum disorders (ASDs), which are best addressed by behavioral and educational interventions. However, such evidence exists for several of the frequently associated/comorbid symptoms such as aggression and severe irritability, hyperactivity, and repetitive behaviors, which can become a major source of additional distress and interference in functioning. This article offers information on the psychopharmacology of ASD that is current, relevant, and organized in a user-friendly manner, to form a concise but informative reference guide for primary pediatric clinicians.
Stein, Dan J
Darwin's seminal publications in the nineteenth century laid the foundation for an evolutionary approach to psychology and psychiatry. Advances in 20th century evolutionary theory facilitated the development of evolutionary psychology and psychiatry as recognized areas of scientific investigation. In this century, advances in understanding the molecular basis of evolution, of the mind, and of psychopathology, offer the possibility of an integrated approach to understanding the proximal (psychobiological) and distal (evolutionary) mechanisms of interest to psychiatry and psychopharmacology. There is, for example, growing interest in the question of whether specific genetic variants mediate psychobiological processes that have evolutionary value in specific contexts, and of the implications of this for understanding the vulnerability to psychopathology and for considering the advantages and limitations of pharmacotherapy. The evolutionary value, and gene-environmental mediation, of early life programming is potentially a particularly rich area of investigation. Although evolutionary approaches to psychology and to medicine face important conceptual and methodological challenges, current work is increasingly sophisticated, and may prove to be an important foundational discipline for clinicians and researchers in psychiatry and psychopharmacology.
Biondi, Massimo; Pasquini, Massimo
Despite the recent DSM-5 review of somatoform disorders, which are now called somatic symptom and related disorders, the categorical definitions of these syndromes have inherent limitations because their causal mechanism or presumed aetiologies are still unknown. These limitations may affect everyday clinical practice and decision-making abilities. As a result, physicians have limited information at their disposal to treat these patients. Furthermore, the clinical presentations of somatic disorders may vary a lot. The purpose of this chapter is to illustrate a psychopathological dimensional approach to the somatising patient. This approach is constantly unconsciously applied in clinical practice using continuous variables, such as rating scales. Moreover, treatment strategies might be improved by adding a dimensional approach, simply recognising the prominent components of the presenting psychopathology of a given patient and addressing them with drugs according to their different mechanisms, targeting circuits and neurotransmitters. Some authors have proposed a shift from the nosological to functional application of psychotropic drugs, in which functional psychopharmacology will be dysfunction oriented and therefore inevitably geared towards utilising drug combinations. Here, we present a summary of the advantages of functional/dimensional psychopharmacology for the treatment of somatic symptoms and related disorders.
Ripoll, Luis H
The best available evidence for psychopharmacologic treatment of borderline personality disorder (BPD) is outlined here. BPD is defined by disturbances in identity and interpersonal functioning, and patients report potential medication treatment targets such as impulsivity, aggression, transient psychotic and dissociative symptoms, and refractory affective instability Few randomized controlled trials of psychopharmacological treatments for BPD have been published recently, although multiple reviews have converged on the effectiveness of specific anticonvulsants, atypical antipsychotic agents, and omega-3 fatty acid supplementation. Stronger evidence exists for medication providing significant improvements in impulsive aggression than in affective or other interpersonal symptoms. Future research strategies will focus on the potential role of neuropeptide agents and medications with greater specificity for 2A serotonin receptors, as well as optimizing concomitant implementation of evidence-based psychotherapy and psychopharmacology, in order to improve BPD patients' overall functioning.
Salzman, Carl; Glick, Ira D
This commentary focuses on psychopharmacology teachers and their teaching. The authors offer broadly based pedagogic suggestions on how to deliver evidence-based and neurobiologically informed prescribing information to clinicians at all levels of experience. They argue that teaching essential psychopharmacology knowledge and practice must be up-to-date, accurate, and consistent with the reality of an individual patient's life experience and beliefs. They stress that educators must teach that nonpsychopharmacological factors in a patient's life may be as relevant to the treatment setting as the actual pharmacological basis of psychotropic drug therapeutics.
Glick, Ira D; Balon, Richard J; Ballon, Jacob; Rovine, Deborah
Rapid advances in neuroscience and clinical research have made the practice of quality clinical psychopharmacology increasingly difficult. While practice guidelines, model psychopharmacology curricula, and clinical algorithms have helped "the science" of psychopharmacology, they often fail to provide guidance for clinicians in specific clinical situations with individual patients. Quality psychopharmacology practice is based on a combination of knowledge, experience, judgment, and luck. In this article, the authors present their collection of psychopharmacology "pearls" for trainees as well as experienced clinicians. (Journal of Psychiatric Practice 2009;15:423-426).
McClain, William A.; Jerman, George
Reviewed on a layman's level was research on psychopharmacology with the emotionally and behaviorally disturbed. General conclusions drawn from the man y studies were that the effect of drugs on intellectual functioning had not been determined and that there was little evidence to indicate that the learning process was consistently and reliably…
McDougall, William Donald
An approach to the use of computer assisted instruction (CAI) for teaching psychopharmacology is presented. A project is described in which, using the TUTOR programing language on the PLATO IV computer system, several computer programs were developed to demonstrate the concepts of aminergic transmitters in the central nervous system. Response…
Meyers, Barnett S; Jeste, Dilip V
The development of geriatric psychopharmacology was built on advances in geriatric psychiatry nosology and clinical pharmacology and on increased investment in aging research by the National Institute of Mental Health and by academic institutions. Application of the US Food and Drug Administration's geriatric labeling rule provided further impetus. Developments in the knowledge about 3 principal classes of medications (antidepressants, antipsychotics, and treatments for Alzheimer's disease) illustrate the trajectory of geriatric psychopharmacology research. Nonetheless, the loss of information about age effects that has resulted from applying age exclusion criteria in studies limited to either younger adults or geriatric patients is regrettable. Antidepressant trials have moved from studying younger and medically well "geriatric" samples to focusing on "older old" persons and those with significant medical comorbidity including coronary artery disease, cerebrovascular disease, and dementia. Increased specificity is reflected in studies of relationships between specific neuropsychological deficits, specific brain abnormalities, and antidepressant responsiveness. Clinical trials in older adults have demonstrated that the efficacy of antipsychotic medications continues across the lifespan, but that sensitivity to specific side effects changes in older age, with poor tolerability frequently mitigating the benefits of treatment. Treatments for Alzheimer's disease have fallen within the purview of geriatric psychopharmacology. The research focus is increasingly shifting from treatments to slow the course of cognitive decline to studies of early diagnosis and of interventions designed to prevent the development of deficits in vulnerable individuals. The importance of geriatric psychopharmacology will grow further as the average lifespan increases all over the world.
The editors of Pharmacopsychiatry have decided in 2016 to prepare special issues regularly in order provide our readers volumes of the journal with a thematic focus 1. The first such special issue is dedicated to the field of child and adolescent psychopharmacology. Many young patients are treated with psychotherapeutic, but also pharmacotherapeutic, methods worldwide. Most of our psychopharmacological agents are not approved by the federal institutions for persons under 18 years old. However, severe mental illnesses like schizophrenia, depression, anxiety, ADHD, and bipolar disorder frequently require pharmacological treatments in children and adolescents. We also see a wide range of rather unspecific emotional and behavioral disturbances up to excitation crises or suicidal acts in this young population, so that we see the necessity for standardized and valid psychopharmacological treatment regimens based on meta-analyses, randomized controlled trials, and guidelines 2. Child and adolescent psychiatry is unfortunately far away from this; industry-supported research is rare in this area, but also not all child and adolescent psychiatrists see the importance of psychopharmacological treatment and trust specific psychotherapy, psychoeducation, and educational strategies. These are all extremely important treatments, but one can/should think that psychopharmacotherapy is an important addition and often a cornerstone for the other treatments.
Belmaker, Rh; Bersudsky, Yuly; Agam, Galila
Individual differences in response to pharmacologic treatment limits the usefulness of mean data obtained from randomized controlled trials. These individual differences exist even in genetically uniform inbred mouse strains. While stratification can be of value in large studies, the individual patient history is the most effective currently available guide for personalized medicine in psychopharmacology.
Mohr, Pavel; Hoschl, Cyril; Volavka, Jan
Objective: Psychiatrists and other physicians sometimes read publications superficially, relying excessively on abstracts. The authors addressed this problem by teaching critical appraisal of individual articles. Method: The authors developed a 23-item appraisal instrument to assess articles in the area of psychopharmacology. The results were…
triazolam, flurazepam, and nitrazepam . Psychopharmacology, 1980, 68: 61-65. 12. Pegram, V., Hyde, P., and Linton, P. Chronic use of triazolam: the...Hindmarch, I. and Clyde, C. A. The effects of triazolam and nitrazepam on sleep quality, morning vigilance, and psychomotor performance. Arzneim
Abena, A A; Ngondzo-Kombeti, G R; Bioka, D
Lippia multiflora (L.m.) is a verbenacea used in Congo as conventional tea decoction. No traditional indication is known in this country. Nevertheless, in Ghana the plant is used for the treatment of arterial hypertension. The aim of this study is to investigate the psychotropic activity of the aqueous extract of L.m. using the classical tests of experimental psychopharmacology. The extract of L.m. is constituted by lyophilisated powder obtained from an infusion of dried leaves. Different doses are prepared: 200, 400, 600, 800, 1,000 and 1,200 mg/kg dissolved in 1 ml of NaCl 0.9%. L.m. is administered by intraperitoneal or oral route. The wistar rats of both sexes, weighing between 150-200 g, are used. Animal's behaviour is observed macroscopically. The spontaneous motor activity is appreciated by using the number of squares crossed by animal with the four paws in ten minutes (Martin and al. method slightly modified). The rectal temperature is measured. The effect of L.m. on stereotypies induced by apomorphin and anesthesia induced by phenobarbital are studied. The traction test is used to investigate the muscle relaxant effect of L.m. and analgesic activity is evaluated by using acetic acid and hot plate methods by comparison with diazepam 2 and 4 mg/kg. Fischer-t test is used for the statistical analysis of results. L.m. is well tolerated by rats. No mortality is observed with the doses used. So the doses of 200, 400 and 600 mg/kg were selected for experiments. At theses doses L.m. caused: a precocious ataxia, a sedation, a ptosis and a yellow coloration of urines, these effects are dose dependent; a significant reduction of spontaneous motor activity: control 61.60 +/- 6.48, L.m. 200: 16.40 +/- 5.68 (P < 0.01), L.m. 400: 12.20 +/- 2.01 and L.m. 600: 9.60 +/- 1.90 (P < 0.01); no modification of rectal temperature and apomorphin stereotypies; a reduction of sleep latence: control 22.40 +/- 1.89 min, L.m. 200: 17.20 +/- 2.74 min (P < 0.01), L.m. 400: 13.80 +/- 1
Echarte Alonso, Luis E
In this paper, I analyze risks and limits of the current psychopharmacology and how both are promoting a new social interpretation of health concept. Besides, I show how such interpretation can be detected in four issues related to safety, equality, psychiatrization of human condition, and autonomy. In the conclusions, I defend, first, the obligation of physician to inform patients about the important long-term uncertainties around psychopharmacology. Second, I justify the necessity of promote more prolonged monitoring of patients treated with such kind of drugs. Third, I insist in the relevance of increasing research about drugs ' adverse effects extended over a long time. And forth, I bring up the utility of health concept to avoid the subjective stigmatization of cognitive or affective traits, to prevent potential problems of inequality and coercion, and to keep from mental disorders caused by attempts of getting psychical states supposedly optimized.
Objective: To consider the limited usefulness of expert guidelines for teaching psychopharmacology. Method: Potential problems using expert guidelines for teaching psychopharmacology are reviewed. Results: Expert guidelines are an important contribution to the growth of evidence-based psychiatry. As such, they may also be used to teach…
Carlson, Cindy; Kubiszyn, Tom
Focuses on psychopharmacology and prescription privileges for psychologists. Summarizes nine major findings from Task Force on Psychopharmacology in the Schools, created to review literature on prescription privileges for psychologists; identify specific issues attendant to use of psychoactive medications with children; and clarify implications…
Mintz, David L.
Objective: The author examines one aspect of the psychopharmacology curriculum: the psychology of psychopharmacology. Method: Drawing from his experience teaching this subject to trainees at many different levels and from an emerging evidence base suggesting that psychosocial factors in the doctor-patient relationship may be crucial for medication…
Phillips, Elaine L.; Greydanus, Donald E.; Pratt, Helen D.; Patel, Dilip R.
Reviews the current literature on psychological and psychopharmacologic treatments for bulimia nervosa in the adolescent population. Describes the two most researched psychological treatments--cognitive behavior therapy and interpersonal therapy--in terms of treatment protocols and outcome research. Reviews psychopharmacologic treatment, including…
Farmer, Rosemary L.; Bentley, Kia J.; Walsh, Joseph
The authors reviewed current literature and curriculum resources on psychopharmacology and social work. They argue that baccalaureate and master of social work courses need to routinely include more in-depth knowledge on psychopharmacology and provide a more critical social work-focused approach to this content due to the increasing complexity of…
Prisinzano, Thomas E
At present, the Mexican mint Salvia divinorum is an unregulated hallucinogen. This has resulted in various on-line botanical companies advertising and selling S. divinorum as a legal alternative to other regulated plant hallucinogens. It is predictable that its misuse will increase rapidly. The active ingredient in S. divinorum is the neoclerodane diterpene, salvinorin A (1a), which has been shown to be a kappa agonist both in vitro and in vivo. This review will cover the current state of research into the psychopharmacology of S. divinorum.
Rey, Joseph M.; Walter, Garry; Soh, Nerissa
Children and adolescents often use complementary and alternative medicine (CAM) treatments outside their indications, particularly to lose weight. Some of the herbal remedies and dietary supplements that may of relevance for psychopharmacological practice are discussed with respect to CAM treatments.
Julien, Robert M
Knowledge of psychopharmacology is essential for a clinical psychologist to practice his/her profession, regardless of whether one desires to become licensed to prescribe psychoactive medications. This commentary reiterates a call made almost 20 years ago for all practitioners to gain and utilize this knowledge. Without psychopharmacology knowledge, one is extremely limited in the ability to interact with medical prescribers and to optimally serve their patients as a valued member of the health care team.
Cerullo, Michael A
Advances in neuroscience and biotechnology have heightened the urgency of the debate over "cosmetic psychopharmacology," the use of drugs to enhance mood and temperament in the absence of illness. Beyond Therapy: Biotechnology and the Pursuit of Happiness (2003), the report of the President's Council on Bioethics, has criticized the use of cosmetic psychopharmacology. The Council claimed that cosmetic psychopharmacology will necessarily lead to "severing the link between feelings of happiness and our actions and experiences in the world," but it provided no satisfactory arguments to support this claim and ignored the possibility that cosmetic psychopharmacology might actually enhance the link between happiness and experience. The Council's arguments against cosmetic psychopharmacology depend heavily on the mistaken belief that Prozac and similar antidepressants are mood brighteners in healthy subjects. The empirical evidence, however, clearly indicates that these drugs are not forms of cosmetic psychopharmacology, thus negating much of the Council's arguments. The use of pharmaceutical agents to enhance mood or personality in normal individuals should not be rejected a priori. Instead, the effects of each agent on the individual and on society must be weighed using sound ethical reasoning and the best evidence available.
Persico, Antonio M; Arango, Celso; Buitelaar, Jan K; Correll, Christoph U; Glennon, Jeffrey C; Hoekstra, Pieter J; Moreno, Carmen; Vitiello, Benedetto; Vorstman, Jacob; Zuddas, Alessandro
Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking contrast, pharmacological treatment options presently available in child and adolescent psychiatry are dramatically limited. The most important currently unmet needs in paediatric psychopharmacology are: the frequent off-label prescription of medications to children and adolescents based exclusively on data from randomized controlled studies involving adult patients; the frequent lack of age-specific dose, long-term efficacy and tolerability/safety data; the lack of effective medications for many paediatric psychiatric disorders, most critically autism spectrum disorder; the scarcity and limitations of randomized placebo-controlled trials in paediatric psychopharmacology; the unexplored potential for the prevention of psychiatric disorders with adolescent- and adult-onset; the current lack of biomarkers to predict treatment response and severe adverse effects; the need for better preclinical data to foster the successful development of novel drug therapies; and the effective dissemination of evidence-based treatments to the general public, to better inform patients and families of the benefits and risks of pharmacological interventions during development. Priorities and strategies are proposed to overcome some of these limitations, including the European Child and Adolescent Clinical Psychopharmacology Network, as an overarching Pan-European infrastructure aimed at reliably carrying out much needed psychopharmacological trials in children and adolescents, in order to fill the identified gaps and improve overall outcomes.
Strous, Rael D
Psychopharmacology is a powerful tool in psychiatry; however, it is one that demands responsibility in order to deal with the ethical complexities that accompany advances in the field. It is important that questions are asked and that ethical mindfulness and sensitivity are developed along with clinical skills. In order to cultivate and deepen ethical awareness and subsequently solve issues in optimal fashion, investment should be made in the development of an ethical decision-making process as well as in education in the ethics of psychopharmacology to trainees in the field at all stages of their educational development. A clear approach to identifying ethical problems, engaging various ethical concepts in considering solutions and then applying these principles in problem resolution is demanded. An openness in identifying and exploring issues has become crucial to the future development and maturation of psychopharmacologists, both research and clinical. Consideration must be given to the social implications of psychopharmacological practice, with the best interests of patients always paramount. From both a research and clinical perspective, psychopharmacology has to be practised with fairness, sensitivity and ethical relevance to all. While ethical issues related to psychopharmacological practice are varied and plentiful, this review focuses on advances in technology and biological sciences, personal integrity, special populations, and education and training.
Fornaro, Michele; Martino, Matteo
Background: Subjective tinnitus is a frequent, impairing condition, which may also cause neurotransmitter imbalance at the cochlea. Psychopharmacologic agents, although not being the first-line treatment for tinnitus, may modulate cochlear neurotransmission, thereby influencing the subjective tinnitus experience. Method: A comprehensive review of MEDLINE literature (from January 1990–January 2010) was performed searching for: “tinnitus”, major classes of psychopharmacological agents, and psychiatric disorders. The most relevant clinical evidence is reported briefly along with a concise description of the main neurotransmitters purported to be involved in tinnitus, in order to provide the reader with a rational evaluation of tinnitus therapy with psychopharmacological agents. Results: Although strong methodological issues limit the reliability of the current results, a broad number of psychopharmacological agents have already been considered for tinnitus, both as candidate triggers or potential therapies. Conclusions: Selected psychopharmacological drugs may play a role in the clinical management of this disorder. While the rational use of these agents for the treatment of tinnitus should not be overlooked, research should be undertaken on their neuromodulating actions at the cochlea. PMID:20628627
Chang, Trina; Fava, Maurizio
There are clear limitations to the currently approved pharmacotherapies of depression, including the fact that they are all essentially monoamine-based, have modest efficacy and a relatively slow onset of efficacy, and suffer from significant tolerability issues, particularly in the long term, including sexual dysfunction, weight gain, and cognitive impairments. This article reviews some of the most promising novel mechanisms that are not represented in compounds currently approved for depression in either the United States or Europe and that may represent the future of the psychopharmacologic treatment of depression, potentially addressing some of the efficacy and tolerability issues of antidepressants on the market. These potential antidepressant treatments include the multimodal serotonergic agents, the triple uptake inhibitors, the neurokinin-based novel therapies, the glutamatergic treatments, the nicotinic receptor-based treatments, the neurogenesis-based treatments, and antiglucocorticoid therapies. Some of these mechanisms appear to be more advanced in terms of drug development than others, but they all contribute to the global effort to develop more effective and better tolerated treatments for major depressive disorder.
McElroy, Susan L; Guerdjikova, Anna I; Mori, Nicole; Keck, Paul E
Psychopharmacologic treatment is playing a greater role in the management of patients with eating disorders. In this paper, we review randomized, placebo-controlled trials (RCTs) conducted in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other eating disorders over the past 3 years. Fluoxetine remains the only medication approved for an eating disorder, that being BN. RCTs of antipsychotics in AN have had mixed results; the only agent with some evidence of efficacy is olanzapine. One study suggests dronabinol may induce weight gain in AN. Preliminary studies suggest lack of efficacy of alprazolam, dehydroepiandrosterone, or physiologic estrogen replacement in AN; erythromycin in BN; and the opioid antagonist ALKS-33 in BED. In BED with obesity or overweight, bupropion may cause mild weight loss without seizures, and chromium may improve glucose regulation. Also in BED, three RCTs suggest the stimulant prodrug lisdexamfetamine may reduce binge eating episodes, and another RCT suggests intranasal naloxone may decrease time spent binge eating. There remains a disconnection between the size of eating disorders as a public health problem and the lack of pharmacotherapy research of these conditions.
DuPaul, George J.; Carlson, John S.
Psychopharmacological treatments have been used with increased frequency to treat a variety of internalizing and externalizing disorders in children. Given the potential impact that medication has on children's school performance, school psychologists should be involved in helping physicians and families make effective decisions by assisting with…
Scarlet, Janina; Ampolos, Lauren
This article reviews several approaches used to teach psychopharmacology for graduate clinical psychology students. In order to promote engagement and increase student interest, students were broken up into groups and were asked to demonstrate their understanding of the material through a variety of interactive games (i.e., game-based learning, or…
Matson, Johnny L.; Bamburg, Jay W.; Mayville, Erik A.; Pinkston, Jim; Bielecki, Joanne; Kuhn, David; Smalls, Yemonja; Logan, James R.
Review of the literature on psychopharmacology and mental retardation from 1990-1999 found most studies had major methodological flaws. Also, most drug administrations were not based in science, were not evaluated appropriately, and generally did not follow best practices for treatment of persons with mental retardation. A table lists the studies…
Ingersoll, R. Elliot
In the last decade, the use of medication to treat psychological disorders has greatly expanded. In order to work effectively in school and community settings, counselors will need a sophisticated knowledge of psychopharmacology. This article describes the curriculum, structure, resources, and teaching methods suggested for effective instruction…
Glick, Ira D.; Salzman, Carl; Cohen, Bruce M.; Klein, Donald F.; Moutier, Christine; Nasrallah, Henry A.; Ongur, Dost; Wang, Po; Zisook, Sidney
Objective: The authors summarize two special sessions focused on the teaching of psychopharmacology at the 2003 and 2004 annual meeting of the American College of Neuropsychopharmacology (ACNP). The focus was on whether "improving the teaching-learning process" in psychiatric residency programs could improve clinical practice. Method: Problems of…
Smith, Robert L.; Garcia, Elda E.
Certain mental disorders are caused by or accompanied by neurochemical abnormalities. The use of psychotropic medications has dramatically increased over the past two decades in all age groups, particularly with children. Therefore, psychopharmacology, the branch of pharmacology dealing with the psychological effects of drugs, needs to be…
Mohiuddin, Sarah; Ghaziuddin, Mohammad
While there is no cure for autism spectrum disorder, psychopharmacologic agents are often used with behavioral and educational approaches to treat its comorbid symptoms of hyperactivity, irritability, and aggression. Studies suggest that at least 50% of persons with autism spectrum disorder receive psychotropic medications during their life span.…
Del Mundo, Amor S.; Pumariega, Andres J.; Vance, Hubert R.
Discusses issues regarding the use of a pharmacological approach to the treatment of children with serious emotional and mental disorders that interfere with learning. Addresses the current state of psychopharmacological treatment for diagnostic entities and behavioral symptomatology. Discusses the roles of the child, family, and health and…
... HUMAN SERVICES Food and Drug Administration Psychopharmacologic Drugs Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and Drug Administration (FDA). The meeting will be...
... HUMAN SERVICES Food and Drug Administration Psychopharmacologic Drugs Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and Drug Administration (FDA). The meeting will be...
... HUMAN SERVICES Food and Drug Administration Psychopharmacologic Drugs Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and Drug Administration (FDA). The meeting will be...
Practical clinical trials (PCT) are randomized experiments under typical practice conditions with the aim of testing the “real life” benefits and risks of therapeutic interventions. Influential PCTs have been conducted in cardiology, oncology, and internal medicine. Psychotropic medications are widely and increasingly used in medical practice. This review examines recent progress in conducting PCTs in psychopharmacology. The January 2000 – October 2014 MEDLINE, Scopus, and ClinicalTrials.gov databases were searched for peer-reviewed publications of PCTs with at least 100 subjects per treatment arm. Most PCTs in psychiatry evaluated mental health services or psychosocial interventions rather than specific pharmacotherapies. Of 157 PCTs in psychiatry, 30 (19%) were in psychopharmacology, with a median of 2 publications per year and no increase over the period of observation. Sample size ranged from 200 to 18,154; only 11 studies randomized 500 patients or more. Psychopharmacology PCTs were equally likely to be funded by industry as by public agencies. There were 10 PCTs of antidepressants, for a total of 4,206 patients (in comparison with at least 46 PCT of antihypertensive medications, for a total of 208,014 patients). Some psychopharmacology PCTs used suicidal behavior, treatment discontinuation, or mortality as primary outcome, and produced effectiveness and safety data that have influenced both practice guidelines and regulatory decisions. PCTs can constitute an important source of information for clinicians, patients, regulators, and policy makers, but have been relatively underutilized in psychopharmacology. Electronic medical records and integrated practice research networks offer promising platforms for a more efficient conduct of PCTs. PMID:25679131
Practical clinical trials (PCTs) are randomized experiments under typical practice conditions with the aim of testing the "real-life" benefits and risks of therapeutic interventions. Influential PCTs have been conducted in cardiology, oncology, and internal medicine. Psychotropic medications are widely and increasingly used in medical practice. This review examines recent progress in conducting PCTs in psychopharmacology. The January 2000 to October 2014 MEDLINE, Scopus, and ClinicalTrials.gov databases were searched for peer-reviewed publications of PCTs with at least 100 subjects per treatment arm. Most PCTs in psychiatry evaluated mental health services or psychosocial interventions rather than specific pharmacotherapies. Of 157 PCTs in psychiatry, 30 (19%) were in psychopharmacology, with a median of 2 publications per year and no increase during the period of observation. Sample size ranged from 200 to 18,154; only 11 studies randomized 500 patients or more. Psychopharmacology PCTs were equally likely to be funded by industry as by public agencies. There were 10 PCTs of antidepressants, for a total of 4206 patients (in comparison with at least 46 PCTs of antihypertensive medications, for a total of 208,014 patients). Some psychopharmacology PCTs used suicidal behavior, treatment discontinuation, or mortality as primary outcome and produced effectiveness and safety data that have influenced both practice guidelines and regulatory decisions. Practical clinical trials can constitute an important source of information for clinicians, patients, regulators, and policy makers but have been relatively underused in psychopharmacology. Electronic medical records and integrated practice research networks offer promising platforms for a more efficient conduct of PCTs.
Somatic treatments other than psychotropic drugs are increasingly used in the patients with obsessive compulsive disorder (OCD), however there has been little systematic review of them. Therefore, the present review deals with a variety of somatic treatment methods excluding psychotropic drugs. A literature search was performed on the PubMed database from the beginning of 1980, to September 2012, for published English, Turkish and French-language articles of somatic treatment approaches (excluding psychopharmacological agents) in the treatment of OCD. The search was carried out by using some terms in detail. Afterwards, the obtained investigations on electroconvusive therapy (ECT), deep brain stimulation (DBS), neurosurgical methods and transcranial magnetic stimulation (TMS) were presented. Although psychopharmacological treatment and psychotherapeutic approaches are primary treatment modalities in the management of OCD, other somatic treatment options seem to be used as alternatives, especially for patients with treatmentresistant OCD.
Gutheil, Thomas G
Psychopharmacology has revolutionized psychiatric practice but raises a number of ethical issues. This review from an American perspective first describes ethics analyses and attempts to portray the ethical practitioner. Pressures that interfere with appropriate prescribing come from outside the prescriber and from within, including from insurers, other treatment staff and the prescriber's own will to act for the patient. Clinicians also face binds in which alternate choices seem to have merit and leave the prescriber feeling pulled in contradictory directions, frequently related to risk-benefit dilemmas. The ethics of psychopharmacology poses many questions that cannot yet be answered at the current state of the field. Pharmacology also seems to promote extremes of attitudes, such as "All such drugs are poisons" and the like. This review then provides some risk management principles, and concludes that such a review, though not comprehensive, may serve to open questions that are not always considered by clinicians.
Shorter, Edward; Segesser, Kathryn
This paper demonstrates that in the treatment of psychiatric disorders, there are striking similarities between the mechanisms of psychoactive agents used in Traditional Chinese Medicine (TCM) and those of western psychopharmacology. While western researchers search for new treatments and novel mechanisms of action, investigators in Asia are analyzing traditional remedies in order to understand the mechanisms responsible for their effectiveness. A review of contemporary pharmacologic studies of agents used in TCM for psychiatric indications reveals that virtually all of the active principles of drug action established in 20th century psychopharmacology were encountered empirically in Chinese herbal medicine over the past 2000 years. Building bridges between these two traditions may thus be of benefit to both cultures. In addition to providing western patients with a wider selection of treatment options, the effort may help Asian clinicians and researchers avoid some of the errors that have troubled their western counterparts.
Olivier, B; Chan, J S W; Pattij, T; de Jong, T R; Oosting, R S; Veening, J G; Waldinger, M D
Most of our current understanding of the neurobiology, neuroanatomy and psychopharmacology of sexual behavior and ejaculatory function has been derived from preclinical studies in the rat. When a large population of male rats is tested on sexual activity during a number of successive tests, over time individual rats display a very stable sexual behavior that is either slow, normal or fast as characterized by the number of ejaculations performed. These sexual endophenotypes are postulated as rat counterparts of premature (fast rats) or retarded ejaculation (slow rats). Psychopharmacology in these endophenotypes helps to delineate the underlying mechanisms and pathology. This is illustrated by the effects of serotonergic antidepressants and serotonergic compounds on sexual and ejaculatory behavior of rats. These preclinical studies and models contribute to a better understanding of the neurobiology of ejaculation and boost the development of novel drug targets to treat ejaculatory disorders such as premature and retarded ejaculation.
Fanton, John; Gleason, Mary Margaret
Rates of prescriptions for very young children have increased notably in the last 20 years. These changes have occurred in the context of increasing attention to early childhood mental health, availability of medications perceived to be safer than older medications, application of the medical model to the mental health care of young children, as well as other cultural shifts. Psychopharmacological treatment for any patient, but especially very young children, requires consideration of central nervous system (CNS) and metabolic development and issues of diagnostic validity and should be guided by an empirical literature. In young children, this literature is quite limited. In this article, the authors review developmental issues involved in psychopharmacological treatment and present existing literature and practical guidelines for common preschool diagnoses, recognizing that for some disorders, the extant literature does not support even consideration of medications.
Poling, Alan; Durgin, Amy; Bradley, Kelly P; Porter, Lindsay K; Van Wagner, Karen; Weeden, Marc; Panos, John J
This study determined the involvement of women as first authors and other authors for every article published in Experimental and Clinical Psychopharmacology, Pharmacology Biochemistry and Behavior, and Psychopharmacology in 1991, 1996, 2001, and 2006. Their involvement as editors also was determined. Women's participation as authors, but not as editors, slightly increased over time. In 2006, 43% of first authors, 38% of other authors, and 24% of editors were women. The gender of subjects was examined for the same years and journals, but could not be determined for 6% and 9% of articles employing nonhuman and human subjects, respectively. In 2006, when subjects' gender could be determined, 77% of articles involving nonhuman subjects used only males, 9% only females, and 14% both males and females. In articles using human subjects in that same year, 17% involved only males, 6% only females, and 77% both males and females. Women researchers clearly make substantial contributions to the psychopharmacology literature, but are nonetheless underrepresented as editors. Findings regarding subjects indicate that there is growing recognition of the importance of gender as a determinant of drug effects, although the vast majority of nonhuman studies continue to involve only male subjects.
Shahidullah, Jeffrey D.; Carlson, John S.
A randomly selected group of Nationally Certified School Psychologists (NCSPs; n = 817) were mailed the 42-item "School Psychopharmacology Roles and Training Evaluation" (SPRTE) which inquired about their caseloads, practice roles as proposed by DuPaul and Carlson ([DuPaul, G. J., 2005]), and prior training in psychopharmacology. A…
Carlson, John S.; Demaray, Michelle Kilpatrick; Hunter-Oehmke, Shana
A national sample of 320 school-based, practicing members of the National Association of School Psychologists provided information on (a) their caseloads receiving medications, (b) types of school psychopharmacology training opportunities available and perceptions of their current training in child psychopharmacology, and (c) information about…
Juul, Dorthea; Winstead, Daniel K.; Sheiber, Stephen C.
OBJECTIVE: To report the assessment of psychopharmacology on the certification and recertification exams in general psychiatry and in the subspecialties administered by the American Board of Psychiatry and Neurology (ABPN). METHODS: The ABPN's core competencies for psychiatrists were reviewed. The number of items addressing psychopharmacology or…
Hermanns, Melinda; Lilly, Mary LuAnne; Wilson, Kathy; Russell, Nathan Andrew
The purpose of this article is to discuss the use of music (i.e., two original songs, "Neurotransmitter Twitter" and "Parkinson's Shuffle") to teach aspects of psychopharmacology to students in the course Psychiatric/Mental Health Nursing. Songs were incorporated in both the clinical and classroom settings. This innovative teaching method allowed students the opportunity to revisit the information through multiple exposures of the content for reinforcement and enhancement of student learning in a fun, creative approach. Brain-based research will be discussed, along with the process of development.
Sack, Robert L.; Shore, James H.
Psychopharmacology has become a major approach to treatment in primary medical care. However, combined psychiatric and medical illness can give rise to some challenging diagnostic problems. Furthermore, drug treatment of patients with such illnesses can involve important drug-disease interactions and drug-drug interactions. One should keep in mind the issues that arise when an emotionally troubled patient would benefit from a psychotropic drug but a concurrent medical illness complicates this treatment. An awareness of both the medical and psychiatric issues involved may make successful treatment possible. PMID:7269559
Stoyanova-Beninska, Violeta V; Wohlfarth, Tamar; Isaac, Maria; Kalverdijk, Luuk J; van den Berg, Henk; Gispen-de Wied, Christine
Child and adolescent psychiatry is a relatively young field and the recognition, classification, and treatment of disorders in children and adolescents lag behind those in adults. In recent years there is an increasing awareness of the differences between children and adults in psychopathology and pharmacology. Related to this new paediatric regulations have been introduced. This article reviews the regulatory and legislative measures that were adopted in the EU in 2007 and the subsequent impact of these measures on the field of paediatric psychopharmacology. The consequences of the paediatric regulation in the EU are reflected in several domains: regulatory, research aimed at drug development and clinical practices. In the regulatory domain, the consequences include: new paediatric indications, inclusion of special (class) warnings, specification of dose regimens, and information on safety specific to children and adolescents, and development of new medicinal formulations. The paediatric regulation leads to timely development of paediatric friendly formulations and better quality of the clinical evidence. In clinical practices, an increased awareness of the uniqueness of paediatric pharmacology is emerging among medical professionals, and subsequent improvement of medical care (i.e. correct doses, appropriate formulation, monitoring for expected adverse events). In addition, clinical guidelines will have to be revised more frequently in order to integrate the recently acquired knowledge. The new regulations stimulate transparency and discussions between academia, pharmaceutical industry, and regulators. The purpose is to optimize clinical research and obtain evidence for paediatric psychopharmacology, thereby providing adequate support for treatment.
Mintz, David L; Flynn, David F
Despite advances in psychopharmacology over the past several decades, treatment outcomes for depression have not substantially improved. Depression is not being eradicated. If anything, the evidence suggests that the problem of depression and treatment-resistant depression is growing, not shrinking. As biologically reductionistic approaches dominate psychiatric practice, patient care has steered away from considering the potent effects of meaning and relationships in the psychopharmacologic treatment of our patients. By construing patients as passive recipients of concrete, specific, and straightforward medical interventions, the field has succumbed to a delusion of precision, and unwittingly moved into an era of treatment resistance in which some of our most potent tools are wasted. In such a model we have settled for treating a disorder rather than a whole person. This article is intended as a step toward remedy. Meaning effects, therapeutic alliance, ambivalence, and patient autonomy, among others, have a powerful and measurable impact on the use of medication that should be considered if we are to treat the whole person. Bringing these elements together into a coherent model of treatment, however, is only a starting point. More research is needed if we are to understand the effects these elements have when used together in an integrated model that is simultaneously personalized and evidence-based.
Leahy, Laura G
Genetic testing in psychiatric practice may be a beneficial adjunct to the nursing toolbox of considerations used to improve patient outcomes. Since 2004, the psychiatric community has used genotyping to personalize medication options for their patients. Although not a definitive or exact science, pharmacogenetic testing for psychopharmacological treatment options offers nurses and their patients insights into potential treatments that will reduce the current trial-and-error prescribing practices and more quickly improve patients' quality of life. The current article guides nurses through the process of conducting genetic testing, interpreting the results, and applying the results in clinical practice using a fictitious case example. [Journal of Psychosocial Nursing and Mental Health Services, 55(3), 19-23.].
Hypotheses may be generated (and conclusions drawn) from observational studies in areas where information from randomized controlled trials (RCTs) is unavailable. However, observational studies can only establish that significant associations exist between predictor and outcome variables. Observational studies cannot establish that the associations identified represent cause-and-effect relationships. This article discusses examples of associations that were identified in observational studies and that were subsequently refuted in RCTs. Examples are also provided of associations that have yet to be confirmed or refuted but that are nevertheless influential in psychopharmacologic practice. Explanations are offered about how confounding might explain significant relationships between variables that are not related by cause and effect. As a conclusion of this exercise, clinicians are cautioned against placing too much reliance on the findings of observational research.
Preskorn, Sheldon H
The four Ds of medical malpractice are duty, dereliction (negligence or deviation from the standard of care), damages, and direct cause. Each of these four elements must be proved to have been present, based on a preponderance of the evidence, for malpractice to be found. The principles of psychopharmacology and the information in the package insert for a drug often play a central role in deciding whether dereliction and direct cause for damages were or were not applicable in a particular case. The author uses data from two cases in which patients were inadvertently fatally poisoned by medication to illustrate two ways in which such information can affect the outcome. In one case, the clinician should have known that he was giving a toxic dose to the patient, whereas that was not true in the other case.
Bhattacharya, S K; Bose, R; Ghosh, P; Tripathi, V J; Ray, A B; Dasgupta, B
(--)-Nuciferine and its Hofmann degradation product atherosperminine showed divergent psychopharmacological effects. Because nuciferine has been reported to be a neuroleptic and atherosperminine has some chemical resemblance to dopamine, they were investigated for their dopamine-receptor activities. Nuciferine had a pharmacologic profile of action associated with dopamine-receptor blockade; i.e., it induced catalepsy, inhibited spontaneous motor activity, conditioned avoidance response, amphetamine toxicity and stereotypy. On the other hand, atherosperminine produced effects associated with dopamine receptor stimulation, i.e., stereotypy, increase in spontaneous motor activity and amphetamine toxicity, reversal of haloperidol-induced catalepsy and inhibition of conditioned avoidance response, inhibition of morphine analgesia, and potentiation of the anticonvulsant action of diphenylhydantoin. The results are discussed on the basis of the chemical configuration of the two compounds.
Mohiuddin, Sarah; Ghaziuddin, Mohammad
While there is no cure for autism spectrum disorder, psychopharmacologic agents are often used with behavioral and educational approaches to treat its comorbid symptoms of hyperactivity, irritability, and aggression. Studies suggest that at least 50% of persons with autism spectrum disorder receive psychotropic medications during their life span. This selective review examines recent studies about the use of psychotropic medications in persons with autism spectrum disorder. The aim was to focus on randomized controlled trials conducted from 1990 to 2010 on this topic. A comprehensive literature search was performed using PubMed and Cochrane databases. Out of 105 studies identified for the review, only 24 were randomized controlled trials. Thus, despite the common use of these medications in autism spectrum disorder, more controlled studies are needed to determine their long-term efficacy and safety.
Ghaemi, S Nassir; Goodwin, Frederick K
Objective To assess the scientific and ethical basis for clinical innovation in psychopharmacology. Methods We conducted a literature review, utilizing MEDLINE search and bibliographic cross-referencing, and historical evidence regarding the discovery and development of new medications in psychiatry. Clinical innovation was defined as use of treatments in a clinical setting which have not been well-proven in a research setting. Results Empirical data regarding the impact of clinical innovation in psychopharmacology are lacking. A conceptual and historical assessment of this topic highlights the ethical and scientific importance of clinical innovation. Ethically, it touches a borderline that, in our judgment, is not adequately framed in contemporary mainstream bioethics. Currently, research is viewed as not at all benefiting the patients who participate in it, while clinical care is viewed as being solely for the benefit of patients. Clinical innovation straddles these two worlds, uncomfortably at times. While many argue that clinical innovation should either be avoided or folded into research projects, we argue that clinical innovation is necessary for progress in psychopharmacology research, and that it can prosper best when guided by the following ethical principles: 1.) The treatment should be based on a viable hypothesis. 2.) Whenever possible, one's clinical observations should be reported so they can be evaluated by the scientific community. 3.) One should be willing to report unexpected observations of drug effects. 4.) A high standard of informed consent should be maintained. Again, this proposal goes against the standard view among bioethicists that research and clinical care are categorically opposed activities, as made clear by the either-or dichotomy of the Belmont Report on bioethics. This approach has so polarized our profession into clinicians versus researchers, that many clinicians will not apply new knowledge produced by clinical research until it
Baumann, Pierre; Spies, Marie; Möller, Hans-Jürgen; Kasper, Siegfried; Bitter, Istvan; Laux, Gerd
Objectives Post-graduate training for specialisation in psychiatry and psychotherapy is part of a 4-6-year programme. This paper aims to inform on the general situation of teaching and training of psychopharmacology-psychopharmacotherapy in Europe. It presents the need for a psychopharmacotherapy education in psychiatric training programmes. Arguments as well as a proposal for a catalogue of learning objectives and an outline of a psychopharmacology curriculum are presented. Methods Based on their experience and on an analysis of the literature, the authors, experts in psychopharmacology-pharmacotherapy teaching, critically analyse the present situation and propose the development of a curriculum at the European level. Results Teaching programmes vary widely between European countries and, generally, teaching of psychopharmacology and pharmacotherapy does not exceed two-dozen hours. This is insufficient if one considers the central importance of psychopharmacology. A psychopharmacology-psychopharmacotherapy curriculum for the professional training of specialists in psychiatry and psychotherapy is proposed. Conclusions As the number of hours of theoretical teaching and practical training is insufficient, a catalogue of learning objectives should be established, which would then be part of a comprehensive curriculum at the European level. It could be inspired partly by those few previously proposed by other groups of authors and organisations.
Schermer, M H N
Aldous Huxley's Brave New World is a famous dystopia, frequently called upon in public discussions about new biotechnology. It is less well known that 30 years later Huxley also wrote a utopian novel, called Island. This paper will discuss both novels focussing especially on the role of psychopharmacological substances. If we see fiction as a way of imagining what the world could look like, then what can we learn from Huxley's novels about psychopharmacology and how does that relate to the discussion in the ethical and philosophical literature on this subject? The paper argues that in the current ethical discussion the dystopian vision on psychopharmacology is dominant, but that a comparison between Brave New World and Island shows that a more utopian view is possible as well. This is illustrated by a discussion of the issue of psychopharmacology and authenticity. The second part of the paper draws some further conclusions for the ethical debate on psychopharmacology and human enhancement, by comparing the novels not only with each other, but also with our present reality. It is claimed that the debate should not get stuck in an opposition of dystopian and utopian views, but should address important issues that demand attention in our real world: those of evaluation and governance of enhancing psychopharmacological substances in democratic, pluralistic societies.
De las Cuevas, Carlos; de Leon, Jose; Peñate, Wenceslao; Betancort, Moisés
Purpose To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients’ adherence to psychopharmacological medications. Method A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. Results Structural equation modeling demonstrated that psychiatric patients’ treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients’ trust in their psychiatrists (doctors’ subscale), 3) negatively with patients’ belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. Conclusion This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients’ adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients’ psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.
Mallo, C Jason; Mintz, David L; Lewis, Katie C
A growing body of evidence suggests that psychiatric medication outcomes are shaped significantly by psychological and social factors surrounding the prescribing process. Little, however, is known about the extent to which psychiatry programs integrate this evidence base into residency training or the methods by which this is accomplished. Psychiatry residency program directors and chief residents participated in an exploratory online survey to establish how psychosocial factors known to impact medication outcomes are integrated into psychopharmacology education. While participants highly valued the importance of psychosocial factors in the prescribing process, there was limited emphasis of these factors in psychopharmacology training. Additionally, some teaching methods that could advance understanding of complex interactions in the psychopharmacology relationship were found to be underutilized. Given that medication outcomes are significantly influenced by psychosocial factors, psychiatric educators have a responsibility to teach residents about the evidence base available. Residents exposed to this evidence base will be better equipped to manage the complexities of the psychopharmacology role. The results of this study offer clues as to how psychosocial factors may be more fully integrated into residency psychopharmacology training.
Portillo-Salido, Enrique F
From the very outset of scientific Psychology, psychologists have shown interest for drugs and their effects on behavior. This has given rise to numerous contributions, mostly in the form of Psychopharmacology publications. The aim of this study was to quantitatively evaluate these contributions and compare them with other academic disciplines related to Psychopharmacology. Using the PubMed database, we retrieved information about articles from 15 journals included in the Pharmacology and Pharmacy category of the Journal Citation Reports database for a 21-year period (1987 to 2007). There were 37540 articles which about 52% were represented by 3 journals. About 70% of psychology publications were represented by 2 of these journals. Psychology departments accounted for the 11% of the published papers, which places Psychology third behind Psychiatry and Pharmacology, which contributed to 22.69 and 13% respectively. Psychology contributed to the greatest number of studies in 3 journals, second in 3 and third in 8. This report represents the first effort to explore the contribution of academic Psychology to the multidisciplinary science of psychopharmacology. Although leaders of production of psychopharmacology research were from Psychiatry and Pharmacology, Psychology departments are an important source of studies and thus of knowledge in the field of Psychopharmacology.
Howland, Robert H
Seven topics previously described in this column are revisited. The use of quantitative electroencephalography has been shown in a prospective study to be effective for predicting antidepressant treatment response. A novel antidepressant drug, agomelatine, has generated much controversy, and its development for the U.S. market was discontinued. A long awaited revised system for categorizing the safety of medications during pregnancy and lactation has finally been published by the Food and Drug Administration. Dextromethorphan/quinidine, eslicarbazepine acetate, levomilnacipran, and esketamine are recent examples of drugs that were developed based on the complex concepts of chirality and stereochemistry. Lisdexamfetamine, a stimulant drug, failed to show benefit as an augmentation therapy for the treatment of depression. The combination drug naltrexone/bupropion was finally approved as a therapy for obesity, after its cardiovascular safety was confirmed in a prospective premarketing study. Further development of the glucocorticoid receptor antagonist drug mifepristone as a treatment for psychotic depression was stopped based on a large negative trial, but the drug continues to be investigated for other potential psychiatric indications. These examples illustrate how the field of psychopharmacology continues to evolve.
van Praag, Herman M.
Nosological classification in psychiatry, as it is currently applied, does not facilitate biological and psychopharmacological research. • Syndromal acuity has disappeared. Consequently, it is impossible to determine: (i) vi/hether a particular drug affects a particular symptom configuration; (ii) what exactly the behavioral correlate of a particular biological disturbance is. The problem of unfocused diagnoses is greatly magnified by the phenomenon called comorbidity. • The boundary between distress and disorder is illdefined. • Symptom configuration and certain nonsymptomatological variables such as duration and severity are prematurely linked, so as to conceptualize categorical entities. The validity of those constructs has not been sufficiently demonstrated. This undermines the validity of biological studies and leads to “nosologomania,” ie, an ever-growing series of undervalidated psychiatric “disorders.” • Symptoms are grouped horizontally as if they all had the same diagnostic “valence.” This, however, is highly unlikely. • The nosological disease model is unconditionally and uncritically accepted. Alternative models are ignored, particularly the reaction-form model, though it has substantial heuristic value, and deserves to be thoroughly scrutinized. (Research) strategies to remedy this situation are pointed out. PMID:22034250
There is increased interest in the role that ethnicity, sociocultural factors, and gender play in research, health care delivery, and response to intervention. The impact of these factors on AIDS awareness programs, on the phenomenology of suicide and anorexia nervosa, and on clinical psychopharmacology in a homogeneous population is discussed. Risky sex practices can be related to cultural norms that stigmatize condom use and sex education; economic deprivation; and male dominance. Gender, cultural, and ethnic demographics can identify high-risk groups as well as influence effective interventions. Suicide rates and risk factors are compared in African-American, Canadian Native, and South Korean adolescents. Academic stress was a differential risk factor for the Koreans. Anorexia nervosa predominantly affects women and has cultural differences in prevalence. The homogeneous population in Hong Kong illustrates the impact of ethnicity, sociocultural factors, and gender on clinical psychopharmacology. Attention to ethnicity, sociocultural factors, and gender can individualize and improve the effectiveness of clinical psychopharmacology.
Concurrences of scientific, cultural, and economic developments in the past decade have changed psychiatric practice and psychiatric training. The explosion in neurobiological sciences has left residents with an overwhelming amount of neurobiology to master at the same time that managed care has led to a de-emphasis on psychiatrists providing psychotherapy. Consequently, many residents are left questioning the relevance of psychodynamics for psychiatry, given that the majority will function primarily as prescribers. However, the illusion, increasingly common in our culture, that medications are a simple fix leaves residents unprepared to make sense of the complex and irrational processes that happen in the acts of prescribing and taking medications (or not taking medications). Consequently, residents may feel confused, angry, hopeless, and/or abandoned in their role. These residents are often hungry for a context to explain why they feel hopeless, confused, or defeated in carrying out the "simple" task of prescribing. A psychodynamic understanding can provide such a holding context, just as it can give residents tools for backing out of futile and/or destructive enactments and turning conflicts around medications to some therapeutic good. Many psychodynamic concepts that initially may have seemed to residents part of some arcane and outmoded pseudoscience suddenly become relevant when they provide both a context for understanding the resident's distress and useful clinical tools. Those psychodynamic psychiatrists wishing to promulgate a psychodynamic understanding may need to meet psychiatric trainees at their developmental level and take seriously the current emphasis on providing effective somatic treatments. By engaging trainees at the junction of psychodynamics and psychopharmacology, psychodynamic psychiatrists may find a more receptive audience and open the door for greater interest in developing psychodynamic understanding and technical skills.
Rambert, F A; Pessonnier, J; de Sereville, J E; Pointeau, A M; Duteil, J
The following psychopharmacological effects of adrafinil have been observed in mice: increase in locomotor activity (64-256 mg.kg-1), antagonism (16-128 mg.kg-1) of the hypnotic effects of barbitone but not of pentobarbitone, reduction of immobility duration in the forced swimming test (16-256 mg.kg-1); slight antagonism (256 mg.kg-1) of electroshock-induced convulsions; no modification of rectal temperature; no stereotyped or climbing behaviour; no increase in lethality in aggregated mice (LD50 isolated = 1022 mg.kg-1, LD50 aggregated = 859 mg.kg-1); lack of effects on the provisional tests for antidepressants: no interaction with reserpine-, oxotremorine-, or apomorphine-induced hypothermia but potentiation of yohimbine-induced toxicity; lack of peripheral sympathetic effects (no mydriasis, no salivation, no contraction of the pilomotor muscles, no antagonism of reserpine-induced ptosis); lack of peripheral anticholinergic effects (no mydriasis, no antagonism of oxotremorine-induced salivation or lacrimation). As compared to no analeptic, anticholinergic or antidepressant drugs, adrafinil shows a unique behavioural profile in mice defined on the one hand by a specific stimulant activity associated with antidepressant-like effects that do no seem related to a beta-adrenergic mechanism and on the other hand by a lack of dopaminergic effects. Most adrafinil-induced effects (increase in locomotor activity, reduction of immobility duration in the forced swimming test) may correspond to a central alpha 1-adrenergic stimulation, but the unexpected lack of peripheral sympathetic effects remains unexplained.
Greenhill, Laurence L.; Vitiello, Benedetto; Fisher, Prudence; Levine, Jerome; Davies, Mark; Abikoff, Howard; Chrisman, Allan K.; Chuang, Shirley; Findling, Robert L.; March, John; Scahill, Lawrence; Walkup, John; Riddle, Mark A.
Objective: To improve the gathering of adverse events (AEs) in pediatric psychopharmacology by examining the value and acceptability of increasingly detailed elicitation methods. Method: Trained clinicians administered the Safety Monitoring Uniform Report Form (SMURF) to 59 parents and outpatients (mean age [+ or -] SD = 11.9 [+ or -] 3.2 years)…
Glick, Ira D.; Zisook, Sidney
Objective: For a variety of pedagogical, political and financial reasons, there are major problems in achieving effective teaching of cutting-edge psychopharmacology for psychiatric residents. This article focuses on ways to improve the teaching/learning process, in part through the use of structured curricula. The authors review 1) attempted…
This article discusses the evidence behind two approaches to psychopharmacological management in children with autism: selecting and treating target symptoms or treatment or curing the primary social impairment underlying autism. The effectiveness of stimulants, antidepressants, melatonin, naltrexone, fenfluramine, and secretin is appraised. The…
Durston, Sarah; Konrad, Kerstin
This paper aims to illustrate how combining multiple approaches can inform us about the neurobiology of ADHD. Converging evidence from genetic, psychopharmacological and functional neuroimaging studies has implicated dopaminergic fronto-striatal circuitry in ADHD. However, while the observation of converging evidence from multiple vantage points…
Osser, David N.; Patterson, Robert D.; Levitt, James J.
Objective: The authors describe a course of instruction for psychiatry residents that attempts to provide the cognitive and informational tools necessary to make scientifically grounded decision making a routine part of clinical practice. Methods: In weekly meetings over two academic years, the course covers the psychopharmacology of various…
Deveaugh-Geiss, Joseph; March, John; Shapiro, Mark; Andreason, Paul J.; Emslie, Graham; Ford, Lisa M.; Greenhill, Laurence; Murphy, Dianne; Prentice, Ernest; Roberts, Rosemary; Silva, Susan; Swanson, James M.; van Zwieten-Boot, Barbara; Vitiello, Benedetto; Wagner, Karen Dineen; Mangum, Barry
Objective: To give academic researchers, government officials, and industry scientists an opportunity to assess the state of pediatric psychopharmacology and identify challenges facing professionals in the field. Method: Increased federal spending and the introduction of pediatric exclusivity led to large increases in pediatric psychopharmacology…
Sepulveda, Victoria I.
Counseling professionals and researchers have advocated for counselor training in psychopharmacology in order to heighten counselors' awareness of client needs and treatment standards (Ingersoll, 2000; King & Anderson, 2004; Smith & Garcia, 2003). There has been a lack of this training within counselor education graduate programs (Buelow, Hebert,…
Kratochwill, Thomas R.
Notes that biological interventions have been relatively neglected within field of school psychology in terms of its professional training, research agendas, and professional relationships with other specialties within psychology. Responds to previous articles in this special miniseries on psychopharmacology with children and adolescents, and…
Brodkey, Amy C.
OBJECTIVE: To describe and examine the role of the pharmaceutical industry in the teaching of psychopharmacology to residents and medical students and to make recommendations for changes in curriculum and policy based on these findings. METHODS: Literature reviews and discussions with experts, educators, and trainees. RESULTS: The pharmaceutical…
Reviews literature on pediatric psychopharmacology practice, lack of empirical support for efficacy and safety of most psychotropics for pediatric use, and need for further basic and clinical trials research and evaluation. Identifies shortcomings in training and experience that must be addressed if school psychology is to meet demands of three…
Schaefer, David; Wong-Wylie, Gina
The psychopharmacology training experiences and attitudes of Canadian counsellors were the focus of our national Internet-based survey. This study was part of a larger investigation on Canadian counsellors' attitudes, practices, and training experiences related to clients on antidepressants. Results of the current study indicate Canadian…
Hendriksen, Hendrikus; Groenink, Lucianne
Psychopharmacology has had some bad publicity lately. Frankly, there have been some major problems along the way in developing new effective drugs for psychiatric disorders. After a prolonged period of high investments but low success rates, big pharmaceutical companies seem to retract their activities in the psychopharmacology field. Yet, the burden of mental disorders is likely to keep on growing in the next decades. In this position paper, we focus on drug development for depression and anxiety disorders, to narrow the scope of the assay. We describe the current situation of the psychopharmacology field, and analyse some of the methods and paradigms that have brought us here, but which should perhaps change to bring us even further. In addition, some of the factors contributing to the current stagnation in psychopharmacology are discussed. Finally, we suggest a number of changes that could lead to a more rational strategy for central nervous system drug development and which may circumvent some of the pitfalls leading to "me too" approaches. Central to the suggested changes, is the notion that mental disorders do not lead to several symptoms, but a network of causally related symptoms convolutes into a mental disorder. We call upon academia to put these changes in the early phases of drug development into effect.
Huemer, J.; Erhart, F.; Steiner, H.
PTSD in children and adolescents differs from the adult disease. Therapeutic approaches involve both psychotherapy and psychopharmacotherapy. Objectives: The current paper aims at reviewing studies on psychopharmacological treatment of childhood and adolescent PTSD. Additionally, developmental frameworks for PTSD diagnosis and research along with…
Kirsch, Daniel J.; Doerfler, Leonard A.; Truong, Debbie
Objective: To describe diagnostic and psychotropic medication prescription characteristics among college students referred by college counseling centers for psychopharmacologic evaluation. Participants: Participants were 540 college students referred by 6 college counseling centers in Massachusetts between November 2005 and May 2011. Methods:…
The present work's purpose is to open a discussion on the notion of Resistance in Psychopharmacology. Despite the fact that the phenomenon is observable in psychiatric practice, its meaning and consequences for medical practice are not sufficiently established, so that a critical reformulation is required for the sake of greater conceptual clarity in this area.
Sulkowski, Michael L.; Jordan, Cary; Nguyen, Matthew L.
School psychologists frequently examine children who are prescribed psychotropic medications. With advanced training in psychological assessment and professional consultation, school psychologists may play an integral role in assisting with children's psychopharmacological treatment regimens. In this vein, this article discusses various ways for…
Kutcher, Stan; Murphy, Andrea; Gardner, David
The article examines the World Health Organization's Model List of Essential Medicines (EML) and suggests modification for appropriate psychopharmacological treatment of child- and adolescent-onset mental disorders. The EML enlists few of the psychotropic medicines that are useful for the treatment of young people thereby limiting the…
Sweeney, Dwight P.; Forness, Steven R.; Kavale, Kenneth A.; Levitt, Jennifer G.
Discusses the potential uses and abuses of psychopharmacologic therapy with children or adolescents who display learning, emotional, or behavioral disorders. Explores the indications and contraindications of such therapy and enumerates the known side effects of the most frequently prescribed medications, including psychostimulants,…
Jones, M; Robson, D; Whitfield, S; Gray, R
The implementation of Mental Health Nurse (MHN) prescribing in the UK remains disappointing. A much cited critique of MHNs prescribing is that it would be unsafe, as MHN would not have the appropriate knowledge of pharmacology to practise mental health prescribing. The knowledge of pharmacology of MHNs with the prescribing qualification has not been assessed in the UK. In addition, the views of MHNs with the prescribing qualification who have undertaken a psychopharmacology course have not been explored. The aims of this study are to measure the efficacy of a 10-day advanced training programme on psychopharmacology on the knowledge levels of MHNs with the prescribing qualification; and to explore the positive and negative experiences of individual participants of the training in psychopharmacology and how it supported their prescribing practice. A repeated measures design was used in which participants acted as their own controls. Participants were assessed 10 weeks before the training programme and again on day one of the training programme using a Multiple Choice Questionnaire. In addition, a series of focus groups were conducted to explore the helpful and unhelpful aspects of the course in sustaining the MHNs' prescribing practice. Following the training period there were significant increases in the MHNs' knowledge of psychopharmacology in comparison with the two base line means. Participants when interviewed 18 months after completing the training described the training as a helpful though they described it had not resulted in large increases in prescribing practice, citing systemic barriers to its implementation. Short and focussed training for MHNs who prescribe may increase their knowledge of psychopharmacology. The development of such programmes may well be part of the solution to support MHNs with the prescribing qualification to prescribe, supported by the views of the MHNs who participated in the focus groups. However, further work is required to remove
Although cannabis use disorder is strongly related to schizophrenia and treatment of patients with double diagnosis provides serious problem, specific pharmacological, molecular and therapeutical data on this subgroup are poorly available. In this paper we present a critical review on psychopharmacological boundaries of schizophrenia with concurrent cannabis use. The relevant data available in the literature suggest that a weaker compliance, poorer therapy response and higher sensitivity for extrapyramidal side effects are key features of schizophrenia and comorbid cannabis use disorder and represent a clinical challenge. Because of paucity of available research in the field there is not enough evidence to clearly depict the exact psychopharmacological profile of cannabis related schizophrenia. Further investigations are needed to assess phenotypic characteristics of this entity and to tailor effective treatment options accordingly.
Serra, Héctor A; Fadel, Daniel O
Nowadays, the term receptor is obvious in psychopharmacology. However, this was not so obvious a century ago. To try to explain how drugs act, European scientists began to develop theories that turned into deeds with the scientific progress. Thus, the receptor concept and their applications in medicine and psychiatry began to gain substance. In this paper we relate the facts that have led to the current knowledge of receptor, the cornerstone of pharmacology.
Möller, Hans-Jürgen; Broich, Karl
Proof of efficacy of a psychotropic medicinal product is the key point of clinical psychopharmacology. This especially concerns the licensing of a new compound, but apart from this special case, lots of efficacy questions need to be answered in clinical psychopharmacology, such as, e.g. the question of the efficacy of a combination therapy. The methodology of the scientific proof of efficacy has already had a long tradition and has been developed further in the recent past under different aspects. Especially the double-blind randomised parallel group comparison has been developed as a design of highest methodological standard. However, often designs have their place and justification under certain conditions and in relation to certain questions. Although in the recent past, with the over-emphasis of so-called effectiveness studies, the inherent methodological limitations of these studies have not been addressed properly (Möller in Eur Arch Psychiatry Clin Neurosci 258:257-270, 2008), which in consequence devaluated the scientific merits of the classical double-blind randomised control group study designs in the view of those colleagues, who are not that experienced in study design issues. Therefore, it seems to be timely and necessary to review the principle standards and problems concerning the proof of efficacy in clinical psychopharmacology.
Mallo, C Jason; Mintz, David L
The discipline of psychiatry appears poised at the edge of a paradigm shift. Enthusiasm about psychopharmacological treatments and neuroscientific understandings is giving way to a sobering recognition of the limitations of current biologically oriented approaches. Psychiatry training programs have both an opportunity and a responsibility to address the challenges presented by the evidence. Although the average psychiatrist would profess a biopsychosocial ideal, an examination of our practice, journals, and training curricula suggests that we still have a long way to go before we employ a truly integrated model. There is a compelling, though oft-neglected evidence base demonstrating that pharmacologic treatment outcomes are as dependent on psychological and interpersonal factors as on medical ones. In order to maximize our usefulness to patients, psychiatry must embrace more complex and integrated understandings, transcending reductionistic models that promote mind-body splits. This article explores some of the costs of a model that places disproportionate emphasis on a biological framework. Relevant evidence bases are reviewed that demonstrate the utility of emphasizing the psychology of psychopharmacology. Implications for psychiatric training are considered, and suggestions are made for better integrating meaning factors into psychopharmacology education.
Baumeister, Alan A; Hawkins, Mike F; López-Muñoz, Francisco
Contradictory views are expressed in the literature about the role played by serendipity in discoveries that led to modern psychopharmacology. This article attempts to resolve these contradictions by providing an operational definition of serendipity. The utility of the proposed definition is explored in the context of 18 discoveries. The results show that the most common pattern in the development of early psychiatric medications is serendipitous observation leading to non-serendipitous demonstration of clinical utility. The analysis also reveals examples of relatively pure serendipitous and non-serendipitous discoveries. The proposed definition appears to be reliable and valid.
Kornhuber, Johannes; Terfloth, Lothar; Bleich, Stefan; Wiltfang, Jens; Rupprecht, Rainer
We developed a structure-property-activity relationship (SPAR)-model for psychopharmacological drugs acting as non-competitive 5-HT(3A) receptor antagonists by using a decision-tree learner provided by the RapidMiner machine learning tool. A single molecular descriptor, namely the molecular dipole moment per molecular weight (mu/MW), predicts whether or not a substance non-competitively antagonizes 5-HT-induced Na(+) currents. A low mu/MW is compatible with drug-cumulation in apolar lipid rafts. This study confirms that size-intensive descriptors allow the development of compact SPAR models.
Osser, David N; Roudsari, Mohsen Jalali; Manschreck, Theo
This article is an update of the algorithm for schizophrenia from the Psychopharmacology Algorithm Project at the Harvard South Shore Program. A literature review was conducted focusing on new data since the last published version (1999-2001). The first-line treatment recommendation for new-onset schizophrenia is with amisulpride, aripiprazole, risperidone, or ziprasidone for four to six weeks. In some settings the trial could be shorter, considering that evidence of clear improvement with antipsychotics usually occurs within the first two weeks. If the trial of the first antipsychotic cannot be completed due to intolerance, try another until one of the four is tolerated and given an adequate trial. There should be evidence of bioavailability. If the response to this adequate trial is unsatisfactory, try a second monotherapy. If the response to this second adequate trial is also unsatisfactory, and if at least one of the first two trials was with risperidone, olanzapine, or a first-generation (typical) antipsychotic, then clozapine is recommended for the third trial. If neither trial was with any these three options, a third trial prior to clozapine should occur, using one of those three. If the response to monotherapy with clozapine (with dose adjusted by using plasma levels) is unsatisfactory, consider adding risperidone, lamotrigine, or ECT. Beyond that point, there is little solid evidence to support further psychopharmacological treatment choices, though we do review possible options.
Birur, Badari; Math, Suresh Bada; Fargason, Rachel E.
Background Disasters are mega-scale catastrophic events which cause trauma and mental health sequelae. A review of early pharmacological interventions for the prevention of psychiatric disorders following disasters is sorely needed. Methods A literature search of “Psychiatric Sequelae AND Disasters”, “Disaster mental health/Disaster psychiatry”, “Psychotropics AND Disasters”, and “Drug therapy AND Disasters” yielded 213 articles, 38 of which were included in the review. Results Common post-disaster psychiatric conditions are: posttraumatic stress disorder (PTSD), depressive and anxiety disorders, substance use disorders and medically-unexplained psychological symptoms. Early psychopharmacological interventions to prevent PTSD provide promising evidence for hydrocortisone in medically ill trauma populations. Less robust benefits were noted for other pharmacological interventions. No reported trials have explored prevention of depression or other common post-disaster psychiatric conditions. Conclusion Hydrocortisone shows promise in preventing and reducing the psychiatric sequelae of PTSD following disasters. Further evaluation of hydrocortisone and other potentially beneficial psychopharmacological interventions are needed. PMID:28138200
On the publication of Robert Lowell's Life Studies in 1959, some critics were shocked by the poet's use of seemingly frank autobiographical material, in particular the portrayal of his hospitalizations for bipolar disorder. During the late fifties and throughout the sixties, a rich vein, influenced by Lowell, developed in American poetry. Also during this time, the nascent science of psychopharmacology competed with and complemented the more established somatic treatments, such as psychosurgery, shock treatments, and psychoanalytical therapies. The development of Thorazine was a remarkable breakthrough allowing patients previously thought incurable to leave hospital. In 1955, the release of Miltown, the first 'minor' tranquilizer, was heralded with a media fanfare promising a new dawn of psychological cure-all. These two events blurred the boundary between 'normality' and madness by making treatment in the community more widely possible and by medicalizing more commonplace distress. Lowell's early depictions of madness situate it as emblematic of the cultural malaise of 'the tranquilized fifties.' By his final collection, Day by Day (1977), mental illness had lost its symbolic power. These late poems explore the power of art as a way of representing and remedying suffering in a culture where psychopharmacology has normalized madness.
Bos, Fionneke M; Schoevers, Robert A; aan het Rot, Marije
Experience sampling methods (ESM) and ecological momentary assessment (EMA) offer insight into daily life experiences, including symptoms of mental disorders. The application of ESM/EMA in psychopharmacology can be a valuable addition to more traditional measures such as retrospective self-report questionnaires because they may help reveal the impact of psychotropic medication on patients' actual experiences. In this paper we systematically review the existing literature on the use of ESM/EMA in psychopharmacology research. To this end, we searched the PsycInfo and Medline databases for all available ESM/EMA studies on the use of psychotropic medication in patients with DSM-III-R and DSM-IV disorders. Dissertations were excluded. We included 18 studies that applied ESM/EMA to study the effects of medication on patients with major depressive disorder, substance use disorder, attention-deficit hyperactivity disorder, psychotic disorder, and anxiety disorder. We found that ESM/EMA may allow researchers and clinicians to track patients during different phases of treatment: before treatment to predict outcome, during treatment to examine the effects of treatment on symptoms and different aspects of daily life experience, and after treatment to detect vulnerability for relapse. Moreover, ESM/EMA can potentially help determine how long and in what contexts medications are effective. Thus, ESM/EMA may benefit both researchers and clinicians and might prove to be an effective tool for improving the treatment of psychiatric patients.
Bobon, D P; Lecoq, A; von Frenckell, R; Mormont, I; Lavergne, G; Lottin, T
As far back as the second century, Ptolemy reported the apparent immobility of wheel radius at a certain speed. The psychophysical laws of this flicker fusion phenomenon related to the frequency of the light stimulus were established in 1834-1835 by the Englishman Talbot and by the Belgian Plateau, whose thesis in Liège is described as a landmark in the field. CFF is more a measurement of cortical arousal than of visual functions. In psychophysiology, CFF underwent periods of success and oblivion, at the mercy of researcher's enthusiasm or disappointment. At the turn of this century, Pierre Janet measured CFF in the laboratory of physiology of the Salpêtrière Hospital and demonstrated its decrease 'in hysteria, in states of depression, of lowered tension'. All reviewers of CFF literature have overlooked these observations, reported by Henri Piéron in the 'Melanges dedicated to Monsieur Pierre Janet'. When CFF falls into disgrace, it is because of the variability of its results, due to differences in apparatus and designs of the trials as well as the great number and the intrication of the variables which modify CFF thresholds, among them the nonsensory variables. When CFF is reappraised, as it has been the case in psychopharmacology in recent years, the reason is that it represents a brief, easy and economical measure of vigilance which, under certain conditions, seems to be also reliable, valid and sensitive. In the present monograph, the first in French on CFF, the authors try to analyze the most important contributions of the literature from the standpoint of the most relevant variables: characteristics of the stimulus (light intensity, wave form, wavelength, light-dark-ratio, diameter of the flickering point), test procedure (light vs. dark adaptation, visual angle, continuous vs. discontinuous presentation, monocular vs. binocular vision), influence of various physiological or psychological conditions (pupillary diameter, age, training, IQ; anxiety
Bulach, C; Doaré, L; Massari, B; Simon, P
Norepinephrine (NE), octopamine (OA) and phenethylamine (PEA) are easily destroyed by M.A.O. but we could show, even injected intraperitoneally that they are active upon tests used generally to reveal an "antidepressant" effect. This effect is especially studied by using antagonism of apomorphine, reserpine, oxotremorine-induced hypothermia. The psychopharmacological spectra of NE and OA are close to the one of salbutamol and the observed effects correspond to alpha- and beta-adrenergic stimulations. The PEA spectrum is similar to the one of amphetamine and the observed effects correspond to adrenergic stimulations and to a dopaminergic stimulation. The mechanisms involved in the tests realized to show an "antidepressant" effect could reflect an activity not only through endogeneous NA but also possibly through endogeneous OA and PEA.
Nonspecific factors have long been known in both psychotherapy and psychopharmacology. In recent years, 2 studies showed that placebo benefits were lower when the treated subjects were told that the placebo, presented as an active treatment, cost less. One of these studies had assessed motor and other outcomes in Parkinson disease patients; the other had assessed analgesia in paid, healthy volunteers to whom electric shocks were administered. The implication of the finding that lower treatment cost may diminish treatment gains is that patients who receive generic medicines may have lower expectations and may consequently derive less placebo-related benefit. This could be of concern in psychiatric disorders that are characterized by a large placebo response. Although the 2 "placebo cost" studies cannot be easily generalized to clinical and especially psychiatric contexts, clinicans should consider offering reassurance to patients receiving generic drugs that cost, per se, has no bearing on treatment-related benefit.
Beek, Terra S; Boone, Cheryl; Hubbard, Grace
Experiential teaching strategies have the potential to more effectively help students with critical thinking than traditional lecture formats. Gaming is an experiential teaching-learning strategy that reinforces teamwork, interaction, and enjoyment and introduces the element of play. Two Bachelor of Science in Nursing students and a clinical instructor created a Jeopardy!(®)-style game to enhance understanding of psychopharmacology, foster student engagement in the learning process, and promote student enjoyment during clinical postconference. The current article evaluates the utility, relevance, and effectiveness of gaming using a Jeopardy!(®)-style format for the psychiatric clinical setting. Students identified the strengths of this learning activity as increased awareness of knowledge deficits, as well as the reinforcement of existing knowledge and the value of teamwork.
Sarris, Jerome; Panossian, Alexander; Schweitzer, Isaac; Stough, Con; Scholey, Andrew
Research in the area of herbal psychopharmacology has increased markedly over the past decades. To date however, a comprehensive review of herbal antidepressant, anxiolytic and hypnotic psychopharmacology and applications in depression, anxiety and insomnia has been absent. A search of MEDLINE (PubMed), CINAHL, PsycINFO, and the Cochrane Library databases was conducted (up to February 21st 2011) on commonly used psychotropic herbal medicines. A review of the literature was conducted to ascertain mechanisms of action of these botanicals, in addition to a systematic review of controlled clinical trials for treatment of mood, anxiety and sleep disorders, which are common comorbid psychiatric disorders. Specific emphasis was given to emerging phytomedicines. Analysis of evidence levels was conducted, as were effect sizes (Cohen's d) where data were available. Results provided evidence of a range of neurochemical, endocrinological, and epigenetic effects for 21 individual phytomedicines, which are detailed in this paper. Sixty six controlled studies were located involving eleven phytomedicines. Several of these provide a high level of evidence, such as Hypericum perforatum for major depression, and Piper methysticum for anxiety disorders. Several human clinical trials provide preliminary positive evidence of antidepressant effects (Echium amoenum, Crocus sativus, and Rhodiola rosea) and anxiolytic activity (Matricaria recutita, Ginkgo biloba, Passiflora incanata, E. amoenum, and Scutellaria lateriflora). Caution should however be taken when interpreting the results as many studies have not been replicated. Several herbal medicines with in vitro and in vivo evidence are currently unexplored in human studies, and along with use of emerging genetic technologies "herbomics", are areas of potential future research.
Wong, Angel Y S; Hsia, Yingfen; Chan, Esther W; Murphy, Declan G M; Simonoff, Emily; Buitelaar, Jan K; Wong, Ian C K
There is significant variation in prescriptions among countries in clinical practice for the treatment of comorbidities associated with autism spectrum disorder (ASD). It has been suggested that many people with mental health disorders in low-/middle-income countries do not receive adequate treatment. Hence, this study investigated psychopharmacological treatment patterns for ASD comorbidities in 30 countries and the association between country's income and prescription rates. The IMS Prescribing Insights database was used to investigate prescription patterns for ASD comorbidity treatment from 2007 to 2012. Data were obtained from 30 countries in continents of Europe, Asia, Oceania, Central America, South America, and Africa. The gross domestic product (GDP) per capita was used as a proxy for each country's income. Spearman correlation was used to examine the association between prescription rate and GDP per capita. The highest prescription rates were found in Western Europe (3.89-36.36/10,000) while the lowest prescription rates were found in Asian countries, such as Turkey, Indonesia, Saudi Arabia, and Pakistan (0.04-0.82/10,000). The most commonly prescribed drug for ASD comorbidity treatment in most of the countries was risperidone, but antidepressants and antiepileptic drugs were also frequently prescribed. There was a significant positive correlation between GDP per capita and prescription rate (Spearman ρ = 0.60; P = 0.0011; 95% confidence interval 0.27-0.81), that is, the higher the GDP per capita, the higher the prescription rate. There are marked international differences in prescription rates, and this is partially accounted by economic factors. Future research should combine more data for ASD comorbidity treatment to explore the disparity of psychopharmacological treatment between countries.
Mizoguchi, Kazushige; Ikarashi, Yasushi
Yokukansan (YKS), a traditional Japanese Kampo medicine, has indications for use in night crying and irritability in children, as well as neurosis and insomnia. It is currently also used for the remedy of the behavioral and psychological symptoms of dementia (BPSD), such as aggressiveness, agitation, and hallucinations. In parallel with clinical evidence, a significant amount of fundamental researches have been undertaken to clarify the neuropsychopharmacological efficacies of YKS, with approximately 70 articles, including our own, being published to date. Recently, we reviewed the neuropharmacological mechanisms of YKS, including its effects on glutamatergic, serotonergic, and dopaminergic neurotransmission, and pharmacokinetics of the ingredients responsible for the effects. This review is aimed to integrate the information regarding the psychopharmacological effects of YKS with the brain regions known to be affected, to facilitate our understanding of the clinical efficacy of YKS. In this review, we first show that YKS has several effects that act to improve symptoms that are similar to BPSDs, like aggressiveness, hallucinations, anxiety, and sleep disturbance, as well as symptoms like tardive dyskinesia and cognitive deficits. We next provide the evidence showing that YKS can interact with various brain regions, including the cerebral cortex, hippocampus, striatum, and spinal cord, dysfunctions of which are related to psychiatric symptoms, cognitive deficits, abnormal behaviors, and dysesthesia. In addition, the major active ingredients of YKS, geissoschizine methyl ether and 18β-glycyrrhetinic acid, are shown to predominantly bind to the frontal cortex and hippocampus, respectively. Our findings suggest that YKS has multiple psychopharmacological effects, and that these are probably mediated by interactions among several brain regions. In this review, we summarize the available information about the valuable effects of a multicomponent medicine YKS on complex
Lichtor, Stephanie A.
Rationale Nonmedical use and abuse of prescription opioids is a significant problem in the USA. Little attention has been paid to assessing the relative psychopharmacological profile (including abuse liability-related effects) of specific prescription opioids. Objectives The aim of this study is to directly compare the psychopharmacological profile of two oral opioids within the same subject. Methods A randomized, placebo-controlled, crossover study was done in which 20 non-drug-abusing volunteers ingested 10 and 20 mg of oxycodone, 30 and 60 mg of morphine, and placebo in separate sessions. Drug doses were equated on an objective measure of opiate effects: miosis. Subjective, psychomotor, reinforcing, and physiological effects of the opioids were assessed. Results In general, the two opioids at equimiotic doses produced similar prototypic opiate-like effects and psychomotor impairment of similar magnitude. However, several effects were found only with 20 mg oxycodone. Both drugs produced abuse liability-related subjective effects but also dysphoric effects, particularly with 60 mg morphine. Neither drug at either dose functioned as a reinforcer, as measured by the Multiple Choice Procedure. Relative potency ratios indicated an average oxycodone:morphine ratio of 1:3. Conclusions The psychopharmacological profile of oxycodone and morphine at equimiotic doses had many similarities; however, differences were found in producing abuse liability-related and dysphoric effects. In the medical community, it is commonly accepted that oral oxycodone is 1.5 to 2 times as potent as oral morphine in producing analgesia; using this ratio, although patients may experience similar degrees of pain relief, those receiving oxycodone may be experiencing stronger and potentially different psychopharmacological effects. PMID:17899018
Recent attention to the monoamine oxidase inhibiting properties of Banisteriopsis caapi's harmala alkaloids has precluded a balanced assessment of B. caapi's overall significance to indigenous South American societies. Relatively little attention has been paid to the cultural contexts, local meanings and patterns of use of B. caapi among snuff-using societies, such as the Piaroa, who do not prepare decoctions containing N,N-dimethyltryptamine (DMT) admixtures. This article reviews the psychopharmacological literature on B. caapi in light of recent ethnographic work conducted among the Piaroa of southern Venezuela. Piaroa shamans use only B. caapi's cambium, identify at least five distinct varieties of B. caapi, and emphasise the plant's importance for heightening empathy. Some Piaroa people also attribute a range of extra-shamanic uses to B. caapi, including as a stimulant and hunting aid. In light of the psychopharmacological complexity of harmala alkaloids, and ethnographic evidence for a wide range of B. caapi uses,future research should reconsider B. caapi's cultural heritage and psychopharmacological potential as a stimulant and antidepressant-like substance.
Berry-Kravis, Elizabeth; Sumis, Allison; Hervey, Crystal; Mathur, Shaguna
Fragile X syndrome (FXS) is associated with behavior that limits functioning, including distractibility, hyperactivity, impulsivity, hyperarousal, anxiety, mood dysregulation, and aggression. Medication response and side effect data were reviewed retrospectively for 257 patients (age 14 ± 11 years, range 4–60 years, 203 M, 54 F) attending an FXS clinic. Treatment success rates were defined as the percentage of positive response in the form of documented clinical report of improvement in the behavior(s) being targeted over at least a 6-month period on the medication, without side effects requiring medication discontinuance, while failures were defined as discontinuance of medication due to lack of clinical effectiveness or side effects. Success rate for treatment of targeted behaviors with trials of individual medications was 55% for stimulants, 53% for antidepressants, 62% for alpha2-agonists, and 54% for antipsychotics. With sequential trials of different medications in the same class, success rate improved to 73–77%. Side effect-related failures were highest for antipsychotics. Systematic psychopharmacologic intervention targeted to behavioral symptoms appears helpful in the majority of patients with FXS. PMID:22899942
Abejuela, Harmony Raylen; Osser, David N
This revision of previous algorithms for the pharmacotherapy of generalized anxiety disorder was developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. Algorithms from 1999 and 2010 and associated references were reevaluated. Newer studies and reviews published from 2008-14 were obtained from PubMed and analyzed with a focus on their potential to justify changes in the recommendations. Exceptions to the main algorithm for special patient populations, such as women of childbearing potential, pregnant women, the elderly, and those with common medical and psychiatric comorbidities, were considered. Selective serotonin reuptake inhibitors (SSRIs) are still the basic first-line medication. Early alternatives include duloxetine, buspirone, hydroxyzine, pregabalin, or bupropion, in that order. If response is inadequate, then the second recommendation is to try a different SSRI. Additional alternatives now include benzodiazepines, venlafaxine, kava, and agomelatine. If the response to the second SSRI is unsatisfactory, then the recommendation is to try a serotonin-norepinephrine reuptake inhibitor (SNRI). Other alternatives to SSRIs and SNRIs for treatment-resistant or treatment-intolerant patients include tricyclic antidepressants, second-generation antipsychotics, and valproate. This revision of the GAD algorithm responds to issues raised by new treatments under development (such as pregabalin) and organizes the evidence systematically for practical clinical application.
Lopez-Munoz, F; Garcia-Garcia, P; Alamo, C
The most outstanding novel of the Spanish literature, Don Quixote, represents the source to which the different specialists who intend to deepen their knowledge of the late Renaissance society usually address. This masterpiece of Miguel de Cervantes has been frequently approached from the psychopathological perspective to obtain a psychiatric diagnosis of its main character, Alonso Quijano. Also, other clinical approaches from the traumatological and general therapeutical view (oils, ointments, balms and other pharmacy preparations) have been frequent. We have tackled Don Quixote from the psychopharmacological perspective, a barely explored field. In this work, we intend to study the therapeutical cures used during the Cervantine time for the treatment of insane and mentally disturbed people (sedatives like opium, laxatives like hellebore, tonics, irritants and surgical techniques like bloodlettings and
Himmerich, Hubertus; Kaufmann, Christian; Schuld, Andreas; Pollmächer, Thomas
Increased circulating levels of liver enzymes emerging during treatment with psychotropic drugs are frequently encountered and, in general, attributed to drug metabolism or toxic effects. Because obesity was shown to be associated with elevated liver enzyme levels in different non-psychiatric study samples, we hypothesized that drug-induced weight gain might be an additional causative factor. We tested this hypothesis in 67 inpatients who received psychopharmacological treatment across five weeks. Stepwise linear regression was used to predict changes in the serum levels of aspartate-amino transferase (ASAT) and alanine-amino transferase (ALAT) by changes in the body mass index (BMI), by changes in other biological parameters related to body weight (tumor necrosis factor-alpha [TNF-alpha], soluble TNF receptors [sTNF-R], interleukin-6 [IL-6], leptin plasma levels) and by the respective liver enzyme baseline level. BMI changes from baseline to endpoint were significantly associated with the changes in ALAT and ASAT levels across five weeks of treatment and with ALAT and ASAT levels at the end point of the study. The baseline levels of ALAT and ASAT also had a significant impact on these liver enzyme level changes, whereas all other variables had not. These results suggest that weight gain-associated metabolic changes occurring during treatment with psychotropic drugs have consistent and clinically relevant effects on the liver.
Molteni, Massimo; Nobile, Maria; Cattaneo, Dario; Radice, Sonia; Clementi, Emilio
The core symptoms of Autistic Spectrum Disorder (ASD) are impairment in reciprocal social interaction, communication, narrow interests, and stereotyped behaviour. These are frequently severe and persistent, although their severity may change over the course of life. Furthermore, the frequently associated symptoms of self-injury, aggressive behaviour, impulsivity, poor attention, anxiety, depression, and sleep disruption, can become a major source of additional distress and interference in functioning. The causes of autism are not yet known, but there is a general consensus that ASDs are highly heritable. Comprehension of the neurobiological basis for autism-spectrum disorders is still in its initial stages: a large body of research, however, has established ASD signs and symptoms are of neurological origin, and suggest that autism is a distributed neural system disorder, which disproportionately impairs many higher order abilities. Currently available medical treatments, primarily address co-morbid symptoms, rather than core symptoms. Thus, in spite of recent advances in psychopharmacology, the treatment approach still has important limits and shows poor efficacy on global outcomes. A potential pathway for improving clinical outcomes is that of the personalised treatment for autism, by using therapeutic drug monitoring (TDM) - a valuable tool for drugs with narrow therapeutic index - as well as systematic genetic background assessment, foreseen in future applications. However, it is already possible to implement an active surveillance programme to address safety concerns and to optimise therapeutic drug interventions in ASD.
The likelihood of being helped or harmed (LHH) ratio is an indirect measure of effect size. It tells the reader how much as likely a patient is to benefit from a treatment as to suffer from an adverse outcome with that treatment; larger values for LHH indicate more favorable treatment outcomes. The numerator for LHH is usually a measure of response or remission with a treatment, and the denominator is usually a measure of all-cause discontinuation or discontinuation due to adverse events; so, there can be more than 1 LHH statistic for a study. As an example, an LHH of 5 could indicate that after removal of placebo effects a patient is 5 times as likely to respond to a treatment as to drop out of treatment because of the experience of an adverse event. This article explains the LHH with the help of a worked example, shows how the LHH can be derived from the numbers needed to treat and harm (NNT, NNH) statistics, discusses practical issues related to the concept, and considers its limitations. The LHH is little used in clinical psychopharmacology, and authors who report or review clinical trial data should consider presenting all the LHH information that is clinically relevant in addition to NNT, NNH, and other information. Because LHH statistics present the results of risk-benefit trade-off analyses, they can help clinicians and patients more easily evaluate potential treatments during decision-making processes.
Kenemans, J Leon; Kähkönen, Seppo
This review surveys human event-related brain potential (ERP) and event-related magnetic field (ERF) approaches to psychopharmacology and psychopathology, and the way in which they complement behavioral studies and other neuroimaging modalities. The major paradigms involving ERP/ERF are P50 suppression, loudness-dependent auditory evoked potential (LDAEP), mismatch negativity (MMN), P300, mental chronometry, inhibitory control, and conflict processing (eg, error-related negativity (ERN)). Together these paradigms cover a range of more bottom-up driven to more top-down controlled processes. A number of relationships between the major neurotransmitter systems and electrocortical mechanisms are highlighted. These include the role of dopamine in conflict processing, and perceptual processing vs motor preparation; the role of serotonin in P50 suppression, LDAEP, and MMN; glutamate/NMDA and MMN; and the role of acetylcholine in P300 generation and memory-related processes. A preliminary taxonomy for these relationships is provided, which should be helpful in attuning possible new treatments or new applications of existing treatments to various disorders. PMID:20927044
Fava, Giovanni A; Tomba, Elena; Tossani, Eliana
The standard randomized controlled trial design is still based on the acute disease model. This is in sharp contrast with the fact that the patient is likely to have experienced other treatments before, that may actually modify clinical course and responsiveness. The current standard of therapeutic trial in psychiatry is represented by the large, multi-center, controlled randomized trial with broad inclusion criteria, and little attention to other factors such as the clinical history of patients and comorbidity. The heterogeneous features of these patients would then affect the outcome of the trial. Conflicting results among randomized controlled trials can represent a spectrum of outcomes, based on different patient groups, more than bias or random variability. If a treatment is tested by a series of small trials with inclusion criteria for specific characteristics (including treatment history, subgroups and comorbidity), we may have a better knowledge of its indications and contraindications. Further, there is increasing need of expanding the content of customary clinical information, by including evaluation of variables such as stress, lifestyle, well-being, illness behavior and psychological symptoms. These joint strategies would actually constitute a paradigm shift in psychopharmacology and psychotherapy research.
Coull, Jennifer T
Functional Magnetic Resonance Imaging (fMRI) is an effective tool for identifying brain areas and networks implicated in human timing. But fMRI is not just a phrenological tool: by careful design, fMRI can be used to disentangle discrete components of a timing task and control for the underlying cognitive processes (e.g. sustained attention and WM updating) that are critical for estimating stimulus duration in the range of hundreds of milliseconds to seconds. Moreover, the use of parametric designs and correlational analyses allows us to better understand not just where, but also how, the brain processes temporal information. In addition, by combining fMRI with psychopharmacological manipulation, we can begin to uncover the complex relationship between cognition, neurochemistry and anatomy in the healthy human brain. This chapter provides an overview of some of the key findings in the functional imaging literature of both duration estimation and temporal prediction, and outlines techniques that can be used to allow timing-related activations to be interpreted more unambiguously. In our own studies, we have found that estimating event duration, whether that estimate is provided by a motor response or a perceptual discrimination, typically recruits basal ganglia, SMA and right inferior frontal cortex, and can be modulated by dopaminergic activity in these areas. By contrast, orienting attention to predictable moments in time in order to optimize behaviour, whether that is to speed motor responding or improve perceptual accuracy, recruits left inferior parietal cortex.
Kenemans, J Leon; Kähkönen, Seppo
This review surveys human event-related brain potential (ERP) and event-related magnetic field (ERF) approaches to psychopharmacology and psychopathology, and the way in which they complement behavioral studies and other neuroimaging modalities. The major paradigms involving ERP/ERF are P50 suppression, loudness-dependent auditory evoked potential (LDAEP), mismatch negativity (MMN), P300, mental chronometry, inhibitory control, and conflict processing (eg, error-related negativity (ERN)). Together these paradigms cover a range of more bottom-up driven to more top-down controlled processes. A number of relationships between the major neurotransmitter systems and electrocortical mechanisms are highlighted. These include the role of dopamine in conflict processing, and perceptual processing vs motor preparation; the role of serotonin in P50 suppression, LDAEP, and MMN; glutamate/NMDA and MMN; and the role of acetylcholine in P300 generation and memory-related processes. A preliminary taxonomy for these relationships is provided, which should be helpful in attuning possible new treatments or new applications of existing treatments to various disorders.
Font, Laura; Luján, Miguel Á.; Pastor, Raúl
Significant evidence implicates the endogenous opioid system (EOS) (opioid peptides and receptors) in the mechanisms underlying the psychopharmacological effects of ethanol. Ethanol modulates opioidergic signaling and function at different levels, including biosynthesis, release, and degradation of opioid peptides, as well as binding of endogenous ligands to opioid receptors. The role of β-endorphin and µ-opioid receptors (OR) have been suggested to be of particular importance in mediating some of the behavioral effects of ethanol, including psychomotor stimulation and sensitization, consumption and conditioned place preference (CPP). Ethanol increases the release of β-endorphin from the hypothalamic arcuate nucleus (NArc), which can modulate activity of other neurotransmitter systems such as mesolimbic dopamine (DA). The precise mechanism by which ethanol induces a release of β-endorphin, thereby inducing behavioral responses, remains to be elucidated. The present review summarizes accumulative data suggesting that the first metabolite of ethanol, the psychoactive compound acetaldehyde, could participate in such mechanism. Two lines of research involving acetaldehyde are reviewed: (1) implications of the formation of acetaldehyde in brain areas such as the NArc, with high expression of ethanol metabolizing enzymes and presence of cell bodies of endorphinic neurons and (2) the formation of condensation products between DA and acetaldehyde such as salsolinol, which exerts its actions via OR. PMID:23914161
Galanter, C A; Wasserman, G; Sloan, R P; Pine, D S
Developmental changes in the cardiovascular system could have an impact on risks associated with psychopharmacological interventions. Children may be more vulnerable to adverse cardiac events due to immaturity in autonomic control of the heart. These changes are incompletely understood and are characterized in this study. A consecutive series of 70 boys, aged 6-14 years, was recruited. Developmental variation in the autonomic nervous system was evaluated by assessing heart period variability (HPV), pulse, and blood pressure in response to orthostasis. Increased age correlated significantly with greater heart rate and diastolic blood pressure response to orthostasis. HPV at rest and in response to tilt did not significantly correlate with age. Boys with family histories of hypertension had a significantly greater blood pressure response to orthostasis. These findings suggest that developmental age-related changes in the sympathetic nervous system, as reflected by changes of pulse and blood pressure response to tilt, occur across this age range. Parasympathetic changes, as reflected by HPV, do not. In light of these findings, more research is needed on children's and adolescents' relative cardiac risk with psychotropic medications as opposed to adults'.
Yildiz, Mesut; Batmaz, Sedat; Songur, Emrah; Oral, Esat Timuçin
Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are still needed to evaluate the effectiveness of other treatment options, e.g., propranolol, melatonin, hypericum, etc. In addition to the above proposed treatments, patients with seasonal depressive symptoms should thoroughly be evaluated for any cues of bipolarity, and their treatment should be planned accordingly.
Nierenberg, Andrew A; Smoller, Jordan W; Eidelman, Polina; Wu, Yelena P; Tilley, Claire A
Systematic biases in decision-making have been well characterized in medical and nonmedical fields but mostly ignored in clinical psychopharmacology. The purpose of this paper is to sensitize clinicians who prescribe psychiatric drugs to the issues of the psychology of risk, especially as they pertain to the risk of side effects. Specifically, the present analysis focuses on heuristic organization and framing effects that create cognitive biases in medical practice. Our purpose is to increase the awareness of how pharmaceutical companies may influence physicians by framing the risk of medication side effects to favor their products.
Kafkafi, Neri; Yekutieli, Daniel; Elmer, Greg I
Data mining is a powerful bioinformatics strategy that has been successfully applied in vitro to screen for gene-expression profiles predicting toxicological or carcinogenic response ('class predictors'). In this report we used a data mining algorithm named Pattern Array (PA) in vivo to analyze mouse open-field behavior and characterize the psychopharmacological effects of three drug classes--psychomotor stimulant, opioid, and psychotomimetic. PA represents rodent movement with approximately 100,000 complex patterns, defined as multiple combinations of several ethologically relevant variables, and mines them for those that maximize any effect of interest, such as the difference between drug classes. We show that PA can discover behavioral predictors of all three drug classes, thus developing a reliable drug-classification scheme in small group sizes. The discovered predictors showed orderly dose dependency despite being explicitly mined only for class differences, with the high doses scoring 4-10 standard deviations from the vehicle group. Furthermore, these predictors correctly classified in a dose-dependent manner four 'unknown' drugs (ie that were not used in the training process), and scored a mixture of a psychomotor stimulant and an opioid as being intermediate between these two classes. The isolated behaviors were highly heritable (h(2)>50%) and replicable as determined in 10 inbred strains across three laboratories. PA can in principle be applied for mining behaviors predicting additional properties, such as within-class differences between drugs and within-drug dose-response, all of which can be measured automatically in a single session per animal in an open-field arena, suggesting a high potential as a tool in psychotherapeutic drug discovery.
Mohammad, Othman; Osser, David N
This new algorithm for the pharmacotherapy of acute mania was developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. The authors conducted a literature search in PubMed and reviewed key studies, other algorithms and guidelines, and their references. Treatments were prioritized considering three main considerations: (1) effectiveness in treating the current episode, (2) preventing potential relapses to depression, and (3) minimizing side effects over the short and long term. The algorithm presupposes that clinicians have made an accurate diagnosis, decided how to manage contributing medical causes (including substance misuse), discontinued antidepressants, and considered the patient's childbearing potential. We propose different algorithms for mixed and nonmixed mania. Patients with mixed mania may be treated first with a second-generation antipsychotic, of which the first choice is quetiapine because of its greater efficacy for depressive symptoms and episodes in bipolar disorder. Valproate and then either lithium or carbamazepine may be added. For nonmixed mania, lithium is the first-line recommendation. A second-generation antipsychotic can be added. Again, quetiapine is favored, but if quetiapine is unacceptable, risperidone is the next choice. Olanzapine is not considered a first-line treatment due to its long-term side effects, but it could be second-line. If the patient, whether mixed or nonmixed, is still refractory to the above medications, then depending on what has already been tried, consider carbamazepine, haloperidol, olanzapine, risperidone, and valproate first tier; aripiprazole, asenapine, and ziprasidone second tier; and clozapine third tier (because of its weaker evidence base and greater side effects). Electroconvulsive therapy may be considered at any point in the algorithm if the patient has a history of positive response or is intolerant of medications.
Hasler, F; Studerus, E; Lindner, K; Ludewig, S; Vollenweider, F X
Serotonin (5-HT) release is the primary pharmacological mechanism of 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') action in the primate brain. Dopamine release and direct stimulation of dopamine D2 and serotonin 5-HT2A receptors also contributes to the overall action of MDMA. The role of 5-HT1A receptors in the human psychopharmacology of MDMA, however, has not yet been elucidated. In order to reveal the consequences of manipulation at the 5-HT1A receptor system on cognitive and subjective effects of MDMA, a receptor blocking study using the mixed beta-adrenoreceptor blocker/5-HT1A antagonist pindolol was performed. Using a double-blind, placebo-controlled within-subject design, 15 healthy male subjects were examined under placebo (PL), 20 mg pindolol (PIN), MDMA (1.6 mg/kg b.wt.), MDMA following pre-treatment with pindolol (PIN-MDMA). Tasks from the Cambridge Neuropsychological Test Automated Battery were used for the assessment of cognitive performance. Psychometric questionnaires were applied to measure effects of treatment on core dimensions of Altered States of Consciousness, mood and state anxiety. Compared with PL, MDMA significantly impaired sustained attention and visual-spatial memory, but did not affect executive functions. Pre-treatment with PIN did not significantly alter MDMA-induced impairment of cognitive performance and only exerted a minor modulating effect on two psychometric scales affected by MDMA treatment ('positive derealization' and 'dreaminess'). Our findings suggest that MDMA differentially affects higher cognitive functions, but does not support the hypothesis from animal studies, that some of the MDMA effects are causally mediated through action at the 5-HT1A receptor system.
Bachmann, Christian J; Roessner, Veit; Glaeske, Gerd; Hoffmann, Falk
Data on medical treatment of children and adolescents with tic disorders are scarce. This study examined the administrative prevalence of psychopharmacological prescriptions in this patient group in Germany. Data of the largest German health insurance fund were analysed. In outpatients aged 0-19 years with diagnosed tic disorder, psychotropic prescriptions were evaluated for the years 2006 and 2011. In 2011, the percentage of psychotropic prescriptions was slightly higher than in 2006 (21.2 vs. 18.6%). The highest prescription prevalence was found in Tourette syndrome (51.5 and 53.0%, respectively). ADHD drugs were most frequently prescribed, followed by antipsychotics. In 2011, prescriptions of second generation antipsychotics (SGA) were higher and prescriptions of first generation antipsychotics (FGA) lower than in 2006. Concerning prescribed antipsychotic substances, in 2011 risperidone prescriptions were higher and tiapride prescriptions lower. Paediatricians issued 37.4%, and child and adolescent psychiatrists issued 37.1% of psychotropic prescriptions. The FGA/SGA ratio was highest in GPs (1.25) and lowest in child and adolescent psychiatrists (0.96). From 2006 to 2011, there was only a slight increase in psychotropic prescriptions for children and adolescents with a diagnosis of tic disorder in Germany, which stands in contrast towards the significant increase in psychotropic prescriptions in other child and adolescent psychiatric disorders (e.g. ADHD). There were marked differences in treatment patterns by tic disorder subgroups, with Tourette syndrome patients receiving most frequently psychopharmacotherapy. Risperidone prescriptions increased, probably reflecting a switch in prescribing practice towards up-to-date treatment guidelines. In primary care physicians, dissemination of current tic disorder treatment guidelines might constitute an important educational goal.
Aladeokin, Aderemi C; Umukoro, Solomon
The extract of the nut of Tetracarpidium conophorum (TC), commonly known as African walnut, is widely used to relieve pain, increase sperm count, enhance sexual performance in males and as a nerve tonic in ethnomedicine. This study describes the psychopharmacological properties of the aqueous extract of the nut of TC in mice. The spectrum of activities studied were the effects of TC on the duration of immobility in the forced swim test of the behavioural despair model of depression; prolongation of the duration of sleep produced by thiopentone; amphetamine-induced stereotyped behaviour; and on pain episodes produced by acetic acid and by formalin. Orally administered TC (50-200 mg/kg) produced a significant and dose-related decrease in the duration of immobility in the forced swim test in mice. TC also exhibited analgesic property, as shown by its ability to reduce the frequency of abdominal constrictions induced by acetic acid and to inhibit the nociceptive responses produced by formalin. However, at the tested oral doses of 50-200 mg/kg, TC did not prolong the duration of sleep produced by thiopentone nor alter the pattern of the stereotyped behaviour induced by amphetamine. This investigation provides evidence that may support the ethnomedicinal applications of the extract of the nut of TC in the treatment of pain. The study also revealed that TC seems to demonstrate antidepressant-like activity, as evidenced by its ability to shorten the period of immobility in the forced swim test; however, further studies are necessary to clearly define the role of TC in depression.
Baghdadli, A; Gonnier, V; Aussilloux, C
Autism is an early developmental disorder. It leads to severe and durable disturbances. Given this problem, no treatment can be excluded a priori. Thus, many approaches are used to deal with autistic disorders. In France, pharmacological treatments are, for instance, largely and mostly used in adults. In the USA, these treatments concern 50% of persons with autism of any age. Nevertheless, they are rarely based on controlled studies. At the present, however, prescriptions and expected effects appear to be hard to localize. Furthermore, only few controlled studies validate their use. Aim - We offer a review of studies about medical treatments used in adolescents and adults with autism. They are classified in 3 categories: the first (category I) includes drugs used for their neurochemical effects focusing on autistic signs. The second (category II) covers drugs used for treatment of behavioural disorders frequently associated with autism. The third (category III) corresponds to a wide range of drugs or vitamins for wich only few case studies exist reporting irregular positive effects. The main hypothesis of this review is that autism involves a dysfunction of the neuromediation systems. This hypothesis opens new perspectives in the research of medical treatments in autism by focusing on molecules, which are supposed to have an effect on neuromediation systems. Method - Our review is based on studies, which have been published during the past twenty years. For many studies, data are limited to adolescents and adults. So we expanded our review to data available in children. The data bases that we have used are medline and psyclit. Keywords have been chosen according to: pharmacological considerations (psychotropic, psychoactive drugs, psychopharmacology) and clinical symptoms (autism, automutilations, aggressive behavior, and hyperactivity). Hypothesis of a dysfunction in the neuromediation systems in autism - Many studies exist about biochemical abnormalities in
Alcohol abuse continues to be an issue of major concern for the health and well-being of college students. Estimates are that over 80% of college students are involved in the campus “alcohol culture.” Annually, close to 2000 students die in the United States due to alcohol-related accidents, with another 600,000 sustaining injury due to alcohol-related incidents (NIAAA, 2013). Students enrolled in a Psychopharmacology course engaged in action projects (community outreach) focused on alcohol abuse on our campus. Research has indicated that these types of projects can increase student engagement in course material and foster important skills, including working with peers and developing involvement in one’s community. This paper describes the structure and requirements of five student outreach projects and the final projects designed by the students, summarizes the grading and assessment of the projects, and discusses the rewards and challenges of incorporating such projects into a course. PMID:27385923
Goodwin, G M
The British Association for Psychopharmacology guidelines specify the scope and target of treatment for bipolar disorder. The second version, like the first, is based explicitly on the available evidence and presented, like previous Clinical Practice guidelines, as recommendations to aid clinical decision making for practitioners: they may also serve as a source of information for patients and carers. The recommendations are presented together with a more detailed but selective qualitative review of the available evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from participants and interested parties. The strength of supporting evidence was rated. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in treatment of episodes, relapse prevention and stopping treatment.
Alcohol abuse continues to be an issue of major concern for the health and well-being of college students. Estimates are that over 80% of college students are involved in the campus "alcohol culture." Annually, close to 2000 students die in the United States due to alcohol-related accidents, with another 600,000 sustaining injury due to alcohol-related incidents (NIAAA, 2013). Students enrolled in a Psychopharmacology course engaged in action projects (community outreach) focused on alcohol abuse on our campus. Research has indicated that these types of projects can increase student engagement in course material and foster important skills, including working with peers and developing involvement in one's community. This paper describes the structure and requirements of five student outreach projects and the final projects designed by the students, summarizes the grading and assessment of the projects, and discusses the rewards and challenges of incorporating such projects into a course.
Soderstrom, Ken; Gilbert, Marcoita T
Normal CNS development proceeds through late-postnatal stages of adolescent development. The activity-dependence of this development underscores the significance of CNS-active drug exposure prior to completion of brain maturation. Exogenous modulation of signaling important in regulating normal development is of particular concern. This mini-review presents a summary of the accumulated behavioral, physiological and biochemical evidence supporting such a key regulatory role for endocannabinoid signaling during late-postnatal CNS development. Our focus is on the data obtained using a unique zebra finch model of developmental psychopharmacology. This animal has allowed investigation of neuronal morphological effects essential to establishment and maintenance of neural circuitry, including processes related to synaptogenesis and dendritic spine dynamics. Altered neurophysiology that follows exogenous cannabinoid exposure during adolescent development has the potential to persistently alter cognition, learning and memory.
Barnes, Thomas R E
These guidelines from the British Association for Psychopharmacology address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting, involving experts in schizophrenia and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from the participants and interested parties, and cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. The practice recommendations presented are based on the available evidence to date, and seek to clarify which interventions are of proven benefit. It is hoped that the recommendations will help to inform clinical decision making for practitioners, and perhaps also serve as a source of information for patients and carers. They are accompanied by a more detailed qualitative review of the available evidence. The strength of supporting evidence for each recommendation is rated.
López-Muñoz, Francisco; Alamo, Cecilio; García-García, Pilar; Molina, Juan D; Rubio, Gabriel
German psychiatry and pharmacology both enjoyed an extraordinary international reputation prior to the promulgation of the Third Reich. However, with the triumph of eugenic ideas and the imposition of a "racial hygiene" policy by the Nazi regime, various organs of the German health system saw themselves involved in a perverse system of social control, in which the illicit use of psychopharmacological tools became customary. In the present work, we review, from the historical perspective, the factors that helped to bring about this situation and we analyze the abuses (known and documented) committed through the specific use of psychotropic drugs during the Nazi period. Among such abuses we can identify the following illegitimate activities: the use of psychoactive drugs, mainly sedatives from the barbiturates family, in the different euthanasia programmes implemented by the Nazi authorities, in police activity and various types of repression, and for purely criminal and extermination purposes within the so-called "Final Solution"; psychopharmacological research on the mentally ill, without the slightest ethical requirements or legal justification; and the use of psychotropic agents in research on healthy subjects, recruited from concentration camps. Finally, we refer to the role of poisonous nerve agents (tabun, sarin and soman) as instruments of chemical warfare and their development by the German authorities. Many of these activities, though possibly only a small portion of the total - given the destruction of a great deal of documentation just before the end of World War II - came to light through the famous Nuremberg Trials, as well as through other trials in which specific persons were brought to justice unilaterally by individual Allied nations or by the authorities of the new German government after the War.
Vitiello, Benedetto; Heiligenstein, John H; Riddle, Mark A; Greenhill, Laurence L; Fegert, Jörg M
Pediatric psychopharmacology research is undergoing a major expansion consequent to increasing use of psychotropic medications in children and recent legislative incentives to industry. In this rapidly changing context, the interface between publicly and privately funded research needs to be reconsidered to integrate activities and avoid unnecessary duplication of efforts. Once, by default, the almost exclusive domain of public research, child research is now increasingly funded by industry. There are, however, important issues unlikely to be addressed through private funding for which public support is needed, such as direct comparisons between active medications, between pharmacological and psychosocial interventions, or between combined and single treatment modalities; development of effective treatment strategies for patients unresponsive to first-line treatments; development of better research methods to assess efficacy and safety; identification of moderators and mechanisms of treatment response; and impact of treatment on illness course and prognosis. Industry-sponsored research is limited by the restricted access to proprietary databases, which impedes independent analyses and meta-analyses. Translation of basic neuroscience discoveries into treatment applications for children with mental illness is a critical area of inquiry that can benefit from integration of efforts and collaborations among academia, government, and industry.
Goodwin, G.M.; Haddad, P. M.; Ferrier, I.N.; Aronson, J.K.; Barnes, T.R.H.; Cipriani, A.; Coghill, D.R.; Fazel, S.; Geddes, J.R.; Grunze, H.; Holmes, E.A.; Howes, O.; Hudson, S.; Hunt, N.; Jones, I.; Macmillan, I.C.; McAllister-Williams, H.; Miklowitz, D.M.; Morriss, R.; Munafò, M.; Paton, C.; Saharkian, B.J.; Saunders, K.E.A.; Sinclair, J.M.A.; Taylor, D.; Vieta, E.; Young, A.H.
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines: in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change. PMID:26979387
Wilson, S J; Nutt, D J; Alford, C; Argyropoulos, S V; Baldwin, D S; Bateson, A N; Britton, T C; Crowe, C; Dijk, D-J; Espie, C A; Gringras, P; Hajak, G; Idzikowski, C; Krystal, A D; Nash, J R; Selsick, H; Sharpley, A L; Wade, A G
Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners. These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. Those invited to attend included BAP members, representative clinicians with a strong interest in sleep disorders and recognized experts and advocates in the field, including a representative from mainland Europe and the USA. Presenters were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomized controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aimed to reach consensus where the evidence and/or clinical experience was considered adequate or otherwise to flag the area as a direction for future research. A draft of the proceedings was then circulated to all participants for comment. Key subsequent publications were added by the writer and speakers at draft stage. All comments were incorporated as far as possible in the final document, which represents the views of all participants although the authors take final responsibility for the document.
Comai, Stefano; Tau, Michael; Pavlovic, Zoran; Gobbi, Gabriella
Patients experiencing mental disorders are at an elevated risk for developing aggressive behavior. In the past 10 years, the psychopharmacological treatment of aggression has changed dramatically owing to the introduction of atypical antipsychotics on the market and the increased use of anticonvulsants and lithium in the treatment of aggressive patients.This review (second of 2 parts) uses a translational medicine approach to examine the neurobiology of aggression, discussing the major neurotransmitter systems implicated in its pathogenesis (serotonin, glutamate, norepinephrine, dopamine, and γ-aminobutyric acid) and the neuropharmacological rationale for using atypical antipsychotics, anticonvulsants, and lithium in the therapeutics of aggressive behavior. A critical review of all clinical trials using atypical antipsychotics (aripiprazole, clozapine, loxapine, olanzapine, quetiapine, risperidone, ziprasidone, and amisulpride), anticonvulsants (topiramate, valproate, lamotrigine, and gabapentin), and lithium are presented. Given the complex, multifaceted nature of aggression, a multifunctional combined therapy, targeting different receptors, seems to be the best strategy for treating aggressive behavior. This therapeutic strategy is supported by translational studies and a few human studies, even if additional randomized, double-blind, clinical trials are needed to confirm the clinical efficacy of this framework.
Cleare, Anthony; Pariante, C M; Young, A H; Anderson, I M; Christmas, D; Cowen, P J; Dickens, C; Ferrier, I N; Geddes, J; Gilbody, S; Haddad, P M; Katona, C; Lewis, G; Malizia, A; McAllister-Williams, R H; Ramchandani, P; Scott, J; Taylor, D; Uher, R
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
Comai, Stefano; Gobbi, Gabriella
Background Melatonin (MLT) is a pleiotropic neurohormone controlling many physiological processes and whose dysfunction may contribute to several different diseases, such as neurodegenerative diseases, circadian and mood disorders, insomnia, type 2 diabetes and pain. Melatonin is synthesized by the pineal gland during the night and acts through 2 G-protein coupled receptors (GPCRs), MT1 (MEL1a) and MT2 (MEL1b). Although a bulk of research has examined the physiopathological effects of MLT, few studies have investigated the selective role played by MT1 and MT2 receptors. Here we have reviewed current knowledge about the implications of MT2 receptors in brain functions. Methods We searched PubMed, Web of Science, Scopus, Google Scholar and articles reference lists for studies on MT2 receptor ligands in sleep, anxiety, neuropsychiatric diseases and psychopharmacology, including genetic studies on the MTNR1B gene, which encodes the melatonin MT2 receptor. Results These studies demonstrate that MT2 receptors are involved in the pathophysiology and pharmacology of sleep disorders, anxiety, depression, Alzheimer disease and pain and that selective MT2 receptor agonists show hypnotic and anxiolytic properties. Limitations Studies examining the role of MT2 receptors in psychopharmacology are still limited. Conclusion The development of novel selective MT2 receptor ligands, together with further preclinical in vivo studies, may clarify the role of this receptor in brain function and psychopharmacology. The superfamily of GPCRs has proven to be among the most successful drug targets and, consequently, MT2 receptors have great potential for pioneer drug discovery in the treatment of mental diseases for which limited therapeutic targets are currently available. PMID:23971978
Bioque, Miquel; Llerena, Adrián; Cabrera, Bibiana; Mezquida, Gisela; Lobo, Antonio; González-Pinto, Ana; Díaz-Caneja, Covadonga M.; Corripio, Iluminada; Aguilar, Eduardo J.; Bulbena, Antoni; Castro-Fornieles, Josefina; Vieta, Eduard; Lafuente, Amàlia; Mas, Sergi; Parellada, Mara; Saiz-Ruiz, Jerónimo; Cuesta, Manuel J.
Background: The characterization of the first episode of psychosis and how it should be treated are principal issues in actual research. Realistic, naturalistic studies are necessary to represent the entire population of first episode of psychosis attended in daily practice. Methods: Sixteen participating centers from the PEPs project recruited 335 first episode of psychosis patients, aged 7 to 35 years. This article describes and discusses the psychopharmacological interventions and safety profiles at baseline and during a 60-day pharmacovigilance period. Results: The majority of first episode of psychosis patients received a second-generation antipsychotic (96.3%), orally (95%), and in adjusted doses according to the product specifications (87.2%). A total of 24% were receiving an antipsychotic polytherapy pattern at baseline, frequently associated with lower or higher doses of antipsychotics than the recommended ones. Eight patients were taking clozapine, all in monotherapy. Males received higher doses of antipsychotic (P=.043). A total of 5.2% of the patients were being treated with long-acting injectable antipsychotics; 12.2% of the patients received anticholinergic drugs, 12.2% antidepressants, and 13.7% mood stabilizers, while almost 40% received benzodiazepines; and 35.52% reported at least one adverse drug reaction during the pharmacovigilance period, more frequently associated with higher antipsychotic doses and antipsychotic polytherapy (85.2% vs 45.5%, P<.001). Conclusions: These data indicate that the overall pharmacologic prescription for treating a first episode of psychosis in Spain follows the clinical practice guideline recommendations, and, together with security issues, support future research of determinate pharmacological strategies for the treatment of early phases of psychosis, such as the role of clozapine, long-acting injectable antipsychotics, antipsychotic combination, and the use of benzodiazepines. PMID:26506856
Laughery, K.D.; Drews, C.
In time of war, the human operators of military systems may be exposed to harmful psychopharmacological agents. Certain pretreatment drugs are known to ward off the harmful effects of chemical agents, but these drugs have adverse side effects that may degrade a soldier's ability to perform an operation. This report describes the development of a task network modeling tool which is used to simulate the effect of drugs on human performance. This tool is a software package known as Micro SAINT. It runs on an IBM PC or compatible microcomputer. The construction of models is entirely menu-driven, and does not require knowledge of computer programming. This report contains recommended procedures for conducting simulation analysis. Micro SAINT is presently being used in over 55 government installations.
Stoops, William W; Sigmon, Stacey C; Evans, Suzette M
This is an introduction to the special issue "50th Anniversary of APA Division 28: The Past, Present, and Future of Psychopharmacology and Substance Abuse." Taken together, the scholarly contributions included in this special issue serve as a testament to the important work conducted by our colleagues over the past five decades. Division 28 and its members have advanced and disseminated knowledge on the behavioral effects of drugs, informed efforts to prevent and treat substance abuse, and influenced education and policy issues more generally. As past and current leaders of the division, we are excited to celebrate 50 years of Division 28 and look forward to many more successful decades for our division and its members. (PsycINFO Database Record
Bolea-Alamañac, Blanca; Nutt, David J; Adamou, Marios; Asherson, Phillip; Bazire, Stephen; Coghill, David; Heal, David; Müller, Ulrich; Nash, John; Santosh, Paramala; Sayal, Kapil; Sonuga-Barke, Edmund; Young, Susan J
Attention deficit hyperactivity disorder (ADHD) is a common condition with a high societal burden. The present guidelines summarise current literature, generating expert consensus recommendations for the treatment of ADHD in children and adults. These guidelines also provide a review of recent research in the fields of neuroimaging, neuropsychology and genetics of ADHD. Novel discoveries in these areas have informed physiological models for the disease. Since the publication of the previous British Association for Psychopharmacology guidelines in 2008, new drugs have been licensed and further compounds are being investigated. The publication of randomised controlled trials of psychological interventions has contributed to the range of treatment options for ADHD. As the disorder has been diagnosed more frequently there has been greater focus on comorbid conditions and how they impact treatment. Services have continued to develop for the treatment of ADHD in adults and care agreements have been introduced to facilitate access to treatment.
Howland, Robert H
This article describes several examples where the development of drugs and devices for use in psychiatry followed from initial serendipitous observations. The potential psychotropic properties of chlorpromazine (Thorazine(®)) were first noted in surgical patients when the drug was being investigated as a potentiator of anesthesia. Similar findings were noted with iproniazid (Marsilid(®)), developed for the treatment of tuberculosis, and the drug was later released for clinical use as an antidepressant agent. The development of meprobamate (Miltown(®)), an approved treatment for anxiety, evolved from initial efforts to find a chemical that would inhibit the enzymatic destruction of the antibiotic drug penicillin. The psychiatric uses of lamotrigine (Lamictal(®)) and vagus nerve stimulation were prompted by initial observations that epilepsy patients receiving these treatments had positive mood effects. Nurses should be familiar with the concept of serendipity, as they often are in the best position to observe, record, and report on unexpected clinical effects in patients taking any kind of prescription or nonprescription medication.
Proteins isolated from the brain and used as drugs can improve and apparently even transfer mental states and behavior. Much of the pioneering work and recent research with humans and animals is reviewed and crucial questions that are being posed about the psychologically active peptides are related. (BT)
Roerig, James L; Steffen, Kristine
Currently, it has been demonstrated that psychotropic drugs, particularly antidepressants, are frequently prescribed for patients who seek bariatric surgery. Many bariatric surgery patients have a history of a mood disorder. Unlike medications for diabetes, hypertension or hyperlipidemia, which are generally reduced and at times discontinued, postsurgery antidepressants use is only slightly reduced. The Roux-en-Y procedure is most frequently associated with alteration in drug exposure. Medication disintegration, dissolution, absorption, metabolism and excretion have been found to be altered in postbariatric patients, although data are sparse at this time. This paper will review the current evidence regarding the effect of bariatric surgery on drug treatment including mechanism of interference as well as the extent of changes identified to date. Data will be presented as controlled trials followed by case series and reports.
Semrud-Clikeman, Margaret; Pliszka, Steve R.
This review presents the most recent research concerning neuroimaging in developmental disabilities. Changes in structure and activation have been found in children with ADHD and learning disabilities, following intervention. For the children with learning disabilities changes in activation have been found following intensive behavioral and…
Abrams, Laura; Flood, Jillian; Phelps, LeAdelle
Psychotropic medications prescribed frequently to children and adolescents for the treatment of anxiety, depression, and attention deficit hyperactivity disorder are reviewed. Pediatric pharmacological options based on double-blind, randomized studies are examined. We advocate that psychotropic medications be used only in conjunction with…
Davis, W M; Wellwuff, H G; Garew, L; Kydd, O U
OBJECTIVE: To develop pharmacotherapies for the orphan disease lycanthropy through the pursuit of the etiologic hypothesis of a genetically determined hypersecretion of endogenous lycanthropogens. DESIGN: Quadruple-blind, Rubik's Cube matrix analysis. SETTING: Community practice and malpractice. PARTICIPANTS: Subjects selected from inbred Ruficolla populations in Mississippi, Georgia, North Carolina and Minnesota. All who entered the study finished it. INTERVENTIONS: Chemical screening of blood samples over a hypothesized secretory cycle of lycanthropogen peaking on the day of maximum lunar illumination. Administration of synthetic lycanthropogens for behavioural testing. Experimental lycosomatization through the illumination method of Kirschbaum. OUTCOME MEASURES: None were post hoc, but some are still in hock. MAIN RESULTS: Two putative lycanthropogens were isolated from the blood samples. Structural elucidation and synthesis permitted animal and clinical trials; in each of these, behavioural dysfunction was observed. Antilycanthropogen strategies included application of the principle of caged compounds and generation of a therapeutic immunoglobulin. The effects of a newly developed antihirsutic agent seemed promising. An interaction of the lycanthropogen-secretion system and ethanol was noted, which may explain behavioural aspects of alcoholism. CONCLUSIONS: The incidence of lycomania in North America is underestimated. Soon-to-be-available pharmacotherapies should promote its early detection and treatment. Full control may depend upon advances in gene therapy. PMID:1555146
Bullock, Kim; Koran, Lorrin
No standard treatment exists for the DSM-IV Impulse Control Disorders, Not Elsewhere Classified, including Compulsive Buying Disorder. This paper reviews the suggested pharmacotherapies for this disorder and their theoretical basis. McElroy et al. first reported benefit from antidepressant therapy in three cases of Compulsive Buying Disorder with comorbid depression and anxiety. In a retrospective chart review, McElroy's group reported on 20 patients that benefited from antidepressants, often in combination with mood stabilizers. Lejoyeux reported on two patients in whom treatment of a comorbid mood disorder led to remission of compulsive buying behavior. Black reported fluvoxamine to be effective in patients without comorbid major depression, suggesting that improvement was independent of the treatment of mood symptoms. Kim reported improvement with naltrexone, an opioid antagonist, in a case series. Two double-blind placebo-controlled trials found fluvoxamine no better than placebo; however, in both studies patients kept shopping logs, which may have confounded the results. An open-label trial of citalopram and a double-blind crossover trial which excluded shopping logs both reported positive results. Twelve-month follow-up data for the open-label group found that remission rates at quarterly time points were independent of continuing drug therapy. The data reviewed above suggest that pharmacologic interventions may be effective for compulsive buying disorder. Whether pharmacological treatment is superior to placebo and whether it is more, less or equally effective compared to psychotherapeutic interventions remains to be established.
Hartley, D.S. III
This report contains the results of a Direct Assistance Project performed by Lockheed Martin Energy Systems, Inc., for Dr. K. O. Jobson. The purpose of the project was to perform preliminary analysis of the data acquisition instruments used in the field of psychiatry, with the goal of identifying commonalities of data and strategies for handling and using the data in the most advantageous fashion. Data acquisition instruments from 12 sources were provided by Dr. Jobson. Several commonalities were identified and a potentially useful data strategy is reported here. Analysis of the information collected for utility in performing diagnoses is recommended. In addition, further work is recommended to refine the commonalities into a directly useful computer systems structure.
Tomasetti, Carmine; Iasevoli, Felice; Buonaguro, Elisabetta Filomena; De Berardis, Domenico; Fornaro, Michele; Fiengo, Annastasia Lucia Carmela; Martinotti, Giovanni; Orsolini, Laura; Valchera, Alessandro; Di Giannantonio, Massimo; de Bartolomeis, Andrea
Dopamine-glutamate interplay dysfunctions have been suggested as pathophysiological key determinants of major psychotic disorders, above all schizophrenia and mood disorders. For the most part, synaptic interactions between dopamine and glutamate signaling pathways take part in the postsynaptic density, a specialized ultrastructure localized under the membrane of glutamatergic excitatory synapses. Multiple proteins, with the role of adaptors, regulators, effectors, and scaffolds compose the postsynaptic density network. They form structural and functional crossroads where multiple signals, starting at membrane receptors, are received, elaborated, integrated, and routed to appropriate nuclear targets. Moreover, transductional pathways belonging to different receptors may be functionally interconnected through postsynaptic density molecules. Several studies have demonstrated that psychopharmacologic drugs may differentially affect the expression and function of postsynaptic genes and proteins, depending upon the peculiar receptor profile of each compound. Thus, through postsynaptic network modulation, these drugs may induce dopamine-glutamate synaptic remodeling, which is at the basis of their long-term physiologic effects. In this review, we will discuss the role of postsynaptic proteins in dopamine-glutamate signals integration, as well as the peculiar impact of different psychotropic drugs used in clinical practice on postsynaptic remodeling, thereby trying to point out the possible future molecular targets of “synapse-based” psychiatric therapeutic strategies. PMID:28085108
Bussing, Regina; Reid, Adam M.; McNamara, Joseph P.H.; Meyer, Johanna M.; Guzick, Andrew G.; Mason, Dana M.; Storch, Eric A.; Murphy, Tanya K.
Selective serotonin reuptake inhibitors (SSRIs) are an efficacious and effective treatment for pediatric obsessive-compulsive disorder (OCD) but have received scrutiny due to a potential side effect constellation called activation syndrome. While recent research introduced a subjective measure of activation syndrome, objective measures have not been tested. This pilot study, using data from a larger randomized-controlled trial, investigated the potential of actigraphy to provide an objective measure of activation symptoms in 44 youths with OCD beginning an SSRI medication regimen. Data were collected over the first four weeks of a multisite, parallel, double-blind, randomized, placebo controlled psychopharmacological treatment study and statistical modeling was utilized to test how activation syndrome severity predicts daily and nightly activity levels. Results indicated that youths with higher activation symptoms had lower daytime activity levels when treatment averages were analyzed; in contrast youths who experienced onset of activation symptoms one week were more likely to have higher daytime and night-time activity ratings that week. Results support actigraphy as a potential objective measure of activation symptoms. Subsequent studies are needed to confirm these findings and test clinical applications for use by clinicians to monitor activation syndrome during SSRI treatment. National Institutes of Health (5UO1 MH078594-01); NCT00382291. PMID:25535011
Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology.
Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; den Boer, Johan A; Christmas, David M; Davies, Simon; Fineberg, Naomi; Lidbetter, Nicky; Malizia, Andrea; McCrone, Paul; Nabarro, Daniel; O'Neill, Catherine; Scott, Jan; van der Wee, Nic; Wittchen, Hans-Ulrich
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.
The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts of categories, and then puts forward an integrative position that is based on cognitive-affective research. This position can in turn be used to consider the debate between pharmacological Calvinism (which may adopt a moral metaphor of disorder) and psychotropic utopianism (which may emphasize a medical metaphor of disorder). I argue that psychiatric treatment of serious psychiatric disorders is justified, and that psychotropics are an acceptable kind of intervention. The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values. PMID:22244084
Mohamed, Ahmed D.; Sahakian, Barbara J.
Pharmacological cognitive enhancers (PCEs) are used to improve cognitive functions, such as attention, learning, memory and planning in patients with impairments in cognition resulting from traumatic brain injury (TBI) or from neuropsychiatric disorders such as Alzheimer's disease (AD), mild cognitive impairment, schizophrenia, and attention deficit hyperactivity disorder (ADHD). Moreover, PCEs have been shown to improve cognition in healthy volunteers with no psychiatric disorders. This article describes the rationale behind the need for their use in neuropsychiatric patients and illustrates how PCEs can ameliorate cognitive impairments, improve quality of life and wellbeing, and therefore reduce the economic burden associated with these disorders. We also describe evidence that PCEs are being used as cognitive enhancers by healthy people. Crucially, as the lifestyle use of these drugs becomes very popular in the healthy population, a final aim is to present an overview of the current and future neuroethical considerations of enhancing the healthy brain. As information regarding their actual use, benefits and harms in various healthy populations is currently lacking, we propose research that aims to obtain relevant empirical data, monitor the short- and long-term effectiveness and side-effects, and initiate accurate surveys to determine current patterns and quantity of usage of PCE drugs by healthy people. Furthermore, in order to instigate a dialogue between neuroethics and neuropsychopharmacology, we urge scientists to explore and communicate the social and ethical implications of their research to the public. Finally, we discuss and highlight other means of enhancing cognition in both patients and healthy adults, including education and physical exercise. PMID:21396152
Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semistructured interview of schizophrenic and neurotic patients and methadone-substituted opiate addicts.
Teusch, L; Scherbaum, N; Böhme, H; Bender, S; Eschmann-Mehl, G; Gastpar, M
Little is known about sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. In the present study schizophrenic patients (n = 45, mostly under neuroleptic treatment), neurotic patients (n = 50, mostly treated without medication), methadone-substituted opiate addicts (n = 37), and normal controls (n = 41) were included. They were interviewed with the aid of a sex-differentiated semistructured questionnaire on sexual function. All the methadone-substituted opiate addicts and nearly all the schizophrenic patients suffered from dysfunctions in at least one criterion. The three clinical groups differed significantly from the controls in sexual interest, emotional arousal, physiological arousal (erectile function/vaginal lubrication), performance (ejaculatory function/vaginism, dyspareunia), and orgasm satisfaction. Characteristic patterns of dysfunction were found in the male patients. The schizophrenic patients had significantly more dysfunctions of interest, physiological arousal, performance, and orgasm than the controls. Emotional arousal, erectile and ejaculatory functions, and orgasm satisfaction were impaired more frequently in the male schizophrenics than in the neurotic patients. Reduced sexual interest, emotional arousal, and orgasm satisfaction were reported more frequently by the methadone-substituted opiate addicts than by the neurotic men. Emotional arousal was even more frequently reduced than in the schizophrenic men. There was no correlation between sexual dysfunction and particular neuroleptics or neuroleptic or methadone dosage. The results are compared with the literature and suggestions made for further investigations.
Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology.
Nutt, D J; Fone, K; Asherson, P; Bramble, D; Hill, P; Matthews, K; Morris, K A; Santosh, P; Sonuga-Barke, E; Taylor, E; Weiss, M; Young, S
Attention-deficit/hyperactivity disorder (ADHD) is an established diagnosis in children, associated with a large body of evidence on the benefits of treatment. Adolescents with ADHD are now leaving children's services often with no readily identifiable adult service to support them, which presents problems as local pharmacy regulations often preclude the prescription of stimulant drugs by general practitioners (GPs). In addition, adults with ADHD symptoms are now starting to present to primary care and psychiatry services requesting assessment and treatment. For these reasons, the British Association for Psychopharmacology (BAP) thought it timely to hold a consensus conference to review the body of evidence on childhood ADHD and the growing literature on ADHD in older age groups. Much of this initial guidance on managing ADHD in adolescents in transition and in adults is based on expert opinion derived from childhood evidence. We hope that, by the time these guidelines are updated, much evidence will be available to address the many directions for future research that are detailed here.
Neuroanatomical and psychopharmacological evidence for interaction between opioid and GABAergic neural pathways in the modulation of fear and defense elicited by electrical and chemical stimulation of the deep layers of the superior colliculus and dorsal periaqueductal gray matter.
Eichenberger, G C D; Ribeiro, S J; Osaki, M Y; Maruoka, R Y; Resende, G C C; Castellan-Baldan, L; Corrêa, S A L; Da Silva, L A; Coimbra, N C
The effects of central administration of opioid antagonists on the aversive responses elicited by electrical (at the freezing and escape thresholds) or chemical stimulation (crossings, rearings, turnings and jumps, induced by microinjections of bicuculline) of the midbrain tectum were determined. Central microinjections of naloxone and naltrexone in the mesencephalic tectum caused a significant increase in the freezing and escape thresholds elicited by electrical midbrain tectum stimulation. Furthermore, both opioid antagonists caused a significant decrease in the mean incidence of aversive behavioral responses induced by microinjections of bicuculline in the deep layers of the superior colliculus (DLSC) and in dorsal aspects of the periaqueductal gray matter (DPAG), as compared with controls. These findings suggest an opioid modulation of the GABAergic inhibitory inputs controlling the aversive behavior elicited by midbrain tectum stimulation. In fact, immunohistochemical evidence suggests that the dorsal mesencephalon is rich in beta-endorphin-containing neurons and fibers with varicosities. Iontophoretical microinjections of the neurotracer biodextran in the substantia nigra, pars reticulata (SNpr), show nigro-tectal pathways connecting SNpr with the same neural substrate of the DPAG rich in neuronal cells immunoreactive for opioid peptides. Labeled neurons of the DLSC and periaqueductal gray matter send inputs with varsicosities to ipsi- and contralateral DPAG and ipsilateral SNpr. These findings, in addition to the psychopharmacological evidence for the interaction between opioid and GABAergic mechanisms, offer a neuroanatomical basis of a possible presynaptic opioid inhibition of GABAergic nigro-tectal neurons modulating the fear in aversive structures of the cranial mesencephalon, in a short link, and maybe through a major neural circuit, also in GABA-containing perikarya of nigro-tectal neurons.
Schwartz, Thomas L.
In 1952, the Diagnostic and Statistical Manual of Mental Disorders (DSM) system of creating, validating, studying and employing a diagnostic system in clinical psychiatric practice was introduced. There have been several updates and revisions to this manual and, regardless of its a theoretical framework, it actually does have a framework and presupposition. Essentially the DSM dictates that all psychiatric disorders are syndromes, or a collection of symptoms that commonly occur together and impair psychosocial functioning. These syndromes allow for homogenous groups of patients to be studied and psychotherapies and pharmacotherapies to be developed. This editorial will examine the DSM system with regards to its applicability to central nervous system dysfunction where psychiatric disorders are concerned. Specifically, the brain does not follow categorical, or syndromal, constructs. In fact, the psychiatric patient likely inherits several risk genes that promote abnormal proteins along several neuropathways in the brain. These abnormalities create dysfunctional neurocircuits which create individual psychiatric symptoms, but not a categorical syndrome or diagnosis. The concept that the DSM may be excellent for clinical diagnostic purposes, but less correct in its assumptions for a psychopharmacologist's treatment approaches will be discussed. PMID:23678236
Baggott, Matthew J.; Childs, Emma; Hart, Amy B.; de Bruin, Eveline; Palmer, Abraham A.; Wilkinson, Joy E.; de Wit, Harriet
Background Theobromine, a methylxanthine related to caffeine and present in high levels in cocoa, may contribute to the appeal of chocolate. However, currently evidence for this is limited. Objectives We conducted a within-subjects placebo-controlled study of a wide range of oral theobromine doses (250, 500, and 1000 mg) using an active control dose of caffeine (200 mg) in 80 healthy participants. Results Caffeine had the expected effects on mood including feelings of alertness, and cardiovascular parameters. Theobromine responses differed according to dose: it showed limited subjective effects at 250 mg and negative mood effects at higher doses. It also dose-dependently increased heart rate. In secondary analyses we also examined individual differences in the drugs' effects in relation to genes related to their target receptors, but few associations were detected. Conclusions This study represents the highest dose of theobromine studied in humans. We conclude that theobromine at normal intake ranges may contribute to the positive effects of chocolate, but at higher intakes effects become negative. PMID:23420115
Novick, Andrew M
Antidepressant drugs are a mainstay in psychiatric treatment and have the ability to influence neural substrates related to social bonding and interaction. This article explores the potential neurobiological overlap between social attachment and antidepressant mechanisms and reviews work related to the effects of antidepressants on separation distress, social affiliation, dominance hierarchies, romantic love, and socio-emotional processing. It is proposed that similarities between antidepressant pharmacology and the neurobiological effects of an effective care-giver may help create a sense of safety that in turn promotes changes in behavior and mood.
Marazziti, Donatella; Presta, Silvio; Baroni, Stefano; Silvestri, Stefano; Dell'Osso, Liliana
Although addictive syndromes have been traditionally related to substance-use disorders, during the last few decades a novel addictive group, including the so-called "behavioral or no-drug addictions," has been recognized and has attracted increasing attention for its relevant social impact. This group includes pathological gambling, compulsive shopping, TV/Internet/social network/videogame addictions, workaholism, sex and relationship addictions, orthorexia, and overtraining syndrome. Substance and behavioral addictions show similar phenomenological features, such as craving, dependence, tolerance, and abstinence, and perhaps they share a common possible pathophysiology. It is, however, controversial whether all or at least some of them should be considered real disorders or just normal, albeit extreme, behaviors. The aim of this article is to review current data on pharmacological treatment of behavioral addictions. As no specific and validated treatment algorithms are currently available, only an improved knowledge on their psychopathological, clinical, and neurobiological features may have relevant implications for more focused preventive and therapeutic strategies.
Pilc, Andrzej; Wierońska, Joanna M; Skolnick, Phil
Over the past 20 years, converging lines of evidence have both linked glutamatergic dysfunction to the pathophysiology of depression and demonstrated that the glutamatergic synapse presents multiple targets for developing novel antidepressants. The robust antidepressant effects of the N-methyl-D-aspartate receptor antagonists ketamine and traxoprodil provide target validation for this family of ionotropic glutamate receptors. This article reviews the preclinical evidence that it may be possible to develop glutamate-based antidepressants by not only modulating ionotropic (N-methyl-D-aspartate and alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid) and metabotropic glutamate (mGlu) receptors, including mGlu2/3, mGLu5 and mGlu7 receptors, but also by altering synaptic concentrations of glutamate via specialized transporters such as glial glutamate transporter 1 (excitatory amino-acid transporter 2).
In 1967, select members of the American College of Neuropsychopharmacology (ACNP) met to discuss the future of the field. In their publication from this meeting, Psychotropic Drugs in the Year 2000, in 1971, the group imagined wild possibilities for chemical alteration of human behaviors and experience. These men thought that drugs could be used to solve social problems for all people. Not surprisingly, few of the predictions came true because the ACNP members could not have foreseen changes in American society and politics, a separation between street drugs and prescribed medications, and the increasing power of the pharmaceutical industry.
Roberts, Holly J.; Floress, Margaret T.; Ellis, Cynthia R.
The number of children taking psychotropic medications has dramatically increased in recent years. These children typically take medication during school hours, thereby making the school setting an optimal venue in which evaluate the effectiveness of medications. Given their training in data-based decision making, intervention, and assessment,…
Physicians are presented with great challenges when attempting to integrate information from multiple sources, often with conflicting recommendations, to meet the present and future needs of adolescents and the expectations of their families and caregivers. For this reason, this article attempts to outline a general strategy in assessment and use of information. General history of presenting symptoms, results of examination details, and additional history from family or other contexts lead to the development of a reasoned hypothesis. The working hypothesis is the basis for subsequent treatment. Revisiting the ongoing data, including response to therapeutic intervention, leads to revised hypotheses that provide the basis for the new treatment formulation. Patients and their families become informed self-advocates and partners in achieving improved outcomes.
Research papers and research summaries frequently present results in the form of data accompanied by 95% confidence intervals (CIs). Not all students and clinicians know how to interpret CIs. This article provides a nontechnical, nonmathematical discussion on how to understand and glean information from CIs; all explanations are accompanied by simple examples. A statistically accurate explanation about CIs is also provided. CIs are differentiated from standard deviations, standard errors, and confidence levels. The interpretation of narrow and wide CIs is discussed. Factors that influence the width of a CI are listed. Explanations are provided for how CIs can be used to assess statistical significance. The significance of overlapping and nonoverlapping CIs is considered. It is concluded that CIs are far more informative than, say, mere P values when drawing conclusions about a result.
Repetto, Martin J; Petitto, John M
Neuropsychiatric disorders and syndromes may be underdiagnosed and inadequately treated in individuals infected with HIV. Depression in particular is among the most prevalent diagnoses, and data from controlled clinical studies have shown that antidepressant medications are efficacious and safe for treating depression in HIV-infected persons. A significant shortcoming of this literature is that most of the available data are from studies conducted before the advent of highly active antiretroviral therapy. In addition, apart from antidepressant medications, controlled studies systematically assessing efficacy and safety issues for other classes of psychotropic drugs (e.g., antipsychotic and anxiolytic medications) in HIV-infected persons are lacking. This review summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of HIV. It includes a discussion of clinically relevant treatment considerations (e.g., side effects, drug-drug interactions) derived from the existing literature as well as judgments that clinicians face in the absence of research data. Despite some shortcomings of the existing literature, overall there is compelling evidence that the appropriate use of psychotropic medications (coupled with behavioral therapy) can improve the quality of life of mentally ill HIV-infected individuals.
Skolnick, M. R.
Theoretical and practical issues involved in integrating pharmacotherapy and psychosocial therapy in a long-term day hospital for schizophrenics are addressed. The limitations and risks of relying too heavily on a biomedical conceptual framework are discussed. In addition to diagnosis, target symptoms, pharmacodynamics, and pharmacokinetics, individual interpersonal, family, and institutional dynamics can exert profound effects on the effectiveness of medication. Through case illustrations it is shown how an open systems model and a group approach can allow for an integration of the many variables involved in the medication process. A weekly medication group which emphasizes education, informed choice, patient responsibility, and the examination of the boundary between medication effect and the need for psychological work is described. It is shown that the chemical control of psychosis alone may reinforce the psychosocial aspects of the schizophrenic syndrome. A distinction is drawn between chemical control of psychosis and the sensitive use of medication as a facilitator of growth-promoting psychosocial treatment. PMID:2864762
Gilligan, James; Lee, Bandy
Aggressive violence has been described as the greatest problem and the most frequent reason for referrals in child and adolescent psychiatry. In this country we have only partially emerged from an epidemic of violence that was really an epidemic of youth violence. Thus it is hardly surprising that psychiatrists are being asked more and more frequently whether psychiatric medications might help to diminish the toll from this behavioral plague. Medications are useful and appropriate for only a small minority of the people who commit serious violence. Even when they are indicated, they can never be the sole treatment modality, but should be supplemented by psychological and social therapies. When the violence is a byproduct or symptom of an underlying mental illness, treating that illness is generally the most effective method of preventing future violence on a long-term basis. However, most violence is not committed by those who are mentally ill, and most of the mentally ill never commit a serious act of violence. That is why many attempts have been made to discover whether there are drugs that diminish the symptom, violence, even when there is no underlying mental illness for which drugs would normally be prescribed. In fact there are several, and their indications and use are reviewed here. Different principles govern the acute short-term emergency treatment of a violent crisis and the long-term treatment of those who are chronically and repetitively violent, and these differences are also summarized here.
Siegel, S; Baptista, M A; Kim, J A; McDonald, R V; Weise-Kelly, L
The Pavlovian conditioning analysis of drug tolerance emphasizes that cues present at the time of drug administration become associated with drug-induced disturbances. These disturbances elicit unconditional responses that compensate for the pharmacological perturbation. The drug-compensatory responses eventually come to be elicited by drug-paired cues. These conditional compensatory responses (CCRs) mediate tolerance by counteracting the drug effect when the drug is administered in the presence of cues previously paired with the drug. If the usual predrug cues are presented in the absence the drug, the unopposed CCRs are evident as withdrawal symptoms. Recent findings elucidate intercellular and intracellular events mediating CCRs and indicate the importance of internal stimuli (pharmacological cues and interoceptive cues inherent in self-administration) to the acquisition of drug tolerance and the expression of withdrawal symptoms.
Forness, Steven R.; Kavale, Kenneth A.
Intended for teachers, the article provides an introduction to the four major classes of psychotropic medication (stimulants, tranquilizers, anticonvulsants, and antidepressants) commonly prescribed for children with learning or behavioral disorders. Specific effects on the classroom are addressed. (DB)
Strassman, R J
We generated dose-response data for the endogenous and ultra-short-acting hallucinogen, N,N-dimethyltryptamine (DMT), in a cohort of experienced hallucinogen users, measuring multiple biological and psychological outcome measures. Subjective responses were quantified with a new rating scale, the HRS, which provided better resolution of dose effects than did the biological variables. A tolerance study then was performed, in which volunteers received four closely spaced hallucinogenic doses of DMT. Subjective responses demonstrated no tolerance, while biological measures were inconsistently reduced over the course of the sessions. Thus, DMT remains unique among classic hallucinogens in its inability to induce tolerance to its psychological effects. To assess the role of the 5-HT1A site in mediating DMT's effects, a pindolol pre-treatment study was performed. Pindolol significantly increased psychological responses to DMT, suggesting a buffering effect of 5-HT1A agonism on 5-HT2-mediated psychedelic effects. These data are opposite to those described in lower animal models of hallucinogens' mechanisms of action.
Kubiszyn, Tom; Carlson, John S.; DeHay, Tamara
Evidence-based studies of drug, psychosocial and combined treatments for prepubertal internalizing disorders (depression, obsessive-compulsive disorder [OCD], and non-OCD anxiety) were reviewed. No age effects were found. Although no combined studies met evidence-based criteria, efficacious and possibly efficacious psychosocial and pharmacological…
Gadow, Kenneth D.
Notes that psychopharmacologists have made considerable strides in establishing safety and efficacy of psychotropic drug therapy for childhood behavior disorders. Discusses controversy pertaining to appropriateness of medication or inadequacies of clinical management. Presents brief overview of the safety and efficacy of psychotropic drugs and the…
Safren, Steven A.; Duran, Petra; Yovel, Iftah; Perlman, Carol A.; Sprich, Susan
Objective: One of the potential causes of residual symptoms of ADHD in adults can be difficulties with consistent adherence to medications. Method: This formative study examined self-reported medication adherence in adults with ADHD with clinically significant symptoms despite medication treatment. Results: Mean adherence for the two-week period…
Khalil, Rami Bou
Specific phobias are among the most frequently diagnosed disorders in community with a twelve-month prevalence of 8.7% and a lifetime prevalence of 12.5%. Exposure-based therapies constitute the most effective treatment for this type of anxiety disorders. However, pharmacotherapies can still be considered for patients suffering from specific phobias in case they were non-adherent or resistant to exposure-based therapies or in case this kind of therapies was not accessible for them. Few data support the use of antidepressant in the treatment of specific phobias. A literature search via MedLine has been done in order to review all available studies in the domain of non-antidepressant pharmacotherapy of specific phobias. The importance of benzodiazepines such as diazepam, alprazolam and midazolam resides in the short-term reduction of subjective self-reported fear during the exposure to the feared object or situation. General anesthesia for the treatment of dental phobia does not seem to be efficient unless conducted with the inhalation anesthetic nitrous oxide which seems to be efficient on the short and on the long-term. Beta-adrenergic antagonists have been essayed with conflicting results. Cognitive enhancers such as D-cycloserine, glucocorticoids and yohimbine hydrochloride, seem to be more effective than placebo after a short term period of follow-up in treating specific phobia sympotms. In conclusion, promising efficient pharmacotherapies for specific phobias consists of drugs that enhance the efficacy of exposure-based therapies sessions by reducing anticipating phobia-related fear and/or by enhancing cognition during these sessions.
Mula, Marco; Cavanna, Andrea E; Monaco, Francesco
Topiramate (TPM) is one of the novel antiepileptic drugs and exhibits a wide range of mechanisms of action. Efficacy of TPM has been demonstrated in partial-onset seizures and primary generalized seizures in adults and children, as both monotherapy and adjunctive therapy. More recently, TPM has been proposed as an add-on treatment for patients with lithium-resistant bipolar disorder, especially those displaying rapid-cycling and mixed states. This paper reviews the multiple mechanisms of action and the tolerability profile of TPM in the light of its therapeutic potential in affective disorders. Studies of TPM in bipolar disorder are evaluated, and the efficacy and tolerability issues as a mood stabilizing agent are discussed. PMID:19412496
In mental health settings, human service education students may participate in the administration, recording, and monitoring of prescribed psychoactive medications. This paper reviews three common groups of psychiatric medications, focusing on clinical applications, central effects, and how human service education students can assist in their safe…
Mithoefer, Michael C; Grob, Charles S; Brewerton, Timothy D
4-phosphorloxy-N,N-dimethyltryptamine (psilocybin) and methylenedioxymethamfetamine (MDMA), best known for their illegal use as psychedelic drugs, are showing promise as therapeutics in a resurgence of clinical research during the past 10 years. Psilocybin is being tested for alcoholism, smoking cessation, and in patients with advanced cancer with anxiety. MDMA is showing encouraging results as a treatment for refractory post-traumatic stress disorder, social anxiety in autistic adults, and anxiety associated with a life-threatening illness. Both drugs are studied as adjuncts or catalysts to psychotherapy, rather than as stand-alone drug treatments. This model of drug-assisted psychotherapy is a possible alternative to existing pharmacological and psychological treatments in psychiatry. Further research is needed to fully assess the potential of these compounds in the management of these common disorders that are difficult to treat with existing methods.
Gold, Ian; Olin, Lauren
Despite the remarkably widespread use of the new generation of antidepressants, almost everything we know about their effects comes from animal studies and clinical trials in which the sole parameter of interest is depressive symptomatology. Almost nothing is known about the effects that antidepressants have on cognition, affect, or motivation when used over a period of months or years. Nor do we understand what effects, if any, antidepressants have on what we think of as the self. In this article, we argue that neither psychiatry nor philosophy, in their current state, are well equipped to think about these issues. In order to explore this idea, we consider the neurobiology of romantic love and its relation to antidepressant neurochemistry. This case study, we suggest, supports the view that antidepressants are very likely to have significant effects on personhood as well as the suggestion that we are in need of new ways of thinking about the self and its pathologies.
McIntosh, David E.; Trotter, Jeffrey S.
Although published research continues to advocate medication as the first line of treatment for early onset bipolar spectrum disorder (EOBSD; N. Lofthouse & M.A. Fristad, 2004), preliminary research demonstrating the utility of cognitive, cognitive-behavioral, and psychoeducational therapies is promising. It appears as if future treatment of EOBSD…
Bipolar disorder is associated with subtle neuroanatomical deficits including lateral ventricular enlargement, grey matter deficits incorporating limbic system structures, and distributed white matter pathophysiology. Substantial heterogeneity has been identified by structural neuroimaging studies to date and differential psychotropic medication use is potentially a substantial contributor to this. This selective review of structural neuroimaging and diffusion tensor imaging studies considers evidence that lithium, mood stabilisers, antipsychotic medication and antidepressant medications are associated with neuroanatomical variation. Most studies are negative and suffer from methodological weaknesses in terms of directly assessing medication effects on neuroanatomy, since they commonly comprise posthoc assessments of medication associations with neuroimaging metrics in small heterogenous patient groups. However the studies which report positive findings tend to form a relatively consistent picture whereby lithium and antiepileptic mood stabiliser use is associated with increased regional grey matter volume, especially in limbic structures. These findings are further supported by the more methodologically robust studies which include large numbers of patients or repeated intra-individual scanning in longitudinal designs. Some similar findings of an apparently ameliorative effect of lithium on white matter microstructure are also emerging. There is less support for an effect of antipsychotic or antidepressant medication on brain structure in bipolar disorder, but these studies are further limited by methodological difficulties. In general the literature to date supports a normalising effect of lithium and mood stabilisers on brain structure in bipolar disorder, which is consistent with the neuroprotective characteristics of these medications identified by preclinical studies. PMID:26412064
Many women with psychiatric disorders want to become mothers and only a minority seek advise prior to becoming pregnant. In those women, in whom pregnancy can be planned, the decision, if a medication is required for stabilisation and which one to choose if this is the case, is easier to make than in women in whom pregnancy occurs unplanned. The physician has to weigh the risk that a relapse of the psychiatric disorder during pregnancy poses to the foetus against the reproductive risk of psychotropic drugs. This presentation is intended to assist in understanding the general principles of pharmacotherapy during pregnancy as well as the morphological, perinatal and neurobehavioural toxicity of antidepressants, antipsychotics, benzodiazepines and mood stabilisers.
Parens, Erik; Johnston, Josephine
The number of children in the US taking prescription drugs for emotional and behavioral disturbances is growing dramatically. This growth in the use of psychotropic drugs in pediatric populations has given rise to multiple controversies, ranging from concerns over off-label use and long-term safety to debates about the societal value and cultural meaning of pharmacological treatment of childhood behavioral and emotional disorders. This commentary summarizes the authors' eight main findings from the first of five workshops that seek to understand and produce descriptions of these controversies. The workshop series is convened by The Hastings Center, a bioethics research institute located in Garrison, New York, U.S.A. PMID:18261228
Berry-Kravis, Elizabeth; Potanos, Kristina
In addition to cognitive disability, fragile X syndrome (FXS) is associated with behavioral problems that are often functionally limiting. There are few controlled trials to guide treatment; however, available information does suggest that medications can be quite helpful for a number of categories of behavioral disturbance in FXS. Specifically,…
Miczek, Klaus A; de Wit, Harriet
We introduce below several principles that recur in the discussion of translating preclinical findings to clinical applications, and conversely, developing animal models of human disorders: 1. The translation of preclinical data to clinical concerns is more successful when the scope of experimental models is restricted to a core symptom of a psychiatric disorder. 2. Preclinical experimental models gain in clinical relevance if they incorporate conditions that induce maladaptive behavioral or physiological changes that have some correspondence with species-normative behavioral adaptations. 3. Preclinical data are more readily translated to the clinical situation when they are based on converging evidence from several experimental procedures, each capturing cardinal features of the disorder. 4. The more closely a model approximates significant clinical symptoms, the more likely it is to generate data that will yield clinical benefits. 5. The choice of environmental, genetic, and/or physiological manipulations that induce a cardinal symptom or cluster of behavioral symptoms reveals the theoretical approach used to construct the model. 6. Preclinical experimental preparations that are validated by predicting treatment success with a prototypic agent are only able to detect alternative treatments that are based on the same mechanism as the existing treatment that was used to validate the screen. 7. The degree to which an experimental model fulfills the criteria of high construct validity relative to face or predictive validity depends on the purpose of the model. 8. Psychological processes pertinent to affect and cognition can only be studied in preclinical models if they are defined in behavioral and neural terms.
Handen, Benjamin L.; Gilchrist, Richard
Background: The use of psychotropic medication to treat children and adults with mental retardation (MR) has a long and extensive history. There are no identified medications to address specific cognitive deficits among persons with MR. Instead, psychotropic medications are used to treat specific behavioral symptoms and/or psychiatric syndromes.…
Riddle, Mark A; dosReis, Susan; Reeves, Gloria M; Wissow, Lawrence S; Pruitt, David B; Foy, Jane Meschan
In a 2009 policy statement focused on children's mental health, the American Academy of Pediatrics recommended that pediatric primary care physicians achieve competence in initiating care for children with attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, and substance use/abuse. Because treatment for 3 of these conditions--ADHD, anxiety, and depression--may, under certain conditions, include medication, the primary purpose of this article is to offer guidance to assist primary care physicians in decision-making about their use of psychotropic medications for these conditions. A few medications with proven efficacy and safety are emphasized. Secondarily, other medications that may be useful for other disorders are noted.
Vázquez, Gustavo H
Clinical psychiatric evaluations of patients have changed dramatically in recent decades. Both initial assessments and follow-up visits have become brief and superficial, focused on searching for categorical diagnostic criteria from checklists, with limited inquiry into patient-reported symptomatic status and tolerability of treatments. The virtually exclusive therapeutic task has become selecting a plausible psychotropic, usually based on expert consensus guidelines. These guidelines and practice patterns rest mainly on published monotherapy trials that may or may not be applicable to particular patients but are having a profound impact, not only on modern psychiatric practice but also on psychiatric education, research, and theory.
Khanzode, Leena A.; Saxena, Kirti; Kraemer, Helena; Chang, Kiki; Steiner, Hans
Little is known about how deeply medication treatment penetrates different levels of the mind/brain system. Psychopathology consists of relatively simple constructs (e.g., anger, irritability), or complex ones (e.g., responsibility). This study examines the efficacy of a specific compound, divalproex sodium (DVPX), on the various levels of…
Gebicke-Haerter, Peter J
The multifactorial origin of most chronic disorders of the brain, including schizophrenia, has been well accepted. Consequently, pharmacotherapy would require multi-targeted strategies. This contrasts to the majority of drug therapies used until now, addressing more or less specifically only one target molecule. Nevertheless, quite some searches for multiple molecular targets specific for mental disorders have been undertaken. For example, genome-wide association studies have been conducted to discover new target genes of disease. Unfortunately, these attempts have not fulfilled the great hopes they have started with. Polypharmacology and network pharmacology approaches of drug treatment endeavor to abandon the one-drug one-target thinking. To this end, most approaches set out to investigate network topologies searching for modules, endowed with “important” nodes, such as “hubs” or “bottlenecks”, encompassing features of disease networks, and being useful as tentative targets of drug therapies. This kind of research appears to be very promising. However, blocking or inhibiting “important” targets may easily result in destruction of network integrity. Therefore, it is suggested here to study functions of nodes with lower centrality for more subtle impact on network behavior. Targeting multiple nodes with low impact on network integrity by drugs with multiple activities (“dirty drugs”) or by several drugs, simultaneously, avoids to disrupt network integrity and may reset deviant dynamics of disease. Natural products typically display multi target functions and therefore could help to identify useful biological targets. Hence, future efforts should consider to combine drug-target networks with target-disease networks using mathematical (graph theoretical) tools, which could help to develop new therapeutic strategies in long-term psychiatric disorders. PMID:27014599
Raz, Sivan; Berger, Barry D
Environmental and situational factors are important determinants of recreational drug use in humans. We aimed to develop a reliable animal model for studying the effects of environmental variables on drug-seeking behavior using the 'social isolation/social restriction' paradigm. Adult Wistar rats housed in short-term isolation (21 days) consumed significantly more morphine solution (0.5 mg/ml) than rats living in pairs, both in one-bottle and in two-bottle tests. No differences were found in their water consumption. This effect was observed in both males and females and the results were also replicated after reversal of housing conditions. We also found that as little as 60-min of daily social-physical interaction with another rat was sufficient to completely abolish the increase in morphine consumption in socially restricted animals. We discuss some possible interpretations for these effects. These results indicate that environmental and situational factors influence drug intake in laboratory rats as they do in humans, and thus may be of interest in studying drug-seeking behavior in humans.
Santosh, Paramala; Parker, Jennifer Ruth; Jones, Lynn
The present report illustrates successful use of psychotropic medication targeted at symptom clusters of behavioural disturbance in a 7-year-old girl with Sanfilippo syndrome, a mucopolysaccharidosis. By identifying and targeting symptom clusters, psychotropic medication was prescribed with significant results. This approach to treatment of behavioural disturbance in Sanfilippo syndrome has not been previously described to our knowledge. Caution with regards side effects and interaction of medication is advised.
Sramek, John J; Murphy, Michael F; Cutler, Neal R
Although a number of studies have observed that females respond better to serotonergic antidepressants than males and that postmenopausal females have a diminished response to antidepressants compared with younger females, there are also studies that conflict with both of these findings, making any generalizations regarding sex differences difficult to make. Sex variance in antidepressant efficacy and pharmacokinetics profiles have been attributed to sex-based physiological differences, behavioral differences, related disorders, and sex-specific conditions, including pregnancy and menopause. This paper will review the history and current research on sex effects of antidepressant treatment.
Stanishevskaya, A. V.; Mezentseva, L. N.
Experiments staged on rats demonstrated that the formation of pathological states caused by stress and accompanied by the development of ulcerative lesion of the gastric mucosa are associated with the degree of the catecholamines level drop in the mesencephalon and hypothalamus. The application of seduxen and also of combinations consisting of L-DOPA with seduxen, or with an L-adrenoblocking agent pyroxan tends to reduce the frequency of developing alcerative lesions of the stomach. The protective effect produced by the combination of L-DOPA with an L-adrenoblocking agent pyroxan is barred by an additional administration of an B-adrenoblocking agent, inderal.
Sramek, John J.; Murphy, Michael F.; Cutler, Neal R.
Although a number of studies have observed that females respond better to serotonergic antidepressants than males and that postmenopausal females have a diminished response to antidepressants compared with younger females, there are also studies that conflict with both of these findings, making any generalizations regarding sex differences difficult to make. Sex variance in antidepressant efficacy and pharmacokinetics profiles have been attributed to sex-based physiological differences, behavioral differences, related disorders, and sex-specific conditions, including pregnancy and menopause. This paper will review the history and current research on sex effects of antidepressant treatment. PMID:28179816
Golmirzaei, Javad; Mahboobi, Hamidreza; Yazdanparast, Maryam; Mushtaq, Gohar; Kamal, Mohammad A; Hamzei, Enayatollah
Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children which manifests with hyperactivity, impulsivity, and/or inattention. Several drugs are used in treatment of ADHD. Stimulants, atomoxetine, anti-depressants, and bupropion are common medications used in the treatment of ADHD. Stimulants are widely used as the first line treatment in children with ADHD. Their mechanism of action is the release of dopamine and norepinephrine in central nervous system. Methylphenidate is the most common stimulant used for the treatment of ADHD. Methylphenidate significantly reduces ADHD symptoms in children both at home and school and improves their social skills. Methylphenidate is safe in healthy children and has shown to have no cardiac side effects in these patients. Other medications include: Atomoxetine, Amphetamines, Clonidine, Melatonin, and anti-depressants. Effects, side effects, and mechanism of action these drugs have been discussed in this paper.
March, John; Kratochvil, Christopher; Clarke, Gregory; Beardslee, William; Derivan, Albert; Emslie, Graham; Green, Evelyn P.; Heiligenstein, John; Hinshaw, Stephen; Hoagwood, Kimberly; Jensen, Peter; Lavori, Philip; Leonard, Henrietta; McNulty, James; Michaels, M. Alex; Mossholder, Andrew; Osher, Trina; Petti, Theodore; Prentice, Ernest; Vitiello, Benedetto; Wells, Karen
Objective: The use of placebo in the pediatric age group has come under increasing scrutiny. At the 2002 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, the Academy's Workgroup on Research conducted a research forum. The purpose was to identify challenges and their solutions regarding the use of placebo in randomized…
Einat, Haim; George, Angela
Objective: Psychiatric care in many rural communities has been demonstrated to be less adequate compared with urban environments partially because of attitudes and stigmatization issues. Educated pharmacists with professional attitudes can have a major impact in helping mental health patients receive more accurate diagnostic assessments and safe…
Bishop, Andrew C.
A six-point program of diagnostic inquiry and treatment strategy for individuals with behavior disorders in addition to severe or profound mental retardation is presented, which allows alternate etiological hypotheses to be tested in a clinical setting. This format is intended to unify psychopharmacy practice in mental retardation and in general…
Patients with schizophrenia have increased prevalence rates for many cardiometabolic risk factors; the prevalence and severity of these risks increase after the institution of antipsychotic medication. Nearly 2 dozen different pharmacologic interventions have been trialed to prevent or attenuate antipsychotic-related cardiometabolic changes. Metformin (usually 1,000-1,500 mg/d) has emerged as the best-studied intervention; in short- and intermediate-duration randomized controlled trials, it has been shown to bring about improvements in weight and other anthropometric indices, in fasting sugar and other glycemic control indices, and in total cholesterol and other lipid metabolism indices. Topiramate and aripiprazole are other possible interventions with support in literature; besides improving metabolic outcomes, these drugs may improve indices of psychopathology, as well. Encouraging though the findings are, there are many unanswered questions that require attention in future research.
Tobin, Thomas J; Tobin, Mary L
Similar names between two unrelated drugs have led the FDA to issue warnings about and now approve a name change for vortioxetine, which was branded as Brintellix® until recently. While the trade name had been screened prior to the product's launch, the FDA received numerous reports of prescribing and dispensing errors, specifically with regard to the anti-coagulant drug Brilinta® (ticagrelor). Starting 1 June 2016, vortioxetine will be marketed under the name Trintellix™ in an effort to reduce confusion. Clinicians are advised that while the name and National Drug Code number with this product will change, it will retain the same formulation, indication, and dosage information. To the extent possible, clinicians can and should take actions to identify and reduce potential medication errors in prescriptions, especially when using electronic records and e-prescription systems.
Noggle, Chad A.
The number of children and adolescents using prescription medications is continually climbing. The preceding articles have offered discussions on a multitude of areas within this subject matter. This article will serve to summarize some of those points raised with particular emphasis on where we go from here in terms of training and professional…
Davis, Michael C; Horan, William P; Marder, Stephen R
The past decade has witnessed a resurgence of interest in the development of novel pharmacological agents to treat the negative symptoms of schizophrenia. This review provides an overview of pharmacological approaches that have been evaluated as potential treatments and describes the emergence of several promising new approaches. First, we briefly describe recent methodological developments, including consensus-based clinical trial guidelines for patient selection criteria, symptom assessment, and trial duration. Next, we overview mono- and adjunctive-therapies that have been evaluated, including first- and second-generation antipsychotics, antidepressants, psychostimulants, molecules targeting cholinergic and glutamatergic systems, and hormones. We highlight the most promising pharmacological agents on the horizon, including glycine transporter-1 inhibitors, α7-nicotinic receptor positive allosteric modulators, and oxytocin, as well as non-pharmacological electromagnetic stimulation approaches. Further investigations, using optimal clinical trial design, hold considerable promise for discovering effective treatments for these functionally disabling symptoms in the near future.
Pharmacological treatment of acute anxiety still relies on benzodiazepines, while chronic anxiety disorders and depression are treated with different antidepressants, according to specific indications. The monoaminergic axis is represented by two families which are being developed: (i) serotonin-norepinephrine-dopamine reuptake inhibitors (SNDRI), also called triple reuptake inhibitors (TRI), for the treatment of depression (amitifadine), (ii) multimodal antidepressants for depression and anxiety disorders (generalized anxiety disorder mainly) (tedatioxetine, vortioxetine and vilazodone). Third-generation antipsychotics (aripiprazole, lurasidone, brexpiprazole, cariprazine) appear relevant in the treatment of resistant depression and some anxiety disorders. Among the modulators of the glutamatergic axis, promising compounds include: (i) ionotropic regulators of NMDA receptors: esketamine, AVP-923 and AVP-786, CERC-301, rapastinel (Glyx-13), NRX-1074 developed for depression, rapastinel and bitopertine developed for obsessive compulsive disorder, (ii) metabotropic glutamate receptors modulators: decoglurant and basimglurant developed for depression and mavoglurant developed for obsessive compulsive disorder.
Muthukumaraswamy, Suresh D
Magnetoencephalography (MEG) is a neuroimaging technique that allows direct measurement of the magnetic fields generated by synchronised ionic neural currents in the brain with moderately good spatial resolution and high temporal resolution. Because chemical neuromodulation can cause changes in neuronal processing on the millisecond time-scale, the combination of MEG with pharmacological interventions (pharmaco-MEG) is a powerful tool for measuring the effects of experimental modulations of neurotransmission in the living human brain. Importantly, pharmaco-MEG can be used in both healthy humans to understand normal brain function and in patients to understand brain pathologies and drug-treatment effects. In this paper, the physiological and technical basis of pharmaco-MEG is introduced and contrasted with other pharmacological neuroimaging techniques. Ongoing developments in MEG analysis techniques such as source-localisation, functional and effective connectivity analyses, which have allowed for more powerful inferences to be made with recent pharmaco-MEG data, are described. Studies which have utilised pharmaco-MEG across a range of neurotransmitter systems (GABA, glutamate, acetylcholine, dopamine and serotonin) are reviewed.
El-Alfy, Abir; Wilson, Lisa; ElSohly, Mahmoud A.; Abourashed, Ehab A.
Ethnopharmacological relevance Nutmeg, the seeds of Myritica fragrans (family Myristicaceae), is a well known kitchen spice with a long-standing reputation as a psychoactive herb. Nutmeg at high doses is considered a cheap substitute to several drugs of abuse. Earlier reports have attributed amphetamine-like activities to nutmeg. Aim of the study To characterize the neuropharmacological effects of different nutmeg extracts, administered orally and intraperitoneally, in comparison to Δ9-terahydrocannabinol, amphetamine, and morphine. Materials and methods Methanolic (ME), dichloromethane (DE), and hexane (HE) extracts were obtained from a chromatographically fingerprinted batch of nutmeg. Biological evaluation was conducted in sets of 6–8 mice in the tetrad assay at doses ranging from 100–500 and 500–1000 mg/kg for i.p. and oral administration, respectively. Results While oral administration of all the nutmeg extracts at 500 mg/kg caused a significant increase in locomotor activity, the i.p. administration of DE showed significant reduction in rectal temperature along with a significant increase in tail flick latency at 300 mg/kg. A significant decrease in core body temperature was observed with HE at 100 mg/kg, while higher doses caused significant increases in hot plate latency. Conclusion Different behavioral effects were observed that varied by the type of extract as well as by the route of administration. PMID:19703539
Placebo response theory and set and setting theory are two fields which examine how non-biological factors shape the response to therapy. Both consider factors such as expectancy, preparation and beliefs to be crucial for understanding the extra-pharmacological processes which shape the response to drugs. Yet there are also fundamental differences between the two theories. Set and setting concerns itself with response to psychoactive drugs only; placebo theory relates to all therapeutic interventions. Placebo theory is aimed at medical professionals; set and setting theory is aimed at professionals and drug users alike. Placebo theory is primarily descriptive, describing how placebo acts; set and setting theory is primarily prescriptive, educating therapists and users on how to control and optimize the effects of drugs. This paper examines how placebo theory and set and setting theory can complement and benefit each other, broadening our understanding of how non-biological factors shape response to drugs and other treatment interventions.
The multidisciplinary research on Salvia divinorum and its chemical principles is analyzed concerning whether the ethnobotany, phytochemistry, mental effects, and neuropharmacology of this sacred psychoactive plant and main principle clarify its experienced effects and divinatory uses. The scientific pursuit spans from the traditional practices, continues with the botanical identification, isolation of active molecules, characterization of mental and neural effects, possible therapeutic applications, and impinges upon the mind-body problem. The departure point is ethnopharmacology and therefore the traditional beliefs, ritual uses, and mental effects of this Mazatec sacred mint recorded during a 1973- 1983 field research project are described. A water potion of crushed leaves produced short-lasting light-headedness, dysphoria, tactile and proprioceptive sensations, a sense of depersonalization, amplified sound perception, and an increase visual and auditory imagery, but not actual hallucinations. Similar effects were described using questionnaires and are attributable to salvinorin A, but cannot be explained solely by its specific and potent brain kappa-opioid receptor agonist activity. Some requirements for a feasible classification and mechanism of action of consciousness-altering products are proposed and include the activation of neural networks comprising several neurochemical systems. Top-down analyses should be undertaken in order to characterize such neural networks and eventually allowing to explore the differential ethnic effects. As is the case for other consciousness-altering preparations, a careful and encompassing research on this plant and principle can be consequential to endeavors ranging from the mind-body problem, a better understanding of shamanic ecstasy, to the potential generation of analgesic, antidepressant, and drug-abuse attenuating products.
Berthold-Losleben, Mark; Himmerich, Hubertus
Changes of the tumor necrosis factor-alpha (TNF-α) system have been shown to be involved in the development of psychiatric disorders and are additionally associated with changes in body weight as well as endocrine and metabolic changes in psychiatric patients. TNF-α might, for example, contribute to the pathogenesis of depression by an activation of the hypothalamo-pituitary-adrenocortical (HPA) axis, an activation of neuronal serotonin transporters and the stimulation of the indoleamine 2,3-dioxygenase which leads to tryptophan depletion. On the other hand, during an acute depressive episode, an elevated HPA axis activity may suppress TNF-α system activity, while after remission, when HPA axis activity has normalized the suppression of the TNF-α system has been shown not to be apparent any more. In narcoleptic patients, soluble TNF receptor (sTNF-R) p75 plasma levels have been shown to be elevated, suggesting a functional role of the TNF-α system in the development of this disorder. Additionally, psychotropic drugs influence the TNF-α system as well as the secretion and the effect of hormones which counteract or interact with the TNF-α system such as the intestinal hormone ghrelin. However, only preliminary studies with restricted sample sizes exist on these issues, and many open questions remain. PMID:19506720
Inagaki, Hideaki; Kiyokawa, Yasushi; Takeuchi, Yukari; Mori, Yuji
Previously, we demonstrated that an alarm pheromone released from male donor Wistar rats evoked anxiety-related physiological and behavioral responses in recipient rats. Thus, we believe that this pheromone may increase anxiety levels in rats. In the current study, we evaluated the predictive validity of this alarm pheromone-induced anxiogenic effect in detail by investigating whether six types of human anxiolytics, each of which has a different mechanism of action, were efficacious in reducing anxiety, using changes in the acoustic startle reflex (ASR) as an index. The alarm pheromone-enhanced ASR was not affected by vehicle pretreatment but was dose-dependently attenuated by pretreatment with midazolam, phenelzine, propranolol, clonidine, and CP-154,526-although not buspirone. These results may reflect some aspects of the predictive validity of the alarm pheromone-induced anxiety in rats as an animal model of human anxiety.
Oluwabusi, Olumide O; Parke, Susan; Ambrosini, Paul J
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder (ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments. PMID:26862512
Saleh, Fabian M.; Berlin, Fred S.
Paraphilic disorders are psychiatric syndromes primarily characterized by deviant sexual thoughts, cravings, urges, and/or behaviors. Paraphilic men may engage in inappropriate sexual behaviors when cravings for socially unacceptable sexual acts become overpowering. These often chronic disorders may not only cause emotional distress and social…
Stahl, Stephen M; Davis, Richard L
Medical presentations can be enhanced by systematically collecting audience feedback. This is readily accomplished with polling systems, called audience response systems. Several systems are now available that are small, inexpensive, and can be readily integrated into standard powerpoint presentations without the need for a technician. Use of audience response systems has several advantages. These include improving attentiveness, increasing learning, polling anonymously, tracking individual and group responses, gauging audience understanding, adding interactivity and fun, and evaluating both participant learning and instructor teaching. Tips for how to write questions for audience response systems are also included.
Floyd, Elizabeth Freeman; McIntosh, David E.
Autism spectrum disorders (ASDs) are a complex group of neurodevelopmental conditions that develop in early childhood and involve a range of impairments in core areas of social interaction, communication, and restricted behavior and interests. Associated behavioral problems such as tantrums, aggression, and self-injury frequently compound the core…
Pieper, W A
A group of experiments is described in which chimpanzees and orangutans are utilized as subjects in research projects designed to evaluate the effects of stimulant and depressant drugs on learning and performance. Efficiency of performance on a task which measures spaced responding was impaired when subjects smoked cigarettes containing delta9-tetrahydrocannabinol prior to testing. In a sequential learning task, these subjects also demonstrated reduced performance when stimulatn drugs were orally administered before testing. Depressant drugs did not produce comparable decrements in sequential learning performance. Physical and behavioral tolerance and dependence on ethanol were investigated in rhesus monkey subjects using a variety of experimental procedures, including forced oral acceptance, intragastric intubation, intravenous infusion, and conditioned voluntary oral acceptance.
Maki, Pauline M; Dumas, Julie
Use of estrogen therapy in the perimenopausal and postmenopausal periods has been shown in several clinical trials to help women maintain a premenopausal level of cognitive function. What is not yet fully understood is how the neurobiological effects of estrogen contribute to these cognitive effects. This review explores data from two related bodies of human literature that provide compelling evidence in support of the biological plausibility that estrogen treatment can benefit cognition. The first half of the literature review focuses on studies from the estrogen neuroimaging literature, and the second half focuses on pharmacologic challenge studies assessing estrogen-neurotransmitter interactions. We integrate these two bodies of literature by focusing on the neurophysiologic underpinnings of estrogen effects on cognition and linking these clinical studies to preclinical studies. The focus on verbal memory is important because it is a cognitive function that has been shown to change with estrogen treatment and predict Alzheimer's disease risk but is not addressed by preclinical studies. Overall, we conclude that estrogen interacts with cholinergic and serotonergic systems to affect hippocampal and frontal cortical brain areas and thereby enhance memory, particularly at the retrieval stage.
Khouzam, Hani Raoul
Chronic pain is considered one of the most prevalent causes of costly and disabling medical conditions. This review will define chronic pain and its categories and then will summarize the effectiveness and side effects associated with the use of various antidepressants, including the tricyclics, the selective serotonin reuptake inhibitors, the serotonin norepinephrine reuptake inhibitors, other miscellaneous antidepressants and the atypical antipsychotics in the treatment of chronic pain.
Rojo, Leonel E; Gaspar, Pablo A; Silva, H; Risco, L; Arena, Pamela; Cubillos-Robles, Karen; Jara, Belen
Second generation antipsychotics (SGAs), such as clozapine, olanzapine, risperidone and quetiapine, are among the most effective therapies to stabilize symptoms schizophrenia (SZ) spectrum disorders. In fact, clozapine, olanzapine and risperidone have improved the quality of life of billions SZ patients worldwide. Based on the broad spectrum of efficacy and low risk of extrapyramidal symptoms displayed by SGAs, some regulatory agencies approved the use of SGAs in non-schizophrenic adults, children and adolescents suffering from a range of neuropsychiatric disorders. However, increasing number of reports have shown that SGAs are strongly associated with accelerated weight gain, insulin resistance, diabetes, dyslipidemia, and increased cardiovascular risk. These metabolic alterations can develop in as short as six months after the initiation of pharmacotherapy, which is now a controversial fact in public disclosure. Although the percentage of schizophrenic patients, the main target group of SGAs, is estimated in only 1% of the population, during the past ten years there was an exponential increase in the number of SGAs users, including millions of non-SZ patients. The scientific bases of SGAs metabolic side effects are not yet elucidated, but the evidence shows that the activation of transcriptional factor SRBP1c, the D1/D2 dopamine, GABA2 and 5HT neurotransmitions are implicated in the SGAs cardiovascular toxicity. Polypharmacological interventions are either non- or modestly effective in maintaining low cardiovascular risk in SGAs users. In this review we critically discuss the clinical and molecular evidence on metabolic alterations induced by SGAs, the evidence on the efficacy of classical antidiabetic drugs and the emerging concept of antidiabetic polyphenols as potential coadjutants in SGA-induced metabolic disorders.
Bruce, M; Scott, N; Lader, M; Marks, V
The effects of single doses of anhydrous caffeine (250 mg and 500 mg) and placebo on physiological, psychological measures and subjective feelings were studied in a double-blind, cross-over study in nine healthy subjects who had abstained from caffeine-containing beverages for 24 h before each occasion. Caffeine and caffeine metabolites in plasma and urine were assayed. Peak plasma concentrations were observed at 1 to 2 h with an approximate half-life of 5 h. The concentrations of the metabolite 1,7-dimethylxanthine increased during the 5 h. The major urine metabolite was 1-methyluric acid. The EEG showed a dose-related decrease in log 'theta' power and a decrease in log 'alpha' power. Other dose-related effects were an increase in skin conductance level (sweat-gland activity) and self rating of alertness. Ratings of headache and tiredness were decreased by the caffeine. The study illustrates the complexities of studying a drug which is widely taken and which is often associated with withdrawal effects. PMID:3741730
Shi, Yuan; Dong, Jing-Wen; Zhao, Jiang-He; Tang, Li-Na; Zhang, Jian-Jun
Insomnia is a common sleep disorder which is prevalent in women and the elderly. Current insomnia drugs mainly target the γ-aminobutyric acid (GABA) receptor, melatonin receptor, histamine receptor, orexin, and serotonin receptor. GABAA receptor modulators are ordinarily used to manage insomnia, but they are known to affect sleep maintenance, including residual effects, tolerance, and dependence. In an effort to discover new drugs that relieve insomnia symptoms while avoiding side effects, numerous studies focusing on the neurotransmitter GABA and herbal medicines have been conducted. Traditional herbal medicines, such as Piper methysticum and the seed of Zizyphus jujuba Mill var. spinosa, have been widely reported to improve sleep and other mental disorders. These herbal medicines have been applied for many years in folk medicine, and extracts of these medicines have been used to study their pharmacological actions and mechanisms. Although effective and relatively safe, natural plant products have some side effects, such as hepatotoxicity and skin reactions effects of Piper methysticum. In addition, there are insufficient evidences to certify the safety of most traditional herbal medicine. In this review, we provide an overview of the current state of knowledge regarding a variety of natural plant products that are commonly used to treat insomnia to facilitate future studies. PMID:24851093
Voith, K; Bruderlein, F T; Humber, L G
The synthesis and some pharmacological effects of 16 3-aryl analogues of butaclamol, a new antipsychotic drug, are described. The animal models were predictive of neuroleptic activity as well as side effects commonly associated with neuroleptic therapy. The results indicate that the 3-substituent plays a critical role with regard to the potency of the compounds as well as to their tendencies to induce extrapyramidal side effects and/or hypotension.
Scahill, Lawrence; Hallett, Victoria; Aman, Michael G.; McDougle, Christopher J.; Arnold, L. Eugene; McCracken, James T.; Tierney, Elaine; Deng, Yanhong; Dziura, James; Vitiello, Benedetto
There is growing interest in measuring social disability as a core element of autism spectrum disorders in medication trials. We conducted a secondary analysis on the Aberrant Behavior Checklist Social Withdrawal subscale using data from two federally-funded, multi-site, randomized trials with risperidone. Study 1 included 52 subjects assigned to…
Wessa, Michèle; Lois, Giannis
In the last two decades, neuroimaging research has reached a much deeper understanding of the neurobiological underpinnings of major depression (MD) and has converged on functional alterations in limbic and prefrontal neural networks, which are mainly linked to altered emotional processing observed in MD patients. To date, a considerable number of studies have sought to investigate how these neural networks change with pharmacological antidepressant treatment. In the current review, we therefore discuss results from a) pharmacological functional magnetic resonance imaging (fMRI) studies investigating the effects of selective serotonin or noradrenalin reuptake inhibitors on neural activation patterns in relation to emotional processing in healthy individuals, b) treatment studies in patients with unipolar depression assessing changes in neural activation patterns before and after antidepressant pharmacotherapy, and c) predictive neural biomarkers of clinical response in depression. Comparing results from pharmacological fMRI studies in healthy individuals and treatment studies in depressed patients nicely showed parallel findings, mainly for a reduction of limbic activation in response to negative stimuli. A thorough investigation of the empirical findings highlights the importance of the specific paradigm employed in every study which may account for some of the discrepant findings reported in treatment studies in depressed patients.
Jepma, Marieke; Te Beek, Erik T; Wagenmakers, Eric-Jan; van Gerven, Joop M A; Nieuwenhuis, Sander
Animal research and computational modeling have indicated an important role for the neuromodulatory locus coeruleus-norepinephrine (LC-NE) system in the control of behavior. According to the adaptive gain theory, the LC-NE system is critical for optimizing behavioral performance by regulating the balance between exploitative and exploratory control states. However, crucial direct empirical tests of this theory in human subjects have been lacking. We used a pharmacological manipulation of the LC-NE system to test predictions of this theory in humans. In a double-blind parallel-groups design (N = 52), participants received 4 mg reboxetine (a selective norepinephrine reuptake inhibitor), 30 mg citalopram (a selective serotonin reuptake inhibitor), or placebo. The adaptive gain theory predicted that the increased tonic NE levels induced by reboxetine would promote task disengagement and exploratory behavior. We assessed the effects of reboxetine on performance in two cognitive tasks designed to examine task (dis)engagement and exploitative versus exploratory behavior: a diminishing-utility task and a gambling task with a non-stationary pay-off structure. In contrast to predictions of the adaptive gain theory, we did not find differences in task (dis)engagement or exploratory behavior between the three experimental groups, despite demonstrable effects of the two drugs on non-specific central and autonomic nervous system parameters. Our findings suggest that the LC-NE system may not be involved in the regulation of the exploration-exploitation trade-off in humans, at least not within the context of a single task. It remains to be examined whether the LC-NE system is involved in random exploration exceeding the current task context.
In this collection of papers, psychoanalytic principles come to life in a variety of settings: in a therapeutic nursery, in two schools serving children with special needs, in mainstream schools, and in a psychiatric practice. From dyadic work with a two-year-old's tantrums, to play therapy using deep-sea symbolism with a five-year-old; from the interchange with parents and school administrators in a middle school regarding "sexting, " to the in-depth assessment of children upon entry to a special school, these papers illustrate enriching exchanges between psychoanalysts, educators, children, and their communities.
Nevels, Robert M; Dehon, Erin E; Alexander, Katrina; Gontkovsky, Samuel T
Research examining the role of pharmacological therapy in the treatment of children and adolescents with clinical disorders is growing. Clinical disorders that present with comorbid aggression can add a challenge to treatment. Child and adolescent neuropsychiatric disorders associated with aggression include attention-deficit hyperactivity disorder, various mood disorders and in particular bipolar disorders/pediatric mania, schizophrenia, mental retardation, oppositional defiant disorder, conduct disorder, and autism spectrum disorders. This review describes the psychopharmacy to treat these disorders and the aggression that often appears comorbidly. Existing literature regarding the efficacy and safety of psychotropics for youth with neuropsychiatric disorders also is discussed. In addition, general guidelines for psychopharmacy of aggression in children and adolescents are presented. Studies reviewed in this article provide evidence for the use of psychostimulants, alpha-2 agonists, beta blockers, lithium, anticonvulsant mood-stabilizers, atypical antipsychotics, traditional antipsychotics, and selective serotonin reuptake inhibitors in treating pediatric aggression with the choice of medication dependent on symptomology. Despite increased support for pediatric psychotropic use, there is a need for more long-term safety and efficacy studies of existing medications and newer, safer, and more effective agents with fewer side effects for the pharmacological treatment of all childhood disorders in which aggression is prominent.
Johnson, Matthew W; MacLean, Katherine A; Reissig, Chad J; Prisinzano, Thomas E; Griffiths, Roland R
Salvinorin A is a potent, selective nonnitrogenous kappa opioid agonist and the known psychoactive constituent of Salvia divinorum, a member of the mint family that has been used for centuries by Mazatec shamans of Mexico for divination and spiritual healing. S. divinorum has over the last several years gained increased popularity as a recreational drug. This is a double-blind, placebo controlled study of salvinorin A in 4 psychologically and physically healthy hallucinogen-using adults. Across sessions, participants inhaled 16 ascending doses of salvinorin A and 4 intermixed placebo doses under comfortable and supportive conditions. Doses ranged from 0.375 μg/kg to 21 μg/kg. Subject-rated drug strength was assessed every 2 min for 60 min after inhalation. Orderly time- and dose-related effects were observed. Drug strength ratings peaked at 2 min (first time point) and definite subjective effects were no longer present at approximately 20 min after inhalation. Dose-related increases were observed on questionnaire measures of mystical-type experience (Mysticism Scale) and subjective effects associated with classic serotonergic (5-HT2(A)) hallucinogens (Hallucinogen Rating Scale). Salvinorin A did not significantly increase heart rate or blood pressure. Participant narratives indicated intense experiences characterized by disruptions in vestibular and interoceptive signals (e.g., change in spatial orientation, pressure on the body) and unusual and sometimes recurring themes across sessions such as revisiting childhood memories, cartoon-like imagery, and contact with entities. Under these prepared and supportive conditions, salvinorin A occasioned a unique profile of subjective effects having similarities to classic hallucinogens, including mystical-type effects.
Hermes, Eric; Rosenheck, Robert
Using national Veterans Health Administration (VHA) administrative data, this study evaluated differences in psychotropic medication use between homeless and non-homeless adults with serious mental illness (SMI) who used VHA services in 2010. The adjusted mean number of psychotropic prescription fills associated with homeless individuals were identified using regression models adjusted for socio-demographics, diagnoses, and use of health services. Of the 876,989 individuals with SMI using VHA services, 7.2 % were homeless at some time during 2010. In bivariate analysis, homeless individuals filled more psychotropic medication prescriptions compared with non-homeless individuals. However, after adjusting for potentially confounding variables, homeless individuals were found to have filled 16.2 % fewer prescriptions than non-homeless individuals when all psychotropics were analyzed together (F = 6947.1, p < .001) and for most individual classes of psychotropics. Greater use of residential/inpatient mental health services by the homeless was the most important single factor associated with filling more psychotropic prescriptions than non-homeless individuals.
Lakshmanan, Manu N; Meier, Stacey L Colton; Meier, Robert S; Lakshmanan, Ramaswamy
We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient's comorbid bipolar disorder contributed to the patient's instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method.
Arnold, L. Eugene; Anthony, Bruno J.
Abstract Objective This article reviews rational approaches to treating attention-deficit/hyperactivity disorder (ADHD) in preschool children, including pharmacological and nonpharmacological treatments. Implications for clinical practice are discussed. Data Sources We searched MEDLINE, PsychINFO, Cumulative Index to Nursing & Allied Health, Educational Resources Information Center, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects for relevant literature published in English from 1967 to 2007 on preschool ADHD. We also reviewed the references cited in identified reports. Study Selection Studies were reviewed if the sample included at least some children younger than 6 years of age or attending kindergarten, the study participants had a diagnosis of ADHD or equivalent symptoms, received intervention aimed at ADHD symptoms, and included a relevant outcome measure. Data Extraction Studies were reviewed for type of intervention and outcome relevant to ADHD and were rated for the level of evidence for adequacy of the data to inform clinical practice. Conclusions The current level of evidence for adequacy of empirical data to inform clinical practice for short-term treatment of ADHD in preschool children is Level A for methylphenidate and Level B for parent behavior training, child training, and additive-free elimination diet. PMID:18844482
Irusta, A E; Savoldi, M; Kishi, R; Resende, G C; Freitas, R L; Carvalho, A D; Coimbra, N C
In order to investigate the effects of sweet substance intake on pain modulation, male albino Wistar rats weighing 180-200 g received either tap water or sucrose solutions (250 g/l) for 14 days as their only source of liquid. Each rat consumed an average of 15.6 g sucrose/day. Their tail withdrawal latencies in the tail-flick test (probably a spinal reflex) were measured immediately before and after this treatment. An analgesia index was calculated from the withdrawal latencies before and after treatment. The index (mean +/- SEM, N = 8) for the groups receiving sucrose solution plus saline (NaCl; 0.9%) for 14 days was 0.70 +/- 0.01. Atropine (1 and 2 mg/kg)-treated rats (N = 8) after intake of sucrose exhibited an analgesia index of 0.39 +/- 0.09 and 0.39 +/- 0.08, respectively, while mecamylamine (1 and 2 mg/kg)-treated rats (N = 10) after intake of sucrose had an index of -0.02 +/- 0.07 and 0.03 +/- 0.07, respectively. These results indicate that the effect of sucrose intake on nociceptive thresholds is controlled by neurotransmission of acetylcholine and depends on the nicotinic cholinergic receptors for its major analgesic effect, although muscarinic receptors were also involved in this antinociceptive process.
Jepma, Marieke; te Beek, Erik T.; Wagenmakers, Eric-Jan; van Gerven, Joop M.A.; Nieuwenhuis, Sander
Animal research and computational modeling have indicated an important role for the neuromodulatory locus coeruleus–norepinephrine (LC–NE) system in the control of behavior. According to the adaptive gain theory, the LC–NE system is critical for optimizing behavioral performance by regulating the balance between exploitative and exploratory control states. However, crucial direct empirical tests of this theory in human subjects have been lacking. We used a pharmacological manipulation of the LC–NE system to test predictions of this theory in humans. In a double-blind parallel-groups design (N = 52), participants received 4 mg reboxetine (a selective norepinephrine reuptake inhibitor), 30 mg citalopram (a selective serotonin reuptake inhibitor), or placebo. The adaptive gain theory predicted that the increased tonic NE levels induced by reboxetine would promote task disengagement and exploratory behavior. We assessed the effects of reboxetine on performance in two cognitive tasks designed to examine task (dis)engagement and exploitative versus exploratory behavior: a diminishing-utility task and a gambling task with a non-stationary pay-off structure. In contrast to predictions of the adaptive gain theory, we did not find differences in task (dis)engagement or exploratory behavior between the three experimental groups, despite demonstrable effects of the two drugs on non-specific central and autonomic nervous system parameters. Our findings suggest that the LC–NE system may not be involved in the regulation of the exploration–exploitation trade-off in humans, at least not within the context of a single task. It remains to be examined whether the LC–NE system is involved in random exploration exceeding the current task context. PMID:21206527
Vasa, Roma A.; Carroll, Laura M.; Nozzolillo, Alixandra A.; Mahajan, Rajneesh; Mazurek, Micah O.; Bennett, Amanda E.; Wink, Logan K.; Bernal, Maria Pilar
This study systematically examined the efficacy and safety of psychopharmacological and non-psychopharmacological treatments for anxiety in youth with autism spectrum disorders (ASD). Four psychopharmacological, nine cognitive behavioral therapy (CBT), and two alternative treatment studies met inclusion criteria. Psychopharmacological studies were…
Arnold, L. Eugene; Aman, Michael G.; Li, Xiaobai; Butter, Eric; Humphries, Kristina; Scahill, Lawrence; Lecavalier, Luc; McDougle, Christopher J.; Swiezy, Naomi B.; Handen, Benjamin; Wilson, Krystina; Stigler, Kimberly A.
Objective: To follow up on a three-site, 24-week randomized clinical trial (N = 124) comparing antipsychotic medication alone (MED) with antipsychotic medication plus parent training in the behavior management (COMB) of children with autism spectrum disorders and severe behavior problems. The COMB treatment had shown a significant advantage for…
Johnson, Matthew W.; MacLean, Katherine A.; Reissig, Chad J.; Prisinzano, Thomas E.; Griffiths, Roland R.
Salvinorin A is a potent, selective nonnitrogenous kappa opioid agonist and the known psychoactive constituent of Salvia divinorum, a member of the mint family that has been used for centuries by Mazatec shamans of Mexico for divination and spiritual healing. Salvia divinorum has over the last several years gained increased popularity as a recreational drug. This is a double-blind, placebo controlled study of salvinorin A in 4 psychologically and physically healthy hallucinogen-using adults. Across sessions, participants inhaled 16 ascending doses of salvinorin A and 4 intermixed placebo doses under comfortable and supportive conditions. Doses ranged from 0.375 μg/kg to 21 μg/kg. Subject-rated drug strength was assessed every 2 minutes for 60 minutes after inhalation. Orderly time- and dose-related effects were observed. Drug strength ratings peaked at 2 minutes (first time point) and definite subjective effects were no longer present at approximately 20 minutes after inhalation. Dose-related increases were observed on questionnaire measures of mystical-type experience (Mysticism Scale) and subjective effects associated with classic serotonergic (5-HT2A) hallucinogens (Hallucinogen Rating Scale). Salvinorin A did not significantly increase heart rate or blood pressure. Participant narratives indicated intense experiences characterized by disruptions in vestibular and interoceptive signals (e.g., change in spatial orientation, pressure on the body) and unusual and sometimes recurring themes across sessions such as revisiting childhood memories, cartoon-like imagery, and contact with entities. Under these prepared and supportive conditions, salvinorin A occasioned a unique profile of subjective effects having similarities to classic hallucinogens, including mystical-type effects. PMID:21131142
Chen, 1992; Newcomb & Bentler, 1986 ). Further, retrospective reports by Kandel and colleagues (Kandel & Yamaguchi, 1993; Kandel et al., 1992) indicate...animals suggest that there is a positive relationship between stress and substance abuse (Kosten, Rounsaville, & Kleber, 1986 ; O’Doherty, 1991; Shaham et...activation (Grunberg et al., 1997; USDHHS, 1988). Nicotine 9 administration also stimulates dopamine release from the ventral tegmental area ( Nisell
Chemical neuroanatomical and psychopharmacological evidence that κ receptor-mediated endogenous opioid peptide neurotransmission in the dorsal and ventral mesencephalon modulates panic-like behaviour.
da Silva, Juliana Almeida; de Freitas, Renato Leonardo; Eichenberger, Gustavo Cavalcanti Dutra; Padovan, Cláudia Maria; Coimbra, Norberto Cysne
The chemical neuroanatomy and the effects of central administration of opioid antagonists on the innate fear-induced responses elicited by electrical (at escape behaviour threshold) stimulation of the midbrain tectum were determined. The aim of the present work was to investigate the interaction between the tecto-nigral endogenous opioid peptide-mediated disinhibitory pathways and nigro-tectal inhibitory links in the control of panic-like behaviour and their organisation in the continuum comprised by the deep layers of the superior colliculus (dlSC) and the dorsolateral columns of the periaqueductal grey matter (dlPAG). Beta-endorphin-labelled neurons and fibres were found in the dorsal midbrain and also in the substantia nigra. Opioid varicose fibres and terminal buttons were widely distributed in PAG columns and in all substantia nigra subdivisions. Microinjections of naltrexone (a non-selective opioid receptor antagonist; 5.0 μg/0.2 μl) or nor-binaltorphimine (a selective κ-opioid receptor antagonist; 5.0 μg/0.2 μl) in the dlSC/dlPAG continuum, in independent groups of animals, induced significant increases in the escape thresholds for midbrain tectum electrical stimulation. The microinjection of naltrexone or nor-binaltorphimine into the SNpr also increased the escape behaviour threshold for electrical stimulation of dlSC/dlPAG. These morphological and neuropharmacological findings support previous evidence from our team for the role played by the interaction between opioidergic and GABAergic mechanisms in the modulation of innate fear-induced responses. The present data offer a neuroanatomical basis for both intratectal axo-axonic/pre-synaptic and tecto-nigral axo-somatic opioid inhibition of GABAergic nigro-tectal neurons that modulate the dorsal midbrain neurons related to the organisation of fear-related emotional responses.
Recreational 3,4-methylenedioxy-N-methylamphetamine (MDMA) or 'ecstasy' and self-focused compassion: Preliminary steps in the development of a therapeutic psychopharmacology of contemplative practices.
Kamboj, Sunjeev K; Kilford, Emma J; Minchin, Stephanie; Moss, Abigail; Lawn, Will; Das, Ravi K; Falconer, Caroline J; Gilbert, Paul; Curran, H Valerie; Freeman, Tom P
3,4-methylenedioxy-N-methylamphetamine (MDMA) produces diverse pro-social effects. Cognitive training methods rooted in Eastern contemplative practices also produce these effects through the development of a compassionate mindset. Given this similarity, we propose that one potential mechanism of action of MDMA in psychotherapy is through enhancing effects on intrapersonal attitudes (i.e. pro-social attitudes towards the self). We provide a preliminary test of this idea. Recreational MDMA (ecstasy) users were tested on two occasions, having consumed or not consumed ecstasy. Self-critical and self-compassionate responses to self-threatening scenarios were assessed before (T1) and after (T2) ecstasy use (or non-use), and then after compassionate imagery (T3). Moderating roles of dispositional self-criticism and avoidant attachment were examined. Separately, compassionate imagery and ecstasy produced similar sociotropic effects, as well as increases in self-compassion and reductions in self-criticism. Higher attachment-related avoidance was associated with additive effects of compassionate imagery and ecstasy on self-compassion. Findings were in line with MDMA's neuropharmacological profile, its phenomenological effects and its proposed adjunctive use in psychotherapy. However, although conditions were balanced, the experiment was non-blind and MDMA dose/purity was not determined. Controlled studies with pharmaceutically pure MDMA are still needed to test these effects rigorously.
... hematology; genomics; Bayesian statistics; clinical epidemiology; clinical trial methodology; knee, hip, and other joint replacement surgery; ophthalmology; psychopharmacology; rheumatology; screening...
... include cancer screening, genetic testing, clinical epidemiology; psychopharmacology; screening and diagnostic testing analysis; and vascular surgery. We also need experts in biostatistics in clinical...
James, Susan Hackbarth; Nims, Donald R.
Although school counselors are increasingly involved in administering medications to students with emotional, conduct, and behavioral problems, few counselors have training in psychopharmacology. Gives a brief history of psychopharmacological interventions, and describes usage and side effects of drugs for psychosis, depression, anxiety, and…
Brammer, Robert; Haller, Katherine; Roberson, Janice
Attendees at the 1998 Texas Counseling Association's annual convention were given a brief survey and short test on psychopharmacology. Analysis was performed to examine the effects of demographic and ideological variables. The model moderately explained the variance on the psychopharmacology test with only 2.5% of the adjusted variance explained…
Nagel, K. L.; Jones, Karen H.
Reviews literature concerned with investigating psychiatric disturbances and genetic variables hypothesized as predisposing factors in etiology of anorexia nervosa. Gives particular emphasis to research which discusses association between anorexia nervosa and depression. Reviews psychopharmacological evidence and family genetics studies. Offers…
Beamish, Patricia M.; And Others
Reviews outcome studies in the treatment of panic disorder without agoraphobia for adults. Presents evidence supporting the efficacy of psychopharmacological and cognitive-behavioral interventions. Addresses the need for standards of care in counseling persons with panic disorder. (RB)
Chernow, B. )
This book contains papers addressing the pharmacologic approach to the critically ill patient. Chapter topics include: Radiation injury; Red cell substitutes: a current appraisal; and Psychopharmacology in the ICU.
Beamish, Patricia M.; Granello, Darcy Haag; Belcastro, Amy L.
This article presents current research information on the treatment of panic disorder. Specific guidelines are presented to guide the mental health counselor in the delivery of effective psychopharmacological and cognitive-behavioral treatment. (Contains 81 references.) (Author)
Psychopathy is a disorder involving personality and behavioral features associated with a high rate of violent aggression and recidivism. This paper explores potential psychopharmacological therapies to modulate dysfunctional neural pathways in psychopaths and reduce the incidence of their harmful behavior, as well as the ethical and legal implications of offering these therapies as an alternative to incarceration. It also considers whether forced psychopharmacological intervention in adults and children with psychopathic traits manifesting in violent behavior can be justified. More generally, the paper addresses the question of how to weigh the psychopath's presumptive right to non-interference in his brain and mind against the public interest in avoiding harm.
Kirkpatrick, Michael A.
This article reviews "ADHD with Comorbid Disorders: Clinical Assessment and Management" by Steven R. Pliszka, Caryn L. Carlson, and James M. Swanson, a book that provides information on children displaying both attention-deficit/hyperactivity disorder and other comorbid psychiatric conditions, complex psychopharmacological interventions that may…
The use of educationally oriented biotechnology has grown drastically in recent decades and is likely to continue to grow. Advances in both the neurosciences and genetics have opened up important areas of application and industry, from psychopharmacology to gene-chip technologies. This article reviews the current state of educationally oriented…
Norvilitis, Jill M., Ed.
The treatment of Attention Deficit Hyperactivity Disorder is a matter of ongoing research and debate, with considerable data supporting both psychopharmacological and behavioral approaches. Researchers continue to search for new interventions to be used in conjunction with or in place of the more traditional approaches. These interventions run the…
Romanelli, Lisa Hunter; Landsverk, John; Levitt, Jessica Mass; Leslie, Laurel K.; Hurley, Maia M.; Bellonci, Christopher; Gries, Leonard T.; Pecora, Peter J.; Jensen, Peter S.
The Best Practices for Mental Health in Child Welfare Consensus Conference focused on developing guidelines in five key areas (screening and assessment, psychosocial interventions, psychopharmacologic treatment, parent engagement, and youth empowerment) related to children's mental health. This paper provides an overview of issues related to the…
Arnold, L. Eugene; Aman, Michael G.; Martin, Andres; Collier-Crespin, Angie; Vitiello, Benedetto; Tierney, Elaine; Asarnow, Robert; Bell-Bradshaw, Felicia; Freeman, Betty Jo; Gates-Ulanet, Patricia; Klin, Ami; McCracken, James T.; McDougle, Christopher J.; McGough, James J.; Posey, David J.; Scahill, Lawrence; Swiezy, Naomi B.; Ritz, Louise; Volkmar, Fred
This paper explains how the Autism Research Units on Pediatric Psychopharmacology (RUPP Autism Network) resolved common assessment problems including communication problems compromising use of the patient as informant, broad subject heterogeneity, difficulties in assessing low-end IQs, scarcity of autism-adapted cognitive and neuropsychological…
Hammock, Ron; Levine, William R.; Schroeder, Stephen R.
This study reports marked reductions in self-injurious behavior and aggression of two adults with profound mental retardation treated with clozapine, who were non-responsive to all other behavioral and psychopharmacological interventions, including risperidone. The most effective dose was 200mg/day. Side effects were mild and the drug was…
Hassler, Frank; Reis, Olaf
The review presented here describes the state of the art of pharmacological treatment of aggression in subjects with mental retardation (MR) summing up results for both, children and adults. In general, psychopharmacological treatment of disruptive behavior in individuals with MR is similar to the treatment in subjects without MR. Compared to…
Deb, S.; Sohanpal, S. K.; Soni, R.; Lenotre, L.; Unwin, G.
Background: Psychopharmacological intervention in the management of behaviour problems in adults with intellectual disabilities (ID) has become a common treatment strategy. This has become a cause for concern, given that the evidence for its effectiveness is uncertain and most drugs are not licensed for this use. Methods: A comprehensive…
Reichow, Brian; Barton, Erin E.; Boyd, Brian A.; Hume, Kara
Background: The rising prevalence of autism spectrum disorders (ASD) increases the need for evidence-based behavioral treatments to lessen the impact of symptoms on children's functioning. At present, there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorder. Early intensive behavioral intervention…
Maccaferri, G E; Cavassini, M; Berney, A
Mood disorders represent the most prevalent psychiatric condition in patients infected by HIV virus. Screening and treatment of depression as well as the evaluation of the risk suicide is of the utmost importance. When psychopharmacological treatment is required, interaction with antiretroviral treatment must be carefully considered. More generally a close collaboration between the physician and the psychiatrist is recommended.
Doerfler, Leonard A.; Connor, Daniel F.; Volungis, Adam M.; Toscano, Peter F., Jr.
The present study examined the frequency and characteristics of panic disorder in children and adolescents who had been referred to a pediatric psychopharmacology clinic. Of the 280 children and adolescents evaluated in this clinic, 35 were diagnosed with panic disorder using a semi-structured clinical interview (K-SADS) and other objective…
Motta, Robert W.; Kuligowski, Jenna M.; Marino, Dawn M.
A great many interventions for posttraumatic stress disorder (PTSD) in adults have been described in the literature. These include, but are not limited to, cognitive-behavioral therapy, psychodynamic therapy, psychopharmacology, exposure therapy, anxiety management training, stress management techniques, eye movement desensitization and…
Food and Drug Administration (DHEW), Washington, DC.
These guidelines are intended to help those who design and conduct investigations of psychopharmacologic agents in children. A progression of studies in four phases is advocated. First, early short term studies should establish single and multiple dose safety baselines. Second, early pilot efficacy studies may be initiated jointly with longer…
Dew, Rachel Elizabeth; Kramer, Stephen I.; McCall, W. Vaughn
Objective: Facility in psychopharmacology is a major goal of psychiatric residency. This study assesses the adequacy of pharmacotherapy provided to depressed patients in a resident clinic. Methods: Charts of all 285 patients seen in an outpatient triage clinic during 2000 were reviewed. One hundred twelve patients had diagnoses of major…
Hemmings, Colin; Deb, Shoumitro; Chaplin, Eddie; Hardy, Steve; Mukherjee, Rittick
This review of research into mental disorders in people with intellectual disabilities (ID) focuses on research in this field that has originated from the United Kingdom in the last 2 decades. It considers research developments into the epidemiology of mental disorders and problem behaviors, psychopharmacology, psychosocial interventions, and…
Poling, Alan; LeSage, Mark
Journal articles dealing with drug treatment of individuals with mental retardation were examined to determine treatment goals and outcomes of treating behavior problems. Analysis of articles published from 1987 to 1993 in 5 major journals revealed that none of the 68 articles concerned with the psychopharmacology of mental retardation reported…
Kratochvil, Christopher J.; Vitiello, Benedetto; Brent, David; Bostic, Jeff Q.; Naylor, Michael W.
This column aims to discuss practical approaches to everyday issues in pediatric pharmacotherapy. The cases and discussions specifically target aspects of clinical care related to psychopharmacology for which there are no adequate applicable controlled trials. Given the need to address symptoms in youths with complex, severe, and comorbid…
Solomon, Marjorie; Ono, Michele; Timmer, Susan; Goodlin-Jones, Beth
We report the results of a pilot trial of an evidence-based treatment--Parent-Child Interaction Therapy (PCIT; Eyberg et al. "Psychopharmacology Bulletin", 31(1), 83-91, 1995) for boys aged 5-12 with high functioning autism spectrum disorders and clinically significant behavioral problems. The study also included an investigation of the role of…
Joshi, Gagan; Petty, Carter; Wozniak, Janet; Henin, Aude; Fried, Ronna; Galdo, Maribel; Kotarski, Meghan; Walls, Sarah; Biederman, Joseph
The objective of the study was to systematically examine patterns of psychiatric comorbidity in referred youth with autism spectrum disorders (ASD) including autistic disorder and pervasive developmental disorder not otherwise specified. Consecutively referred children and adolescents to a pediatric psychopharmacology program were assessed with…
Kollins, Scott H.; Barkley, Russell A.; DuPaul, George J.
This article provides information and guidelines for the effective use of medication in treating attention deficit hyperactivity disorder (ADHD). Basic principles of psychopharmacology, different types of medications that have been used successfully to treat ADHD, and best practices for assessing the effects of medication in children with ADHD are…
Griffith, James L.; And Others
Discusses metaphors used to describe problems when family therapy and psychopharmacology are employed together. Identifies coupling metaphors that support both therapies as valid treatments and exclusionary metaphors that invalidate one approach. Presents consultation model for psychiatrists consulting to family therapists wherein the psychiatrist…
Nikolov, Roumen N.; Bearss, Karen E.; Lettinga, Jelle; Erickson, Craig; Rodowski, Maria; Aman, Michael G.; McCracken, James T.; McDougle, Christopher J.; Tierney, Elaine; Vitiello, Benedetto; Arnold, L. Eugene; Shah, Bhavik; Posey, David J.; Ritz, Louise; Scahill, Lawrence
Objective: To evaluate gastrointestinal (GI) problems in a large, well-characterized sample of children with pervasive developmental disorders (PDDs). Methods: One hundred seventy two children entering one of two trials conducted by the Research Units on Pediatric Psychopharmacology (RUPP) Autism Network were assessed comprehensively prior to…
Scahill, Lawrence; McDougle, Christopher J.; Williams, Susan K.; Dimitropoulos, Anastasia; Aman, Michael G.; McCracken, James T.; Tierney, Elaine; Arnold, L. Eugene; Cronin, Pegeen; Grados, Marco; Ghuman, Jaswinder; Koenig, Kathleen; Lam, Kristen S. L.; McGough, James; Posey, David J.; Ritz, Louise; Swiezy, Naomi B.; Vitiello, Benedetto
Objective: To examine the psychometric properties of the Children's Yale-Brown Obsessive Compulsive Scales (CYBOCS) modified for pervasive developmental disorders (PDDs). Method: Raters from five Research Units on Pediatric Psychopharmacology (RUPP) Autism Network were trained to reliability. The modified scale (CYBOCS-PDD), which contains only…
King, Jason H.; Anderson, Shannon M.
The use of psychotropic medications (pharmacotherapy) in conjunction with psychotherapy is regarded as the standard of care for many mental health disorders. Counselors, therefore, need to be knowledgeable about psychopharmacology to monitor its impact on the therapeutic relationship and on client outcome. Discussed are potential ethical dilemmas…
The article discusses the following conceptual models of depression, noting their related treatment approaches: (1) biological model (psychopharmacology); (2) behavioral model (behavior modification, social skills training, problem-solving skills); (3) cognitive model (cognitive therapy); (4) life stress model (focusing on environmental stresses…
Escobedo, Pedro Sanchez; Beamish, Patricia M.; Stump, Earl; Krause, Naomi
Counselors working in clinical settings are frequently confronted with clients taking psychotropic medications. Counselors working in non-clinical school and industrial settings are often required to identify clients who need referral for psychopharmacological support. If counselors are to assist their clients in exploring treatment options, it is…
Forness, Steven R.; Oswald, Donald
This article discusses the need to incorporate research findings in developmental psychopathology, psychiatric comorbidity, and psychopharmacology in school mental health programs to enable early detection and primary prevention of emotional and behavioral disorders in students. A response stresses the need for a multidisciplinary approach.…
Thomas, Adrian; Donnell, Alison J.; Young, Tony R.
The Brief Psychiatric Rating Scale (BPRS) is one of the most widely used measures in psychiatric outcome and clinical psychopharmacology research. To date, however, research on the psychometric properties of the expanded version of the BPRS (BPRS-E) has been limited. An exploratory factor analysis (n = 360) using maximum likelihood extraction with…
Oades, Robert D.; Sadile, Adolfo G.; Sagvolden, Terje; Viggiano, Davide; Zuddas, Alessandro; Devoto, Paola; Aase, Heidi; Johansen, Espen B.; Ruocco, Lucia A.; Russell, Vivienne A.
We explore the neurobiological bases of attention deficit hyperactivity disorder (ADHD) from the viewpoint of the neurochemistry and psychopharmacology of the catecholamine-based behavioural systems. The contributions of dopamine (DA) and noradrenaline (NA) neurotransmission to the motor and cognitive symptoms of ADHD (e.g. hyperactivity, variable…
Carlson, John S.; Thaler, Cara L.; Hirsch, Amanda J.
Assessing, consulting, and intervening with students being treated with psychotropic medications is an increasingly common activity for school psychologists. This article reviews some of the literature providing evidence for the greater need for training in school psychopharmacology. A legal and ethical case study is presented that highlights the…
Pallone, Nathaniel J.
Discusses inconsistencies in societal responses to criminal behavior. Maintains that some offenders who are both guilty of criminal behavior and psychiatrically (or biochemically) disordered are being diverted from the criminal justice system into the mental health system. Suggests that clinical neuropsychology and psychopharmacology can…
Farmer, Cristan; Lecavalier, Luc; Yu, Sunkyung; Arnold, L. Eugene; McDougle, Christopher J.; Scahill, Lawrence; Handen, Benjamin; Johnson, Cynthia R.; Stigler, Kimberly A.; Bearss, Karen; Swiezy, Naomi B.; Aman, Michael G.
The Research Units on Pediatric Psychopharmacology-Autism Network reported additional benefit when adding parent training (PT) to antipsychotic medication in children with autism spectrum disorders and serious behavior problems. The intent-to-treat analyses were rerun with putative predictors and moderators. The "Home Situations…
Forness, Steven R.
The author urges the field of education for children with emotional or behavioral disorders to address three critical areas: (1) developmental psychopathology (to improve early identification and prevention); (2) psychiatric comorbidity (e.g., disruptive disorders present with depression or anxiety disorder); and (3) psychopharmacology (especially…
Evans, Wayne O.
A researcher in psychopharmacology foresees a flood of new drugs that will make man feel happy, cause him to forget his past, and arouse his sexual desires. Man may actually have the possibility of attaining sustained happiness, or something like it, through drugs, and so must ask the question, Is happiness what I most want?" (Author)
van den Anker, Johannes N.
Understanding the pharmacokinetics and pharmacodynamics of drugs used in psychopharmacology across the pediatric age spectrum from infants to adolescents represents a major challenge for clinicians. In pediatrics, treatment protocols use either standard dose reductions for these drugs for children below a certain age or use less conventional…
Vitiello, B; Jensen, P S
Progress in pediatric psychopharmacological research has suffered notable delay, especially compared with the achievements in adult psychopharmacology. Although safety and efficacy of the use of many psychotropic agents in children remain largely unproved, their pediatric use has been increasing and their widespread off-label prescribing by practitioners has raised some important concerns. The National Institute of Mental Health, in cooperation with the Food and Drug Administration and leading researchers, has coordinated systematic efforts to identify the major obstacles to research in pediatric psychopharmacology and to propose feasible solutions. In 1995, a conference cosponsored by the national Institute of Mental Health and the Food and Drug Administration gathered more than 100 research experts, family and patient advocates, and representatives of mental health professional associations. Participants met in working groups focused on specific aspects of child research and reached consensus on various recommendations. Each of the various aspects relevant to conducting research in this area (methodological, ethical, legal, regulatory, financial, and family or community context) presents specific challenges, which are herein outlined. Recommendations for possible solutions are presented, some of which are being implemented. Because data about drug safety and efficacy in adults can rarely be extrapolated to children, there is no substitute for pediatric psychopharmacological research. Successful strategies for overcoming the many obstacles with which this research has to contend must enlist the concerted efforts of all the relevant parties (investigators, clinicians, industry, federal agencies, ethicists, families, and community representatives).
Kirson, Tamara; And Others
The bibliography on the hyperkinetic behavior syndrome focuses on the behavior characteristics of and treatment for hyperactivity. Entries are divided into the following sections (sample subsections are in parentheses): general review of pediatric psychopharmacology; the hyperkinetic behavior syndrome (overview, diagnosis and evaluation,…
Scahill, Lawrence; Sukhodolsky, Denis G.; Anderberg, Emily; Dimitropoulos, Anastasia; Dziura, James; Aman, Michael G.; McCracken, James; Tierney, Elaine; Hallett, Victoria; Katz, Karol; Vitiello, Benedetto; McDougle, Christopher
Repetitive behavior is a core feature of autism spectrum disorder. We used 8-week data from two federally funded, multi-site, randomized trials with risperidone conducted by the Research Units on Pediatric Psychopharmacology Autism Network to evaluate the sensitivity of the Children's Yale-Brown Obsessive Compulsive Scale modified for autism…
Pierson, Eric E.
The past two decades have seen a rapid increase in the number and types of psychopharmacological medications that are available for the treatment of depression in children and adolescents. Parents and adolescents often raise questions as to the potential increase in suicidal ideation associated with the use of primarily selective serotonin…
excursion, such as seen in subjects under methadone treatment (Rothenberg et al. 1980), we found that mainte- nance of accurate phase response during...acute methadone . II. smooth pursuit eye movements. Psychopharmacology 67:229–234 Rowland lM, thomas Ml, thorne DR, sing hc et al (2005) Oculo- motor
Pliszka, Steven R.; Crismon, M. Lynn; Hughes, Carroll W.; Corners, C. Keith; Emslie, Graham J.; Jensen, Peter S.; McCracken, James T.; Swanson, James M.; Lopez, Molly
Objective: In 1998, the Texas Department of Mental Health and Mental Retardation developed algorithms for medication treatment of attention-deficit/hyperactivity disorder (ADHD). Advances in the psychopharmacology of ADHD and results of a feasibility study of algorithm use in community mental health centers caused the algorithm to be modified and…
Singh, Nirbhay N.; Lancioni, Giulio E.; Manikam, Ramasamy; Winton, Alan S. W.; Singh, Ashvind N. A.; Singh, Judy; Singh, Angela D. A.
Some individuals with autism engage in physical aggression to an extent that interferes with not only their quality of life, but also that of their parents and siblings. Behavioral and psychopharmacological treatments have been the mainstay of treatments for aggression in children and adolescents with autism. We evaluated the effectiveness of a…
Weiden, Peter J.; Rao, Nyapati
OBJECTIVE: Medication compliance is an orphan topic. Training in the understanding and management of noncompliance does not neatly fall within the domain of psychopharmacology, nor does it clearly fit into other core curricula areas, such as clinical interviewing or psychotherapy training. The objective of this article is to increase awareness…
National Inst. of Mental Health (DHEW), Rockville, MD.
The 14 conference papers on mental illness focus on the biological, genetic, psychopharmacological, psychopathological, and epidemiological and social factors related to psychoses. Divided into five sections each preceded by a brief introduction, entries include the following titles and authors: "The Biological Substrates of Schizophrenia" (S.…
Karper, Laurence P.; And Others
The psychopharmacologic treatment of aggression is a critical component of the treatment of psychiatric patients. The diagnostic assessment of aggressive patients is reviewed and relevant literature is presented to help clinicians select appropriate medication. Side-effects, dosages, and methods of administration are highlighted. (JPS)
Carlson, John S.; Mitchell, Angela D.; Segool, Natasha
This article reviews the current state of evidence for the psychopharmacological treatment of children diagnosed with selective mutism within the context of its link to social anxiety disorder. An increased focus on potential medication treatment for this disorder has resulted from significant monetary and resource limitations in typical practice,…
This paper explains that an interdepartmental writing across the curriculum course at Syracuse University was developed and proposed by a writing teacher and a professor of experimental psychology and psychopharmacology. The paper states that the course, Perspectives on Drug Experience, was to be offered in both writing and psychology and sought…
Telles-Correia, Diogo; Barbosa, António; Cortez-Pinto, Helena; Campos, Carlos; Rocha, Nuno B F; Machado, Sérgio
The liver is the organ by which the majority of substances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first-pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised. The authors carefully review the pharmacokinetic disturbances induced by end-stage liver disease and the potential of psychopharmacological agents for liver toxicity. PMID:28217372
Cordes, J; Lange-Asschenfeldt, C; Hiemke, C; Kahl, K G
Increased cardiometabolic morbidity and increased overall mortality has been observed in patients with severe mental disorders. Therefore, cardiometabolic safety is an important issue in the treatment of patients with psychiatric disorders, in particular in patients with comorbid cardiometabolic diseases. Frequent adverse side effects include disturbances of lipid and glucose metabolism, body weight changes and alterations of the QTc interval. Dependent on the particular substance used and on factors concerning individual vulnerability, these side effects vary in relative frequency. Therefore, regular monitoring is recommended including ECG. Furthermore, interactions between different medicaments may occur, either leading to enhanced or decreased drug concentrations. Prior to psychopharmacological treatment, proper cardiological treatment is recommended. The management of cardiovascular risks under psychopharmacology requires interdisciplinary cooperation between the cardiologist, general practitioner and psychiatrist.
Barthelemy, Olivier J; Richardson, Mark A; Cabral, Howard J; Frank, Deborah A
This manuscript reviews research exploring the relationship between prenatal, perinatal, and adolescent exposure to marijuana and aggressive behavior, including physical aggression. Areas of inquiry include animal research, as well as human research, on prenatal exposure and on marijuana use during adolescence. Potential psychosocial and psychopharmacological mechanisms are identified, as well as relevant confounds. The prenatal marijuana exposure literature provides minimal support for a direct relationship with aggressive behavior in childhood. The adolescent use literature suggests a marginal (at best) association between acute intoxication and aggressive behavior, and an association between chronic use and aggressive behavior heavily influenced by demographic variables, rather than direct, psychopharmacological mechanisms. Cannabis withdrawal symptoms also may include aggression and anger, but there is little evidence to suggest that these effects are large or specific to withdrawal from marijuana compared to other substances. This review will offer recommendations for clinical care and public policy, as well as important questions for future research.
Reeves, Gloria; Anthony, Bruno
Practice guidelines for the treatment of youth with mental health problems tend to endorse integrating psychopharmacologic treatment with psychosocial interventions, such as psychotherapy and parent skills training. However, poor access to pediatric mental health specialists and inadequate training of primary care physicians in psychosocial interventions make it difficult for families to receive this standard of care. Large pediatric randomized, multicenter trials, including the Multimodal Treatment Study of ADHD (attention deficit hyperactivity disorder) [MTA] and the Treatment for Adolescents with Depression Study (TADS), have begun to identify specific advantages of multimodal treatment compared with psychopharmacology alone. Advantages of combined treatment include improvement of both symptoms and family functioning. More research is needed to determine effective and appropriate multimodal interventions for complex and severe pediatric mental illness. Advantages of multimodal treatment must be balanced with the treatment burden on the family system.
Baldwin, David S; Aitchison, Katherine; Bateson, Alan; Curran, H Valerie; Davies, Simon; Leonard, Brian; Nutt, David J; Stephens, David N; Wilson, Sue
Over the last decade there have been further developments in our knowledge of the risks and benefits of benzodiazepines, and of the risks and benefits of alternatives to benzodiazepines. Representatives drawn from the Psychopharmacology Special Interest Group of the Royal College of Psychiatrists and the British Association for Psychopharmacology together examined these developments, and have provided this joint statement with recommendations for clinical practice. The working group was mindful of widespread concerns about benzodiazepines and related anxiolytic and hypnotic drugs. The group believes that whenever benzodiazepines are prescribed, the potential for dependence or other harmful effects must be considered. However, the group also believes that the risks of dependence associated with long-term use should be balanced against the benefits that in many cases follow from the short or intermittent use of benzodiazepines and the risk of the underlying conditions for which treatment is being provided.
Kafka, Martin P
Disinhibited sexual desire, clinically manifested as hypersexual desire disorders, can be operationally defined by considering three behavioral domains associated with sexual motivation or appetitive behavior: (a) sexual preoccupation (time/day consumed by fantasies, urges, and activities), (b) the repetitive frequency of enacted sexual behavior (total sexual outlet/week), and (c) adverse consequences associated with repetitive sexual behavior: Data are presented suggesting that clinical samples of males with paraphilias, paraphilia-related disorders, and sexual coercion may be associated with disinhibited sexual appetite. These conditions need to be addressed by an integrated combination of psychotherapeutic and psychopharmacologic interventions that specifically target disinhibited sexual appetitive behaviors, their antecedents, and consequences. Although combination therapies (empirically based specific psychotherapies in conjunction with psychopharmacological treatments) have demonstrated superior efficacy in many Axis I psychiatric disorders, such combination therapies to reduce paraphilias, paraphilia-related disorders, and adult sexual coercion are currently underutilized in both North and South America and Europe.
Problems of eye contact and expressive language limit the effectiveness of educational and behavioral interventions in patients suffering from pervasive developmental disorders. For that reason, additive psychopharmacological interventions are sometimes needed to improve symptomatology. In our preliminary open trial, three male patients with autistic disorder, diagnosed by ICD-10 criteria, completed an open trial of St John's Wort. Subjects were included in the study if their eye contact and expressive language was inadaequate for their developmental level and if they had not tolerated or responded to other psychopharmacologic treatments (methylphenidate, clonidine or desipramine). Parent and mentor ratings on the Aberrant Behavior Checklist, irritability, stereotypy, and inappropriate speech factors improved slightly during treatment with St John's Wort. Clinician ratings (Psychiatric Rating Scale Autism, Anger and Speech Deviance factors; Global Assessment Scale; Clinical Global Impressions efficacy) did not improve significantly. St John's Wort was only modestly effective in the short-term treatment of irritability in some patients with autistic disorder.
Current psychiatric practice does not seem to have kept pace with the best recommendations of modern clinical psychopharmacology. Polypharmacy, inadequate dosage, overly brief drug trails, and erratic medication changes are commonplace. Psychopharmacology is obligated to disseminate the most current thinking in usuable form and psychiatry to attempt to implement it in clinical practice. Unique here is the concept that there are pharmacologic, theoretical, and technical reasons to prefer the use of high potency neuroleptics for the routine treatment of schizophrenia and to relegate low potency drugs to secondary status. Routine employment of higher standard neuroleptic doses is advanced to minimize the effects of individual variations in compliance, absorption, and metabolism. A suggested protocol for the acute treatment of schizophreniform disorders is offered.
Silver, Gabrielle; Shapiro, Theodore; Milrod, Barbara
Synopsis Information is presented here on CAPP – child and adolescent psychodynamic psychotherapy. Following a definition of anxiety, the authors present study outcomes of non-psychodynamic treatment approaches, alone and in combination with psychopharmacologic treatment, then explore psychodynamic approaches. A detailed overview of psychodynamic psychotherapy is presented, along with two cases illustrating the use of CAPP with young patients with anxiety. The authors also present tables and boxes summarizing CAPP therapeutic processes and strategies as intervention for anxious youth. PMID:23164129
Bonnet, U; Khalil-Boutros, Y
Parotitis is a fairly uncommon adverse drug reaction of psychopharmacological treatment. Here, we report on an acute bilateral parotitis, which was associated with titration of venlafaxine in a 20-year-old female suffering from a severe depressive episode. The parotitis recovered quickly with oral penicillin and was most likely caused by bacteria assumed to spread from oral flora into Stensen's duct as a complication of pronounced venlafaxine-induced xerostomia.
methadone or chlorpromazine in the guinea-pig. Psychopharmacology 48:132-146 Elkhawad AO, Woodruff GN (1975) Studies on the behavioural pharmacology of a...Pharmacol Toxicol Suppl 4, 25:59 Fog RL, Randrup A, Pakkenberg H (1968) Neuroleptic action of quaternary chlorpromazine and related drugs injected into...concerning amphetamine effects.. Curr Dev Psychopharmacol 2:79-163 Mandel RJ, Randall PK (1985) Quantification of lesion induced dopaminergic supersensitivity
were controlled and creased firing rate of CNS neurons and the continued recorded by a computer system. release of catecholamines, tyrosine hydroxylase ... hydroxylase . In: Lipton MA, DiMascio ducing a working memory deficit under field conditions A, Killam KF (eds) Psychopharmacology: a generation of pro...of rats after acute oral doses of aspar- References tame, phenylalanine , and tyrosine. Fundam Appi Toxicol 16:495-505 Ahlers ST, Thomas JR, Berkey DL
Mota de Freitas, Duarte; Leverson, Brian D; Goossens, Jesse L
In this chapter, we review the mechanism of action of lithium salts from a chemical perspective. A description on how lithium salts are used to treat mental illnesses, in particular bipolar disorder, and other disease states is provided. Emphasis is not placed on the genetics and the psychopharmacology of the ailments for which lithium salts have proven to be beneficial. Rather we highlight the application of chemical methodologies for the characterization of the cellular targets of lithium salts and their distribution in tissues.
nicotine regularly within the past year, whose daily caffeine intake exceeded 600 milligrams, whose alcohol consumption exceeded six beers/week or four...were asked to abstain from caffeine and alcohol consumption for 48 hours prior to arrival at the laboratory. Participants arrived at the laboratory on...and Belenky, G. 1993. Caffeine reversal of sleep deprivation effects on alertness and mood. Psychopharmacology. 112: 359-365. Previc, F. H
mediated wet-dog shake behav- Covington HE, Miczek KA (2001) Repeated social -defeat stress, iors Psychopharmacology 108:27-32 cocaine or morphine ...synergistic with oxidative and metabolic insults as well as glutamate to culminate in dopamine cell death. The major objective is to examine the interaction ...The major objective is to examine in rats the interaction between environmental stress and methamphetamine and the convergent action of excitotoxicity
by female rats during agonistic interactions : Effects of morphine and naltrexone. Psychopharmacology. 114, 441-448. Hardy, J.B., & Mellits, ED...Rakic and colleagues in primates. Particularly of interest in spatial working memory is the connection of the hippocampus with the prefrontal cortex...Early work of Olton and others have identified the key role that the hippocampus plays in spatial memory processing (Olton, 1983; Olton et aI., 1979a
stimulants, morphine and cocaine, both showed enhanced conditioned place preference in state-dependent tests (Bespalov et al., 1999; Dockstader and van der...peripheral regions (Charles, 2013). μ-Opioid receptor agonists such as codeine, hydrocodone, oxycodone, meperidine and morphine , are commonly used in...PM (1999). Effects of test conditions on the outcome of place conditioning with morphine and naltrexone in mice. Psychopharmacology (Berl) 141: 118–122
NTG. However, previous work has shown that the locomotor stimulants, morphine and cocaine, both showed enhanced conditioned place preference in state...hydrocodone, oxycodone, meperidine and morphine , are commonly used in North America as ‘rescue’ therapy for migraine (Bigal and Lipton, 2009). In Europe... morphine and naltrexone in mice. Psychopharmacology (Berl) 141: 118–122. Bigal ME, Lipton RB (2008). Excessive acute migraine medication use and migraine
computerized medical information systems. In addition to the above more tangible operational support, Dr. Cheryl L. Spinweber provides consultations to...this Department: BEHAVIORAL PSYCHOPHARMACOLOGY study the effects of two dose levels on Deputy Head: Cheryl L. Spinweber, Ph.D. sleep, memory...November 84 T. D. Knott (with LT Hilton) - "How Context Dependent Roles of Evaluators can Affect Professional Activities and Attitudes" Federation of
Silver, Gabrielle; Shapiro, Theodore; Milrod, Barbara
This article presents information on child and adolescent psychodynamic psychotherapy (CAPP). Following a definition of anxiety, the authors present study outcomes of nonpsychodynamic treatment approaches, alone and in combination with psychopharmacologic treatment, then explore psychodynamic approaches. A detailed overview of psychodynamic psychotherapy is presented, along with 2 cases illustrating the use of CAPP in young patients with anxiety. Also presented are tables and boxes summarizing CAPP therapeutic processes and strategies as intervention for anxious youth.
Autism is a pervasive developmental disorder, with impairments in reciprocal social interaction and verbal and nonverbal communication. There is often the need of psychopharmacological intervention in addition to psychobehavioral therapies, but benefits are limited by adverse side effects. For that reason, Panax ginseng, which is comparable with Piracetam, a substance effective in the treatment of autism, was investigated for possible improvement of autistic symptoms. There was some improvement, which suggests some benefits of Panax ginseng, at least as an add-on therapy.
This is an informative read for any nurse or student training in the mental health field. It includes more than 70 conditions from anxiety to schizophrenia, as well as the range of treatment options. It also looks at nursing concepts in mental health and subjects such as communication, consent, multidisciplinary care, advocacy and scope of practice. There are expert tips on patient care, research, cultural considerations and the latest news in psychopharmacology.
exposure period. 8 a 15. Consroe, P., Elisaldo A. Carlini, Asteroids P. Zwicker and Luiz Alveline Lacerda Interaction of Cannabidiol and Alcohol in Humans...Psychopharmacology, 1979, Vol. 66, 45-50 The authors investigated the interactive effects of cannabidiol (CBD) and alcohol on human motor and cognitive...Research & Development 7 Rue Ancelle 92200, Neuilly sur Seine, France , no date The authors point out that most of the research on cockpit keyboards is based
measures. The d-alpha plane was also used to systematically compare various methylenedioxy -substituted phenethylamines having varying potencies as...Psychopharmacology and Biological Psychiatry, 15(6):903-919, 1991. Paulus, M.P and Geyer, M.A.: The effects of MDMA and other methylenedioxy substituted...M.P and Geyer, M.A.: The effects of MDMA and other methylenedioxy substituted phenylalkylamines on the structure of rat locomotor activity
Suárez Richards, Manuel
Neuroscientific knowledge have enter to psychiatry in a new era, however, new technology for viewing images, brain function, psychopharmacology, non-invasive methodology requires an ethical approach, framed in the bioethical environment. The field of neuroethics has evolved to address many of the specific concerns and what neuroenhancement and neuroimaging provide us, is necessary to extend the scope of ethical things to consider the clinical implications for the psychiatric work.
Morina, Nexhmedin; Koerssen, Rachel; Pollet, Thomas V
This meta-analysis aimed at determining the efficacy of psychological and psychopharmacological interventions for children and adolescents suffering from symptoms of posttraumatic stress disorder (PTSD). A search using the Medline, PsycINFO, and PILOTS databases was conducted to identify randomized controlled trials (RCTs) for pediatric PTSD. The search resulted in 41 RCTs, of which 39 were psychological interventions and two psychopharmacological interventions. Results showed that psychological interventions are effective in treating PTSD, with aggregated effect sizes of Hedge's g=0.83 when compared to waitlist and g=0.41 when compared to active control conditions at posttreatment. Trauma-focused cognitive behavior therapy was the most researched form of intervention and resulted in medium to large effect sizes when compared to waitlist (g=1.44) and active control conditions (g=0.66). Experimental conditions were also more effective than control conditions at follow-up. Interventions were further effective in reducing comorbid depression symptoms, yet the obtained effect sizes were small to medium only. The findings indicate that psychological interventions can effectively reduce PTSD symptoms in children and adolescents. There is very little evidence to support use of psychopharmacological interventions for pediatric PTSD.
Kraemer, Helena C.; Epstein, Robert S.; Frank, Ellen; Haynes, Ginger; Laughren, Thomas P.; Mcnulty, James; Reed, Shelby D.; Sanchez, Juan; Leon, Andrew C.
Objective: This article captures the proceedings of a meeting aimed at defining clinically meaningful effects for use in randomized controlled trials for psychopharmacological agents. Design: Experts from a variety of disciplines defined clinically meaningful effects from their perspectives along with viewpoints about how to design and interpret randomized controlled trials. Setting: The article offers relevant, practical, and sometimes anecdotal information about clinically meaningful effects and how to interpret them. Participants: The concept for this session was the work of co-chairs Richard Keefe and the late Andy Leon. Faculty included Richard Keefe, PhD; James McNulty, AbScB; Robert S. Epstein, MD, MS; Shelby D. Reed, PhD; Juan Sanchez, MD; Ginger Haynes, PhD; Andrew C. Leon, PhD; Helena Chmura Kraemer, PhD; Ellen Frank, PhD, and Kenneth L. Davis, MD. Results: The term clinically meaningful effect is an important aspect of designing and interpreting randomized controlled trials but can be particularly difficult in the setting of psychopharmacology where effect size may be modest, particularly over the short term, because of a strong response to placebo. Payers, regulators, patients, and clinicians have different concerns about clinically meaningful effects and may describe these terms differently. The use of moderators in success rate differences may help better delineate clinically meaningful effects. Conclusion: There is no clear consensus on a single definition for clinically meaningful differences in randomized controlled trials, and investigators must be sensitive to specific concerns of stakeholders in psychopharmacology in order to design and execute appropriate clinical trials. PMID:23882433
Hulgaard, Ditte; Wacher, Jeanette; Dehlholm-Lambertsen, Gitte
Pervasive refusal syndrome (PRS) is a severe, pervasive and potentially life-threatening disorder, which was first de--scribed in 1991, as a syndrome of child psychiatric disorder. Little has been written about PRS. We report a case story of a ten-year-old boy developing all symptoms of PRS, including inability to eat, move or speak. Psychopharmacological treat-ment was not successful. Full rehabilitation was reported after a period of inpatient treatment and outpatient follow-up. Different aetiological factors for PRS have been proposed. A number of these are presented in the case story.
Kasprow, Mark C.; Scotton, Bruce W.
Transpersonal theory proposes that there are developmental stages beyond the adult ego, which involve experiences of connectedness with phenomena considered outside the boundaries of the ego. In healthy individuals, these developmental stages can engender the highest human qualities, including altruism, creativity, and intuitive wisdom. For persons lacking healthy ego development, however, such experiences can lead to psychosis. Superficially, transpersonal states look similar to psychosis. However, transpersonal theory can assist clinicians in discriminating between these two conditions, thereby optimizing treatment. The authors discuss various therapeutic methods, including transpersonal psychopharmacology and the therapeutic use of altered states of consciousness. (The Journal of Psychotherapy Practice and Research 1999; 8:12–23) PMID:9888104
Jouvent, R; Lecrubier, Y; Puech, A J; Simon, H F; Widlocher, D
In animals, the psychopharmacological profile of beta-adrenergic stimulants is very similar to that of tricyclic antidepressants. In patients, more particularly in endogenous depressive patients, the antidepressant effect of salbutamol was very clear. A definite improvement was observed in all of the 22 studied patients after 1 to 3 days of intermittent venous infusion. The place of salbutamol in the therapeutic armamentarium of depressive states has still to be defined exactly. It is speculated that the antidepressant effect of imipramine-like derivatives is related to the stimulation of central beta 2-adrenergic receptors.
Buljan, Danijel; Buljan, Marija; Situm, Mirna
Psychodermatologic disorders are conditions involving an interaction between the mind and the skin. These disorders fall into three major categories: psychosomatic disorders, primary psychiatric disorders and secondary psychiatric disorders (Koo 1995). The treatment of psychodermatologic disorders is almost impossible without a holistic team approach involving psychiatrist, dermatologist and psychologist. Majority of psychodermatologic disorders can be treated with cognitive-bihevioral psychotherapy, psychoterapeutic stress-and-anxiety-management techniques and psychotropic drugs. Psychopharmacologic treatment with anxiolytics, antidepressants, antipsychotics and mood stabilizers can be prescribed by dermatologist, after consulting the psychiatrist.
Campbell, Nancy D
Behavioral pharmacology emerged in the early to mid-20th century as an experimental and observational science, helping to consolidate an empirically based psychological science of behavior. Behavioral psychologists came to play significant roles in toxicology, neuropharmacology, and psychopharmacology. This article traces the first 3 decades of American Psychological Association Division 28. Sources include the Division 28 Oral History Project; formal interviews conducted by the author in the early 2000s with behavioral, experimental, and clinical pharmacologists; and the archived newsletters of Division 28. (PsycINFO Database Record
Rapp, Amy; Dodds, Alice; Walkup, John T; Rynn, Moira
This article provides a brief review of the current available data concerning present treatment and potential new treatment advances for pediatric anxiety disorders, such as generalized anxiety disorder, separation anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Disorder-specific treatment methods and innovations, particularly computer-assisted methods of delivery for cognitive behavioral therapy (CBT) will be reviewed. Additionally, the paper will discuss novel psychopharmacological compounds (e.g., D-cycloserine, riluzole, memantine, and anticonvulsant medications). Available evidence for the efficacy of novel medication strategies in adult studies and implications for their use in pediatrics will be discussed.
Cummings, Michael A
Psychopathic individuals account for substantial predatory and impulsive violence. To the present, the principal intervention used to decrease the harm inflicted by psychopaths has been confinement. Nevertheless, most confined psychopathic persons return to the community. Recent advances in the understanding of the neurobiology of psychopathy hold promise for new research directions and more effective treatments. In this article, we will explore recent advances in genetics, electrophysiology, brain imaging, and psychopharmacology, as well as, in brief, their implications for new directions in research and treatment.
Möller, H J; Rujescu, D
Pharmacogenetic influences on therapeutic response to e.g. antidepressant or neuroleptic treatment are poorly understood and the lack of efficacy in many of the patients together with side effects can both limit therapy and compliance. Thus the aim of pharmacogenetics and pharmacogenomics is to provide predictive tools for the response to psychopharmacologic agents in the therapy of psychiatric disorders and in that ways to provide a real personalized psychiatry. The following review will summarize the current stage of pharmacogenetics and pharmacogenomics and will critically discuss the possibilities of a personalized medicine.
Andrabi, Sara; Greene, Spencer; Moukaddam, Nidal; Moukkadam, Nidal; Li, Benjamin
New drugs of abuse continue to emerge, including synthetic cannabinoids, synthetic cathinones, and hallucinogens. It is important to recognize their individual psychopharmacologic properties, symptoms of intoxication, and symptoms of withdrawal. Providers must be vigilant of acute medical or psychiatric complications that may arise from use of these substances. Treatment of the patient also includes recognition of any substance use disorders as well as comorbid psychiatric disorders. Although pharmacologic treatments for substance use disorder (of the drugs included in this article) are limited, there are a variety of psychotherapeutic modalities that may be of some benefit.
Based on his clinical experience and knowledge in the humanities, phenomenology, and natural sciences, the Swiss psychiatrist and Rorschach expert Roland Kuhn discovered the specific antidepressant effect of imipramine in the treatment of vital depressive disorder. This discovery of the first tricyclic antidepressant drug shows how an education covering the various fields of psychiatry facilitates therapeutic and scientific achievements. Kuhn's methods as a psychiatrist and his papers can show present and future generations of psychiatrist ways to make new discoveries in the field of psychiatry, psychotherapy, and psychopharmacology.
Phelps, Kenneth; Bullard, Crystal; Helps, Stacey; Getz, Alexander
The authors provide a template of focused skills drawn from various psychotherapy modalities for integration into follow-up psychopharmacology appointments. Titled the Six E model, this approach includes strategies to elicit an agenda, externalize the presenting problem, seek exceptions, engage empathetically, utilize enactments, and offer education. The template was trialed in a child and adolescent outpatient residency clinic under the guidance of two attendings. Qualitative feedback was solicited from fellows following utilization of the template. The Six E model was felt to improve structure and subjective satisfaction of patient, family, and provider participating in the brief appointments.
Ethical problems resulting from brain research have given rise to a new discipline termed neuroethics, representing a new kind of knowledge capable of discovering the neural basis for universal ethics. The article (1) tries to evaluate the contributions of neuroethics to medical ethics and its suitability to outline the foundations of universal ethics, (2) critically analyses the process of founding this universal ethic. The potential benefits of applying neuroimaging, psychopharmacology and neurotechnology have to be carefully weighed against their potential harm. In view of these questions, an intensive dialogue between neuroscience and the humanities is more necessary than ever.
Bentley, Kia J
This article raises questions about how social workers can be more responsive to the needs and wants of women who struggle with mental, emotional, and behavioral disorders. Specifically, the article examines the history and theoretical context of mental health services for women, reviews lessons learned from women's own descriptions of their lived experiences with mental illness, and summarizes needed responses to the treatment needs of women. Recommendations are offered in areas of the general structure of the service delivery system, psychosocial and psychotherapeutic interventions, and psychopharmacology.
Santy, Patricia A.
The operational psychiatric requirements for a comprehensive Health Maintenance Facility (HMF) on a permanently manned Space Station are examined. Consideration is given to the psychological health maintenance program designed for the diagnosis of mental distress in astronauts during flight and for prevention of mental breakdown. The types of mental disorders that can possibly affect the astronauts in flight are discussed, including various organic, psychotic, and affective mental disorders, as well as anxiety, adjustment, and somatoform/dissociative disorders. Special attention is given to therapeutic considerations for psychiatric operations on Space Station, such as restraints, psychopharmacology, psychotherapy, and psychosocial support.
Haggerty, Greg; Siefert, Caleb; Stoycheva, Valentina; Sinclair, Samuel Justin; Baity, Matthew; Zodan, Jennifer; Mehra, Ashwin; Chand, Vijay; Blais, Mark A
Growing economic pressure on inpatient services for adolescents has resulted in fewer clinicians to provide individual psychotherapy. As a result, inpatient treatment trends have favored group psychotherapy modalities and psychopharmacological interventions. Currently, no clinician-rated measures exist to assist clinicians in determining who would be able to better utilize individual psychotherapy on inpatient units. The current study sought to demonstrate the utility of the Readiness for Inpatient Psychotherapy Scale with an adolescent inpatient sample. This study also used the RIPS as it is intended to be used in everyday practice. Results from the authors' analyses reveal that the RIPS demonstrates good psychometrics and interrater reliability, as well as construct validity.
The presented work provides a review of literature dealing with dermatoses (dermatitis atopica, eczemas, allergies, urticaria, pruritus, etc.) from the psychosomatic point of view. The presented work attracts attention to the association of psychical state with the skin; it indicates the necessity to comprehend each patient from the bio-psycho-social aspect and to take into account the multifactorial etiopathogenesis of each disease. The author recommends cooperation between dermatologists, clinical psychologists and psychiatrists. The aim of the cooperation is to supplement local therapy by psychotherapy in psychosomatic disorders, and the field of psychodermatology by psychopharmacology.
Post, Michal; Haymes, Linda; Storey, Keith; Loughrey, Tamara; Campbell, Camille
Stalking behavior among some students with Autism Spectrum Disorders (ASDs) is of concern both for the individual being stalked as well as the student with ASDs. This manuscript reviews effective interventions based upon functional assessment and appropriate positive behavior supports. Specific interventions for addressing staking behavior by students with ASDs are analyzed and evaluated with suggestions for best practice for instructional procedures. Interventions covered are social skills groups, video modeling, self-management, video feedback, rule governed behavior, scripts, visual supports, counseling, psychopharmacology and reducing the amount of isolating interests and activities while increasing more opportunities for integration. Recommendations for future research are discussed.
Schizophrenia is characterized not only by symptoms, but also by a reduced insight that contributes to functional outcomes through a bad acceptation of the disease and a low involvement in treatment and care. Functional outcomes of schizophrenia are conditioned by the acceptance of the troubles, by the involvement in psychopharmacological treatment and in psychosocial care and by the expressed emotion level of the family. Psychoeducation improves adherence to treatment. Psychoeducation lowers relapse rate. All the patients suffering from schizophrenia and their families should benefit from psychoeducation.
Kohrt, Brandon A.; Duncan, Erica
Hemicrania continua is a headache characterized by chronic unremitting unilateral pain associated with ipsilateral autonomic findings. This type of headache responds to high-flow oxygen and indomethacin. This case report describes a male veteran with posttraumatic stress disorder (PTSD) and major depressive disorder who suffers from comorbid hemicrania continua. The psychiatric symptoms were recalcitrant to psychopharmacological intervention. However, when the patient's hemicrania continua was treated appropriately, the patient's psychiatric symptoms also abated. This case demonstrates the need to address physical comorbidities that may exacerbate psychiatric disorders, such as PTSD. PMID:22937418
Michaels, Timothy I; Novakovic, Vladan
In recent years, increasing popular support for the medicinal and recreational use of cannabis has led to legalization for both medicinal and recreational purposes in the United States. To the extent that these changes in policy lead to increase widespread use, it is important to consider the association between heavy chronic cannabis use and the onset of psychotic illnesses, such as schizophrenia. This article provides a brief review of evidence that support cannabis use as a risk factor in the complex etiology of psychotic illness. In addition to reviewing psychopharmacology, longitudinal research, and clinical studies, the article addresses the potential implications of current research on public health policy.
Current treatment of the schizophrenic patient relies primarily on psychopharmacological management, psychoeducation, and family work. If individual psychotherapy is an adjunct, it is generally supportive. Recent focus on determinants of change in classical psychoanalysis suggests that noninterpretive mechanisms may have an impact at least equivalent to that of the well-timed transference interpretation. The author argues that the same noninterpretive mechanisms may be even more important for change in patients in a supportive process. A case study is used to illustrate that such an application of psychoanalytic principles and developmental research can be used to help even the most disturbed patients. PMID:10896741
Rao, Nyapati R.; Meinzer, Arthur E.; Berman, Sheldon S.
Psychotherapy is likely to play a minor or nonexistent role in the future general psychiatrist's training and practice. However, the component skills of recognition and management of the countertransference will remain important. Because psychotherapy training and supervision have been the venues for countertransference learning, the field is in danger of losing its teaching laboratory and hence losing these skills. The authors examine the concept of countertransference and discuss its importance in four increasingly significant areas: managed care, psychopharmacological treatment, emergency intervention, and the management of professional boundaries regarding sexual misconduct. Methods are discussed for enhancing residents' countertransference skills through supervision, training groups, and the resident's personal psychotherapy. PMID:9058556
Noriega, Nicolás H
This study aims at determining whether there was an association among anxiety, depression and allergic illnesses. It suggests the proper therapeutic treatment. During a year, our research work team worked with a group of 82 female and male patients (from 13 to 76 years old) who suffered from various types of allergies. Two psychometric scales were used to carry out this study: Hamilton's scale for anxiety whereas Beck Depression Inventory (BDI-II) and Zung's for depression. The association and its percentage were analyzed in patients who reported typical symptoms during their first check-up. They were free of psychopharmacologic drugs and psychotherapies. The presence of anxiety and depression was interpreted as another factor in the development of allergic symptoms. The following results were achieved as regards: for anxiety, an association positive 95 %. For depression, the results showed that there was a positive tendency for the association with an allergic illness. The conclusions showed that there is a positive association between anxiety and allergies. As regards depression and allergic illness, there is only a positive tendency. These final results would raise awareness of how to deal with anxiety and depression in allergic patients, both psychopharmacologically and psychotherapeutically.
Goodwin, Frederick K
It is important to consider, in light of how innovation has so often occurred, whether today's managed care environment is conducive to continued psychopharmacologic innovation. The initial step in the development of a new area in psychopharmacology has historically relied in large part on individual clinicians who pursued unconventional methods of treatment. When a set of guidelines such as a formulary (a list of drugs eligible for reimbursement compiled by a managed care organization) becomes restrictive, it decreases clinician innovation. In addition to this long-term threat to innovation, studies have found greater restrictiveness in formularies to be associated with higher health care utilization. Thus, restricted formularies that are based on a naive interpretation of "therapeutic equivalence" may slow the advance of medical science without even achieving the only goal that could possibly justify such restrictions-cost control. If innovation is to flourish, formularies must be flexible and advisory, not restrictive. Preserving the climate for innovation in health care requires the management culture to focus on the long-term impact of policies on quality and innovation as well as on the overall health cost in the system.
Clerici, C A; Giacon, B; Veneroni, L; Ferrari, A; Luksch, R; Meazza, C; Polastri, D; Simonetti, F; Massimino, M
At Pediatric Oncology Centers, psychological intervention and psychotherapy are generally offered to children and adolescents for supporting their adjustment to disease and treatment. The clinical practice, however, point out that cognitive and emotional symptoms, such as psychic distortions, fatigue, anxiety, irritability and depression, are sustained by biological mechanisms connected with disease and treatment and not respondent to psychological consultation and to other psychosocial resources. These manifestations could interfere with treatment or with the long-term adjustment and call for psychopharmacological treatments. Biological factors able to cause these alterations are not yet studied in depth in clinical tradition and scientific literature on the integration of psychological and psychopharmacological intervention in pediatric oncology is still poor. In this paper organic components of psychic and behavioral alterations in the course of disease are illustrated, considering the symptoms, causes and possible remedies in the light of the most recent interdisciplinary views. The main mechanism connected with oncologic treatments - chemotherapy, surgery, radiotherapy - and responsible for psycho-organic alterations in children and adolescent with cancer are also described.
Wehry, Anna M; Beesdo-Baum, Katja; Hennelly, Meghann M; Connolly, Sucheta D; Strawn, Jeffrey R
Recent advances in the developmental epidemiology, neurobiology, and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social, and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity, and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive behavioral therapy (CBT) for the treatment of these conditions in youth and suggest that the combination of psychotherapy + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy.
[Reconsideration of nicotine and other substance dependence: a clue from dependence-related mentation including reward, motivation, learning, delusion and hallucination toward understanding the concept of non-substance-related addiction].
Nicotine produces core symptoms of substance dependence (craving and withdrawal) without any psychotic symptoms. The psychopharmacological structure of craving is hypothesized to be constituted by three components: the primary reinforcing property of a substance, the secondary reinforcing property of that substance (conditioned aspects of the environment, such as contextual or specific cues associated with substance taking), and the negative affective motivational property during withdrawal (i.e. the desire to avoid the dysphoric withdrawal symptoms elicits craving). Among the three components, the primary reinforcing property of a substance forms the most fundamental factor for establishing substance dependence. Sensitization or reverse tolerance observed in locomotor activity of animals, which had been believed to be a methamphetamine psychosis model, is demonstrated to reflect the establishment of conditioned reinforcement. Finally, non-substance-related addiction such as gambling, internet, and sex is discussed. From the aspect of the above hypothetical psychopharmacological structure of craving, the most significant difference between substance dependence and non-substance-related addiction is that the primary reinforcing property of non-substance reward is relatively intangible in comparison with that of a substance of abuse.
Despite of the huge progress in clinical psychopharmacology and recent introduction of many new mental health medicines, a significant proportion of psychiatric patients do not respond satisfactory to pharmacological treatment. Such patients are commonly labeled "treatment resistant" although there is no full agreement about definition of the term. The precise prevalence of treatment resistance is hard to determine due to the lack of consensus regarding the term definition and too many cases of pseudo-resistance. Resistant and refractory mental disorders have significant economic, social, physical, and psychological consequences. The suffering and disability associated with chronic, unremitting mental disorders is profound. Changing treatment philosophy may be a critical step towards overcoming what some view as "therapeutic stagnation in psychiatry" and providing better treatment effectiveness and efficiency for patients benefit. A "paradigm shift" is needed from the mechanistic, formistic and reducionistic way of thinking of technical and impersonal psychopharmacology to contextual and systemic thinking with new treatment holodigm individualizing and personalizing psychopharmacotherapy in a more creative manner. Treatment resistance as a construct should be reconsidered as well as "monotherapy before polytherapy" treatment strategy. The best treatments are those that utilize and integrate multiple therapeutic modalities. The concept of creative, person-centered narrative psychopharmacotherapy gives a hope for increasing treatment effectiveness and efficiency in psychiatry.
López-Muñoz, Francisco; Baumeister, Alan A; Hawkins, Mike F; Alamo, Cecilio
The serendipity is the faculty for making a discovery through a combination of accident and sagacity. In psychopharmacology, the serendipity played a key role in the discovery of many psychotropic drugs, although there are marked disputes in this regard, possibly due to semantic differences in relation to the meaning of this term. We have implemented an operational definition of serendipity based on the discovery of something unexpected or not sought intentionally, irrespective of the systematic process leading to the accidental observation. The present paper analyses some representative examples of discoveries in the field of psychopharmacology according to different serendipitous intervention patterns. Following this approach there would be four different imputability patterns: pure serendipitous discoveries (valproic acid/valproate); serendipitous observation leading to a non-serendipitous discoveries (imipramine); non-serendipitous discoveries secondarily associated with serendipitous observation (barbiturates); non-serendipitous discoveries (haloperidol). We can conclude that pure serendipitous discoveries in this field are not very frequent, most common being a mixed pattern; an initial serendipitous observation which leads to a non-serendipitous discovery of clinical utility. This is the case of imipramine, lithium salts, chlorpromazine or meprobamate.
Vasile, Russell G; Bruce, Steven E; Goisman, Robert M; Pagano, Maria; Keller, Martin B
The past decade has brought major new developments in the psychopharmacologic management of generalized anxiety disorder and social phobia. We examined medication-prescribing patterns for the treatment of these anxiety disorders for 12 years to assess changes in patients' anti-anxiety psychotropic medication usage during that period of evolving practice guidelines. We examined psychotropic medication use in 305 patients with generalized anxiety disorder and 232 with social phobia enrolled in the Harvard/Brown Anxiety Disorders Research Project (HARP), a prospective, longitudinal study of anxiety disorders. Psychotropic treatment patterns seem to have remained relatively stable over 12 years with benzodiazepines the medications most commonly used for both generalized anxiety disorder and social phobia. Comparatively, selective serotonin reuptake inhibitor (SSRI) and venlafaxine usage as stand-alone medications for these disorders remained low throughout the follow-up period. At the 12-year follow-up, 24% of patients with generalized anxiety disorder and 30% of patients with social phobia were utilizing neither an SSRI/selective norepinephrine reuptake inhibitor (SNRI) nor a benzodiazepine. Treatment recommendations for use of SSRIs and venlafaxine in the management of generalized anxiety disorder and social phobia initially promulgated in 1998 had a modest impact on changes in psychopharmacologic practice 4-5 years later. Difficulties in the implementation of treatment guidelines are discussed.
Castro-Fornieles, Josefina; Garcia, Ana Isabel; Lazaro, Luisa; Andrés-Perpiñá, Susana; Falcón, Carles; Plana, Maria Teresa; Bargallo, Nuria
Various neuroimaging techniques have revealed morphological and functional alterations in anorexia nervosa (AN), although few spectroscopic magnetic resonance studies have examined short-term weight-recovered AN patients. Subjects were 32 female adolescent patients (between 13 and 18 years old) seen consecutively in our department and who met DSM-IV diagnostic criteria for AN. All of them had received a minimum of six months of treatment and were short-term weight-recovered (for one to three months) with a body mass index ranging from 18 to 23. A group of 20 healthy female volunteer controls of similar age were also included. All subjects were assessed with psychopathological scales and magnetic resonance spectroscopy. Total choline (Cho) (p=0.007) and creatine (Cr) (p=0.008) levels were significantly higher in AN patients than in controls. AN patients receiving psychopharmacological treatment with SSRIs (N=9) had metabolite levels similar to control subjects, but patients without this treatment did not. The present study shows abnormalities in brain neurometabolites related to Cho compounds and Cr in the prefrontal cortex in short-term weight-recovered adolescent AN patients, principally in patients not undergoing psychopharmacological treatment. More studies with larger samples are necessary to test the generalizability of the present results.
Harrison, Paul J
One justification for the major scientific and financial investments in genetic and genomic studies in medicine is their therapeutic potential, both for revealing novel targets for drugs which treat the disease process, as well as allowing for more effective and safe use of existing medications. This review considers the extent to which this promise has yet been realised within psychopharmacology, how things are likely to develop in the foreseeable future, and the key issues involved. It draws primarily on examples from schizophrenia and its treatments. One observation is that there is evidence for a range of genetic influences on different aspects of psychopharmacology in terms of discovery science, but far less evidence that meets the standards required before such discoveries impact upon clinical practice. One reason is that results reveal complex genetic influences that are hard to replicate and usually of very small effect. Similarly, the slow progress being made in revealing the genes that underlie the major psychiatric syndromes hampers attempts to apply the findings to identify novel drug targets. Nevertheless, there are some intriguing positive findings of various kinds, and clear potential for genetics and genomics to play an increasing and major role in psychiatric drug discovery.
Fads in psychiatry are little more than bad ideas with short half-lives. They have arisen because of the great discontinuities that have swept psychiatry unlike other specialties in the 20th century: the transition in the 1920s from asylum-based biological psychiatry to psychoanalysis, and the transition in the 1960s from psychoanalysis to a biological model based on psychopharmacology. In no other medical specialty has the knowledge base been scrapped and rebuilt, and then again scrapped and rebuilt. In these great transitions, when psychiatry each time has had to reconstruct from scratch, bad ideas have crept in with good. Psychiatry, in its heavy use of consensus conferences, is often unable to employ science as a means of discarding fads, which, once installed, are often difficult to remove. Each of the great paradigms of psychiatry in the last hundred years has given rise to fads, and psychopharmacology is no exception, with faddish uses of neurotransmitter doctrine claiming centre stage. Only when psychiatry becomes firmly linked to the neurosciences will its subjugation to the turbulence of faddism be moderated.
Biological treatment of mental disorders has obviously strong links to psychopharmacology. It is no wonder that the greatest expectations for progress in the treatment of mental conditions are focused on new drugs or molecules that share interesting properties of pharmacological mechanisms of action. However, nowadays the development of non-pharmacological options, including transcranial magnetic stimulation or vagus nerve stimulation, indicates the need for more efficacious and better tolerated treatment modalities. Before the age of modern psychopharmacology, which began in the 1950s, treatment of mental disorders was rather limited to only a few methods that had proved to be of some efficacy. In the absence of other, more efficacious treatment methods, these therapies-such as insulin coma or atropine coma-brought at least some relief to those who suffered from serious mental disorders. Obviously, at present we are aware that these therapies should be considered far less efficient than modern psychotropic drugs; however, at the time when these methods were used, no other efficient treatment methods were available.
Correa, Mercè; Salamone, John D; Segovia, Kristen N; Pardo, Marta; Longoni, Rosanna; Spina, Liliana; Peana, Alessandra T; Vinci, Stefania; Acquas, Elio
Mainly known for its more famous parent compound, ethanol, acetaldehyde was first studied in the 1940s, but then research interest in this compound waned. However, in the last two decades, research on acetaldehyde has seen a revitalized and uninterrupted interest. Acetaldehyde, per se, and as a product of ethanol metabolism, is responsible for many pharmacological effects which are not clearly distinguishable from those of its parent compound, ethanol. Consequently, the most recent advances in acetaldehyde's psychopharmacology have been inspired by the experimental approach to test the hypothesis that some of the effects of ethanol are mediated by acetaldehyde and, in this regard, the characterization of metabolic pathways for ethanol and the localization within discrete brain regions of these effects have revitalized the interest on the role of acetaldehyde in ethanol's central effects. Here we present and discuss a wealth of experimental evidence that converges to suggest that acetaldehyde is an intrinsically active compound, is metabolically generated in the brain and, finally, mediates many of the psychopharmacological properties of ethanol.
Bolt, L L E
Our knowledge of the human brain and the influence of pharmacological substances on human mental functioning is expanding. This creates new possibilities to enhance personality and character traits. Psychopharmacological enhancers, as well as other enhancement technologies, raise moral questions concerning the boundary between clinical therapy and enhancement, risks and safety, coercion and justice. Other moral questions include the meaning and value of identity and authenticity, the role of happiness for a good life, or the perceived threats to humanity. Identity and authenticity are central in the debate on psychopharmacological enhancers. In this paper, I first describe the concerns at issue here as extensively propounded by Carl Elliott. Next, I address David DeGrazia's theory, which holds that there are no fundamental identity-related and authenticity-related arguments against enhancement technologies. I argue, however, that DeGrazia's line of reasoning does not succeed in settling these concerns. His conception of identity does not seem able to account for the importance we attach to personal identity in cases where personal identity is changed through enhancement technology. Moreover, his conception of authenticity does not explain the reason why we find inauthentic values objectionable. A broader approach to authenticity can make sense of concerns about changes in personal identity by means of enhancement technologies.
Bachmann, Katharina; Lam, Alexandra P.; Philipsen, Alexandra
Attention-deficit/hyperactivity disorder (ADHD) is a recognized serious mental disorder that often persists into adulthood. The symptoms and impairments associated with ADHD often cause significant mental suffering in affected individuals. ADHD has been associated with abnormal neuronal activity in various neuronal circuits, such as the dorsofrontostriatal, orbitofrontostriatal, and frontocerebellar circuits. Psychopharmacological treatment with methylphenidate hydrochloride is recommended as the first-line treatment for ADHD. It is assumed that medication ameliorates ADHD symptoms by improving the functioning of the brain areas affected in the condition. However, side effects, contraindications, or non-response can limit the effectiveness of a psychopharmacological treatment for ADHD. It is therefore necessary to develop non-pharmacological interventions that target neuronal mechanisms associated with the condition in the same way as pharmacological treatment. We think that mindfulness meditation employed as a neuropsychotherapeutic intervention could help patients with ADHD to regulate impaired brain functioning and thereby reduce ADHD symptoms. In this paper, we highlight the mechanisms of such mindfulness meditation, and thus provide a rationale for further research and treatment development from a neuropsychotherapeutic perspective. We conclude that mindfulness meditation employed as a neuropsychotherapeutic intervention in therapy is a promising treatment approach in ADHD. PMID:27445873
Dobson, Eric T.; Strawn, Jeffrey R.
Background Randomized controlled trials consistently support the efficacy of antidepressants in treating youth with generalized anxiety disorder (GAD), although integrated examinations of efficacy, safety, and tolerability of psychotropic medications in GAD specifically are rare. With this in mind, we sought to describe the efficacy, safety and tolerability of psychopharmacologic interventions in youth with GAD. Methods Randomized, double-blind, placebo-controlled, prospective trials of psychopharmacologic interventions in youth with GAD were identified through a PubMed/Medline (1966–2015) search. Both authors manually reviewed trials and, to evaluate comparative efficacy and tolerability across medications, numbers needed to treat (NNT) (based on Pediatric Anxiety Rating Scale (PARS) remission criteria (PARS ≤8 ), and number needed to harm (NNH) for selected treatment-emergent adverse events (TEAEs) were calculated. Finally, treatment-emergent suicidality and taper-emergent/post-study adverse events are reported descriptively. Results Five trials that involved 1,186 patients and evaluated four medications were reviewed and efficacy data were extracted with regard to dimensional measures of anxiety. SSRI/SNRIs demonstrated efficacy in the reduction of anxiety symptoms with NNTs ranging from 2.8 to 9.3. TEAEs varied considerably between studies but tended to be mild and generally did not lead to discontinuation. Conclusions Data from five trials of SSRI/SNRI in youth with GAD, many of whom had co-occurring separation and social anxiety disorders, suggest superiority to placebo and favorable tolerability profiles. PMID:26660158
Echarte Alonso, Luis E
In this paper I present similarities and connections between Transhumanism and Eliminative Materialism. Concretely, I study the arguments with which in both positions it is defended a merely instrumental idea of human body and, because of that, one infinitely mouldable. First, I show the social relevance of this idea and its projections in phenomena as medicalization of human condition and, especially, cosmetic psychopharmacology. Besides, I denounce that such influences are caused by illegitimate transference of authority between philosophical and scientific forums. Second, according to my analysis, these new postmodern fashions of chemical sentimentalism (related with radical changes on personal identity and human nature) drive to new eugenic forms what I name autoeugenics. Finally, I call attention to the important role of utopian speeches about the science of tomorrow and super-human civilization in a Carpe Diem society. In my conclusions, I claim that historical reasoning or warnings about what is coming are not efficient strategies to control neither new psychopharmacological habits nor passivity generated by them. Returning social confidence in the power of reason to achieve reality (and other human beings) is, in my opinion, the best way to rehabilitate a more and more devalued human action.
In the early history of psychopharmacology, the prospect of developing technologically sophisticated drugs to alleviate human ills was surrounded with a fervor that could be described as religious. This paper explores the subsequent history of the development of psychopharmacological agents, focusing on the ambivalent position of both the industry and its employees. Based on interviews with retired pharmaceutical employees who were active in the industry in the 1950s and 1960s when the major breakthroughs were made in the development of MAOIs and SSRIs, the paper explores the initial development of educational materials for use in sales campaigns. In addition, based on interviews with current employees in pharmaceutical sales and marketing, the paper describes the complex perspective of contemporary pharmaceutical employees who must live surrounded by the growing public vilification of the industry as rapacious and profit hungry and yet find ways to make their jobs meaningful and dignified. The paper will contribute to the understudied problem of how individuals function in positions that require them to be part of processes that on one description constitute a social evil, but on another, constitute a social good.
Svetlov, Stanislay I; Kobeissy, Firas H; Gold, Mark S
Ritalin, known under chemical name methylphenidate (MPH), is a psychostimulant prescribed to treat attention-deficit/hyperactivity disorder (ADHD) and other conditions. Psychotropic effects and pharmacological pathways evoked by MPH are similar, but not identical to those produced by amphetamines and cocaine. Although not completely understood in detail, MPH psychostimulation is mediated by the increase of central dopamine (DA) and possibly norepinephrine (NE) and serotonin (ST) due to decrease of their re-uptake via binding to and inhibition of DA, NE, and ST transporters. Despite similarity in psychopharmacological effects, the rewarding/ reinforcing ability of MPH appears to be significantly lower than amphetamines and especially cocaine. MPH and similar medications have been widely used on College campuses and by students preparing for exams. Nicknamed 'steroids for SATs,' MPH and related medications are purchased without prescription and their use may even be encouraged by parents and tutors. However, while widely and safely used and administered for over forty years, Ritalin generated significant controversy including MPH abuse and addiction, and adverse reactions. It is now clear that treatment of ADD/ADHD with psychostimulants prevents drug abuse and addictions. Use by those without any medical or psychiatric diagnosis is increasing. In this mini-review, we discuss psychopharmacological and behavioral aspects, and outline neurochemical mechanisms that may provoke Ritalin abuse, addiction and adverse effects compared to amphetamines and cocaine.
Pittman, Julian T; Lott, Chad S
Zebrafish (Danio rerio) are rapidly becoming a popular animal model for neurobehavioral and psychopharmacological research. While startle testing is a well-established assay to investigate anxiety-like behaviors in different species, screening of the startle response and its habituation in zebrafish is a new direction of translational biomedical research. This study focuses on a novel behavioral protocol to assess a tapping-induced startle response and its habituation in adult zebrafish that have been pharmacologically-induced to exhibit anxiety/depression-like behaviors. We demonstrated that zebrafish exhibit robust learning performance in a task adapted from the mammalian literature, a modified plus maze, and showed that ethanol and fluoxetine impair memory performance in this maze when administered after training at a dose that does not impair motor function, however, leads to significant upregulation of hippocampal serotoninergic neurons. These results suggest that the maze associative learning paradigm has face and construct validity and that zebrafish may become a translationally relevant study species for the analysis of the mechanisms of learning and memory changes associated with psychopharmacological treatment of anxiety/depression.
Inada, Toshiya; Inagaki, Ataru
Psychotropic dose equivalence is an important concept when estimating the approximate psychotropic doses patients receive, and deciding on the approximate titration dose when switching from one psychotropic agent to another. It is also useful from a research viewpoint when defining and extracting specific subgroups of subjects. Unification of various agents into a single standard agent facilitates easier analytical comparisons. On the basis of differences in psychopharmacological prescription features, those of available psychotropic agents and their approved doses, and racial differences between Japan and other countries, psychotropic dose equivalency tables designed specifically for Japanese patients have been widely used in Japan since 1998. Here we introduce dose equivalency tables for: (i) antipsychotics; (ii) antiparkinsonian agents; (iii) antidepressants; and (iv) anxiolytics, sedatives and hypnotics available in Japan. Equivalent doses for the therapeutic effects of individual psychotropic compounds were determined principally on the basis of randomized controlled trials conducted in Japan and consensus among dose equivalency tables reported previously by psychopharmacological experts. As these tables are intended to merely suggest approximate standard values, physicians should use them with discretion. Updated information of psychotropic dose equivalence in Japan is available at http://www.jsprs.org/en/equivalence.tables/. [Correction added on 8 July 2015, after first online publication: A link to the updated information has been added.].
Farrelly, N; Dibben, C; Hunt, N
In October 2003 the British Association of Psychopharmacology (BAP) published evidence-based guidelines on the management of bipolar disorder. The aim of this study was to assess whether the guidelines could provide the basis for examining clinical decisions and the extent to which practice accords with these guidelines. Case notes of out patients with bipolar disorder were reviewed. Demographic details, and treatment recommendations were determined. The management of affective episodes was evaluated and compared with BAP guidelines. In 84 subjects, 224 affective episodes were identified. Treatment was consistent with BAP guidelines in 72% of episodes. Mania was more likely to be managed in accordance with guidelines than depression or mixed episodes. The use of antidepressant medication was the most likely intervention to deviate from recommendations. Reasons for treatments at odds with the guidelines were identified. Our study demonstrates that clinical practice among a range of psychiatrists broadly reflects the guidelines that have been issued by the British Association of Psychopharmacology (BAP). The BAP guidelines offer a practical and auditable basis for the short- and long-term treatment of bipolar affective disorder.
Emerging biomarker research could powerfully influence the practice of psychotherapy, a standard treatment that is as strongly rooted in brain plasticity as are psychopharmacologic interventions. Psychotherapy is associated with measurable changes in central and peripheral neurophysiology. These markers could be harnessed to aid informed, personalized recommendations for specific psychosocial treatments, to guide a course of treatment, and to predict treatment outcomes, in lieu of relying on costly, trial-and-error approaches. Psychotherapy and empathy research also demonstrate that the patient-doctor relationship has important neurophysiological correlates that can be salient to treatment outcomes, as illustrated in a case example. These correlates include autonomic nervous system arousal manifested by heart rate, respiration rate, muscle tension, and galvanic skin resistance; electroencephalography; and brain-imaging markers. While additional biomarker research is unfolding, there are specific neurobiologically based clinical and subclinical observations, organized by using the E.M.P.A.T.H.Y. mnemonic, that may guide and enhance psychotherapy. Empathic attunement to patients is equally relevant for psychopharmacologic interventions and psychotherapy, and for all patient-doctor relationships.
This paper explores the differences between bringing about self-change by way of antidepressants versus psychotherapy from an ethical point of view, taking its starting point in the concept of authenticity. Given that the new antidepressants (SSRIs) are able not only to cure psychiatric disorders but also to bring about changes in the basic temperament structure of the person--changes in self-feeling--does it matter if one brings about such changes of the self by way of antidepressants or by way of psychotherapy? Are antidepressants a less good alternative than psychotherapy because antidepressants are in some way less authentic than psychotherapy? And, if so, what does this mean exactly? In this paper I try to show that the self-change brought about by way of antidepressants challenges basic assumptions of authentic self-change that are deeply ingrained in our Western culture: that changes in self should be brought about by laborious 'self-work' in which one explores the deep layers of the self (the unconscious) and comes to realise who one really is and should become. To become oneself has been held to presuppose such a journey. While the assumed importance of self-work appears to be badly founded on closer inspection, the notions of exploring and knowing oneself appear to be more promising in fleshing out an ethical distinction between psychopharmacological and psychotherapeutic practice with the help of the concept of authenticity. Psychotherapy, to a much greater extent than psychopharmacological interventions, involves the whole profile of the self in its attempts to effect a change, not only in the temperament but also in the character of the person in question, and this is important from an ethical point of view. In the article, the concepts of self-change, authenticity, temperament and character are presented and used in order to understand and flesh out the relevant ethical differences between the practice of psychotherapy and the use of antidepressants
Santiago, Macarena Gonzalez; Bucher, Heiner C; Nordmann, Alain J
Background New legal regulations for the marketing of pharmaceutical products were introduced in 2002 in Switzerland. We investigated whether claims in drug advertisements citing published scientific studies were justified by these studies after the introduction of these new regulations. Methods In this cross-sectional study, two independent reviewers screened all issues of six major Swiss medical journals published in the year 2005 to identify all drug advertisements for analgesic, gastrointestinal and psychopharmacologic drugs and evaluated all drug advertisements referring to at least one publication. The pharmaceutical claim was rated as being supported, being based on a potentially biased study or not to be supported by the cited study according to pre-specified criteria. We also explored factors likely to be associated with supported advertisement claims. Results Of 2068 advertisements 577 (28%) promoted analgesic, psychopharmacologic or gastrointestinal drugs. Among them were 323 (56%) advertisements citing at least one reference. After excluding multiple publications of the same drug advertisement and advertisements with non-informative references, there remained 29 unique advertisements with at least one reference to a scientific study. These 29 advertisements contained 78 distinct pairs of claims of analgesic, gastrointestinal and psychopharmacologic drugs and referenced studies. Thirty-seven (47%) claims were supported, 16 (21%) claims were not supported by the corresponding reference, and 25 (32%) claims were based on potentially biased evidence, with no relevant differences between drug groups. Studies with conflict of interest and studies stating industry funding were more likely to support the corresponding claim (RR 1.52, 95% CI 1.07–2.17 and RR 1.50, 95% CI 0.98–2.28) than studies without identified conflict of interest and studies without information on type of funding. Conclusion Following the introduction of new regulations for drug
Converging theoretical, psychopharmacological, neurodevelopmental advances have led to increasing interest in preventive intervention in schizophrenia. In particular, evidence suggests that early treatment is associated with a better prognosis. Furthermore, based on the reported reduction in severe side effects, the new novel antipsychotics potentially provide the tools for early intervention. Nevertheless, initiation of intervention during the prodrome has become controversial because of such unresolved issues as: (i) how to accurately identify susceptible individuals who are in true need of preventive intervention; (ii) at what developmental point in the prodrome medication should be initiated; (iii) how long medication should be continued; and (iv) what medication is optimal for each phase of the prodrome. By adopting a naturalistic, prospective research strategy, the Recognition and Prevention (RAP) program now underway in New York has been designed to address these and other important questions involved in prodromal research and treatment. PMID:22033553
Mann, S J
In most patients with severe and symptomatic paroxysmal hypertension, a pheochromocytoma or other medical cause is rarely identified. This article presents the psychosocial assessment of 10 such patients, in whom the absence of any emotional distress preceding paroxysms had discouraged consideration of any psychological basis. However, a causative role of repressed unreported emotions was strongly suggested by 1) a history of unusually severe emotional trauma in 8 of 10 patients, 2) the absence of feelings related to the trauma, and 3) the prompt and sustained response of 3 patients to psychotherapeutic or psychopharmacologic intervention. These observations suggest that some cases of unexplained paroxysmal hypertension have a psychosomatic etiology and result from repressed rather than perceived and reported emotions. Treatment options are explored.
Madoz-Gúrpide, Agustín; Ballesteros Martín, Juan Carlos; Leira Sanmartín, Mónica; García Yagüe, Ernesto
More than thirty years have passed since the beginning of the psychiatric reform, a period of intense and relevant social, scientific and cultural changes which have directly impacted on mental disorders and their management. Improvement in psychopharmacological treatment, a new model of physician-patient relationship, patient´s empowerment as a key issue and the fight against social stigma related to mental health disorders, changes in clinical governance and health policy, the assistential burden derived from the treatment of less severe pathology in mental health community centers, improvements in teamwork and coordination with other resources involved… are some of the relevant changes which determine the scene of community-based mental health assistance. We think this is a right time to check the state of the community-based care programmes for severe mental disorders, and the role of mental health center. We propose to have a reflexion about two relevant topics: where we are and where we are heading.
Greydanus, D E; Pratt, H D; Patel, D R; Sloane, M A
A wide variety of management options are available to the primary care physician who is presented with a rebellious adolescent. After a careful assessment, the clinician and other health care professionals can choose a diverse combination of interventions: individual therapy, family therapy, youth-centered programs, community-centered programs, psychopharmacology, and others. Rebellious adolescents need access to comprehensive medical and mental health care, academic education (including sexuality education), and full employment opportunities. Primary care physicians can play a vital and sometimes pivotal role coordinating services and helping parents, school personnel, and therapists work with these youth. Even when dealing with the very difficult and resistant group of youth with CD and ODD, optimism for improvement should always be maintained by the clinician.
Whitehead, Clay C
The dynamics of the Asclepian myth are analyzed, and generic dynamics of the healing imperative are illustrated. The story teaches much about the early theories and practice of ancient medicine, and originated the healing symbol of the staff and serpent which appears on the emblem of the American Academy. The multi-modal therapeutic approach used at the Asclepia was often climaxed by dream incubation as a centerpiece of the treatment. Dreams from modern physicians in analysis will be introduced to show that while our practice has changed in external trappings, the underlying dynamics of ancient and modern healers reflect a common humanity. Modern therapists have reacquired the use of dreams and invented a new set of explanatory myths. Consideration of future developments leads to linking the "psychosomatic model" of antiquity with the psychopharmacological interventions which are now common-place in psychodynamic psychotherapy. The Asclepian emphasis on spirituality is also finding increasing recognition among psychoanalysts and other scientists.
Ahn, Dong Hyun; Lee, Young Jin; An, Ho Young; Ahn, Joon Ho
We present the first report of fetal alcohol effect in a 12 year-old child in Korea. The mother had consumed 162 g of alcohol per week continuously during pregnancy. His first febrile seizure occurred before he was 1 year old, and became more frequent 2 years later. He started showing signs of right paraplegia when he was 3.5 years old and brain MRI revealed periventricular leucomalacia near the left ventricle. He was microcephalic and his growth was retarded. He was irritable, impatient, impulsive, and inattentive, and showed disinterest in school activities and aggressive and dangerous behavior. After the diagnosis of attention deficit/hyperactivity disorder was made, psychopharmacological treatment and family support was initiated. After 10 months, he still had intermittent ideas of reference, although the aggressive behavior, inattentiveness, and impulsivity had improved. Using this case study, we stress the importance of maternal alcohol history in patients with these characteristics. PMID:20046374
Cassata, D M; Kirkman-Liff, B L
A questionnaire survey of residency trained graduates and nonresidency trained family physicians showed both groups reporting relatively infrequent practice of behavioral medicine. Referrals and counseling sessions/visits produce a combined total of 20 activities per month, or two to four percent of all patient encounters, even though the physicians in the sample reported that 33 percent of their diagnoses were behavioral/psychological. More than 85 percent of the physicians reported access to more than one mental health provider. The six most common health problems encountered in the office were depression, anxiety, obesity, marital discord, alcohol abuse, and sexual problems. Physicians responding to this survey expressed an interest in continuing education programs that emphasize individual, marital, and parenting counseling, and psychopharmacology. There is a major need to improve the mental health component of residency training, which will enable physicians to better manage psychosocial problems in practice settings.
Carl Lange was the founding father of neurology in Denmark, authoring several pioneering works within this field; however, these remained largely unknown internationally as he did not have them translated into a major language. He became a pioneer of psychophysiology with his contribution to the so-called James-Lange theory of emotion. His treatise on'periodical depressions' ('the Lange theory of depressions', 1886), is not only an early historical landmark but also a masterly 'modern' description concerning the nosology and nosography of recurrent depressions. Moreover, it is a landmark in the early history of lithium therapy, sadly ignored by Lange's contemporaries, but which little more than half a century later, with Cade's rediscovery of lithium's therapeutic effect in mood disorders in 1949, ushered in modern psychopharmacology.
Böhmer, M W
This article aims to review the importance, place and especially the emotional impact of non-verbal communication in psychiatry. The paper argues that while biological psychiatry is in the ascendency with increasing discoveries being made about the functioning of the brain and psycho-pharmacology, it is important to try and understand what is happening between psychiatrist and patient. The importance of being aware of the subtleties of this interaction is argued, as are the roles of phenomena such as transference, counter-transference and projective identification. The workings and use of these phenomena are explored as central in the doctor-patient interaction, as well as the consequences of failure to utilize and understand these phenomena. The author reviews - amongst others - the work of the analysts Casement, Gabbard, Goldstein, Ogden and Symington.
de Timary, Philippe; Leclercq, Sophie; Stärkel, Peter; Delzenne, Nathalie
The vast majority of studies that assessed the importance of biological factors for the development of psychiatric disorders focused on processes occurring at the brain level. Alcohol-dependence is a very frequent psychiatric disorder where psycho-pharmacological interventions are only of moderate efficacy. Our laboratory has recently described that a subpopulation of alcohol-dependent subjects, that accounted for approximately 40% of individuals tested, presented with an increased intestinal permeability, with a dysbiosis, with alterations in the metabolomic content of faeces - that could play a role in the increased permeability - and finally with a more severe profile of alcohol-dependence than the other non-dysbiotic subpopulation. In this addendum, we discuss the implications of our observations for the pathophysiology of alcohol dependence where we try to discriminate which addiction dimensions are likely related to the gut microbiota alterations and whether these alterations are the cause or the consequence of drinking habits. PMID:26727422
Asarnow, Lauren D.; Soehner, Adriane M.; Harvey, Allison G.
Purpose of review The present review provides a conceptual introduction to sleep and circadian research in psychiatric illness, and discusses recent experimental and intervention findings in this area. Recent Findings In this review, studies published since January 2011 on circadian disturbance and psychiatric illness have been summarized. Summary Exciting new results have increasingly utilized objective and validated instruments to measure the circadian system in experimental studies. Since 2011, treatment research has still predominantly utilized self-report measures as outcome variables. However, research in the treatment domain for sleep/circadian disturbances comorbid with psychiatric illness has advanced the field in its work to broaden the validation of existing sleep treatments to additional patient populations with comorbid sleep/circadian disruptions, address how to increase access to and affordability of treatment for sleep and circadian dysfunction for patients with psychiatric disorders, and how to combine psychosocial treatments with psychopharmacology to optimize treatment outcomes. PMID:24060916
Smit, Hendrik Jan
The effects of theobromine in man are underresearched, possibly owing to the assumption that it is behaviourally inert. Toxicology research in animals may appear to provide alarming results, but these cannot be extrapolated to humans for a number of reasons. Domestic animals and animals used for racing competitions need to be guarded from chocolate and cocoa-containing foods, including foods containing cocoa husks. Research ought to include caffeine as a comparative agent, and underlying mechanisms need to be further explored. Of all constituents proposed to play a role in our liking for chocolate, caffeine is the most convincing, though a role for theobromine cannot be ruled out. Most other substances are unlikely to exude a psychopharmacological effect owing to extremely low concentrations or the inability to reach the blood-brain barrier, whilst chocolate craving and addiction need to be explained by means of a culturally determined ambivalence towards chocolate.
Aharonovich, Efrat; Nunes, Edward; Hasin, Deborah
Cognitive-behavioral therapy (CBT) depends on adequate cognitive functioning in patients, but prolonged cocaine use may impair cognitive functioning. Therefore, cognitive impairment may impede the ability of cocaine abusers to benefit from CBT. To begin to address this issue, we investigated the relationship between cognitive impairment and two treatment outcomes, therapy completion and abstention. Eighteen carefully screened non-depressed cocaine-dependent patients in a psychopharmacological clinical trial were administered the MicroCog computerized battery to assess cognitive performance at treatment entry. T-tests were used to compare cognitive functioning between completers (patients remaining in treatment at least 12 weeks) and dropouts. The results indicated that treatment completers had demonstrated significantly better cognitive performance at baseline than patients who dropped out of treatment. Cognitive domains that significantly distinguished between treatment completers and dropouts were attention, mental reasoning and spatial processing. This study provides preliminary evidence that cognitive impairments may decrease treatment retention and abstinence in CBT of cocaine dependence.
Lingford-Hughes, A R; Welch, S; Peters, L; Nutt, D J
The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.
Spermon, Deborah; Gibney, Paul; Darlington, Yvonne
As therapists are confronted with clients who have childhood histories of severe interpersonal trauma, the challenge is to understand how this trauma affects individuals developmentally and how healing might be facilitated. This article explores how integration might be understood in the context of complex posttraumatic stress disorder. It is proposed that the symbolic function is central both to the fracturing of selfhood due to early trauma and to its resolution. The article provides a detailed discussion of symbolism and therapeutic possibilities for the use of symbolism as an adjunct to therapy with sufferers of complex posttraumatic stress disorder. It is argued that symbols provide a potentially powerful means of assisting reintegration and that this can be used within a range of therapeutic traditions, including cognitive-behavioral, psychodynamic, psychopharmacological, and neurophysiological approaches. The work of the first author in this regard is illustrated by means of a case study.
Koola, Maju Mathew; Sebastian, Joseph
Etiologic and pathophysiologic understanding of psychiatric disorders is still in its early stages. The neurobiology of major psychiatric disorders has yet to be fully elucidated. Psychiatric diagnoses are often based on presenting symptoms, lacking reliability and stability. For a variety of reasons, many notable laboratory and clinical observations have not been tested in large trials. Lacking this validation, these potentially valuable practices have not been widely disseminated nor translated into real world practice. Pragmatic practice today requires optimum use of the available resources. This may sometimes require translating novel treatments supported by strong, evidence-based, level II evidence; but still lacking level I evidence into practice and greater utilization of evidence-based approved practices. The purpose of this paper is to highlight some common avoidable pitfalls in practice, and to offer a few psychopharmacological pearls. PMID:26998529
Clonidine, an alpha agonist, formally prescribed in clinical medicine as antihypertensive medication, is currently being used more frequently to address a multitude of psychiatric entities. The long-acting formulation is approved by the Food and Drug Administration for use in treating the attention-deficit/hyperactivity disorder. In addition to this only legitimate indication, it has long been used successfully for opiate detoxification, post-traumatic stress disorder and de la Tourette syndrome. Moreover, clonidine helps in the treatment of neuroleptic-induced akathisia, stimulant-induced insomnia and clozapine-induced sialorrhea. It has been tried in treating menopausal syndrome and psychogenic polydipsia. Although the strength of evidence supporting the use of clonidine in such clinical scenarios is highly variable and oscillating, from strong to only flimsy, this overview is intended to shed some light on the clonidine portfolio as a potential and attractive addition to the psychopharmacologic armamentarium.
Dawson, K A
Although psychedelics can induce "cosmic" consciousness through severe distortions of time and space perceptions, little attention has been given to examination of this psychopharmacological property. With the hope of providing an impetus to further research in this area, a case of cosmic perception under the influence of LSD is reported which included the apparent movement of consciousness to the lunar surface combined with the experience of remote viewing of the Milky Way galaxy. While the possibility of veridical remote viewing is unlikely, it is speculated that the neurocognitive action of LSD can sensitize the user to focused bright light, associated memories, and creative elaborations during actual eclipse events. Experimenters are urged to adopt precautions to avoid potentially detrimental effects of pharmacologically manipulating the space-time continuum.
Mota, Vanine Gomes; de Carvalho, Fabíola Lélis; de Morais, Liana Clébia Soares Lima; Bhattacharyya, Jnanabrata; de Almeida, Reinaldo Nóbrega; de Alencar, Jacicarlos Lima
Acute treatment with the chloroform fraction of Dioclea virgata (Rich.) Amshoff (CFDv) in mice produced decreased ambulation and sedation in the behavioral pharmacological screening. Doses of 125 and 250 mg/kg CFDv decreased latency of sleep onset in the test of sleeping time potentiation. In the open field, animals treated with CFDv reduced ambulation and rearing (250 mg/kg), as well as defecation (125; 250 mg/kg). Regarding the antinociceptive activity, CFDv (125, 250, 500 mg/kg) increased latency to first writhing and decreased the number of writhings induced by acetic acid. In the formalin test, CFDv (250 mg/kg) decreased paw licking time in the first and second phases indicating antinociceptive activity that can be mediated both peripherally and at the central level. CFDv did not affect motor coordination until 120 minutes after treatment. CFDv shows psychopharmacological effects suggestive of CNS-depressant drugs with promising antinociceptive activity. PMID:21776190
Crits-Christoph, Paul; Newman, Michelle G; Rickels, Karl; Gallop, Robert; Gibbons, Mary Beth Connolly; Hamilton, Jessica L; Ring-Kurtz, Sarah; Pastva, Amy M
The current study assessed efficacy of combined cognitive behavioral therapy (CBT) and venlafaxine XR compared to venlafaxine XR alone in the treatment of generalized anxiety disorder (GAD) within settings where medication is typically offered as the treatment for this disorder. Patients with DSM-IV-diagnosed GAD who were recently enrolled in a long-term venlafaxine XR study were randomly offered (n=77), or not offered (n=40), the option of adding 12 sessions of CBT. Of those offered CBT, 33% (n=26) accepted and attended at least one treatment session. There were no differences between the combined treatment group and the medication only group on primary or secondary efficacy measures in any of the sample comparisons. Many patients who present in medical/psychopharmacology settings seeking treatment for GAD decline the opportunity to receive adjunctive treatment. Of those that receive CBT, there appears to be no additional benefit of combined treatment compared to venlafaxine XR alone.
Tang, Victor Mark; Duffin, Jacalyn
Catatonia is a psychomotor disorder that has gone through numerous descriptions since 1874, reflecting the many changes in psychiatric disease conceptualization that have occurred within that time frame. Catatonia has been variously described as a distinct disease entity, as a part of schizophrenia, and as a nonspecific manifestation of many disorders. Because of its association with schizophrenia, the description of catatonia was particularly affected by the psychopharmacological era, beginning in the 1950s, and by the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Changing trends in psychiatric research--especially the brain-based disease model, research methods favoured by the evidence-based medicine movement, and the codes and categories of the DSM--also profoundly influenced the evolving concept of catatonia. This paper discusses these important factors that affected recognition, treatment, and study of catatonia in order to reveal the biases and assumptions made when constructing a disease concept.
Obregon, Demian F; Velasco, Regina M; Wuerz, Timothy P; Catalano, Maria C; Catalano, Glenn; Kahn, David
Catatonia is a movement disorder with various possible etiologies. The majority of cases are associated with an underlying mood or psychotic disorder, while others are caused by medical conditions. Currently, benzodiazepines are the first-line psychopharmacologic agents in the treatment of catatonia. However, several cases have been reported in which treatment with memantine proved to be effective. We present the case of a 92-year-old female with major depressive disorder and associated catatonic symptoms. In this case, the patient's symptoms remitted quickly after the initiation of memantine. We review the possible causes of catatonia and pharmacologic treatments for the condition and highlight the possible benefits of N-methylD-aspartic acid receptor antagonists such as memantine in the treatment of catatonia.
Peana, Alessandra T.; Rosas, Michela; Porru, Simona; Acquas, Elio
In spite of the global reputation of ethanol as the psychopharmacologically active ingredient of alcoholic drinks, the neurobiological basis of the central effects of ethanol still presents some dark sides due to a number of unanswered questions related to both its precise mechanism of action and its metabolism. Accordingly, ethanol represents the interesting example of a compound whose actions cannot be explained as simply due to the involvement of a single receptor/neurotransmitter, a scenario further complicated by the robust evidence that two main metabolites, acetaldehyde and salsolinol, exert many effects similar to those of their parent compound. The present review recapitulates, in a perspective manner, the major and most recent advances that in the last decades boosted a significant growth in the understanding on the role of ethanol metabolism, in particular, in the neurobiological basis of its central effects. PMID:27891052
Amador, T A; Elisabetsky, E; Souza, D O
An ethnopharmacological survey showed that home remedies prepared with flowers and fruits of Psychotria colorata are used by Amazonian peasants as pain killers. Psychopharmacological in vivo evaluation of alkaloids obtained from leaves and flowers of this species showed a marked dose-dependent naloxone-reversible analgesic activity, therefore suggesting an opioid-like pharmacological profile. This paper reports an inhibitory effect of P. colorata flower alkaloids on [3H]naloxone binding in rat striata as well as a decrease in adenylate cyclase basal activity. The alkaloids did not affect [3H] GMP-PNP binding. These findings provide a neurochemical basis for the opioid-like activity previously detected in vivo and point to Psychotria alkaloids as a potential source of new bioactive opiate derivatives.
Sfera, Adonis; Osorio, Carolina; Inderias, Luzmin Acosta; Parker, Victoria; Price, Amy I; Cummings, Michael
Pathological impulsivity is encountered in a broad range of psychiatric conditions and is thought to be a risk factor for aggression directed against oneself or others. Recently, a strong association was found between impulsivity and obesity which may explain the high prevalence of metabolic disorders in individuals with mental illness even in the absence of exposure to psychotropic drugs. As the overlapping neurobiology of impulsivity and obesity is being unraveled, the question asked louder and louder is whether they should be treated concomitantly. The treatment of obesity and metabolic dysregulations in chronic psychiatric patients is currently underutilized and often initiated late, making correction more difficult to achieve. Addressing obesity and metabolic dysfunction in a preventive manner may not only lower morbidity and mortality but also the excessive impulsivity, decreasing the risk for aggression. In this review, we take a look beyond psychopharmacological interventions and discuss dietary and physical therapy approaches.
Klein, Donald F.
“Anxiety” is a key term for behavioral, psychoanalytic, neuroendocrine, and psychopharmacological observations and theories. Commenting on its historical aspects is difficult, since history is properly a study of primary data. Unfortunately, much clinical anecdote does not correspond to factual records of a long time ago. Even reports of objective studies may suffer from allegiance effects. This essay therefore primarily reflects the personal impact of others' work against the background of my experiences, clinical and scientific. These lead me to question the assumption that “anxiety”, as it exists in syndromal disturbances, is simply the quantitative extreme of the normal “anxiety” that occurs during the anticipation of danger. An alternative view that emphasizes dysfunctions of distinct evolved adaptive alarm systems is presented. PMID:22033777
Waldmeier, P C; Glatt, A; Jaekel, J; Bittiger, H
Brofaromine is a tight-binding, reversible inhibitor of monoamine oxidase-A (MAO-A), with concomitant serotonin (5-HT) uptake-inhibiting properties. In psychopharmacologic investigations, the compound shows the properties expected of an MAO inhibitor, antagonizing the effects of reserpine, tetrabenazine, and 5-hydroxytryptophan in rats and mice, and suppressing rapid eye movement sleep in cats. Brofaromine showed antidepressant-like activity in a rat social conflict test. In radioligand binding assays, brofaromine exhibited weak or no interaction with alpha 1- and alpha 2-noradrenergic, 5-HT1, 5-HT2, 5-HT3, cholinergic, histamine H1 and H2, mu-opiate, GABAA, benzodiazepine, adenosine, neurotensin, and substance P receptors. Comparison of in vitro and in vivo potencies to inhibit 5-HT uptake with those of reference drugs, and direct evidence in patients and volunteers suggest that 5-HT uptake inhibition plays a role in the clinical profile of brofaromine.
Bronzino, J D; Morelli, R A; Goethe, J W
This paper describes the development of OVERSEER: a prototype knowledge-based system that monitors the drug treatment of psychiatric patients in real time. Using treatment protocols developed by the expert clinician, OVERSEER monitors the drug treatment process and issues alerts when standard clinical practices are not followed or when laboratory results are abnormal. Written in Prolog, OVERSEER is designed to interface directly with the hospital's database, and, thereby, utilizes all available pharmacy and laboratory data. Moreover, unlike the interactive expert systems developed for the psychiatric clinic, OVERSEER does not require extensive data entry by the clinician. Consequently, the chief benefit of OVERSEER's monitoring approach is the unobtrusive manner in which it evaluates psychopharmacological treatment and provides information regarding patient management to the hospital.
Rynn, Moira A; Barber, Jacques P; Khalid-Khan, Sarosh; Siqueland, Lynne; Dembiski, Michelle; McCarthy, Kevin S; Gallop, Robert
The goals of this study were twofold: to examine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in a clinical sample of 193 children and adolescents who had received a diagnosis of major depressive or anxiety disorder, and to discriminate between these two groups of patients. Participants had volunteered in randomized psychopharmacological clinical trials. The MASC four-factor structure was confirmed and its subscales were found to be reliable. The MASC correlated well with other self-report measures of anxiety, and less so with measures of depressive symptoms. The MASC subscales and two MASC items as well as age differentiated between anxious and depressed pediatric patients. If these results are replicated in an independent study, those items could be used by clinicians to discriminate between these two disorders. The MASC is a clinically useful measure to discriminate between anxious and depressed pediatric patients. Limitations due to the highly selective sample are noted.
Margittai, Zsofia; Nave, Gideon; Strombach, Tina; van Wingerden, Marijn; Schwabe, Lars; Kalenscher, Tobias
People often rely on intuitive judgments at the expense of deliberate reasoning, but what determines the dominance of intuition over deliberation is not well understood. Here, we employed a psychopharmacological approach to unravel the role of two major endocrine stress mediators, cortisol and noradrenaline, in cognitive reasoning. Healthy participants received placebo, cortisol (hydrocortisone) and/or yohimbine, a drug that increases noradrenergic stimulation, before performing the cognitive reflection test (CRT). We found that cortisol impaired performance in the CRT by biasing responses toward intuitive, but incorrect answers. Elevated stimulation of the noradrenergic system, however, had no effect. We interpret our results in the context of the dual systems theory of judgment and decision making. We propose that cortisol causes a shift from deliberate, reflective cognition toward automatic, reflexive information processing.
Between 1953 and 1965, Ogden Lindsley and his associates conducted free-operant research with psychiatric inpatients and normal volunteers at Metropolitan State Hospital in Waltham, Massachusetts. Their project, originally named “Studies in Behavior Therapy,” was renamed “Harvard Medical School Behavior Research Laboratory” in 1955. This name change and its implications were significant. The role of the laboratory in the history of the relationship between the experimental analysis of behavior and applied behavior analysis is discussed. A case is made for viewing Lindsley's early work as foundational for the subfield of the experimental analysis of human behavior that formally coalesced in the early 1980s. The laboratory's work is also contextualized with reference to the psychopharmacological revolution of the 1950s. Finally, a four-stage framework for studying the historical and conceptual development of behavior analysis is proposed. PMID:22478407
Cichon, S.; Noethen, M.M.; Propping, P.; Wolf, H.K.
The term genomic imprinting has been used to refer to the differential expression of genetic material depending on whether it has come from the male or female parent. In humans, the chromosomal region 11p15.5 has been shown to contain 2 imprinted genes (H19 and IGF2). The gene for the dopamine D4 receptor (DRD4), which is of great interest for research into neuropsychiatric disorders and psychopharmacology, is also located in this area. In the present study, we have examined the imprinting status of the DRD4 gene in brain tissue of an epileptic patient who was heterozygous for a 12 bp repeat polymorphism in exon 1 of the DRD4 gene. We show that both alleles are expressed in equivalent amounts. We therefore conclude that the DRD4 gene is not imprinted in the human brain. 30 refs., 1 fig.
Park, Eliza M.; Rosenstein, Donald L.
Adolescents and young adults (AYAs) with cancer are at risk for depression due to disruptions in their developmental trajectory, greater physical symptom burden, and increased likelihood of developing aggressive disease. Rates of depression and other psychological disorders are substantially higher in AYAs with cancer when compared with older adults. Psychiatrists caring for these patients must consider the age-appropriate developmental context of these patients along with familial and medical factors that may influence the presentation and treatment of depression. Previous research suggests that psychosocial interventions specifically designed for AYA patients are promising, but studies of psychopharmacology treatments for depression are lacking. There is a pressing need for prospective studies and controlled clinical trials that evaluate the optimal strategies for treating depression in this patient group. PMID:26246791
1. What is usually taught as biological psychiatry in psychiatric residency training is mainly psychopharmacology, but biology has a lot more to offer to psychiatry educators. 2. The main thesis of this article is that an introductory course on the applications to psychiatry based on the theory of the evolution of the species by natural selection and mutation, along with a comprehensive theory of mind, may contribute to: (i) helping young physicians to integrate the diverse and extensive knowledge acquired during the residency training; (ii) aid in keeping the psychiatrist within the medical approach to mental illnesses while promoting the specific features of the specialty, and (iii) perhaps developing a general theoretical framework that allows psychiatrists to maintain a prominent role in the mental health staff. 3. The author describes how he has conducted such training in Venezuela. It is expected that the author's ideas will serve as a forum for discussion of this pivotal subject.
Ferrão, Ygor Arzeno; Miguel, Euripedes; Stein, Dan Joseph
The question of whether Tourette's syndrome (TS) and trichotillomania (TTM) are best conceptualized as obsessive-compulsive spectrum disorders was raised by family studies demonstrating a close relationship between TS and obsessive-compulsive disorder (OCD), and by psychopharmacological research indicating that both TTM and OCD respond more robustly to clomipramine than to desipramine. A range of studies have subsequently allowed comparison of the phenomenology, psychobiology, and management of TS and TTM, with that of OCD. Here we briefly review this literature. The data indicate that there is significant psychobiological overlap between TS and OCD, supporting the idea that TS can be conceptualized as an OCD spectrum disorder. TTM and OCD have only partial overlap in their phenomenology and psychobiology, but there are a number of reasons for why it may be useful to classify TTM and other habit disorders as part of the obsessive-compulsive spectrum of disorders.
Harth, Wolfgang; Seikowski, Kurt; Hermes, Barbara; Gieler, Uwe
Lifestyle drugs have become an important new group of medications, which are taken by healthy people to increase the individual well-being and quality of life. Nootropics, psychopharmaceuticals, hormones and "ecodrugs" are today the main groups. The wish for eternal youth, beauty and potency is central, and lifestyle medications are also requested to influence cosmetic findings, which are usually simply a result of the natural aging process. Lifestyle drugs seem to be harmless, but the physician must pay attention to possible abuse, side effects, risks and complications. Additionally, however, lifestyle drugs are also frequently used by patients suffering from emotional disorders such as somatoform disorders. Medicalization of physiological life is then expected to solve psychosocial problems, but without success. The use of lifestyle medications in somatoform disorders is contraindicated and psychotherapy or psychopharmacological treatment come first. With this overview article, we would like to make an update of new lifestyle drugs.
Halberstadt, Adam L.
Serotonergic hallucinogens, such as (+)-lysergic acid diethylamide, psilocybin, and mescaline, are somewhat enigmatic substances. Although these drugs are derived from multiple chemical families, they all produce remarkably similar effects in animals and humans, and they show cross-tolerance. This article reviews the evidence demonstrating the serotonin 5-HT2A receptor is the primary site of hallucinogen action. The 5-HT2A receptor is responsible for mediating the effects of hallucinogens in human subjects, as well as in animal behavioral paradigms such as drug discrimination, head twitch response, prepulse inhibition of startle, exploratory behavior, and interval timing. Many recent clinical trials have yielded important new findings regarding the psychopharmacology of these substances. Furthermore, the use of modern imaging and electrophysiological techniques is beginning to help unravel how hallucinogens work in the brain. Evidence is also emerging that hallucinogens may possess therapeutic efficacy. PMID:25036425
Park, Eliza M; Rosenstein, Donald L
Adolescents and young adults (AYAs) with cancer are at risk for depression due to disruptions in their developmental trajectory, greater physical symptom burden, and increased likelihood of developing aggressive disease. Rates of depression and other psychological disorders are substantially higher in AYAs with cancer when compared with older adults. Psychiatrists caring for these patients must consider the age-appropriate developmental context of these patients along with familial and medical factors that may influence the presentation and treatment of depression. Previous research suggests that psychosocial interventions specifically designed for AYA patients are promising, but studies of psychopharmacology treatments for depression are lacking. There is a pressing need for prospective studies and controlled clinical trials that evaluate the optimal strategies for treating depression in this patient group.
Zeeck, A; Hartmann, A; Sandholz, A; Joos, A
Bulimia nervosa is characterized by episodes of binge eating and compensatory behaviours (self-induced vomiting, laxative misuse, dietary restriction). It has a complex aetiology and is mostly found in young women. Bulimia leads to substantial physical and psychosocial morbidity. Bulimia nervosa needs specialized psychotherapeutic treatment. In most cases outpatient treatment is sufficient, but comorbidity with other psychiatric disturbances has to be taken into account. Additional psychopharmacological interventions might be helpful. After 5 to 10 years about 50% of the patients show complete remissions, 30% partial remissions and about 20% a chronic course of the illness. General practitioners, dentists and gynaecologists should be informed about typical signs of the disorder that is often hidden by the patients.
Green, Michael F; Lee, Junghee; Ochsner, Kevin N
Social cognitive impairment is prominent in schizophrenia, and it is closely related to functional outcome. Partly for these reasons, it has rapidly become a target for both training and psychopharmacological interventions. However, there is a paucity of reliable and valid social cognitive endpoints that can be used to evaluate treatment response in clinical trials. Also, clinical studies in schizophrenia have benefited rather little from the surge of activity and knowledge in nonclinical social neuroscience. The National Institute of Mental Health-sponsored study, "Social Cognition and Functioning in Schizophrenia" (SCAF), attempted to address this translational challenge by selecting paradigms from social neuroscience that could be adapted for use in schizophrenia. The project also evaluated the psychometric properties and external validity of the tasks to determine their suitability for multisite clinical trials. This first article in the theme section presents the goals, conceptual background, and rationale for the SCAF project.
Aust, S; Palm, U; Padberg, F; Bajbouj, M
Major depressive disorders are one of the most prevalent psychiatric disorders worldwide but approximately 20-30 % of patients do not respond to standard guideline conform treatment. Recent neuroimaging studies in depressive patients revealed altered activation patterns in prefrontal brain areas and that successful cognitive behavioral therapy and psychopharmacological interventions are associated with a reversal of these neural alterations. Therefore, a direct modulation of prefrontal brain activation by non-invasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS) seems to be a promising and innovative approach for the treatment of depressive disorders. In addition, recent neuropsychological findings indicated an augmentation of positive tDCS effects by simultaneous external activation of the stimulated brain area, for example by cognitive training tasks. Based on these findings, the possibility to augment cognitive-emotional learning processes during cognitive behavioral therapy by simultaneous tDCS to increase antidepressive therapeutic effects is discussed in this article.
Benton, Tami D
HIV/AIDS continues to be a significant public health problem. Millions of people worldwide are infected with this virus daily, and thousands die yearly of AIDS-related illnesses. Despite rapid advances in our knowledge about HIV and its mode of transmission, we have been unable to find a cure or prevent new infections. Psychiatric comorbidity is associated with HIV/AIDS: as a risk factor for HIV infection, a comorbidity of HIV infection, sequelae of HIV/AIDS, and a potential mediator for progression to AIDS. In this article, we focus on depression, which is prevalent in HIV/AIDS. We review the evidence associating depression with HIV, the challenges in recognizing depression in HIV-positive individuals, and the psychopharmacologic strategies known to be effective in the treatment of HIV-positive individuals with depression.
Hidasi, Zoltan; Salacz, Pal; Csibri, Eva
Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases.
Robbins, T W
The significance of investigating effects of deprivation of social experience in rodents is reviewed in the context of the review by Robbins et al. (1996) in the Journal of Psychopharmacology (10: 39-47). The early development of the paradigm by which rats were reared post-weaning in social isolation is described and compared with other early experience manipulations. The specification of the neural and behavioural phenotype of the isolate is brought up-to-date, focusing on changes in motivation and cognitive function, as well as on contrasting changes in the dopamine and serotonin systems, and in cortical (including hippocampal) structure and function. The relevance of the isolate for animal models of psychiatric disorders such as attention deficit hyperactivity disorder and schizophrenia is reviewed, and it is considered that the paradigm best exemplifies a manipulation that can be applied to test effects of certain forms of social adversity during adolescence on brain development and behaviour.
Presents Trevor W. Robbins, the 2011 winner of the American Psychological Association Award for Distinguished Scientific Contributions."For distinguished theoretical and empirical contributions to basic research in experimental psychology and neuroscience. Trevor W. Robbins has made innovative and landmark contributions to understanding monoaminergic and glutamatergic regulation of cortico-striatal-limbic function and its involvement in psychological processes and pathological states such as addiction, depression, schizophrenia, and attention-deficit/hyperactivity disorder. His pioneering accomplishments have included the development of methodologies for parallel sophisticated behavioral assessments in humans, rodents, and monkeys combined with psychopharmacological and imaging studies across species. His vigor and dedication to research, exemplary leadership, scholarship, and stellar productivity have advanced our knowledge of brain function and inspired several generations of cognitive neuroscientists." (PsycINFO Database Record (c) 2011 APA, all rights reserved).
Stevens, Lindsay; Tartaglia, Nicole; Hagerman, Randi; Riley, Karen
A case of a 14-year-old boy with both fragile X syndrome and Down syndrome is described. This is the third reported case of a patient with fragile X syndrome plus Down syndrome and the first reported case in a male. Facial features are generally consistent with Down syndrome; however, a prominent forehead and jaw and maccroorchidism were consistent with fragile X syndrome. Joint laxity is also present, which is consistent with both disorders. Cognitive impairment is more significant than in his siblings with fragile X syndrome, and he meets criteria for autistic disorder. Ongoing behavioral dysregulation has been significant, leading to disruption of home and school environments despite many attempted psychopharmacologic and behavioral strategies and a supportive family. Identification and treatment of underlying medical problems (esophagitis) led to improvements in sleep and behavior. We emphasize discussion of challenges in his behavioral management and present a collaborative approach to behavioral management. PMID:20453578
Gaillard, R; Gourion, D; Llorca, P M
Anhedonia, or markedly diminished interest or pleasure, is a hallmark symptom of major depression, schizophrenia, and other neuropsychiatric disorders. The term "anhedonia" was introduced by the French psychologist Ribot in 1896 to describe the counterpart to analgesia in his patients, for which "it was impossible to find the least pleasure". Over the last decades, the clinical definition of anhedonia has remained relatively unchanged, but recently, behavioral neurosciences have significantly changed our knowledge of reward-related processes. Now, the construct of anhedonia reflects deficits in hedonic capacity, and is closely linked to the processes of reward valuation, decision-making, anticipation, and motivation. The neural circuits underlying these reward-related mechanisms include essentially the ventral striatum and prefrontal cortical regions. Here, we review the clinical concepts, neural bases and psychopharmacological data related to the deficits of hedonia in depression. Understanding anhedonia will facilitate diagnosis and treatment management.
Sidi, Hatta; Yusof, Farid; Das, Srijit; Midin, Marhani; Kumar, Jaya; Hatta, Muhammd Hizri
Premature ejaculation (PE) is one of the commonest male sexual dysfunctions. It is characterized by ejaculation which occurs before or soon after vaginal penetration, which causes significant psychological distress to the individual, and his partner. The exact cause of PE is still unknown but several mechanisms are proposed, and these involve complex interactions of neurophysiological, psychosocial, and cognitive factors. We discuss the role of serotonin, nitric oxide, phosphodiesterase enzymes and other neurotransmitters. Treatment of PE tends to co-occur with other sexual difficulties, especially erectile dysfunction (ED). Treatment with selective serotonin reuptake inhibitors (SSRIs) and Dapoxitene are also discussed in detail. The treatment strategy requires a comprehensive holistic approach incorporating both combination of psychopharmacological agent and cognitive-behavioral therapy (CBT). The present review highlights the integration of the hypothalamic-neural and reverberating emotional circuit and discusses the etiology and treatment for patients with PE.
In general medical-surgical hospital services, depression is the most common reason for seeking psychiatric consultation in behalf of patients with cardiovascular disease. The nontreatment of depression or the use of a psychotropic agent mismatched to a patient's particular cardiac condition or individual sensitivities has considerable negative impact. Therefore, a systematic approach should be used in the differential diagnosis of depression in cardiac patients, to eliminate other psychiatric disorders and to assure the correct treatment strategy. Physicians can develop an appropriate rationale for the use of a psychopharmacologic regimen in cardiovascular settings through recognition of the diagnostic criteria for depression and through comprehensive knowledge of the pharmacologic properties and possible cardiovascular effects of these vital treatments. Standard and alternative pharmacotherapies for depression in cardiac patients are reviewed. PMID:8219822
Recent decades have seen development of research and an increased interest in the psychopharmacology of natural remedies. More than 20 herbal remedies have been identified that may potentially be applied in medicine as antidepressive, anxiety relieving or sleep-inducing agents. Patients often prefer to take herbal remedies and often take them on their own, without consulting a physician. The aim of the study is to present the state of the art concerning the use of natural remedies in the treatment of depression. Following a literature review, 7 herbal remedies for which preclinical and clinical trials suggest their antidepressive influence have been identified: hypericum, lavender, borage, roseroot, chamomile, saffron and ginseng. For two of these, i.e. hypericum and saffron extracts, antidepressive effect in subjects with mild or moderate depression has been confirmed in controlled randomized clinical trials.
This postal questionnaire study investigated the prescribing practices of a group of senior British psychiatrists who have responsibilities for children and adolescents with learning disabilities (mental retardation). The study revealed that all of the clinicians surveyed (n = 16) were prescribing psychotropic medication; psychostimulants and major tranquillizers represented the most frequently prescribed classes and, respectively, methylphenidate, risperidone, melatonin, sodium valproate and carbamazepine were the most frequently employed specific agents. Most patients were receiving monotherapy. Many (14/16) clinicians reported difficulties in shared-care prescribing arrangements with General Practitioners. The study concludes that psychopharmacology is an established part of the psychiatric management of learning disabled children but acknowledges the need for the elaboration of clinical governance standards to this area of practice.
Halberstadt, Adam L; Geyer, Mark A
Serotonergic hallucinogens produce profound changes in perception, mood, and cognition. These drugs include phenylalkylamines such as mescaline and 2,5-dimethoxy-4-methylamphetamine (DOM), and indoleamines such as (+)-lysergic acid diethylamide (LSD) and psilocybin. Despite their differences in chemical structure, the two classes of hallucinogens produce remarkably similar subjective effects in humans, and induce cross-tolerance. The phenylalkylamine hallucinogens are selective 5-HT(2) receptor agonists, whereas the indoleamines are relatively non-selective for serotonin (5-HT) receptors. There is extensive evidence, from both animal and human studies, that the characteristic effects of hallucinogens are mediated by interactions with the 5-HT(2A) receptor. Nevertheless, there is also evidence that interactions with other receptor sites contribute to the psychopharmacological and behavioral effects of the indoleamine hallucinogens. This article reviews the evidence demonstrating that the effects of indoleamine hallucinogens in a variety of animal behavioral paradigms are mediated by both 5-HT(2) and non-5-HT(2) receptors.
Halberstadt, Adam L
Serotonergic hallucinogens, such as (+)-lysergic acid diethylamide, psilocybin, and mescaline, are somewhat enigmatic substances. Although these drugs are derived from multiple chemical families, they all produce remarkably similar effects in animals and humans, and they show cross-tolerance. This article reviews the evidence demonstrating the serotonin 5-HT2A receptor is the primary site of hallucinogen action. The 5-HT2A receptor is responsible for mediating the effects of hallucinogens in human subjects, as well as in animal behavioral paradigms such as drug discrimination, head twitch response, prepulse inhibition of startle, exploratory behavior, and interval timing. Many recent clinical trials have yielded important new findings regarding the psychopharmacology of these substances. Furthermore, the use of modern imaging and electrophysiological techniques is beginning to help unravel how hallucinogens work in the brain. Evidence is also emerging that hallucinogens may possess therapeutic efficacy.
Le, H. M.; Carbutti, G.; Ilisei, D.; Bouccin, E.
Pseudopheochromocytoma has a clinical presentation that is similar to pheochromocytoma. It manifests itself with paroxysmal hypertension crises, associated with various symptoms such as headaches, chest pain, nausea, palpitations, and dizziness. Patients are usually asymptomatic in between the crises. Unlike pheochromocytoma, there is no catecholamines overproduction in this pathology: hypertensive peaks are caused by a hyperactivation of the sympathetic nervous system, which is often triggered by a psychological trauma in the past. Treatment of pseudopheochromocytoma can be challenging due to normal blood pressure values in between the hypertensive peaks; it includes alpha- and beta-blockers for moderate crises and prevention and must be combined with psychopharmacologic agents such as anxiolytics or antidepressant drugs. Psychotherapy and dietetic treatment are also crucial in pseudopheochromocytoma management. PMID:27738531
Attention-deficit/hyperactivity disorder (ADHD) in adults and borderline personality Disorder (BPD) share some similar clinical features (e. g. impulsivity, emotional dysregulation, cognitive impairment). ADHD in childhood has been reported to be highly associated with the diagnosis of BPD in adulthood and adult ADHD often co-occurs with BPD. Treatment studies revealed an efficacy of dialectical behavioral therapy (DBT) and DBT-based psychotherapy, respectively, in BPD and adult ADHD as well as neuroimaging and psychopharmacological studies showed some evidence for a potential common neurobiological dysfunction suggesting the hypothesis that ADHD and BPD may not be two distinct disorders, but represent at least in a subgroup of patients two dimensions of one disorder.
Abdallah, Chadi G.; Averill, Lynnette A.; Krystal, John H.
The discovery of ketamine’s rapid and robust antidepressant effects opened a window into a new generation of antidepressants. Multiple controlled trials and open-label studies have demonstrated these effects across a variety of patient populations known to often achieve little to no response from traditional antidepressants. Ketamine has been generally well tolerated across patient groups, with transient mild to moderate adverse effects during infusion. However, the optimal dosing and route of administration and the safety of chronic treatment is not fully known. This review summarizes the clinical effects of ketamine and its neurobiological underpinnings and mechanisms of action that may provide insight into the neurobiology of depression, relevant biomarkers, and treatment targets. Moreover, we offer suggestions for future research that can continue to advance the field forward and ultimately improve the psychopharmacologic interventions available for those individuals struggling with depressive and trauma-related disorders. PMID:25727103
de Timary, Philippe; Leclercq, Sophie; Stärkel, Peter; Delzenne, Nathalie
The vast majority of studies that assessed the importance of biological factors for the development of psychiatric disorders focused on processes occurring at the brain level. Alcohol-dependence is a very frequent psychiatric disorder where psycho-pharmacological interventions are only of moderate efficacy. Our laboratory has recently described that a subpopulation of alcohol-dependent subjects, that accounted for approximately 40% of individuals tested, presented with an increased intestinal permeability, with a dysbiosis, with alterations in the metabolomic content of faeces--that could play a role in the increased permeability--and finally with a more severe profile of alcohol-dependence than the other non-dysbiotic subpopulation. In this addendum, we discuss the implications of our observations for the pathophysiology of alcohol dependence where we try to discriminate which addiction dimensions are likely related to the gut microbiota alterations and whether these alterations are the cause or the consequence of drinking habits.
Gentile, Julie P; Dillon, Kristy S; Gillig, Paulette Marie
There is a wide variety of what have been called "dissociative disorders," including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Some of these diagnoses, particularly dissociative identity disorder, are controversial and have been questioned by many clinicians over the years. The disorders may be under-diagnosed or misdiagnosed, but many persons who have experienced trauma report "dissociative" symptoms. Prevalence of dissociative disorders is unknown, but current estimates are higher than previously thought. This paper reviews clinical, phenomenological, and epidemiological data regarding diagnosis in general, and illustrates possible treatment interventions for dissociative identity disorder, with a focus on psychotherapy interventions and a review of current psychopharmacology recommendations as part of a comprehensive multidisciplinary treatment plan.
I examined the relationship of recalled and diary recorded frequency of penile-vaginal intercourse (FSI), noncoital partnered sexual activity, and masturbation to measured waist and hip circumference in 120 healthy adults aged 19-38. Slimmer waist (in men and in the sexes combined) and slimmer hips (in men and women) were associated with greater FSI. Slimmer waist and hips were associated with rated importance of intercourse for men. Noncoital partnered sexual activity had a less consistent association with slimness. Slimmer waist and hips were associated with less masturbation (in men and in the sexes combined). I discuss the results in terms of differences between different sexual behaviors, attractiveness, emotional relatedness, physical sensitivity, sexual dysfunction, sociobiology, psychopharmacological aspects of excess fat and carbohydrate consumption, and implications for sex therapy.
Tarragon, E; Baliño, P; Aragon, C M G
Centrally formed acetaldehyde has proven to be responsible for several psychopharmacological effects induced by ethanol. In addition, it has been suggested that the cAMP-PKA signaling transduction pathway plays an important role in the modulation of several ethanol-induced behaviors. Therefore, we hypothesized that acetaldehyde might be ultimately responsible for the activation of this intracellular pathway. We used three pharmacological agents that modify acetaldehyde activity (α-lipoic acid, aminotriazole, and d-penicillamine) to study the role of this metabolite on EtOH-induced PKA activation in mice. Our results show that the injection of α-lipoic acid, aminotriazole and d-penicillamine prior to acute EtOH administration effectively blocks the PKA-enhanced response to EtOH in the brain. These results strongly support the hypothesis of a selective release of acetaldehyde-dependent Ca(2+) as the mechanism involved in the neurobehavioral effects elicited by EtOH.
Curtin, Carol; Jojic, Mirjana; Bandini, Linda G
Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is at least as high as that seen in typically developing children. Many of the risk factors for children with ASD are likely the same as for typically developing children, especially within the context of today's obesogenic environment. The particular needs and challenges that this population faces, however, may render them more susceptible to the adverse effects of typical risk factors, and they may also be vulnerable to additional risk factors not shared by children in the general population, including psychopharmacological treatment, genetics, disordered sleep, atypical eating patterns, and challenges for engaging in sufficient physical activity. For individuals with ASD, obesity and its sequelae potentially represent a significant threat to independent living, self-care, quality of life, and overall health.
Kreyenbuhl, Julie; Record, Elizabeth J; Palmer-Bacon, Jessica
Nonadherence to psychopharmacological treatments poses a significant challenge to treatment success in individuals with serious mental illness, with upwards of 60% of people not taking their psychiatric medications as prescribed. Nonadherence is associated with adverse outcomes, including exacerbation of psychiatric symptoms, impaired functioning, increased hospitalizations and emergency room use, and increased health care costs. Whereas interventions using psychoeducation or cognitive approaches, such as motivational interviewing, have largely proven ineffective in improving adherence, approaches employing behavioral tailoring that incorporate medication taking into the daily routine and/or use environmental supports have shown promise. Recently, adherence-enhancing behavioral tailoring interventions that utilize novel technologies, such as electronic monitors and mobile phones, have been developed. Although interventions utilizing these platforms have the potential for widespread dissemination to a broad range of individuals, most require further empirical testing. This paper reviews selected behavioral tailoring strategies that aim to improve medication adherence and other functional outcomes among individuals with serious mental illness.
Sfera, Adonis; Osorio, Carolina; Inderias, Luzmin Acosta; Parker, Victoria; Price, Amy I.; Cummings, Michael
Pathological impulsivity is encountered in a broad range of psychiatric conditions and is thought to be a risk factor for aggression directed against oneself or others. Recently, a strong association was found between impulsivity and obesity which may explain the high prevalence of metabolic disorders in individuals with mental illness even in the absence of exposure to psychotropic drugs. As the overlapping neurobiology of impulsivity and obesity is being unraveled, the question asked louder and louder is whether they should be treated concomitantly. The treatment of obesity and metabolic dysregulations in chronic psychiatric patients is currently underutilized and often initiated late, making correction more difficult to achieve. Addressing obesity and metabolic dysfunction in a preventive manner may not only lower morbidity and mortality but also the excessive impulsivity, decreasing the risk for aggression. In this review, we take a look beyond psychopharmacological interventions and discuss dietary and physical therapy approaches. PMID:28243210
Mota, Vanine Gomes; de Carvalho, Fabíola Lélis; de Morais, Liana Clébia Soares Lima; Bhattacharyya, Jnanabrata; de Almeida, Reinaldo Nóbrega; de Alencar, Jacicarlos Lima
Acute treatment with the chloroform fraction of Dioclea virgata (Rich.) Amshoff (CFDv) in mice produced decreased ambulation and sedation in the behavioral pharmacological screening. Doses of 125 and 250 mg/kg CFDv decreased latency of sleep onset in the test of sleeping time potentiation. In the open field, animals treated with CFDv reduced ambulation and rearing (250 mg/kg), as well as defecation (125; 250 mg/kg). Regarding the antinociceptive activity, CFDv (125, 250, 500 mg/kg) increased latency to first writhing and decreased the number of writhings induced by acetic acid. In the formalin test, CFDv (250 mg/kg) decreased paw licking time in the first and second phases indicating antinociceptive activity that can be mediated both peripherally and at the central level. CFDv did not affect motor coordination until 120 minutes after treatment. CFDv shows psychopharmacological effects suggestive of CNS-depressant drugs with promising antinociceptive activity.
Collerton, Daniel; Perry, Elaine
Comparing the phenomenology, neurochemical pathology, and psychopharmacology of hallucinations and dreaming is limited by the available data. Evidence to date reveals no simple correspondence between the two states. Differences in the phenomenology of visual hallucinations and the visual component of dreams may reflect variations in visual context acting on the same underlying mechanism - the minimal visual input during dreaming contrasts with the more substantial perceived context in hallucinations. Variations in cholinergic, dopaminergic and serotonergic neurotransmitter function during sleep and during hallucinations in Lewy body dementias, together with relevant drug effects suggest that, on the whole, different, potentially opposite, changes characterise the two states. A similar analysis of other psychotic features in Lewy body dementia and other disorders suggests that, in contrast to hallucinations, there may be more convincing parallels between dreaming and delusional states.
Dell, Mary Lynn
Depression is a common, recurring disorder affecting millions of youth at some point before they reach mature adulthood. Given the shortage of and uneven distribution of psychiatrists who have completed specialized fellowships in child and adolescent psychiatry, a significant number of depressed youth will receive their pharmacotherapy from general psychiatrists and other prescribers with varying degrees of interest, training, and even willingness to treat children and adolescents. For general psychiatrists who will prescribe antidepressants for minors, knowledge of the training and expertise of nonphysician mental health professionals, the psychotherapies they may employ, and familiarity with school services are essential. Physicians who typically work only with adults will also need familiarity with differing ethical, legal, and regulatory issues and standards applicable to pediatric psychopharmacology. General psychiatrists, pediatricians, family physicians, nurse practitioners, and others contribute greatly to the care of depressed children, adolescents, and their families, and many find this work to be a very rewarding part of their professional practices.
Aviram, Ron B.; Rhum, Madeline; Levin, Frances R.
Psychotherapy for comorbid attention-deficit/ hyperactivity disorder (ADHD) and psychoactive substance use disorder (PSUD) is described. The authors suggest that relapse prevention is an appropriate initial treatment because it is well suited to manage both substance abuse and comorbid symptomatology such as impulsivity, distractibility, and avoidance associated with ADHD. Clinical vignettes describe typical interactions between patients and their therapists, highlighting opportunities for therapists to focus on overlapping symptoms. ADHD is one of the most common comorbid diagnoses with PSUD, and it is important that efficacious psychotherapies be developed to complement psychopharmacological approaches. Clinicians should consider psychotherapy as part of a multimodal treatment approach that includes medication and perhaps family therapy. Additional contributions from clinicians who have experience conducting psychotherapy with this population are needed in order to develop effective treatments. PMID:11402081
Compton, Scott N; Burns, Barbara J; Helen, L Egger; Robertson, Elizabeth
This article reviews the empirical literature on psychosocial, psychopharmacological, and adjunctive treatments for children between the ages of 6 and 12 with internalizing disorders. The aim of this review was to identify interventions that have potential to prevent substance use disorders in adolescence by treating internalizing disorders in childhood. Results suggest that a variety of behavioral, cognitive-behavioral, and pharmacological interventions are effective in reducing symptoms of childhood depression, phobias, and anxiety disorders. None of the studies reviewed included substance abuse outcomes. Thus, little can be said about the relationship between early treatment and the prevention of later substance use. The importance of evaluating the generalizability of research-supported interventions to community settings is highlighted and recommendations for future research are offered.
Cottingham, Christopher; Ferryman, Craig J; Wang, Qin
Antidepressant drugs remain poorly understood, especially with respect to pharmacological mechanisms of action. This lack of knowledge results from the extreme complexity inherent to psychopharmacology, as well as to a corresponding lack of knowledge regarding depressive disorder pathophysiology. While the final analysis is likely to be multifactorial and heterogeneous, compelling evidence exists for upregulation of brain α2 adrenergic receptors (ARs) in depressed patients. This evidence has sparked a line of research into actions of a particular antidepressant drug class, the tricyclic antidepressants (TCAs), as direct ligands at α(2A)ARs. Our findings, as outlined herein, demonstrate that TCAs function as arrestin-biased ligands at α(2A)ARs. Importantly, TCA-induced α(2A)AR/arrestin recruitment leads to receptor endocytosis and downregulation of α(2A)AR expression with prolonged exposure. These findings represent a novel mechanism linking α(2)AR trafficking with antidepressant pharmacology.
Moreno, José L; Sealfon, Stuart C; González-Maeso, Javier
Schizophrenia is one of the most common mental illnesses, with hereditary and environmental factors important for its etiology. All antipsychotics have in common a high affinity for monoaminergic receptors. Whereas hallucinations and delusions usually respond to typical (haloperidol-like) and atypical (clozapine-like) monoaminergic antipsychotics, their efficacy in improving negative symptoms and cognitive deficits remains inadequate. In addition, devastating side effects are a common characteristic of monoaminergic antipsychotics. Recent biochemical, preclinical and clinical findings support group II metabotropic glutamate receptors (mGluR2 and mGluR3) as a new approach to treat schizophrenia. This paper reviews the status of general knowledge of mGluR2 and mGluR3 in the psychopharmacology, genetics and neuropathology of schizophrenia.
Gigantesco, Antonella; Giuliani, Massimo
Only recently the interest in the quality of life (QoL) has gained prominence in mental health practice with respect to other medical disciplines, such as oncology or cardiology, perhaps because the QoL measures were considered as tautological and largely overlapping with measures of psychopathology. Moreover, most of the recognized components of QoL represent the main areas of psychiatric intervention. For example, psychological functioning impairment represents the main area of psychotherapeutic and psychopharmacological interventions, social functioning impairment the main area of rehabilitation intervention. In addition, measures of QoL in psychiatric patients may be biased by some aspects of the disease, including impaired evaluation capacity or decreased expectations. Nowadays, QoL issues in relation to mental health care are especially relevant with regard to part of evaluation of treatment outcomes. Suggestions for the choice of the most appropriate QoL instruments for research and routine evaluation in mental health care are given.
Trachsel, Daniel; Hadorn, Marcel; Baumberger, Franz
The role of the metabolism of the entactogen 3,4-(methylenedioxy)methamphetamine (MDMA; 1b) in neurotoxic or psychopharmacologic action is widely discussed, but not yet fully understood. To prompt further investigation into the role of MDMA metabolism, six new 3,4-(difluoromethylenedioxy) analogues of MDMA (1b) were prepared and characterized. Although electronically very different, the fluoro analogues 3-5 should be sterically very similar to the non-fluorinated parent compounds. The F-atoms may prevent the formation of toxic metabolites produced via a radical pathway (Scheme 1). Different theories regarding MDMA-induced neurotoxicity are briefly reviewed and discussed. The novel compounds 3-5 may help to verify the hypothesis that MDMA-induced neurotoxicity is the result of the formation of metabolites lacking the methylenedioxy bridge.
Delgado, Sergio V.
The treatment of children and adolescents with psychotherapy is gradually losing ground to psychopharmacology. The author reviews the value the various forms of psychotherapy have in the treatment of children and the importance of having a clear curriculum for teaching this skill in residency programs. Although the importance of psychodynamic psychotherapy has a long history in the treatment of children, the reluctance some faculty have in recommending this form of therapy may be due to limited experience and limited knowledge of its benefits. The author highlights that a psychodynamic diagnostic evaluation is essential to assess a child’s suitability for psychotherapy. The characteristics of children who will benefit from psychodynamic psychotherapy, their defense mechanisms, and optimal characteristics of their parents are reviewed. The qualifications a psychiatrist needs to succeed in this endeavor are discussed. Two cases illustrate not only the importance in the suitability of the patient, but also the application of psychodynamic theory to practice. PMID:19727254
Psychopharmacotherapy is a fascinating field that can be understood in many different ways. It is both a science and an art of communication with a heavily subjective dimension. The advent of a significant number of the effective and well tolerated mental health medicines during and after 1990s decade of the brain has increased our possibilities to treat major mental disorders in more successful ways with much better treatment outcome including full recovery. However, there is a huge gap between our possibilities for achieving high treatment effectiveness and not satisfying results in day-to-day clinical practice. Creative approach to psychopharmacotherapy could advance everyday clinical practice and bridge the gap. Creative psychopharmacotherapy is a concept that incorporates creativity as its fundamental tool. Creativity involves the intention and ability to transcend limiting traditional ideas, rules, patterns and relationships and to create meaningful new ideas, interpretations, contexts and methods in clinical psychopharmacology.
Farmer, Cristan; Lecavalier, Luc; Yu, Sunkyung; Eugene Arnold, L; McDougle, Christopher J; Scahill, Lawrence; Handen, Benjamin; Johnson, Cynthia R; Stigler, Kimberly A; Bearss, Karen; Swiezy, Naomi B; Aman, Michael G
The Research Units on Pediatric Psychopharmacology--Autism Network reported additional benefit when adding parent training (PT) to antipsychotic medication in children with autism spectrum disorders and serious behavior problems. The intent-to-treat analyses were rerun with putative predictors and moderators. The Home Situations Questionnaire (HSQ) and the Hyperactivity/Noncompliance subscale of the Aberrant Behavior Checklist were used as outcome measures. Candidate predictors and moderators included 21 demographics and baseline measures of behavior. Higher baseline HSQ scores predicted greater improvement on the HSQ regardless of treatment assignment, but no other predictors of outcome were observed. None of the variables measured in this study moderated response to PT. Antipsychotic medication plus PT appears to be equally effective for children with a wide range of demographic and behavioral characteristics.
Svansdottir, Erla; Karlsson, Hrobjartur D; Gudnason, Thorarinn; Olason, Daniel T; Thorgilsson, Hordur; Sigtryggsdottir, Unnur; Sijbrands, Eric J; Pedersen, Susanne S; Denollet, Johan
Type D personality has been associated with poor prognosis in cardiac patients. This study investigated the validity of the Type D construct in Iceland and its association with disease severity and health-related risk markers in cardiac patients. A sample of 1,452 cardiac patients completed the Type D scale (DS14), and a subgroup of 161 patients completed measurements for the five-factor model of personality, emotional control, anxiety, depression, stress and lifestyle factors. The Icelandic DS14 had good psychometric properties and its construct validity was confirmed. Prevalence of Type D was 26-29%, and assessment of Type D personality was not confounded by severity of underlying coronary artery disease. Regarding risk markers, Type D patients reported more psychopharmacological medication use and smoking, but frequency of previous mental problems was similar across groups. Type D is a valid personality construct in Iceland, and is associated with health-related risk markers, but not cardiac disease severity.
Krikorian, Sharon E; Fowler, J Christopher
Treatment resistant patients frequently require treatment modalities beyond combined psychopharmacology and individual psychotherapy. They often require a team effort to manage crises, contain anxiety, and create a psychological space for examining the impact and meaning of behavior. The use of a treatment team as an adjunctive therapeutic modality helps individual team members understand regressions as repetitions of family dynamics, unearths the underlying meaning of behavior, engages patients' authority, and prioritizes the importance of relationships in effecting change. Through engagement with team members and with the team leader's authority, patients may assume responsibility for their behavior, reevaluate familiar roles, and increase self-awareness and psychological integration. The team helps its members identify, bear, and metabolize negative countertransference, address associated anxieties realistically, and optimize the environment for change.
Dickerson, Faith B; Tenhula, Wendy N; Green-Paden, Lisa D
The token economy is a treatment intervention based on principles of operant conditioning and social learning. Developed in the 1950s and 1960s for long-stay hospital patients, the token economy has fallen out of favor since that time. The current review was undertaken as part of the 2003 update of the schizophrenia treatment recommendations of the Patient Outcomes Research Team (PORT). A total of 13 controlled studies of the token economy were reviewed. As a group, the studies provide evidence of the token economy's effectiveness in increasing the adaptive behaviors of patients with schizophrenia. Most of the studies are limited, however, by methodological shortcomings and by the historical context in which they were performed. More research is needed to determine the specific benefits of the token economy when administered in combination with contemporary psychosocial and psychopharmacological treatments.
Gentile, Julie P.; Dillon, Kristy S.
There is a wide variety of what have been called “dissociative disorders,” including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Some of these diagnoses, particularly dissociative identity disorder, are controversial and have been questioned by many clinicians over the years. The disorders may be under-diagnosed or misdiagnosed, but many persons who have experienced trauma report “dissociative” symptoms. Prevalence of dissociative disorders is unknown, but current estimates are higher than previously thought. This paper reviews clinical, phenomenological, and epidemiological data regarding diagnosis in general, and illustrates possible treatment interventions for dissociative identity disorder, with a focus on psychotherapy interventions and a review of current psychopharmacology recommendations as part of a comprehensive multidisciplinary treatment plan. PMID:23556139
Between 1953 and 1965, Ogden Lindsley and his associates conducted free-operant research with psychiatric inpatients and normal volunteers at Metropolitan State Hospital in Waltham, Massachusetts. Their project, originally named "Studies in Behavior Therapy," was renamed "Harvard Medical School Behavior Research Laboratory" in 1955. This name change and its implications were significant. The role of the laboratory in the history of the relationship between the experimental analysis of behavior and applied behavior analysis is discussed. A case is made for viewing Lindsley's early work as foundational for the subfield of the experimental analysis of human behavior that formally coalesced in the early 1980s. The laboratory's work is also contextualized with reference to the psychopharmacological revolution of the 1950s. Finally, a four-stage framework for studying the historical and conceptual development of behavior analysis is proposed.
Lasić, Davor; Cvitanović, Marija Zuljan; Uglešić, Boran; Višić, Vitomir; Hlevnjak, Ivana
Dermatological side effects of psychopharmacological drugs are fortunately not so often. They are mostly presented in the group of mood stabilizers and antiepileptic drugs, particularly the carbamazepine and lamotrigine, and can be manifested through the Stevens Johnson syndrome, Toxic Epidermal Necrolysis (TEN)/Lyell's syndrome with about 30% lethality. According to the literature the group of phenothiazines is the category of drugs with rare appearances of skin reactions. Promazine, aliphatic phenothiazines antipsychotic, including less frequent side effects in the leaflet states increased skin sensitivity to sun, skin rash-associated with contact dermatitis, allergic reactions, cholestatic icterus. The only reported dermatological side effect of promazine is its metabolites deposition in the cornea. Analyzing the e-data basis we have not found references connecting the Exanthema medicamentosum as a side effect of promazine. A forty-two years old female patient was admitted to the Dermatological Clinic because of suspected exanthema, undoubtedly caused by promazine as a medication for Sy. Borderline.
Moreno Caballero, M; Corchos González, N; De Antonio Rubio, I; Gómez-Río, M; Guerrero Velázquez, J F; Rodríguez Fernández, A; Llamas Elvira, J M
We report the case of a patient with a long history of dysthymia and major depressive episodes requiring repeated hospitalization. We describe the most recent episode, associated with catatonia symptomatology and features suggestive of cognitive impairment. The absence of a clear initial psychopharmacological response alongside the clinical severity made the patient a potential candidate for electroconvulsive therapy (ECT). A regional cerebral blood flow SPECT (SPECT-rCBF), performed to rule out concomitant Alzheimer disease (AD), revealed a markedly decreased neocortical uptake, with no definitive pattern of concomitant primary cognitive impairment. Because a gradual clinical improvement was observed in the patient, with evidence of enhanced cerebral reperfusion in a second SPECT-rCBF study at two weeks after admission, the application of ECT was discounted and an expectant attitude was adopted.
Chen, Xing; Long, Feng; Cai, Bin; Chen, Xiaohong; Chen, Gang
Convergent evidence from genetics, symptology and psychopharmacology imply that there are intrinsic connection between schizophrenia (SCZ), bipolar disorder (BPD) and major depressive disorder (MDD). Also, any two or even three of these disorders could co-existe in some families. A total of 47,144 single nucleotide polymorphism (SNPs) on chromosome 7 were genotyped by Affymetrix Genome-Wide Human SNP array 6.0 on 119 SCZ, 253 BPD (type-I), 177 MDD, and 1000 controls. Associated SNP loci were comprehensively revealed and outstanding susceptibility genes were identified including CNTNAP2. a neurexin family gene. Unexpectedly, flanking genes for up to 94.74 % of of the associated SNPs were replicated (P≤9.9 E-8) in an enlarged cohort of 986 SCZ patients. Considering other convergent evidence, our results further implicate that BPD and MDD are subtypes of SCZ.
Slezak, Jonathan M; Katz, Jonathan L
The five-choice serial reaction time (5-CSRT) procedure has been considered a translational tool for assessments of the psychopharmacology of attention in preclinical research. Because greater sensitivity to delayed reinforcement may promote the development of attention-deficit/hyperactivity disorder (ADHD) symptoms, effects of reinforcer delay and psychostimulants on performances under a 5-CSRT procedure were determined. Male rats were trained to respond under a 5-CSRT procedure with different delay-of-reinforcement conditions (0, 2, 4, 8, 16 s), and effects of d-amphetamine, methylphenidate, and morphine (as a negative control) were assessed at 0- and 16-s delays. Under nondrug conditions, as the delay increased both response latency and the number of trials in which a response did not occur (omissions) increased, and the percent correct on trials when responses were emitted decreased. Only modest increases in the percent correct were found with psychostimulants during the 0-s delay condition; however, more substantial enhancements were found with a 16-s delay. Consistent effects of both psychostimulants at either delay on omissions and response latency were not observed. Morphine increased omissions and response latency at both delays and decreased the percent correct (16-s delay). Generally, responses during the intertrial interval were not systematically affected under any condition. The current results demonstrate that measures of attention in a 5-CSRT procedure are sensitive to changes in the delay to reinforcer delivery. More important, psychostimulants significantly enhanced a measure of attention only when reinforcers were delayed, which may be reflective of the psychopharmacological mechanisms involved with clinical treatment of ADHD symptoms.
Takahashi, Taiki; Oono, Hidemi; Radford, Mark H. B.
Impulsivity and inconsistency in intertemporal choice have been attracting attention in econophysics and neuroeconomics. Although loss of self-control by substance abusers is strongly related to their inconsistency in intertemporal choice, researchers in neuroeconomics and psychopharmacology have usually studied impulsivity in intertemporal choice using a discount rate (e.g. hyperbolic k), with little effort being expended on parameterizing subject's inconsistency in intertemporal choice. Recent studies using Tsallis’ statistics-based econophysics have found a discount function (i.e. q-exponential discount function), which may continuously parameterize a subject's consistency in intertemporal choice. In order to examine the usefulness of the consistency parameter (0⩽q⩽1) in the q-exponential discounting function in behavioral studies, we experimentally estimated the consistency parameter q in Tsallis’ statistics-based discounting function by assessing the points of subjective equality (indifference points) at seven delays (1 week-25 years) in humans (N=24). We observed that most (N=19) subjects’ intertemporal choice was completely inconsistent ( q=0, i.e. hyperbolic discounting), the mean consistency (0⩽q⩽1) was smaller than 0.5, and only one subject had a completely consistent intertemporal choice ( q=1, i.e. exponential discounting). There was no significant correlation between impulsivity and inconsistency parameters. Our results indicate that individual differences in consistency in intertemporal choice can be parameterized by introducing a q-exponential discount function and most people discount delayed rewards hyperbolically, rather than exponentially (i.e. mean q is smaller than 0.5). Further, impulsivity and inconsistency in intertemporal choice can be considered as separate behavioral tendencies. The usefulness of the consistency parameter q in psychopharmacological studies of addictive behavior was demonstrated in the present study.
Zainol, Maszaidi; Sidi, Hatta; Kumar, Jaya; Das, Srijit; Ismail, Shaiful; Hatta, Muhammad Hizri; Baharudin, Najwa; Ravindran, Arun
Across the globe, antidepressants (AD) and phosphodiesterase-5 inhibitors (PDE-5i) are commonly prescribed psychopharmacological agents for patients with co-morbid mental-health problem and sexual dysfunction (SD). The serotonergic and/or noradrenergic ADs, although is an effective agent are not without SD side-effects, especially erectile dysfunction (ED). ED is an inability to achieve, or maintain an erection for satisfactory sexual intercourse during the phases of male's sexual arousal. It is recognized as an important reason why non-adherence to treatment was observed in patients who are on AD. AD intervention caused remission to some of the pre-treatment psychopathology of ED, but to many patients, AD potentially magnified the unwanted sexual side-effects. This made this situation a challenging task for the mental health professional. These challenges are based on the complexity of ED - its etiology, and the associated risk factors, which further compounded with AD side-effect. The neuro-psychopharmacological basis for AD treatment selection used was deliberated. Biopsychosocial interventions are recommended at a two pivotal stage. First, a step should be taken for proper assessment (e.g. detailed history, psychosocial and laboratory investigations); and identifying some modifiable risk factors for ED and associated mental health issue. Secondly, with guidance of an algorithm pathway, a practical intervention should include steps like dose reduction, augmentation or changing to an AD with lesser/ no sexual side-effects like bupropion and mirtazepine. Some achievable suggestions, e.g. revising sexual scripts and improving sexual techniques, life-style modifications, psychotherapy and other non-pharmacological approaches will be beneficial for both patients and his partner.
Tartaglia, Nicole R.; Ayari, Natalie; Hutaff-Lee, Christa; Boada, Richard
Objective Attentional problems, hyperactivity, and impulsivity have been described as behavioral features associated with sex chromosome aneuploidy (SCA). In this study, the authors compare attention-deficit hyperactivity disorder (ADHD) symptoms in 167 participants aged 6 to 20 years with 4 types of SCA (XXY n = 56, XYY n = 33, XXX n = 25, and XXYY n = 53). They also evaluate factors associated with ADHD symptomatology (cognitive and adaptive scores, prenatal vs postnatal ascertainment) and describe the clinical response to psychopharmacologic medications in a subset of patients treated for ADHD. Methods Evaluation included medical and developmental history, cognitive and adaptive functioning assessment, and parent and teacher ADHD questionnaires containing DSM-IV criteria. Results In the total study group, 58% (96/167) met DSM-IV criteria for ADHD on parent-report questionnaires (36% in XXY, 52% in XXX, 76% in XYY, and 72% in XXYY). The Inattentive subtype was most common in XXY and XXX, whereas the XYY and XXYY groups were more likely to also have hyperactive/impulsive symptoms. There were no significant differences in Verbal, Performance, or Full Scale IQ between children with symptom scores in the ADHD range compared with those below the ADHD range. However, adaptive functioning scores were significantly lower in the group whose scores in the ADHD range were compared with those of the group who did not meet ADHD DSMIV criteria. Those with a prenatal diagnosis of XXY were less likely to meet criteria for ADHD compared with the postnatally diagnosed group. Psychopharmacologic treatment with stimulants was effective in 78.6% (66/84). Conclusions Children and adolescents with SCA are at increased risk for ADHD symptoms. Recommendations for ADHD evaluation and treatment in consideration of other aspects of the SCA medical and behavioral phenotype are provided. PMID:22333574
Harvey, Eric L.; Baker, Lisa E.
Rationale Recent reports on the abuse of novel synthetic cathinone derivatives call attention to serious public health risks of these substances. In response to this concern, a growing body of preclinical research has characterized the psychopharmacology of these substances, particularly mephedrone (MEPH) or methylenedioxypyrovalerone (MDPV), noting their similarities to MDMA and cocaine. Few studies have utilized drug discrimination methodology to characterize the psychopharmacological properties of these substances. Objectives The present study employed a rodent drug discrimination assay to further characterize the stimulus effects of MEPH and MDPV in comparison to MDMA and to a drug mixture comprised of d-amphetamine and MDMA. Methods Eight male Sprague-Dawley rats were trained to discriminate 1.5 mg/kg 3, 4-methylenedioxymethamphetamine (MDMA) and eight rats were trained to discriminate a mixture of 1.5 mg/kg MDMA and 0.5 mg/kg d-amphetamine (MDMA+AMPH) from vehicle. Substitution tests were conducted with MDMA, d-amphetamine, MDPV, MEPH, and cocaine. Results Dose response curves generated with MDMA and MEPH were comparable between training groups. In contrast, AMPH, MDPV, and cocaine produced only partial substitution in animals trained to discriminate MDMA but produced full substitution in animals trained to discriminate the MDMA+AMPH mixture. Conclusions These findings indicate MDPV's effects may be more similar to those of traditional psychostimulants, whereas MEPH exerts stimulus effects more similar to those of MDMA. Additional experiments with selective DA and 5-HT receptor antagonists are required to further elucidate specific receptor mechanisms mediating the discriminative stimulus effects of MDPV and mephedrone. PMID:26558618
Ossoukhova, Anastasia; Owen, Lauren; Ibarra, Alvin; Pipingas, Andrew; He, Kan; Roller, Marc; Stough, Con
Rationale Over the last decade, Asian ginseng (Panax ginseng) has been shown to improve aspects of human cognitive function. American ginseng (Panax quinquefolius) has a distinct ginsenoside profile from P. ginseng, promising cognitive enhancing properties in preclinical studies and benefits processes linked to human cognition. Objectives The availability of a highly standardised extract of P. quinquefolius (Cereboost™) led us to evaluate its neurocognitive properties in humans for the first time. Methods This randomised, double-blind, placebo-controlled, crossover trial (N = 32, healthy young adults) assessed the acute mood, neurocognitive and glycaemic effects of three doses (100, 200 400 mg) of Cereboost™ (P. quinquefolius standardised to 10.65% ginsenosides). Participants' mood, cognitive function and blood glucose were measured 1, 3 and 6 h following administration. Results There was a significant improvement of working memory (WM) performance associated with P. quinquefolius. Corsi block performance was improved by all doses at all testing times. There were differential effects of all doses on other WM tasks which were maintained across the testing day. Choice reaction time accuracy and ‘calmness’ were significantly improved by 100 mg. There were no changes in blood glucose levels. Conclusions This preliminary study has identified robust working memory enhancement following administration of American ginseng. These effects are distinct from those of Asian ginseng and suggest that psychopharmacological properties depend critically on ginsenoside profiles. These results have ramifications for the psychopharmacology of herbal extracts and merit further study using different dosing regimens and in populations where cognition is fragile. PMID:20676609
Francois, Jennifer; Grimm, Oliver; Schwarz, Adam J; Schweiger, Janina; Haller, Leila; Risterucci, Celine; Böhringer, Andreas; Zang, Zhenxiang; Tost, Heike; Gilmour, Gary; Meyer-Lindenberg, Andreas
Convergent evidence implicates regional neural responses to reward anticipation in the pathogenesis of several psychiatric disorders, such as schizophrenia, where blunted ventral striatal responses to positive reward are observed in patients and at-risk populations. In vivo oxygen amperometry measurements in the ventral striatum in awake, behaving rats reveal reward-related tissue oxygen changes that closely parallel blood oxygen level dependent (BOLD) signal changes observed in human functional magnetic resonance imaging (fMRI), suggesting that a cross-species approach targeting this mechanism might be feasible in psychopharmacology. The present study explored modulatory effects of acute, subanaesthetic doses of ketamine—a pharmacological model widely used in psychopharmacological research, both preclinically and clinically—on ventral striatum activity during performance of a reward anticipation task in both species, using fMRI in humans and in vivo oxygen amperometry in rats. In a region-of-interest analysis conducted following a cross-over placebo and ketamine study in human subjects, an attenuated ventral striatal response during reward anticipation was observed following ketamine relative to placebo during performance of a monetary incentive delay task. In rats, a comparable attenuation of ventral striatal signal was found after ketamine challenge, relative to vehicle, in response to a conditioned stimulus that predicted delivery of reward. This study provides the first data in both species demonstrating an attenuating effect of acute ketamine on reward-related ventral striatal (O2) and fMRI signals. These findings may help elucidate a deeper mechanistic understanding of the potential role of ketamine as a model for psychosis, show that cross-species pharmacological experiments targeting reward signaling are feasible, and suggest this phenotype as a promising translational biomarker for the development of novel compounds, assessment of disease status, and
Wiegers, Maike; Walter, Martin; Abler, Birgit; Graf, Heiko
Background: Various psychiatric populations are currently investigated with resting state fMRI, with the aim of individualizing diagnostics and treatment options and improving treatment outcomes. Many of these studies are conducted in large naturalistic samples, providing rich insights regarding disease-related neural alterations, but with the common psychopharmacological medication limiting interpretations of the results. We therefore investigated the effects of common noradrenergic and anti-dopaminergic medications on local and global resting state activity (rs-activity) in healthy volunteers to further the understanding of the respective effects independent from disease-related alterations. Methods: Within a randomized, double-blind, placebo-controlled crossover design, we investigated 19 healthy male subjects by resting state fMRI after the intake of reboxetine (4mg/d), amisulpride (200mg/d), and placebo for 7 days each. Treatment-related differences in local and global rs-activity were measured by the fractional amplitude of low frequency fluctuations (fALFF) and resting state functional connectivity (rs-FC). Results: fALFF revealed alterations of local rs-activity within regions of the core noradrenergic pathway, including the locus coeruleus under reboxetine, correlated with its plasma levels. Moreover, reboxetine led to increased rs-FC between regions within this pathway, i.e. the locus coeruleus, tectum, thalamus, and amygdala. Amisulpride modulated local rs-activity of regions within the dopaminergic pathway, with the altered signal in the putamen correlating with amisulpride plasma levels. Correspondingly, amisulpride increased rs-FC between regions of the dopaminergic pathway comprising the substantia nigra and putamen. Conclusion: Our data provide evidence of how psychopharmacological agents alter local and global rs-activity within the respective neuroanatomical pathways in healthy subjects, which may help with interpreting data in psychiatric
Rosas, Michela; Zaru, Alessandro; Sabariego, Marta; Giugliano, Valentina; Carboni, Ezio; Colombo, Giancarlo; Acquas, Elio
Sardinian alcohol-preferring (sP) and -non preferring (sNP) rats have been selectively bred for opposite ethanol preference and consumption; sP rats represent a validated experimental tool to model several aspects of excessive ethanol drinking in humans. Phosphorylated Extracellular signal-Regulated Kinase (pERK) in dopamine-rich terminal areas plays a critical role in several psychopharmacological effects of addictive drugs, including ethanol. This study was aimed at investigating whether ethanol-elicited ERK activation may differ in key brain areas of ethanol-naïve sP and sNP rats. To this end, the effects of ethanol (0, 0.5, 1, and 2 g/kg, administered intra-gastrically [i.g.]) on ERK phosphorylation were assessed by pERK immunohistochemistry in the shell (AcbSh) and core (AcbC) of the nucleus accumbens (Acb) as well as in the prelimbic (PrL) and infralimbic (IL) prefrontal cortex (PFCx), in the bed nucleus of stria terminalis (BSTL) and in the central nucleus of the amygdala (CeA). Ethanol (1 g/kg) significantly increased pERK immunoreactivity in AcbSh and AcbC of sP but not sNP rats. Conversely, ethanol failed to affect pERK expression in PrL and IL PFCx as well as in BSTL and CeA of both sP and sNP rats. These results suggest that selective breeding of these rat lines results in differential effects of acute ethanol on ERK phosphorylation in brain regions critical for the psychopharmacological effects of ethanol.
Santangelo, Andrea M; Ito, Mitsuteru; Shiba, Yoshiro; Clarke, Hannah F; Schut, Evelien HS; Cockcroft, Gemma; Ferguson-Smith, Anne C; Roberts, Angela C
Genetic polymorphisms in the repeat upstream region of the serotonin transporter gene (SLC6A4) are associated with individual differences in stress reactivity, vulnerability to affective disorders, and response to pharmacotherapy. However, the molecular, neurodevelopmental and psychopharmacological mechanisms underlying the link between SLC6A4 polymorphisms and the emotionally vulnerable phenotype are not fully understood. Thus, using the marmoset monkey Callithrix jacchus we characterize here a new neurobiological model to help to address these questions. We first sequenced the marmoset SLC6A4 promoter and identified a double nucleotide polymorphism (−2053AC/CT) and two single-nucleotide polymorphisms (−2022C/T and −1592G/C) within the repeat upstream region. We showed their association with gene expression using in vivo quantitative PCR and with affective behavior using a primate test of anxiety (human intruder test). The low-expressing haplotype (AC/C/G) was linked with high anxiety while the high-expressing one (CT/T/C) was associated with an active coping strategy in response to threat. Pharmacological challenge with an acute dose of the selective serotonin reuptake inhibitor, citalopram, revealed a genotype-dependent behavioral response. While individuals homozygous for the high anxiety-related haplotype AC/C/G exhibited a dose-dependent, anxiogenic response, individuals homozygous for the low anxiety-related haplotype CT/T/C showed an opposing, dose-dependent anxiolytic effect. These findings provide a novel genetic and behavioral primate model to study the molecular, neurodevelopmental, and psychopharmacological mechanisms that underlie genetic variation-associated complex behaviors, with specific implications for the understanding of normal and abnormal serotonin actions and the development of personalized pharmacological treatments for psychiatric disorders. PMID:26997299
Shim, Seong; Shuman, Michael; Duncan, Erica
Schizophrenia is a progressive psychotic disorder with devastating effects on the broad aspects of human emotion, perception, thought, and psychosocial interactions. Although treatment with antipsychotic drugs, the mainstay in the treatment of schizophrenia, the large number of patients with schizophrenia respond poorly to the pharmacological and, the large number of patients with schizophrenia poorly respond to the pharmacological treatment. Although a variety of novel therapeutics have long been tested, to date, no drugs clinically efficacious for schizophrenia are available. The multiple lines of evidence strongly suggest that the modulation of cyclic guanosine monophosphate (cGMP) is a promising target in promoting the novel therapeutic strategies of schizophrenia beyond the "receptor-dependent" psychopharmacology. cGMP is modulated via regulating its synthesis by N-methyl-d-aspartate receptor (NMDAR) and nitric oxide (NO), which regulate guannylyl cyclase (GC), the enzyme producing cGMP. cGMP is also regulated by phosphodiesterase (PDE), the enzyme hydrolyzing cGMP. In this review, we critically evaluate the therapeutic potential of agents modulating cGMP activity by regulating cGMP synthesis including NMDAR enhancers, NO enhancers, NO inhibitors including minocycline with anti-inflammatory properties and PDE inhibitors in improving the negative, cognitive and positive symptoms of schizophrenia. We also discuss the possible mechanisms by which these agents produce therapeutic effects on schizophrenia including cGMP signaling pathways, oxidative stress, and neuroinflammation.
Ratey, J J; Grandin, T; Miller, A
The causal factors in the behaviorally defined syndrome of autism remain unclear, although the past decade has brought to bear two significant developments that shape our view of the disorder. The first of these developments is a growing body of biomedical research that indicates there are multiple etiologies associated with the disorder. This research has allowed for the formation of subgroups based upon neuroanatomical, neurobiological, and neurophysiological abnormalities (Damasio 1984; Piggot 1979; Ritvo et al. 1990). The second is neuropsychological research indicating that the socioemotional deficits are primary to the disorder and may underlie much of the behavioral symptomatology (Fein et al. 1986). These areas of concern undoubtedly have enhanced our understanding of the disorder, yet in their achievements they may too easily absorb what we know about autistics who experience a chronic state of physiological hyperarousal, evidence of which has been found in neurophysiological studies (Delius 1967; Hutt et al. 1965), neurochemical studies (Lake et al. 1977), psychopharmacologic studies (Ratey et al. 1987a), and behavioral studies (Kinsbourne 1980; Kootz et al. 1982; Tinbergen and Tinbergen 1972; Zentall and Zentall 1983). These individuals, perhaps constituting a subgroup of their own, experience an inner state of disorganization that markedly impairs their functioning (Sands and Ratey 1986).
Möller-Leimkühler, A M; Möller, H-J; Maier, W; Gaebel, W; Falkai, P
This paper explores causes, explanations and consequences of the negative image of psychiatry and develops recommendations for improvement. It is primarily based on a WPA guidance paper on how to combat the stigmatization of psychiatry and psychiatrists and a Medline search on related publications since 2010. Furthermore, focussing on potential causes and explanations, the authors performed a selective literature search regarding additional image-related issues such as mental health literacy and diagnostic and treatment issues. Underestimation of psychiatry results from both unjustified prejudices of the general public, mass media and healthcare professionals and psychiatry's own unfavourable coping with external and internal concerns. Issues related to unjustified devaluation of psychiatry include overestimation of coercion, associative stigma, lack of public knowledge, need to simplify complex mental issues, problem of the continuum between normality and psychopathology, competition with medical and non-medical disciplines and psychopharmacological treatment. Issues related to psychiatry's own contribution to being underestimated include lack of a clear professional identity, lack of biomarkers supporting clinical diagnoses, limited consensus about best treatment options, lack of collaboration with other medical disciplines and low recruitment rates among medical students. Recommendations are proposed for creating and representing a positive self-concept with different components. The negative image of psychiatry is not only due to unfavourable communication with the media, but is basically a problem of self-conceptualization. Much can be improved. However, psychiatry will remain a profession with an exceptional position among the medical disciplines, which should be seen as its specific strength.
Ito, Mikiko; Haito, Sakiko; Furumoto, Mari; Kawai, Yoshichika; Terao, Junji; Miyamoto, Ken-ichi
Serotonin transporters (SERTs) are pre-synaptic proteins specialized for the clearance of serotonin following vesicular release at central nervous system (CNS) and enteric nervous system synapses. SERTs are high affinity targets in vivo for antidepressants such as serotonin selective reuptake inhibitors (SSRIs). These include 'medical' psychopharmacological agents such as analgesics and antihistamines, a plant extract called St John's Wort (Hypericum). Osteoclasts are the primary cells responsible for bone resorption. They arise by the differentiation of osteoclast precursors of the monocyte/macrophage lineage. The expression of SERTs was increased in RANKL-induced osteoclast-like cells. Using RANKL stimulation of RAW264.7 cells as a model system for osteoclast differentiation, we studied the direct effects of food factor on serotonin uptake. The SSRIs (fluoxetine and fluvoxamine) inhibited markedly (approximately 95%) in serotonin transport in differentiated osteoclast cells. The major components of St. John's Wort, hyperforin and hypericine were significantly decreased in serotonin transport activity. Thus, a new in vitro model using RANKL-induced osteoclast-like cells may be useful to analyze the regulation of SERT by food factors and SSRIs.
Rationale Preclinical data indicates that threat stimuli elicit two classes of defensive behaviors, those that are associated with imminent danger and are characterized by avoidance or fight (fear), and those that are associated with temporally uncertain danger and are characterized by sustained apprehension and hypervigilance (anxiety). Objective To 1) review evidence for a distinction between fear and anxiety in animal and human experimental models using the startle reflex as an operational measure of aversive states, 2) describe experimental models of anxiety, as opposed to fear, in humans, 3) examine the relevance of these models to clinical anxiety. Results The distinction between phasic fear to imminent threat and sustained anxiety to temporally uncertain danger is suggested by psychopharmacological and behavioral evidence from ethological studies and can be traced back to distinct neuroanatomical systems, the amygdala and the bed nucleus of the stria terminalis. Experimental models of anxiety, not fear, are relevant to non-phobic anxiety disorders. Conclusions Progress in our understanding of normal and abnormal anxiety is critically dependent on our ability to model sustained aversive states to temporally uncertain threat. PMID:18058089
Orquin, Jacob L.; Jeppesen, Heine B.; Scholderer, Joachim; Haugtvedt, Curtis
In an attempt to discover new possibilities for advertising in uncluttered environments marketers have recently begun using ambient advertising in, for instance, bars and pubs. However, advertising in such licensed premises have to deal with the fact that many consumers are under the influence of alcohol while viewing the ad. This paper examines the effect of alcohol intoxication on attention to and memory for advertisements in two experiments. Study 1 used a forced exposure manipulation and revealed increased attention to logos under alcohol intoxication consistent with the psychopharmacological prediction that alcohol intoxication narrows attention to the more salient features in the visual environment. Study 2 used a voluntary exposure manipulation in which ads were embedded in a magazine. The experiment revealed that alcohol intoxication reduces voluntary attention to ads and leads to a significant reduction in memory for the viewed ads. In popular terms consuming one or two beers reduces brand recall from 40 to 36% while being heavily intoxicated further reduces brand recall to 17%. PMID:24723899
Bajo, R; Pusil, S; López, M E; Canuet, L; Pereda, E; Osipova, D; Maestú, F; Pekkonen, E
Scopolamine administration may be considered as a psychopharmacological model of Alzheimer's disease (AD). Here, we studied a group of healthy elderly under scopolamine to test whether it elicits similar changes in brain connectivity as those observed in AD, thereby verifying a possible model of AD impairment. We did it by testing healthy elderly subjects in two experimental conditions: glycopyrrolate (placebo) and scopolamine administration. We then analyzed magnetoencephalographic (MEG) data corresponding to both conditions in resting-state with eyes closed. This analysis was performed in source space by combining a nonlinear frequency band-specific measure of functional connectivity (phase locking value, PLV) with network analysis methods. Under scopolamine, functional connectivity between several brain areas was significantly reduced as compared to placebo, in most frequency bands analyzed. Besides, regarding the two complex network indices studied (clustering and shortest path length), clustering significantly decreased in the alpha band while shortest path length significantly increased also in alpha band both after scopolamine administration. Overall our findings indicate that both PLV and graph analysis are suitable tools to measure brain connectivity changes induced by scopolamine, which causes alterations in brain connectivity apparently similar to those reported in AD.
Bystritsky, Alexander; Khalsa, Sahib S.; Cameron, Michael E.; Schiffman, Jason
Anxiety disorders are the most prevalent mental health conditions. Although they are less visible than schizophrenia, depression, and bipolar disorder, they can be just as disabling. The diagnoses of anxiety disorders are being continuously revised. Both dimensional and structural diagnoses have been used in clinical treatment and research, and both methods have been proposed for the new classification in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-5). However, each of these approaches has limitations. More recently, the emphasis in diagnosis has focused on neuroimaging and genetic research. This approach is based partly on the need for a more comprehensive understanding of how biology, stress, and genetics interact to shape the symptoms of anxiety. Anxiety disorders can be effectively treated with psychopharmacological and cognitive–behavioral interventions. These inter ventions have different symptom targets; thus, logical combinations of these strategies need to be further studied in order to improve future outcomes. New developments are forthcoming in the field of alternative strategies for managing anxiety and for treatment-resistant cases. Additional treatment enhancements should include the development of algorithms that can be easily used in primary care and with greater focus on managing functional impairment in patients with anxiety. PMID:23599668
Mann, Samuel J
Paroxysmal hypertension always engenders a search for a catecholamine-secreting pheochromocytoma. Yet 98% of people with paroxysmal hypertension do not have this tumor. The cause and management of paroxysmal hypertension remain a mystery, and the subject of remarkably few papers. This review presents an approach to understanding and successfully treating this disorder. Patients experience symptomatic blood pressure surges likely linked to sympathetic nervous system stimulation. A specific personality profile associated with this disorder suggests a psychological basis, attributable to repressed emotion related to prior emotional trauma or a repressive (nonemotional) coping style. Based on this understanding, three forms of intervention, alone or in combination, appear successful: antihypertensive therapy with agents directed at the sympathetically mediated blood pressure elevation (eg, combined alpha- and beta-blockade or central alpha-agonists such as clonidine); psychopharmacologic interventions including anxiolytic and/or antidepressant agents; and psychological intervention, particularly reassurance and increased psychological awareness. An appropriately selected intervention can reduce or eliminate attacks in most patients.
This review summarizes evidence of dysregulated reward circuitry function in a range of neurodevelopmental and psychiatric disorders and genetic syndromes. First, the contribution of identifying a core mechanistic process across disparate disorders to disease classification is discussed, followed by a review of the neurobiology of reward circuitry. We next consider preclinical animal models and clinical evidence of reward-pathway dysfunction in a range of disorders, including psychiatric disorders (i.e., substance-use disorders, affective disorders, eating disorders, and obsessive compulsive disorders), neurodevelopmental disorders (i.e., schizophrenia, attention-deficit/hyperactivity disorder, autism spectrum disorders, Tourette’s syndrome, conduct disorder/oppositional defiant disorder), and genetic syndromes (i.e., Fragile X syndrome, Prader–Willi syndrome, Williams syndrome, Angelman syndrome, and Rett syndrome). We also provide brief overviews of effective psychopharmacologic agents that have an effect on the dopamine system in these disorders. This review concludes with methodological considerations for future research designed to more clearly probe reward-circuitry dysfunction, with the ultimate goal of improved intervention strategies. PMID:22958744
Cía, Alfredo H; Rojas, Rodrigo Córdoba; Adad, Miguel Abib
The history of Mental Health in Latin America is relatively young. It dates back to the mid nineteenth century and widely developed during the twentieth century, with formidable scientific, social, political, and ethical challenges. Latin American psychiatry has contributed in the fields of epidemiology, phenomenology, social psychiatry, psychiatric and epistemological research, and clinical genetics as well. More recent advances can also be seen in clinical psychotherapy and psychopharmacology. Now, there is a formal and informal recognition of various areas of expertise, such as children and adolescents, addictions, anxiety disorders, among others. However, we need to solve the health problems resulting from mental illnesses as well as the disorders related to the social, environmental, political, and economic factors of a continent marked by the precariousness of underdevelopment, which have a high impact on population health. Therefore, considering and trying to minimize the impact of those factors, contributing to the destigmatization of mental illnesses and their consequences, together with the growing number of non-governmental organizations (NGOs), human rights defenders, public figures, etc., and collaborating in building a society that guarantees the right to mental health and adequate treatment and rehabilitation are part of our present challenges in Latin America.
Frontal lobe syndromes, better termed as frontal network systems, are relatively unique in that they may manifest from almost any brain region, due to their widespread connectivity. The understandings of the manifold expressions seen clinically are helped by considering evolutionary origins, the contribution of the state-dependent ascending monoaminergic neurotransmitter systems, and cerebral connectivity. Hence, the so-called networktopathies may be a better term for the syndromes encountered clinically. An increasing array of metric tests are becoming available that complement that long standing history of qualitative bedside assessments pioneered by Alexander Luria, for example. An understanding of the vast panoply of frontal systems' syndromes has been pivotal in understanding and diagnosing the most common dementia syndrome under the age of 60, for example, frontotemporal lobe degeneration. New treatment options are also progressively becoming available, with recent evidence of dopaminergic augmentation, for example, being helpful in traumatic brain injury. The latter include not only psychopharmacological options but also device-based therapies including mirror visual feedback therapy. PMID:23577266
Franken, Ingmar H A; Zijlstra, Corien; Muris, Peter
It is well-known that persons with a drug addiction experience feelings of anhedonia during "normal" daily activities. It has been proposed that these symptoms of anhedonia are the result of direct pharmacological influences of drugs on the dopamine system. To test the assumption that nonpharmacological processes are also involved in anhedonia, we studied anhedonic symptoms in skydivers who regularly expose themselves to thrillful extreme sport activity and then experience intense hedonic feelings. A group of skydivers completed anhedonia scales and their scores were compared to a control group (a group of rowers). The main finding of the present study was that subjects who engage in the high-risk activity of skydiving, experienced more anhedonic symptoms than subjects who do not engage in such an extreme sport, but rather prefer a low-risk activity like rowing. This finding supports the notion that skydiving has similarities with addictive behaviors and that frequent exposure to "natural high" experiences is related to anhedonia. This suggests that the negative emotional state as observed in drug users may not be exclusively the results of exogenous psychopharmacological effects, but might also result from psychological mechanisms that are partly responsible for these anhedonic feelings.
Hazen, Eric P; Stornelli, Jennifer L; O'Rourke, Julia A; Koesterer, Karmen; McDougle, Christopher J
The aim of this review is to summarize the recent literature regarding abnormalities in sensory functioning in individuals with autism spectrum disorder (ASD), including evidence regarding the neurobiological basis of these symptoms, their clinical correlates, and their treatment. Abnormalities in responses to sensory stimuli are highly prevalent in individuals with ASD. The underlying neurobiology of these symptoms is unclear, but several theories have been proposed linking possible etiologies of sensory dysfunction with known abnormalities in brain structure and function that are associated with ASD. In addition to the distress that sensory symptoms can cause patients and caregivers, these phenomena have been correlated with several other problematic symptoms and behaviors associated with ASD, including restrictive and repetitive behavior, self-injurious behavior, anxiety, inattention, and gastrointestinal complaints. It is unclear whether these correlations are causative in nature or whether they are due to shared underlying pathophysiology. The best-known treatments for sensory symptoms in ASD involve a program of occupational therapy that is specifically tailored to the needs of the individual and that may include sensory integration therapy, a sensory diet, and environmental modifications. While some empirical evidence supports these treatments, more research is needed to evaluate their efficacy, and other means of alleviating these symptoms, including possible psychopharmacological interventions, need to be explored. Additional research into the sensory symptoms associated with ASD has the potential to shed more light on the nature and pathophysiology of these disorders and to open new avenues of effective treatments.
Nóbrega, Franklin F F; Salvadori, Mirian G S S; Masson, Cintia J; Mello, Carlos F; Nascimento, Tiago S; Leal-Cardoso, José H; de Sousa, Damião P; Almeida, Reinaldo N
Terpinen-4-ol (4TRP) is a monoterpenoid alcoholic component of essential oils obtained from several aromatic plants. We investigated the psychopharmacological and electrophysiological activities of 4TRP in male Swiss mice and Wistar rats. 4TRP was administered intraperitoneally (i.p.) at doses of 25 to 200 mg/kg and intracerebroventricularly (i.c.v.) at concentrations of 10, 20, and 40 ng/2 μL. For in vitro experiments, 4TRP concentrations were 0.1 mM and 1.0 mM. 4TRP (i.p.) inhibited pentylenetetrazol- (PTZ-) induced seizures, indicating anticonvulsant effects. Electroencephalographic recordings showed that 4TRP (i.c.v.) protected against PTZ-induced seizures, corroborating the behavioural results. To determine whether 4TRP exerts anticonvulsant effects via regulation of GABAergic neurotransmission, we measured convulsions induced by 3-mercapto-propionic acid (3-MP). The obtained results showed involvement of the GABAergic system in the anticonvulsant action exerted by 4TRP, but flumazenil, a selective antagonist of the benzodiazepine site of the GABAA receptor, did not reverse the anticonvulsant effect, demonstrating that 4TRP does not bind to the benzodiazepine-binding site. Furthermore, 4TRP decreased the sodium current through voltage-dependent sodium channels, and thus its anticonvulsant effect may be related to changes in neuronal excitability because of modulation of these channels.
Argument This paper examines the intersecting histories of psychiatry and psychology (particularly in its clinical guise) in the United States from the second half of the nineteenth century to the present. It suggests that there have been three major shifts in the ideological and intellectual orientation of the "psy complex." The first period sees the dominance of the asylum in the provision of mental health care, with psychology, once it emerges in the early twentieth century, remaining a small enterprise largely operating outside the clinical arena, save for the development of psychometric technology. It is followed, between 1945 and 1980, by the rise of psychoanalytic psychiatry and the emergence of clinical psychology. Finally, the re-emergence of biological psychiatry is closely associated with two major developments: an emphasis that emerges in the late 1970s on rendering the diagnosis of psychiatric illnesses mechanical and predictable; and the long-term effects of the psychopharmacological revolution that began in the early 1950s. This third period has seen a shift the orientation of mainstream psychiatry away from psychotherapy, the end of traditional mental hospitals, and a transformed environment within which clinical psychologists ply their trade.
Mohr, Christine; Claridge, Gordon
A long-standing tradition in personality research in psychology, and nowadays increasingly in psychiatry, is that psychotic and psychotic-like thoughts are considered common experiences in the general population. Given their widespread occurrence, such experiences cannot merely reflect pathological functioning. Moreover, reflecting the multi-dimensionality of schizotypy, some dimensions might be informative for healthy functioning while others less so. Here, we explored these possibilities by reviewing research that links schizotypy to favorable functioning such as subjective wellbeing, cognitive functioning (major focus on creativity), and personality correlates. This research highlights the existence of healthy people with psychotic-like traits who mainly experience positive schizotypy (but also affective features mapping onto bipolar disorder). These individuals seem to benefit from a healthy way to organize their thoughts and experiences, that is, they employ an adaptive cognitive framework to explain and integrate their unusual experiences. We conclude that, instead of focusing only on the pathological, future studies should explore the behavioral, genetic, imaging, and psychopharmacological correlates that define the healthy expression of psychotic-like traits. Such studies would inform on protective or compensatory mechanisms of psychosis-risk and could usefully inform us on the evolutionary advantages of the psychosis dimension. PMID:25810058
Hosseinzadeh, Hossein; Shahandeh, Shabnam; Shahsavand, Shabnam
Background Research in the area of herbal psychopharmacology has clearly improved in recent decades. Self-administration of herbal medicines has been the most popular therapeutic alternative to standard medicine. Objectives Since the extract of Echium amoenum exhibits an anxiolytic effect, the aim of this study is to evaluate the anxiolytic and hypnotic effects in mice of the aqueous and ethanolic extracts of aerial parts of E. italicum, a member of the Boraginaceae family. Materials and Methods Mice were administered the agents intraperitoneally before the start of the experiments for evaluation of hypnotic activity (induced by sodium pentobarbital, 30 mg/kg, i.p.), anxiolytic activity (elevated plus-maze [EPM] test), locomotor activity (open field test), and motor coordination (rotarod test). Result The ethanolic and aqueous extracts of E. italicum, at doses of 1.2 and 2.1 g/kg, increased the percentage of time-spent and the percentage of arm entries in the open arms of the EPM and decreased the percentage of time-spent in the closed arms of the EPM. Moreover, both extracts decreased the pentobarbital-induced latency to sleep and significantly increased the total sleeping time induced by pentobarbital. In addition, locomotor activity was affected by aqueous extracts and ethanolic extract (at higher doses). Both extracts showed no effect in the rotarod test. Conclusions These results suggest that both ethanolic and aqueous extracts of E. italicum may have anxiolytic effects and sedative activity but no effect on muscle relaxation. PMID:24624158
Robinson, Cassandra L.
Psychopharmacological treatment has been the mainstay in long-term maintenance of bipolar disorder (BD) patients for the last 60 years. Conventionally accepted treatment options are primarily based on expert opinion rather than on well-executed, independently funded research. Investigation of maintaining patients without medications using treatment alternatives has been neglected. This clinical case series examines the outcomes of 7 BD patients who experienced a poor response or significant side effects with conventional treatment modalities. Patients were gradually and safely withdrawn from all medications. Treatment strategies were based on an individualized holistic approach using herbs, nutritional supplements, vitamins, amino acids, acupuncture, dietary recommendations, and behavioral modifications. Multiple treatment modalities were combined addressing the etiological causes for BD symptoms. Upon withdrawal from psychotropic medications, patients were free of medication-induced side effects and obtained psychiatric stability for at least 10 months. Further research is needed to investigate the long-term outcomes of BD treatment modalities based on well-defined successful outcome criteria, such as reduction in symptoms, improvement in quality of life, overall health outcomes, and cost effectiveness. PMID:25984407
Gene targeting with homologous recombination in embryonic stem cells created a revolution in the analysis of the function of genes in behavioral brain research. The technology allowed unprecedented precision with which one could manipulate genes and study the effect of this manipulation on the central nervous system. With gene targeting, the uncertainty inherent in psychopharmacology regarding whether a particular compound would act only through a specific target was removed. Thus, gene targeting became highly popular. However, with this popularity came the realization that like other methods, gene targeting also suffered from some technical and principal problems. For example, two decades ago, issues about compensatory changes and about genetic linkage were raised. Since then, the technology developed, and its utility has been better delineated. This review will discuss the pros and cons of the technique along with these advancements from the perspective of the neuroscientist user. It will also compare and contrast methods that may represent novel alternatives to the homologous recombination based gene targeting approach, including the TALEN and the CRISPR/Cas9 systems. The goal of the review is not to provide detailed recipes, but to attempt to present a short summary of these approaches a behavioral geneticist or neuroscientist may consider for the analysis of brain function and behavior.