Showing papers in "Harvard Review of Psychiatry in 2002"
TL;DR: The prevalence and predictors of mental health problems in doctors during their first postgraduate years are investigated to find that individual factors, such as family background, personality traits, as well as contextual factors including perceived medical-school stress, perceived overwork, emotional pressure, working in an intensive-care setting, and stress outside of work, were often predictive ofmental health problems.
Abstract: Previous studies have shown the medical community to exhibit a relatively high level of certain mental health problems, particularly depression, which may lead to drug abuse and suicide. We reviewe...
231 citations
TL;DR: A neural network approach to the attentional and executive function deficits of MDD has ramifications for hypothesis-guided research, the cognitive model of depression, and application of the medical disease model to psychiatric disorders.
Abstract: The deficits in attention and executive function characteristic of major depressive disorder (MDD) are reviewed. The networks underlying attention and executive function, the neuropsychological tests commonly used to evaluate these domains, and the neuroanatomy of MDD are also discussed. A neural network approach to the attentional and executive function deficits of MDD has ramifications for hypothesis-guided research, the cognitive model of depression, and application of the medical disease model to psychiatric disorders.
192 citations
TL;DR: Are alcohol use disorders becoming increasingly prevalent in women, thereby closing the gender gap between men and women and what role does gender play in the process of recovery from alcohol dependence?
Abstract: Although substance abuse and dependence have been increasing among women in the United States for some time, only during the past two decades have researchers started to focus on women and alcohol use disorders. In the past all-male samples were generally used because they were much more easily available; when mixed-gender populations were examined, women were often underrepresented. Gender bias was evident in research on alcohol dependence even in the early 1990s. A critical review of addiction specialty journals in 1995 concluded that researchers still commonly used male populations and generalized the findings to both sexes. Recent studies on gender differences in alcohol use disorders have found that compared to men, women become intoxicated after drinking half as much, metabolize alcohol differently, develop cirrhosis of the liver more rapidly, and have a greater risk of dying from alcohol-related accidents. This article reviews the existing literature, focusing on four central questions: (1) Are alcohol use disorders becoming increasingly prevalent in women, thereby closing the gender gap between men and women? (2) Do the physical effects of alcohol differ by gender, and if so, why? (3) Do men and women differ in frequency and type of treatment services sought for alcohol use disorders? (4) What role does gender play in the process of recovery from alcohol dependence?
171 citations
TL;DR: Evidence indicates that guideline adherence is not high without specific intervention, but that certain interventions (typically multifaceted and resource-intensive ones) improve adherence.
Abstract: Mental health clinical practice guidelines have proliferated, but there is little evidence regarding the degree to which they are actually implemented in clinical practice. The goal of this study w...
167 citations
TL;DR: This paper reviews research studies that have applied DTI for the purpose of understanding neuropsychiatric disorders and considers potential future uses of DTI, including fiber tracking and surgical planning and follow-up.
Abstract: Magnetic resonance diffusion tensor imaging (DTI) is a new technique that can be used to visualize and measure the diffusion of water in brain tissue; it is particularly useful for evaluating white matter abnormalities. In this paper, we review research studies that have applied DTI for the purpose of understanding neuropsychiatric disorders. We begin with a discussion of the principles involved in DTI, followed by a historical overview of magnetic resonance diffusion-weighted imaging and DTI and a brief description of several different methods of image acquisition and quantitative analysis. We then review the application of this technique to clinical populations. We include all studies published in English from January 1996 through March 2002 on this topic, located by searching PubMed and Medline on the key words "diffusion tensor imaging" and "MRI." Finally, we consider potential future uses of DTI, including fiber tracking and surgical planning and follow-up.
139 citations
TL;DR: Assessment of the evidence for persistent neuropsychiatric sequelae in humans of chronic recreational use and reports of presence or absence of neurological, psychiatric, and psychological problems related to MDMA exposure provides substantial evidence that MDMA causes neuronal damage in animals and humans.
Abstract: The recreational drug "ecstasy" (3,4-methylenedioxymethamphetamine, or MDMA) is widely used by young people throughout the world. Experimental studies indicate that MDMA damages serotonergic neurons in animals and possibly in humans. Repeated use may induce long-term neurotoxic effects, with cognitive and behavioral implications. We reviewed both the preclinical and the clinical literature to assess the evidence for persistent neuropsychiatric sequelae in humans. We focused on studies of chronic recreational use and reports of presence or absence of neurological, psychiatric, and psychological problems related to MDMA exposure. These investigations show repeated use of ecstasy to be associated with sleep, mood, and anxiety disturbances, elevated impulsiveness, memory deficits, and attention problems, which may persist for up to 2 years after cessation. In a subset of humans, particularly adolescents, depletion of serotonin by MDMA use may hasten or enhance vulnerability to a wide array of neuropsychiatric problems. Together, the studies reviewed provide substantial evidence that MDMA causes neuronal damage in animals and humans. Additional research is necessary to determine whether the MDMA-induced destruction of serotonergic neurons can have long-term and possibly permanent neuropsychiatric consequences in humans.
99 citations
TL;DR: A review of structural imaging studies in schizotypal personality disorder indicates that individuals with this disorder show brain abnormalities in the superior temporal gyrus, parahippocampus, temporal horn region of the lateral ventricles, corpus callosum, thalamus, and septum pellucidum, similar to those seen in persons with schizophrenia.
Abstract: Studies of schizotypal personality disorder (SPD) are important because the condition is genetically related to schizophrenia and because data accumulating to confirm its biological underpinnings are challenging some traditional views about the nature of per-sonality disorders. This review of 17 structural imaging studies in SPD indicates that individuals with this disorder show brain abnormalities in the superior temporal gyrus, parahippocampus, temporal horn region of the lateral ventricles, corpus callosum, thalamus, and septum pellucidum, as well as in total cerebrospinal fluid volume, similar to those seen in persons with schizophrenia. Differences between SPD and schizophrenia include lack of abnormalities in the medial temporal lobes and lateral ventricles in SPD. Whether the normal volume, and possibly normal functioning, of the medial temporal lobes in individuals with SPD may help to suppress psychosis in this disorder remains an intriguing but still unresolved question. Such speculation must be tempered due to a paucity of studies, and additional work is needed to confirm these preliminary findings. The imaging findings do suggest, however, that SPD probably represents a milder form of disease along the schizophrenia continuum. With further clarification of the neuroanatomy of SPD, researchers may be able to identify which neuroanatomical abnormalities are associated with the frank psychosis seen in schizophrenia.
99 citations
TL;DR: The percentage of patients receiving quetiapine at doses above the manufacturer's recommended maximum is higher than would be expected, further illustrating that dosing ranges established during registration studies may not reflect the needs of day-to-day practice.
Abstract: This review describes dosing strategies used to optimize the beneficial effects of atypical antipsychotic medications. Differences between manufacturers' recommended dosing and actual clinical practice are reconciled using evidence from pivotal double-blind randomized registration studies, other randomized clinical trials, case series, and case reports. With clozapine and perhaps olanzapine, plasma levels are correlated with therapeutic response; with risperidone, plasma levels are not correlated with therapeutic response but may be related to the occurrence of extrapyramidal symptoms. Information related to optimal dosing of quetiapine and ziprasidone is more limited. In clinical practice, the mean daily dose of risperidone has decreased, whereas that for olanzapine is increasing. The percentage of patients receiving quetiapine at doses above the manufacturer's recommended maximum is higher than would be expected, further illustrating that dosing ranges established during registration studies may not reflect the needs of day-to-day practice.
88 citations
TL;DR: No other treatment has performed as well as lithium in as many aspects of long-term care of bipolar disorder patients, and despite some risks and limitations, lithium remains the standard against which all proposed alternatives are compared.
Abstract: The treatment of bipolar disorder has seen greater innovation in the past decade than at any other time since the introduction of lithium and the neuroleptics a half-century ago The place of lithium in contemporary psychiatric therapeutics has become controversial, calling for the present overview of research findings pertaining to its use in treating patients with bipolar disorder Lithium, by itself, typically is inadequate for rapid control of acute mania; antipsychotics, divalproex, or potent sedatives are commonly used, with or without lithium, for this purpose The special usefulness of lithium lies in long-term prevention of recurrences of mania and bipolar depression and in reducing risk of suicidal behavior Lithium also may be beneficial in recurrent unipolar depression and is an effective adjunct for treatment-resistant depression Expectations that prolonged untreated bipolar illness, multiple episodes, rapid cycling, or retreatment following discontinuation might routinely lead to lithium nonresponsiveness, and the belief that lithium is too toxic for use during pregnancy, have not been borne out by research Lithium retains a substantial share of prescriptions for bipolar disorder and is inexpensive No other treatment has performed as well as lithium in as many aspects of long-term care of bipolar disorder patients, and despite some risks and limitations, lithium remains the standard against which all proposed alternatives are compared
73 citations
TL;DR: Fifteen- and 27-year follow-up studies of patients with borderline personality disorder show that most of them no longer meet full criteria for the disorder by age 40, and that even more show improvement by age 50, and therapy can hasten remission.
Abstract: Fifteen- and 27-year follow-up studies of patients with borderline personality disorder show that most of them no longer meet full criteria for the disorder by age 40, and that even more show improvement by age 50. The mechanisms behind remission could include maturation, social learning, and the avoidance of conflictual intimacy. Affective instability is slower to change than impulsivity. Suicide rates in patients with this disorder are close to 10%, with most completions occurring late in the course of illness; early mortality from all causes exceeds 18%. All of these findings have clinical implications. Although treatment effects must be assessed in the context of naturalistic improvement, therapy can hasten remission.
70 citations
TL;DR: Whether Weygandt's important insight that the same person could be both manic and depressed not only at different times but even at the same time served as an important stimulus to Kraepelin's unified manic-depressive disorder concept, which survives as bipolar disorder a century later is considered.
Abstract: Wilhelm Weygandt's Uber die Mischzustande des manisch-depressiven Irreseins (On the Mixed States of Manic-Depressive Insanity) describes and conceptualizes mixed states of mood, behavior, and thinking commonly found in manic-depressive disorders. These ideas emerged from Weygandt's service in the 1890s at the Psychiatric Clinic of the University of Heidelberg, directed by Emil Kraepelin. In the sixth (1899) edition of Kraepelin's influential textbook, the concept of manic-depressive illnesses underwent a fundamental shift from a complex group of syndromal subtypes to a single integrated disorder, widely known from the 1921 English translation of the eighth (1920) edition. In the 1899 edition, Kraepelin acknowledged Weygandt for a new section on mixed manic-depressive states within the new integrated view of manic-depressive disorder. We provide biographical notes on Weygandt, a little-known but historically important figure, as well as the first English translation of his monograph and interpretive summaries of his findings. We also consider whether Weygandt's important insight that the same person could be both manic and depressed not only at different times but even at the same time served as an important stimulus to Kraepelin's unified manic-depressive disorder concept, which survives as bipolar disorder a century later.
TL;DR: It is proposed that depressive traits are best conceptualized dimensionally, and as part of an overarching model of personality structure, rather than as a discrete diagnostic entity.
Abstract: In this paper we review the research literature on depressive personality. We begin with a brief discussion of the historical antecedents of the current debate, noting the long-standing uncertainty...
TL;DR: This report summarizes the experience of one clinician in presenting her clinical work to a group of nationally recognized senior DBT clinicians at the University of Washington in Seattle,* where this form of treatment originated.
Abstract: The last decade has seen an explosive growth in the use of dialectical behavior therapy (DBT) for the treatment of borderline personality disorder (BPD). This combined individual and group therapy blends elements of learning theory, cognitive-behavioral therapy, self-psychology, and Zen Buddhism in a coherent, teachable, replicable fashion to achieve significantly lower rates of self-injurious behavior among patients with BPD. Moreover, it has increased interest among clinicians in treating this often-challenging group of patients. The following is a case report of a chronically suicidal woman treated using the DBT model in multiple settings (outpatient, partial hospital, and group home). Case material is presented along with sufficient explanation to allow readers unfamiliar with DBT to follow the formulation and interventions. Rather than being written by multiple authors, this report summarizes the experience of one clinician in presenting her clinical work to a group of nationally recognized senior DBT clinicians at the University of Washington in Seattle,* where this form of treatment originated.
TL;DR: Individuals with trauma-associated narcissistic symptoms (referred to in this paper by the acronym TANS for simplicity) display a discrete cluster of psychological symptoms that can closely mimic those of PTSD.
Abstract: Individuals with trauma-associated narcissistic symptoms (referred to in this paper by the acronym TANS for simplicity) display a discrete cluster of psychological symptoms that can closely mimic those of PTSD. In TANS, the underlying vulnerability to traumatic stress usually stems from a narcissistic personality disorder or narcissistic personality traits. However, narcissistic symptoms associated with an external traumatic event may be reflexively and erroneously attributed to PTSD, no matter how small or insignificant the traumatic stressor. Mistaking TANS for PTSD usually results in treatment failure. In litigation, distinguishing between TANS and PTSD assists the trier of fact in determining causation and assessing damages.
TL;DR: This review summarizes the available literature on the pharmacological treatments of OCD and discusses treatment of OCD with poor insight and of OCD comorbid with a tic disorder, augmentation strategies, and management of partial response to SRIs.
Abstract: Obsessive-compulsive disorder (OCD) has been treated pharmacologically with drugs that enhance availability of the neurotransmitter serotonin. This review summarizes the available literature on the pharmacological treatments of OCD. Numerous randomized controlled trials have attested to the efficacy of serotonin-reuptake inhibitors (SRIs) in treating this disorder, although a coherent model of serotonin dysfunction in OCD has not been established. Meta-analyses of randomized controlled trials have found better results with clomipramine than with other SRIs, but comparative studies have so far not replicated this finding. Aspects of the methodology in these studies that might explain this discrepancy are considered. Tolerability, side effects, dosing, and safety during pregnancy of the SRIs are discussed. Treatment of OCD with poor insight and of OCD comorbid with a tic disorder, augmentation strategies, and management of partial response to SRIs are reviewed. Finally, the available interventions for refractory OCD are considered.
TL;DR: The Resilience: A Missing Link in Our Understanding of Survival as mentioned in this paper is a book about resilience in the field of psychiatry that focuses on the missing link in our understanding of survival.
Abstract: (2002). Resilience: A Missing Link in Our Understanding of Survival. Harvard Review of Psychiatry: Vol. 10, No. 5, pp. 302-306.
TL;DR: It is found that pharmacotherapy for bulimia yields a moderate initial effect, however, only a small minority of patients recover, and the average patient continues to meet full DSM-IV criteria for the disorder.
Abstract: The empirical literature on pharmacotherapy for bulimia nervosa reveals mixed results. We examined the results of controlled clinical trials of pharmacotherapies for bulimia published from 1980 to 1999. To do this, we employed a multidimensional meta-analysis, a method for aggregating a range of clinically meaningful indicators of outcome (including but not limited to effect-size estimates) across studies. We found that pharmacotherapy for bulimia yields a moderate initial effect. However, only a small minority of patients recover, and the average patient continues to meet full DSM-IV criteria for the disorder. Combined pharmacotherapy and short-term psychotherapy appears to produce better results, although most patients continue to show symptoms at termination, and few data are available on sustained recovery over time. In accordance with recent calls in the medical literature for standardization of reporting practices in clinical trials, we suggest that investigators and meta-analysts report a range of ...
TL;DR: A clinical method is proposed that may be incorporated into periodic child psychiatric consultations with parents of young children who have high-functioning autism or Asperger's disorder, aimed at enhancing parental abilities to track and anticipate developmental progress and the resultant shifts in the parent-child relationship.
Abstract: Parenting young children with pervasive developmental disorder engenders unique sustained stresses, which have been termed "burden of care." One specific source of stress for parents is the childre...
TL;DR: The Harvard Review of Psychiatry: Vol. 10, No. 3, pp. 185-191 as discussed by the authors, has published a survey of competencies in Psychiatry. But it is not focused on mental health.
Abstract: (2002). Competencies in Psychiatry: The New Outcomes-Based Approach to Medical Training and Education. Harvard Review of Psychiatry: Vol. 10, No. 3, pp. 185-191.
TL;DR: In this paper, the implications of developments in Cognitive Neuroscience for psychoanalytic psychotherapy are discussed, with a focus on the use of psychotherapy in the context of cognitive neuroscience.
Abstract: (2002). Implications of Developments in Cognitive Neuroscience for Psychoanalytic Psychotherapy. Harvard Review of Psychiatry: Vol. 10, No. 6, pp. 369-373.
TL;DR: The popularity of CAM reflects biomedicine's failure to give patients the time they need to tell their story and to explain the nature of problems they face, and its failure to provide sufficient information to allow patients their choice among therapeutic alternatives.
Abstract: Complementary and alternative medicine (CAM) remedies vary greatly in safety and effectiveness. Then why is their use increasing at a time when evidence for the effectiveness of "orthodox" treatments is greater than ever before? Dazzled by technology, physicians dismiss "nonspecific" treatment effects as mere "placebo" and ignore the effects of caring. Over half of patients with anxiety or depression consult CAM practitioners in any given year. The popularity of CAM attests to its responsiveness to patients' search for more than procedurally oriented care. It reflects biomedicine's failure to give patients the time they need to tell their story and to explain the nature of problems they face, and its failure to provide sufficient information to allow patients their choice among therapeutic alternatives. Effective CAM practices should be incorporated into care, whether treatments are provided by biomedical or CAM practitioners.
TL;DR: The Natural Course of Depression: Kraepelin and Beyond as mentioned in this paper, a book about the history of depression, is a classic example of such a book and can be found here.
Abstract: (2002). The Natural Course of Depression: Kraepelin and Beyond. Harvard Review of Psychiatry: Vol. 10, No. 4, pp. 249-253.
TL;DR: The Harvard Review of Psychiatry as mentioned in this paper reported that Psychiatric Symptoms in Metabolic and Other Genetic Disorders: Is Our 'Organic' Workup Complete? Harvard review of Psychiatry: Vol. 10, No. 4, pp. 242-248.
Abstract: (2002). Psychiatric Symptoms in Metabolic and Other Genetic Disorders: Is Our 'Organic' Workup Complete? Harvard Review of Psychiatry: Vol. 10, No. 4, pp. 242-248.
TL;DR: The scope of the problem, risk factors, psychological reactions, and appropriate psychiatric interventions during different stages of the disease are discussed.
Abstract: 1Psychological factors play an important role in patients’ compliance with medical treatment, in their reaction to the diagnosis, and in their ability to maintain an acceptable quality of life. Psychiatrists are increasingly asked to participate in the care of cancer patients and can benefit from understanding the disease and its treatment. This paper will discuss the scope of the problem, risk factors, psychological reactions, and appropriate psychiatric interventions during different stages of the disease. In the United States breast cancer accounts for 30% of all new malignancies in women. 2 Each year, some 183,000 American women are diagnosed with the disease and nearly 41,000 die of it. 3 Caucasian women have a 13.1% and black