Showing papers in "Current Opinion in Psychiatry in 2007"
TL;DR: Although interventions with early incipient disorders might help reduce severity-persistence of primary disorders and prevent secondary disorders, additional research is needed on appropriate treatments forEarly incipient cases and on long-term evaluation of the effects of early intervention on secondary prevention.
Abstract: Purpose of reviewThe aim of this article is to review recent epidemiological research on age-of-onset of mental disorders, focusing on the WHO World Mental Health surveys.Recent findingsMedian and inter-quartile range (IQR; 25th–75th percentiles) of age-of-onset is much earlier for phobias (7–14, IQ
2,298 citations
TL;DR: Evidence has emerged that proper control of vascular disorders and maintenance of active lifestyles may prevent or delay the onset and progression of dementia and Alzheimer's disease.
Abstract: Purpose of reviewThe epidemiology of dementia is one of the priority fields in aging research. This review aims to highlight the most relevant findings over last years concerning occurrence, risk factors, and prevention of dementia and its major subtypes.Recent findingsIt is estimated that currently
424 citations
TL;DR: A metacognitive training program is developed that aims to convey scientific knowledge on cognitive biases to patients and provides corrective experiences in an engaging and supportive manner and two new studies provide preliminary evidence for the feasibility and efficacy of this approach.
Abstract: Purpose of reviewThere has been a marked increase in the study of cognitive biases in schizophrenia, which has in part been stimulated by encouraging results with cognitive–behavioral interventions in the disorder. We summarize new evidence on cognitive biases thought to trigger or maintain positive
418 citations
TL;DR: The review of ADHD epidemiology highlights the need for standardizing study methodologies to make findings comparable and indicates that epidemiological cross-national data seem to support the validity of ADHD.
Abstract: Purpose of reviewPrevalence estimates of the attention-deficit hyperactivity disorder (ADHD) and the rate of persistence of symptoms across the lifespan are heterogeneous, raising questions about the validity of the diagnosis. This review aims to discuss potential reasons for variability in ADHD pre
412 citations
TL;DR: It is confirmed that patients' beliefs are associated with important outcomes in a broadening range of illnesses and risk factor testing and new interventions have the potential to improve patient outcomes.
Abstract: Purpose of reviewIn this article we summarize recent investigations into the influence of illness perceptions on outcomes in patients with medical conditions.Recent findingsDevelopments in assessment include the publishing of a new brief scale to assess illness perceptions and the examination of the
397 citations
TL;DR: Results support a key role for response inhibition, a function linked to the right inferior frontal gyrus, in the manifestation of impulsivity, and will contribute to the search for psychiatric endophenotypes, novel treatments, and more optimal diagnostic classification systems for neuropsychiatric disorders.
Abstract: Purpose of review Impulsive symptoms occur across neuropsychiatric disorders, with important ramifications for everyday functioning and quality of life. This article considers recent developments in the neuropsychological assessment of impulsivity with a focus on the ability to suppress motor responses (response inhibition). Recent findings Using objective tests, response inhibition deficits were identified in several neuropsychiatric conditions associated with impulsivity, namely attention deficit hyperactivity disorder, trichotillomania, obsessive‐compulsive disorder, and chronic substance abuse. Deficits were also found in unaffected first-degree relatives of attention deficit hyperactivity disorder and obsessive‐compulsive disorder patients. Evidence from patients with focal brain lesions and from healthy volunteers using functional MRI and transcranial stimulation implicated the right inferior frontal gyrus in response inhibition. Pharmacological manipulations of the serotonin system had no detectable behavioural effects on response inhibition, whereas manipulations of the noradrenaline system did. Summary Neuropsychological assessment shows great promise in the investigation of impulsivity and its brain substrates. These results support a key role for response inhibition, a function linked to the right inferior frontal gyrus, in the manifestation of impulsivity. Measures of response inhibition will contribute to the search for psychiatric endophenotypes, novel treatments, and more optimal diagnostic classification systems for neuropsychiatric disorders.
370 citations
TL;DR: A careful and systematic exploration of suicide risk factors in patients with mood disorder helps clinicians to identify patients at high suicide risk and substantially reduces the suicidal behaviour even in this high-risk population.
Abstract: Purpose of reviewThe aim of this review is to highlight the traditional and newly recognized suicide risk factors in patients with mood disorders.Recent findingsCurrent research findings clearly suggest that suicidal behaviour in patients with mood disorder is a ‘state-dependent’ phenomenon. Recentl
347 citations
TL;DR: Endophenotype-based modelling of depression and bipolar illness is opening up more tractable avenues for understanding the neurobiological and genetic bases of these disorders and promises to yield better translational animal models and hence more fruitful therapeutic targets.
Abstract: Purpose of reviewThe wide spectrum of disruptions that characterizes depression and bipolar illness highlights the difficulties researchers are posed with as they try to mimic these disorders in the laboratory. Nonetheless, numerous attempts have been made to create rodent models of mood disorders,
331 citations
TL;DR: The prevalence of hazardous drinking in Australasia, Europe and South America appears similar to that in North America, but is lower in Africa and Asia, and the effectiveness of intervention methods and implications for future research are reviewed.
Abstract: PURPOSE OF REVIEW: The present review of published articles during 2005-2006 on alcohol use among college students in Africa, Asia, Australasia, Europe and South America assesses the prevalence of alcohol use, hazardous drinking and related problems, and reviews the effectiveness of intervention methods and implications for future research. RECENT FINDINGS: Research on alcohol use and related problems in college students is lacking in many regions of the world. We identified 26 papers in peer-reviewed journals, from Australia, Brazil, Ecuador, Egypt, Germany, Hong Kong, Ireland, Lebanon, New Zealand, Nigeria, Sweden, The Netherlands and Turkey. SUMMARY: More comprehensive studies with systematic methodologies in the world regions reviewed here are needed to yield representative results on alcohol use and related risk and protective factors in college settings. College students in many countries are at elevated risk for heavy drinking, with serious immediate health risks, such as drink-driving and other substance use; and longer term risks, such as alcohol dependence. The prevalence of hazardous drinking in Australasia, Europe and South America appears similar to that in North America, but is lower in Africa and Asia. Alcohol policies should be reviewed and prevention programmes initiated in light of research evidence, for this high-risk population. Language: en
306 citations
TL;DR: There is now strong evidence against selective migration as the explanation for schizophrenia and there is an increasing interest in the impact of social stressors on brain functioning and on the pathogenesis of schizophrenia.
Abstract: Purpose of review An exploration of the evidence that a history of migration is a risk factor for schizophrenia and an evaluation of those studies that seek an explanation for this Recent findings A meta-analysis found an increased risk for schizophrenia among first-generation and second-generation migrants and found a particularly high risk for migrants from countries where the majority of the population was Black The latter finding was confirmed and extended by a large first-contact incidence study in the UK, which found excessive risks for schizophrenia and mania in the African-Caribbean and black-African sections of the population A very high risk of schizophrenia has also been reported for Moroccan males in the Netherlands The explanation for these findings is uncertain Social adversity, racial discrimination, family dysfunction, unemployment and poor housing conditions have been proposed as contributing factors Summary A personal of family history of migration is a high risk factor for schizophrenia and there is now evidence against selective migration as the explanation There is an increasing interest in the impact of social stressors on brain functioning and on the pathogenesis of schizophrenia
179 citations
TL;DR: Early and regular cannabis use in adolescence predicts an increased risk of cannabis dependence which in turn predicts an increase risk of using other illicit drugs, and reporting symptoms of mood and psychotic disorders.
Abstract: Purpose of review The aim of this article is to review recent research on the prevalence, antecedents and correlates of cannabis use in young adults in developed and developing countries. Recent findings Cannabis is the most widely used illicit drug globally and its use appears to be increasing in developed and developing countries. In developed countries rebelliousness, antisocial behaviour, poor school performance, and affiliation with drug-using peers are risk factors for early and regular cannabis use. Similar antecedents are now being reported in developing countries. Dependence is an underappreciated risk of cannabis that affects one in six to seven adolescents who use cannabis in developed countries. Adolescent cannabis dependence is correlated with an increased risk of using other illicit drugs, symptoms of depression, and symptoms of psychosis. The plausibility of cannabis playing a contributory causal role has increased for symptoms of psychosis in longitudinal studies but remains contentious. In the case of other illicit drug use and mood disorders common causal explanations remain difficult to exclude. Summary Early and regular cannabis use in adolescence predicts an increased risk of cannabis dependence which in turn predicts an increased risk of using other illicit drugs, and reporting symptoms of mood and psychotic disorders.
TL;DR: Comorbid posttraumatic stress disorder/substance-use disorder is a frequent diagnosis in clinical populations that severely affects course and outcome and treatment approaches appropriate for this vulnerable population need to be evaluated further and implemented in routine practice.
Abstract: Purpose of reviewThe aim of this article is to review the current literature on co-occuring posttraumatic stress disorder and substance-use disorder, with an emphasis on clinical aspects and emerging treatments.Recent findingsIn clinical populations (focusing on either disorder), about 25–50% have a
TL;DR: Larger, better controlled studies are needed before the genetic sources of cognitive heterogeneity in schizophrenia can be accurately characterized, and this will be aided with the development and use of more specific neuropsychological tasks that can accurately discriminate between different cognitive domains.
Abstract: Purpose Further clarification of the nature of cognitive heterogeneity in schizophrenia is needed to aid the endophenotype approach to the understanding of the genetic basis of the disorder. This review summarizes recent neuropsychological studies of schizophrenia, aimed at establishing whether there are valid forms of cognitive impairment that can be defined with the use of neuropsychological measures in patients with schizophrenia, and studies that have attempted to relate specific neuropsychological findings to genetic polymorphisms.Recent findings There is good evidence for significant cognitive heterogeneity in schizophrenia. It is not yet clear, however, whether this heterogeneity is better accounted for by a general loss of function, varying in degree between different patients, or by impairment in specific cognitive abilities, for example working memory. Molecular genetic studies have provided evidence for associations of single nucleotide polymorphisms with both specific and general impairments, with some additional support for a working memory deficit from neuroimaging studies.Summary Larger, better controlled studies are needed before the genetic sources of cognitive heterogeneity in schizophrenia can be accurately characterized. This will be aided with the development and use of more specific neuropsychological tasks that can accurately discriminate between different cognitive domains.
TL;DR: Somatic health issues in individuals with bipolar disorder are ubiquitous, under-recognized and suboptimally treated and Facile screening for risk factors and laboratory abnormalities along with behavioral modification for reducing medical comorbidity are warranted.
Abstract: Purpose of review The aim of this review is to synthesize results from extant investigations which report on the co-occurrence of bipolar disorder and medical comorbidity. Recent findings We conducted a MEDLINE search of all English-language articles published between January 2004 and November 2006. Most studies report on medical comorbidity in bipolar samples; relatively fewer studies report the reciprocal association. Individuals with bipolar disorder are differentially affected by several 'stress-sensitive' medical disorders notably circulatory disorders, obesity and diabetes mellitus. Neurological disorders (e.g. migraine), respiratory disorders and infectious diseases are also prevalent. Although relatively few studies have scrutinized the co-occurrence of bipolar disorder in medical settings, individuals with epilepsy, multiple sclerosis, migraine and circulatory disorders may have a higher prevalence of bipolar disorder. A clustering of traditional and emerging (e.g. immuno-inflammatory activation) risk factors presage somatic health issues in the bipolar disorder population. Iatrogenic factors and insufficient access to primary, preventive and integrated healthcare systems are also contributory. Summary Somatic health issues in individuals with bipolar disorder are ubiquitous, under-recognized and suboptimally treated. Facile screening for risk factors and laboratory abnormalities along with behavioral modification for reducing medical comorbidity are warranted.
TL;DR: Evidence shows that early intervention reduces the duration of untreated psychosis, produces better outcomes in terms of symptomatic and functional domains, and is cheaper than standard models of care.
Abstract: Purpose of review: Over 15 years, early intervention in psychosis has grown to become a mainstream funded approach to clinical care This review examines recent developments in evaluating the effectiveness of early intervention It considers identification and treatment of those at risk of psychosis, as well as interventions in the postonset phase of illness Recent findings: Development of methods identifying those at risk of psychosis continues to evolve Promising results in the prevention and delay of transition to psychotic disorder from a high-risk state have been found Psychological and psychosocial interventions are important components of these preventive programmes Two recent meta-analyses indicate that there is a consistent relationship between duration of untreated psychosis and outcome independent of other factors Further evidence shows that early intervention reduces the duration of untreated psychosis, produces better outcomes in terms of symptomatic and functional domains, and is cheaper than standard models of care Summary: There is evidence that early intervention is effective for early psychosis Some challenges remain These include developing a greater focus on functional recovery and prevention of relapse (PsycINFO Database Record (c) 2007 APA ) (journal abstract)
TL;DR: A review of the literature on young people who deliberately harmed themselves that was published between March 2005 and December 2006 in English language journals can be found in this article, where risk factors of adolescent deliberate self-harm confirm the importance of depressive disorders, deficient problem solving, exposure to suicidal behavior and familial characteristics.
Abstract: PURPOSE OF REVIEW: To review literature on young people who deliberately harmed themselves that was published between March 2005 and December 2006 in English language journals. RECENT FINDINGS: Recent follow-up studies have confirmed that deliberate self-harm at a young age is an important indication of mental health problems in later life, including a strongly increased risk of subsequent suicidal behavior. Main recent research includes study of risk factors and predictors of deliberate self-harm, and continuing study of the effects of pharmacological treatment, in particular selective serotonin reuptake inhibitors, in children and adolescents. SUMMARY: Recent findings regarding risk factors of adolescent deliberate self-harm confirm the importance of depressive disorders, deficient problem solving, exposure to suicidal behavior and familial characteristics. More biological studies of young people are required to provide evidence regarding neurobiological correlates of risk factors of suicidality in young people. The association between the use of antidepressants in depressed children and adolescents and the emergence of suicidal behavior continues to be a matter of debate due to the conflicting evidence from ecological or observational studies and meta-analyses. Although psychotherapeutic approaches have been examined less extensively, the results regarding cognitive behavior therapy in depressed and suicidal young people are clearly positive. Measures to prevent suicidal behavior in young people require further research. Language: en
TL;DR: Combined cognitive-behavioural therapy and motivational interviewing seems a promising psychological intervention to achieve a cessation of cannabis use in patients suffering from schizophrenia.
Abstract: Purpose of reviewCannabis is the world's most commonly used illicit drug. In this review, we consider the recent literature on the effects of cannabis on mental health and on cognition.Recent findingsCannabis use in adolescence increases the risk of later schizophrenia-like psychoses, especially in
TL;DR: Advances in neuroimaging are increasing the understanding of the pathogenesis of these disorders, and translating these findings into improved methods of treatment for patients presents researchers with pressing challenges.
Abstract: Purpose of reviewThe aim of this review is to summarize the current literature on the neuropsychiatry of multiple sclerosis (MS).Recent findingsData from community samples have supported earlier findings from tertiary referral centres of high rates of depression in MS patients. Neuroimaging offers i
TL;DR: Comorbidity has been shown to be an index of more severe course and outcome of mental disorders and systematic inclusion of comorbidities into clinical evaluation and treatment will enhance the effectiveness of intervention with these conditions.
Abstract: Purpose of reviewTo consider comorbidity across multiple classes of disorders in data derived from recent large-scale community surveys.Recent findingsThere has been substantial recent progress in our understanding of patterns and implications of comorbidity of mental disorders. There is now converg
TL;DR: Schizoaffective disorder unifies schizophrenia and bipolar, blurring the zones of rarity between them and suggesting that schizoAffective disorder is not a separate, ‘bona-fide’ disease.
Abstract: Purpose of reviewSchizoaffective disorder was named as a compromise diagnosis in 1933, and remains popular as judged by its place in the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders, its frequent use in clinical practice, and its extensive di
TL;DR: Recent research provides further examples and lessons on how community care can and should work, which it would be hoped will help those countries just starting the process of institutional closure to move more quickly to full deinstitutionalization.
Abstract: Purpose of reviewThe process of deinstitutionalization for intellectual disability services is at different stages across the world, varying from complete closure in Sweden to a vague hope in Taiwan. This review explores recent literature on deinstitutionalization and intellectual disabilities and f
TL;DR: Current understanding of the complexity of the link between chronic pain and mental disorders not only provides opportunities for designing appropriate interventions but also raises new questions for further research.
Abstract: Purpose of reviewPain is a common reason for seeking healthcare. Chronic pain is commonly comorbid with psychiatric disorders. New evidence provides fresh insights into the nature of the link between pain and mental disorders and offers opportunity to refine treatment approaches.Recent findingsEven
TL;DR: Molecular genetic research in bipolar affective disorder may lead to the development of new diagnostic paradigms for classifying the psychoses and affective states and determining the functional significance of the susceptibility genes will pave the way for enhanced diagnostic accuracy and improved treatments.
Abstract: Purpose of reviewMolecular genetic studies of bipolar affective disorder are beginning to show some positive and reproducible findings The most relevant of these will be reviewedRecent findingsObtaining consistent findings from whole genome scans has been hampered by small sample sizes and phenoty
TL;DR: In view of the common interface of medical and mental-health problems in people with intellectual disabilities, and the disparity in health they often face, initiatives should be taken to enhance their healthcare.
Abstract: Purpose of review To examine the most recently published studies on the co-morbidity of medical and mental-health problems in people with intellectual disabilities. Recent findings Studies that have been published in the review period have advanced our understanding and strengthened the evidence base on how to meet the complex healthcare needs of people with intellectual disabilities more effectively and reduce their health inequalities, as compared with the general population. In particular, there is much emphasis on epidemiology, epilepsy, dementia, use of psychotropic medications and health-screening intervention. Summary In view of the common interface of medical and mental-health problems in people with intellectual disabilities, and the disparity in health they often face, initiatives should be taken to enhance their healthcare. Family carers, social-care providers, primary-care practitioners and specialist psychiatric teams can all play an important role in recognizing ill health and navigating access to the appropriate health services that people with intellectual disabilities need.
TL;DR: The paucity of evidence for some groups of medication does not necessarily mean that these medications are ineffective, but rather that their use is not currently supported by good-quality research.
Abstract: Purpose of review A high proportion of people with intellectual disability have behaviour problems and psychotropic medication is a commonly used management strategy for these behaviours, despite lack of good-quality evidence to support this practice. Recent findings In recent years, one randomized controlled trial among adults and four on children with intellectual disability have been published showing effectiveness of low-dose risperidone in the management of behaviour problems as compared with placebo. Most of these randomized controlled trials are of good quality and included a reasonable number of participants. Most of these studies showed adverse effects, however, somnolence and weight gain particularly being associated with risperidone treatment. Most of the evidence on other psychotropic medications such as antidepressants, mood stabilizers, antianxiety drugs and opioid antagonists is difficult to interpret because it is based primarily on small case studies. Summary There is growing evidence in support of some antipsychotic medication, particularly the atypical antipsychotic, risperidone. Many of the studies of effectiveness included in this review have methodological flaws however. Therefore, the results need to be interpreted with caution. Furthermore, the paucity of evidence for some groups of medication does not necessarily mean that these medications are ineffective, but rather that their use is not currently supported by good-quality research.
TL;DR: This article reviews the most important recent clinically relevant manuscripts in this rapidly expanding new field of brain stimulation techniques, clearing the way for US Food and Drug Administration approval of vagus nerve stimulation for recurrent treatment-resistant depression.
Abstract: Purpose of reviewThere has been a resurgence of interest in brain stimulationtechniques as therapies for psychiatric disorders. Variousnames are used for this class of treatments:neuromodulation, somatic therapies, brain stimulationtechniques. The methods in this class range from non-invasive (transcranial magnetic stimulation) to invasive brainsurgery (deep brain stimulation).Recent findingsWithin the past year, the results of several large multicentertrials have been published, clearing the way for US Foodand Drug Administration approval of vagus nervestimulation for recurrent treatment-resistant depression anda pending consideration of approving transcranial magneticstimulation for the treatment of depression.SummaryThis article reviews the most important recent clinicallyrelevant manuscripts in this rapidly expanding new field.Keywordsanticonvulsant, antidepressant, deep brain stimulation,electroconvulsive therapy, transcranial magneticstimulation, vagus nerve stimulation
TL;DR: Neuroendocrine systems relevant to behavior clearly demonstrate their impact for the field of psychiatry by providing insight into the origins of mental disorders both from an etiological perspective and an interventional perspective.
Abstract: Purpose of reviewThe purpose of the present review is to consider further evidence for the role of neuroendocrine mechanisms in mental disorders by focusing on recent trends and advances in the field of psychoneuroendocrinology.Recent findingsRecent studies confirm the importance of the hypothalamic
TL;DR: Simultaneously with increasing understanding of neurobiological cannabis effects, there is a lack of studies in people with psychosis, there are plausible mechanisms that might explain the psychotogenic effects of cannabis.
Abstract: Purpose of review Cannabis use is the most commonly abused illicit substance. Its relation with psychosis remains a topic of debate. Epidemiological studies suggest that cannabis is a component cause accounting for approximately 10% of cases. An increasing number of studies have been published on neurobiological effects of cannabis and vulnerability of psychosis. Recent findings Acute cannabis administration can induce memory impairments, sometimes persisting months following abstinence. There is no evidence that residual effects on cognition remain after years of abstinence. The scarce literature on neuro-imaging mainly done in nonpsychotic populations, show little evidence that cannabis has effects on brain anatomy. Acute effects of cannabis include increases of cerebral blood flow, whereas long-term effects of cannabis include attenuation of cerebral blood flow. In animals Delta9-tetrahydrocannabinol enhances dopaminergic neurotransmission in brain regions known to be implicated in psychosis. Studies in humans show that genetic vulnerability may add to increased risk of developing psychosis and cognitive impairments following cannabis consumption. Delta9-tetrahydrocannabinol induces psychotic like states and memory impairments in healthy volunteers. Summary Simultaneously with increasing understanding of neurobiological cannabis effects, there is a lack of studies in people with psychosis. There are plausible mechanisms that might explain the psychotogenic effects of cannabis.
TL;DR: New empirical data has shown some psychological and behavioural characteristics of patients with somatoform symptoms that can be landmarks for the revision of this section in Diagnostic and statistical manual for mental disorders-V and International classification of diseases-11.
Abstract: Purpose of reviewDuring the last 2 years, a debate has started over whether the somatoform symptoms/medically unexplained symptoms are wrongly placed under the category of mental disorders (section F in International classification of diseases-10 and in Diagnostic and statistical manual for mental d
TL;DR: Medication interventions, either substantially lowering serum testosterone or treating axis I comorbidities, show definite promise as a significant component of the management of sexual offenders.
Abstract: Purpose of reviewThis review addresses testosterone-lowering and other psychotropic medications for the treatment of paraphilic patients or sexual offenders.Recent findingsRandomized controlled studies are still lacking, and only a few new studies were reported during the past year. On the other han