Treatment Of Many Psychiatric Disorders Research Articles

Deep brain stimulation for autism spectrum disorder.

Deep brain stimulation (DBS) is a medical treatment that aims to obtain therapeutic effects by applying chronic electrical impulses in specific brain structures and neurological circuits. Over the years, DBS has been studied for the treatment of many psychiatric disorders. Scientific research on the use of DBS in people with autism has focused this interest mainly on treatment-resistant obsessive-compulsive disorder, drug-resistant epilepsy, self-injurious behaviors (SIB), and aggressive behaviors toward the self. Autism spectrum disorder (ASD) includes a group of developmental disabilities characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills and the presence of repetitive and stereotyped behaviors as well as restricted interests. People with autism often have numerous medical and psychiatric comorbidities that worsen the quality of life of patients and their caregivers. Obsessive-compulsive symptoms can be found in up to 81.3% of people with autism. They are often severe, refractory to treatment, and particularly difficult to treat. SIB has a high prevalence in severely retarded individuals and is often associated with autism. Drug treatment of both autism and SIB presents a therapeutic challenge. To describe the current state of the art regarding the efficacy of DBS in people with ASD, a literature search was conducted for relevant studies using the PubMed database. Thirteen studies have been considered in this paper. Up to date, DBS has been used for the stimulation of the nucleus accumbens, globus pallidus internus, anterior limb of the internal capsule, ventral anterior limb of the internal capsule, basolateral amygdala, ventral capsule and ventral striatum, medial forebrain bundle, and posterior hypothalamus. In the total sample of 16 patients, 4 were adolescents, and 12 were adults. All patients had symptoms resistant to multiple drug therapy. Many patients taken into consideration by the studies showed clinical improvements as evidenced by the scores of the psychopathological scales used. In some cases, clinical improvements have varied over time, which may require further investigation. Among the new therapeutic perspectives, DBS could be a valid option. However, further, and more in-depth research is needed in this field.

Metacognitive Therapy in Patients with Obsessive-Compulsive Disorder: A review.

Metacognitive therapy is a relatively novel and growing psychotherapeutic approach. Within the last 20 years, several metacognitive-oriented therapy methods have been developed. They are metacognitive therapy which was developed by Wells, metacognitive training which was produced by Moritz et al. especially for patients with psychotic disorder, and metacognitive reflection and insight therapy for psychotic patients. Among them, the most structured one seems the metacognitive therapy. The main notion of metacognitive therapy is to alter the dysfunctional metacognitive interpretations and strategies underlying psychopathology. However, it should be emphasized that it has some fundamental differences from cognitive behavioral therapy because metacognitive therapy is a relatively new school of cognitive therapy, its effectiveness in the treatment of many psychiatric disorders continues to be evaluated intensively. Obsessive-compulsive disorder is one of these disorders. As obsessive-compulsive disorder is a lifelong disorder that causes significant loss of workforce and pharmacotherapy is sometimes insufficient, psychotherapeutic approaches are of great importance. In this context, exposure and response prevention still seems to be an important treatment option in terms of psychotherapeutic approaches. However, it is clear that a new approach is required in psychiatry practice in cases where exposure and response prevention and classical cognitive behavioral therapy are not sufficient and remain with residual symptoms. In this respect, metacognitive therapy can be an important alternative to fill this gap. However, more evidence needs to be created with studies with much larger samples.

Efficacy and Safety of Transcranial Electric Stimulation during the Perinatal Period: A Systematic Literature Review and Three Case Reports.

Introduction: The perinatal period is an at-risk period for the emergence or decompensation of psychiatric disorders. Transcranial electrical stimulation (tES) is an effective and safe treatment for many psychiatric disorders. Given the reluctance to use pharmacological treatments during pregnancy or breastfeeding, tES may be an interesting treatment to consider. Our study aims to evaluate the efficacy and safety of tES in the perinatal period through a systematic literature review followed by three original case reports. Method: Following PRISMA guidelines, a systematic review of MEDLINE and ScienceDirect was undertaken to identify studies on tES on women during the perinatal period. The initial research was conducted until 31 December 2021 and search terms included: tDCS, transcranial direct current stimulation, tACS, transcranial alternating current stimulation, tRNS, transcranial random noise stimulation, pregnancy, perinatal, postnatal, and postpartum. Results: Seven studies reporting on 33 women during the perinatal period met the eligibility criteria. No serious adverse effects for the mother or child were reported. Data were limited to the use of tES during pregnancy in patients with schizophrenia or unipolar depression. In addition, we reported three original case reports illustrating the efficacy and safety of tDCS: in a pregnant woman with bipolar depression, in a pregnant woman with post-traumatic stress disorder (sham tDCS), and in a breastfeeding woman with postpartum depression. Conclusions: The results are encouraging, making tES a potentially safe and effective treatment in the perinatal period. Larger studies are needed to confirm these initial results, and any adverse effects on the mother or child should be reported. In addition, research perspectives on the medico-economic benefits of tES, and its realization at home, are to be investigated in the future.

Rutin protects rat liver and kidney from sodium valproate-induce damage by attenuating oxidative stress, ER stress, inflammation, apoptosis and autophagy.

The present study investigated the effects of rutin (RUT), which has various biological and pharmacological properties, on liver and kidney damage caused by histone deacetylase inhibitor valproic acid (VPA), which is used in the treatment of many psychiatric disorders. In the study, 50 or 100mg/kg RUT treatment was administered 30min after 500mg/kg VPA was given to rats for 14days. Then, some pathways that may be involved in the damage mechanism of VPA in liver and kidney tissues were investigated using biochemical, RT-PCR and Western blotting techniques. The results displayed that the levels of MDA induced by VPA in liver and kidney tissues decreased after RUT treatment, and the levels of SOD, CAT, GPx and GSH suppressed by VPA increased after RUT administration. It was observed that ER stress induced by oxidative stress was alleviated by suppressing the expressions of ATF-6, PERK, IRE1 and GRP78 after RUT treatment. It was observed that the expressions of NF-κB, TNF-α, IL-6, JAK2 and STAT3 in the inflammatory pathway increased after VPA administration, while RUT treatment decreased the levels of these markers. It was also among the data obtained that the levels of markers that played a role in the regulation of apoptosis (Bax, Bcl-2, caspase-3, pERK, pJNK) or autophagy (Beclin-1, LC3A, LC3B) approached the control group after RUT treatment. Taken together, it was determined that RUT treatment protected against liver and kidney damage by attenuating VPA-induced oxidative stress, ER stress, inflammation, apoptosis and autophagy.

N‐acetylcysteine as a new prominent approach for treating psychiatric disorders

N-acetylcysteine (NAC) is a well-known and safe mucolytic agent, also used in patients with paracetamol overdose. In addition to these effects, recent preclinical and clinical studies have shown that NAC exerts beneficial effects on different psychiatric disorders. Many potential mechanisms have been proposed to underlie the therapeutic effects of NAC, including the regulation of several neurotransmitters, oxidative homeostasis, and inflammatory mediators. In this paper, we summarize the current knowledge on the ability of NAC to ameliorate symptoms and neuropathologies related to different psychiatric disorders, including attention deficit hyperactivity disorder, anxiety, bipolar disorder, depression, obsessive-compulsive disorder, obsessive-compulsive-related disorder, posttraumatic stress disorder, and schizophrenia. Although preclinical studies have shown a positive effect of NAC on animal models of psychiatric disorders, the clinical efficacy of NAC is not fully established. NAC remains a strong candidate for adjunct treatment for many psychiatric disorders, but additional preclinical and clinical studies are needed.

Acute urticaria associated with paroxetine

Paroxetine is a well-tolerated drug used in the treatment of many psychiatric disorders. In this case report, we present a 31-year old female patient with major depression who developed acute urticaria during paroxetine therapy. Our patient’s laboratory examinations were normal and she had no history of urticaria or other skin reactions. She also had no family history of urticaria or other skin reactions. Dermatological reactions with paroxetine are rarely seen. Most of them are eczematous and benign lesions. As in our case, urticaria is a rare dermatologic reaction with paroxetine.

Noise analysis and active noise control strategy of transcranial magnetic stimulation device

Transcranial magnetic stimulation (TMS) has been proved to be effective in the treatment of many psychiatric disorders, but the clicking noise produced by the large and short pulse current in the TMS coil may put negative effect to the hearing of patients. However, current researches on noise control of the TMS device are very limited. In this paper, by analyzing the actual noise signal of TMS, the mechanism of noise generation of the device is explained. According to the therapeutic schedule of TMS, an active noise control (ANC) strategy for TMS device with online identification, offline analysis, and real-time output is proposed. A finite element analysis model of noise propagation and noise control of the device is established. The strategy steps are as follows: the secondary pathway is constructed at first; during the first stimulation sequence, the coil noise received by the human ear is collected in real-time, and the noise is analyzed offline; the secondary signal is then produced to reduce the following noise in real-time. The simulation results show that the proposed ANC strategy for TMS can effectively reduce the noise with certain robustness.

Intimate Partner Violence from Schema Therapy Perspective

Schema Therapy developed by Jeffrey Young is a psychotherapy method used in the treatment of many psychiatric disorders, particularly personality disorders. Early maladaptive schemas, which is one of the fundamental concepts of Schema Therapy, are self-destructive emotional and cognitive patterns that begin in early childhood, develop during childhood/adolescence, and elaborate and repeat throughout lifetime. In literature, studies on schema therapy and partner violence (exposure and perpetration) mostly investigated the mediator role of early maladaptive schemas. Study results support the mediator role of early maladaptive schemas to become victims or perpetrators of violence in the future in people with a childhood abuse/neglect history. Especially, the connection between having the schemas in the domain of disconnection/rejection area and being a victim of violence has been determined. Considering that personality traits are more frequently detected in cases of domestic violence, the use of schema therapy, which integrates many therapeutic techniques into a therapy model (especially in a problematic area with multi-faceted manner such as violence), is promising even though there are few studies on the effectiveness of schema therapies in couples. In this review article, we will first give information about the concepts of schema therapy and then review the related studies on relationship between domestic violence/perpetration and early maladaptive schemas. Finally, we will give information about the approach to domestic violence using schema therapy in intimate partners.

The effect of regular exercise on self-esteem in addiction

Objective: Alcohol or any illicit substance addiction known to be an increasing problem in Turkey is very disturbing the mental and physical health, safety and quality of life of a person. The addiction that causes serious deterioration in many areas of patients' lives is also quite challenging. Primer treatment is done by pharmacological methods. In addition, treatment is supported by psychosocial methods. Our study, we aimed to examine the contribution of regular exercise, which is thought to be useful in the treatment of many psychiatric disorders, to effect of regular exercise on self-esteem, body sense and social adjustment. Methods: We conducted our study in two different AMATEM (Alcohol Substance Abuse Research and Treatment Center) clinics, in the Tokat and Elazig Mental Health and Diseases Hospital. During the one month period, the patients in the Tokat center were hospitalized for one hour each day: the course was started with dynamic stretching, three days with aerobics, two days with plates training and finally with static stretching. In the other clinic, only medical treatment was applied. Physical Sensation Scale, Rosenberg Self-Esteem Scale and Social Adjustment Self-Assessment Scale were applied at the beginning and end of the illness treatment. Results: In our study, the Body Sense Scale and Rosenberg Self-Esteem Scale and Social Adjustment Self-Assessment Scale Scores decreased after treatment in both groups. With the use of medical treatment, the Body Sense Scale, Rosenberg Self-Esteem Scale and Social Adjustment Self-Assessment Scale Scores are expected to decrease. However, in the group that included the treatment with the treatment, this decrease occurred only at a higher level than in the group treated with medication. There was a statistically more decrease in the mean score of the scale compared to the group receiving only medication in the group with regular exercise. Conclusion: Regular exercise attachment in addiction treatment may have positive effects on therapeutic response. However, in order to achieve more reliable results, it is necessary to plan and implement larger sample groups and longer working hours.

Efficacy of Anti-Epileptic Drugs in the Treatment of Tumor and Its Associated Epilepsy: An in vitro Perspective

The change in the therapeutic targets from neuron to glia has proved beneficial in the treatment of many psychiatric disorders. The anti-epileptic drugs (AEDs) have been widely prescribed for the treatment of partial and complete seizures, bipolar disorder among others. The current study was carried out to explore the efficacy of some conventional and novel AEDs for the treatment of tumor-associated epilepsy which develops in 29-49% of the patients diagnosed with brain tumors. We used C6 glioma cell line as model system to study the effect of selected AEDs, viz., gabapentin (GBP), valproic acid (VPA) and topiramate (TPM). Morphometry, cell cycle analysis, apoptosis, expression of different protein markers, viz., GFAP, HSP70 and nuclear factor-κB (NFκB) were studied in AED-treated cultures. The study was further extended to rat hypothalamic primary explant cultures, and cell migration and expression of plasticity markers - neural cell adhesion molecule (NCAM) and polysialylation of NCAM (PSA-NCAM) - were studied in the explants. TPM was observed to show more pronounced increase in apoptosis of glioblastoma cells accompanied by significant downregulation in the expression of HSP70 and NFκB. TPM-treated explants also showed highest process ramification and cellular migration accompanied by intense expression of the plasticity markers as compared to those treated with GBP and VPA. Among the 3 AEDs tested, TPM was observed to show more promising effects on cytoprotection and plasticity of C6 glioma cells.

Can I have a quality seizure? A review

IntroductionAfter seventy-five years of its introduction, electroconvulsive therapy (ECT) remains the most effective treatment for severe depressive disorders. It is known that the antidepressant effect is not due only to the electric current itself, but by the general seizure activity. As so, for beneficial or adverse effects of ECTs, it's mainly important to induct a well-generalized seizure. Those can be influence by several variables like, seizure duration and threshold, ECT practice factors and medication, resulting in a lack efficacy. It's advantageous to treatment if physiological markers of adequacy are established to seizure quality, because a high seizure quality has been successfully correlated with better outcome in many studies.Aims and methodsThe aim of this work is to review the available international literature regarding to identified parameters that influence and evidence seizure quality.ConclusionAlthough throughout history ECT is embroiled in controversy, according to international bibliography, this is a technique of great therapeutic relevance and precise indications. It is noteworthy, that it has been shown to be an effective and safe treatment for many psychiatric disorders. Nevertheless, there is not a consensus regarding to the parameters to its efficacy, particularly the seizure quality. Thus, it's important to current practice, to do more studies in this field, in order to establish those parameters, have homogenise clinical practice and promote better results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Factors Affecting Medication Adherence in Children Receiving Outpatient Pharmacotherapy and Parental Adherence

ProblemAlthough pharmacotherapy is an effective treatment for many psychiatric disorders in children and adolescents, medication adherence rates among children are low. This study clarifies factors affecting children's medication adherence and the role of parental involvement.MethodPatients aged 7–17 years with a history of psychotropic medication treatment and their mothers were included in this study. Each mother and child completed self‐administered questionnaires. Thirty mother–child pairs who fully completed the questionnaires were included in the analysis.ResultsMedication adherence was greater in children and mothers when mothers felt that “children's symptoms improved with treatment and medication.” Medication adherence in children and mothers significantly correlated with the child's reported trust in their parent.ConclusionsThe results suggest the need for psychosocial support that considers the influence of mothers on medication adherence in children treated in child psychiatry departments.

Communication Commentary: Obsessive-Compulsive and Related Disorders: From Compulsions to Communication: Forming a Therapeutic Alliance With Individuals Diagnosed With Obsessive-Compulsive Disorder

Back to table of contents Previous article Next article FeaturesFull AccessCommunication Commentary: Obsessive-Compulsive and Related Disorders: From Compulsions to Communication: Forming a Therapeutic Alliance With Individuals Diagnosed With Obsessive-Compulsive DisorderDorothy E. Stubbe, M.D.Dorothy E. StubbeSearch for more papers by this author, M.D.Published Online:15 Apr 2015https://doi.org/10.1176/appi.focus.130201AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The greatest challenge facing contemporary medicine is for it to retain… or regain its humanity, its caritas—without losing its essential foundation in science.James A.R. WillisUntreated obsessive-compulsive disorder (OCD) is usually a chronic condition, often with waxing and waning symptoms. Spontaneous remission rates tend to be low. Individuals suffering from OCD typically experience a reduced quality of life and high levels of social and occupational impairment. Frequent avoidance of situations that may trigger obsessions and compulsions may restrict activities and social relationships. Additionally, individuals with OCD vary substantially in the degree of insight they have about the accuracy of the beliefs that underlie their obsessive-compulsive symptoms. Those individuals with good or fair insight are the most likely to seek and engage in effective treatment. Individuals with more limited or absent insight are less likely to engage in treatment and are often resistant to efforts to eliminate compulsive behaviors, being convinced that such efforts will end in tragedy (1, 2). For those patients, considerable clinical acumen is required to foster the collaborative working relationship required for effective treatment. In addition, the excessive doubting that is characteristic of OCD often requires special approaches to building the therapeutic alliance (3).Establishing a Therapeutic AllianceThe quality of the doctor-patient alliance has been found to be important in the treatment of many psychiatric disorders (4–10). When therapists actively attend to issues of patient engagement and the therapeutic alliance, rates of patient symptom improvement frequently rise, sometimes dramatically (11). In a study of predictors of symptom improvement in the treatment of OCD using multiple regression analyses, Vogel et al. (4) found that the quality of the therapeutic alliance was the most important variable—more important even than patient expectancies and motivation for change. The first-line treatment of OCD is generally considered to be cognitive-behavioral therapy with exposure and response prevention (ERP) alone or in combination with selective serotonin reuptake inhibitors (2, 12). ERP therapy—exposing the patient to that which is feared while preventing the ritualized compulsive response—may be very effective if the treatment regimen is followed. However, fear responses are primal and evoke fight, flight, or, in the case of OCD, a combination of avoidance and ritualized neutralization of the fear. The ERP treatment approach is associated with a high level of discomfort. A great deal of trust is required for an individual with OCD to endure this discomfort and relinquish prior avoidance and ritualized coping mechanisms so as to fully engage in effective treatment (4,13).Enhancing the therapeutic alliance has the potential to improve treatment outcome for patients suffering from OCD. In the context of this disorder, the practitioner should address these issues up front. Explaining the treatment process, listening carefully to and validating the patient’s fears and misgivings, and embarking upon a collaborative treatment plan are methods that assist in fostering a positive alliance (2).Clinical VignetteMs. Jefferson stopped at the entrance to the psychiatrist’s office and symmetrically touched the sides of the door jamb twice before entering. Dr. Thomas smiled warmly as she greeted her. Ms. Jefferson shook Dr. Thomas’s hand but innocuously removed a bottle of hand sanitizer from her purse and cleansed her hands as she sat down. Dr. Thomas noted that dry skin flaked off of Ms. Jefferson’s otherwise smooth brown skin. This was Ms. Jefferson’s first appointment with a mental health professional, and her worried family members had warned Dr. Thomas that she had been resistant to the appointment. “I think she really believes that she will fall sick and die if she doesn’t keep washing her hands and following her rituals,” her husband explained. “She’s been a clean-freak all along, but this is getting out of control. I can hardly get her to leave the house, and she may lose her teaching job.” He sounded desperate for help. Ms. Jefferson sat rigidly, cleansing her hands as she gazed with a forced smile at Dr. Thomas.“I’m glad you came,” began Dr. Thomas. “It must be very hard to be here. Your husband said that you are fearful that you or a family member will become very ill if you don’t wash and follow your rituals. Yet, you kept the appointment,” Dr. Thomas observed.There was a long pause before Ms. Jefferson spoke. “I suppose on some level I know that my kids, husband, and I probably won’t die if I don’t continually wash. But it doesn’t seem worth the risk. I came because my husband and children really wanted me to.”Dr. Thomas smiled and asked about Ms. Jefferson’s family, her job, her family of origin and upbringing, and her understanding of her OCD symptoms. “My husband and kids complain that I am a control freak,” Ms. Jefferson ended her narrative. “But if I’m not in control, I won’t come here.”“Perfect!” Dr. Thomas retorted, having chosen the word carefully. “The more in control you feel, the better the treatment will work. So, it seems like a great match.”Ms. Jefferson noted that she wanted to know what the treatment would be, what would happen if she did not agree, how she would communicate with Dr. Thomas if there were problems, and if medications were involved. She wanted to read the literature on the treatments. She wanted time to consider her options before deciding. She didn’t want to feel pressured or rushed. She didn’t want to be mocked or ridiculed for her rituals and what she termed her “bad thoughts.”Dr. Thomas gazed at Ms. Jefferson empathically. “Wow, it really was hard for you to come here. I’ll tell you what. I will print out some information about OCD and its treatment. You might find this web site helpful as well. If you come to your appointment weekly, we can craft a plan together. No ridicule. No tricks.”For the first time since she had entered the office, Ms. Jefferson flashed a genuine smile. “I would have you do a ‘pinky swear,’ about that, but then I would have to wash my hands again,” she remarked, almost playfully.Dr. Thomas smiled back appreciatively. “See you next week.”Tips for Enhancing Engagement With Individuals Receiving Treatment for OCDThe nature of OCD, with the need for rituals, constant doubting, rigid adherence to self-imposed rules, a frequent need to feel in control, and a fear of giving up symptoms for fear of tragic consequences, requires special skill for the clinician in negotiating the treatment alliance (2, 4, 13). The clinician needs to anticipate that the patient may agree to a plan but then avoid sharing a lack of adherence to homework assignments due to feelings of shame and fear of disappointing the clinician. The patient may need a great deal of reassurance and an extended period of trust-building before truly engaging in the therapy. Establishing a collaborative mutual partnership in which the therapist and patient work together to set goals and complete treatment tasks is particularly important in the crafting of a successful OCD treatment. A few tips are provided to enhance the treatment alliance between the doctor and the patient suffering from OCD:1.Highlight from the first interactions the importance of a collaborative and honest therapeutic relationship, specifying clearly the treatment approach, choices, and philosophy of joint treatment planning.2.Listen carefully to aspirations, beliefs, and concerns, and acknowledge these regularly.3.Tailor one’s communication style to the patient’s needs and capacities, explaining symptoms in understandable terms and demystifying the disorder.4.Provide information and resources about OCD, as requested.5.Allow extra time for the patient to consider treatment decisions and to have explanations repeated. However, set specific limits on explanations and target time periods for treatment decisions to help the patient avoid perseveration and maladaptive avoidance.6.Stress that treatment is an ongoing dialogue, requiring acknowledgment of lack of agreement with the treatment plan and working out these disagreements.7.Write down agreed-upon goals and treatment plans and share a copy with the patient. Refer to these regularly. If a medication trial is agreed upon, specify how long it will be followed and the indications for a change in the medication plan. Once the plan is agreed upon, both the physician and patient should sign this plan.8.Specify a plan for communication outside of appointments for reassurance, to answer questions, and to clarify instructions. Ensure that communication is possible, but set appropriate limits to decrease dependence.9.Acknowledge appreciation of honesty and the efforts of the patient at illness management.10.More severe OCD may warrant a collaborative team approach, with regular and specified methods of team communication with each other and integrating the patient into these discussions whenever possible.Address correspondence to Dorothy E. Stubbe, M.D., Yale University School of Medicine, Child Study Center, New Haven, CT; e-mail: [email protected]Dorothy E. Stubbe, M.D., Associate Professor and Program Director, Yale University School of Medicine, Child Study Center, New Haven, CTDr. Stubbe reports no competing interests.References1 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA, American Psychiatric Publishing, 2013Crossref, Google Scholar2 Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB; American Psychiatric Association: Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry 2007; 164(Suppl):5–53Google Scholar3 Keeley ML, Storch EA, Merlo LJ, Geffken GR: Clinical predictors of response to cognitive-behavioral therapy for obsessive-compulsive disorder. Clin Psychol Rev 2008; 28:118–130Crossref, Google Scholar4 Vogel PA, Hansen B, Stiles TC, Götestam KG: Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD. J Behav Ther Exp Psychiatry 2006; 37:247–255Crossref, Google Scholar5 Horvath AO, Symonds BD: Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Couns Psychol 1991; 38:139–149Crossref, Google Scholar6 Norcross JC, Lambert MJ: Evidence-based therapy relationships, in Psychotherapy Relationships That Work: Evidence-based Responsiveness, 2nd ed. Edited by Norcross JC. New York, NY, Oxford University Press, 2011, pp 3–24Crossref, Google Scholar7 Martin DJ, Garske JP, Davis MK: Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 2000; 68:438–450Crossref, Google Scholar8 Grawe K: Research-informed psychotherapy. Psychother Res 1997; 7:1–19Crossref, Google Scholar9 Waddington L: The therapy relationship in cognitive therapy: a review. Behav Cogn Psychother 2002; 30:179–191Crossref, Google Scholar10 Truog RD: Patients and doctors—evolution of a relationship. N Engl J Med 2012; 366:581–585Crossref, Google Scholar11 Lambert MJ, Whipple JL, Hawkins EJ, Vermeersch D, Nielsen SL, Smart DW: Is it time to track patient outcome on a routine basis? Clin Psychol Sci Pract 2003; 10:288–301Crossref, Google Scholar12 Garcia AM, Sapyta JJ, Moore PS, Freeman JB, Franklin ME, March JS, Foa EB: Predictors and moderators of treatment outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I). J Am Acad Child Adolesc Psychiatry 2010; 49:1024–1033, quiz 1086Crossref, Google Scholar13 Strauss JL, Hayes AM, Johnson SL, Newman CF, Brown GK, Barber JP, Laurenceau JP, Beck AT: Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. J Consult Clin Psychol 2006; 74:337–345Crossref, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 13Issue 2 Spring 2015Pages 195-197OCD and Related Disorders: Diagnosis to Treatment PDF download

Baseline metabolic monitoring of atypical antipsychotics in an inpatient setting

Background: Atypical antipsychotic agents serve an important role in the treatment of many psychiatric disorders but have the potential to cause adverse effects, notably metabolic disturbances. These agents are known to cause increases in obesity, glucose intolerance, dyslipidemia and hypertension. In 2004, the American Diabetes Association (ADA) and the American Psychiatric Association (APA), in collaboration with other organizations, acknowledged the association between the use of atypical antipsychotics and the development of metabolic abnormalities and provided monitoring recommendations for the use of these agents. Despite these recommendations, rates of monitoring remain low. Objective: The purpose of this study is to assess whether a pharmacist recommendation form is effective in improving baseline metabolic monitoring for patients admitted to an acute inpatient psychiatry unit who are ordered a scheduled atypical antipsychotic. Methods: A pharmacist recommendation form with metabolic monitoring parameters was placed on the charts of patients ordered a scheduled atypical antipsychotic during a two month period. A retrospective chart review was conducted to compare the percentage of baseline monitoring ordered pre-intervention versus the intervention period. Patients ages 18 years or older who were ordered a scheduled atypical antipsychotic were included. Results: During the intervention period, there was a significant increase in documentation for presence or absence of diabetes (p = 0.018) and cardiovascular disease (p < 0.001). A significant difference in the number of orders for hemoglobin A1c (p = 0.007) and lipid panels (p < 0.001) were noted. No other significant differences were found. Conclusion: A pharmacist recommendation form was effective in improving the baseline monitoring of personal history of diabetes and cardiovascular disease and monitoring of hemoglobin A1c and lipid panels, but rates of other baseline monitoring parameters did not improve.

Biosynthesis, mechanism of action, and clinical mportance of neuroactive steroids: Pearls from literature

Aim: To review the biosynthesis, mechanism, and important effects of neurosteroids on brain functions and brain disease by modulating synaptic and extrasynaptic transmission. Materials and Methods: This article is based on a comprehensive database search on the internet. Full-text articles in English, published between 2001 and 2012, were searched for, using the terms 'neuroactive steroids', 'neurotransmitter agents', 'molecular mechanism', 'depression', 'anxiety' 'neuropsychopharmacology', 'interactions with receptors', 'neuroprotection', and 'neuroendocrinology' to identify potential therapeutic targets. The reference lists of leading review articles identified during this search were checked for additional publications. Results: Neurosteroids regulate physiological functions of the central nervous system (CNS) and help in the neurodevelopmental functions relating to their neuroprotective effects in brain injury and possible therapeutic potential in brain lesions and other diseases of the nervous system. Neurosteroids have been shown to affect neuronal excitability via their interaction with the ligand-gated ion channel family, such as the GABA A and 5-HT 3 receptors, by acting genomically as well as nongenomically. By virtue of these properties, neurosteroids appear to be relevant to pathophysiology and pharmacological treatment of many psychiatric disorders, including not only the notable mood and anxiety disorders, but also psychotic disorders, childhood dementia and stress disorders. They have also been found to be involved in the pathophysiology and treatment of epilepsy, alcohol and substance abuse. Conclusion: Neurosteroids may become potential targets for pharmacological intervention in the future, with further research at the basic science level as well as in the context of large double-blinded placebo-controlled investigations to elicit their role fully in the understanding and management of various psychiatric conditions.

Phenotyping and Genotyping of Drug Metabolism to Guide Pharmacotherapy in Psychiatry

In psychiatry, around 130 drugs are available which have been detected and developed during the last 60 years. These drugs are effective and essential for the treatment of many psychiatric disorders and symptoms. Therapeutic outcomes, however, are still far from satisfactory for many patients. One major reason underlying insufficient response or problems of tolerability or toxicity is considerable interindividual variability in the pharmacokinetic properties of the patients. At the exact same dose, a more than 20-fold interindividual variation in steady state concentrations of the drugs in the body may result. Patients differ in their ability to absorb, distribute, metabolize and excrete drugs due to concurrent disease, age, concomitant medication or genetic peculiarities. A valuable tool for tailoring the dosage of the prescribed medication(s) to the individual characteristics of a patient is therapeutic drug monitoring (TDM). For a considerable number of psychopharmacologic compounds, TDM has become a clinical routine for dose adjustment. The benefits of TDM regarding optimization of psychopharmacotherapy can be further enhanced by genotyping of cytochrome P450 enzymes (CYP). These enzymes are highly polymorphic and involved in the metabolism of most psychotherapeutic drugs. Genotyping related information may be supportive especially for drugs that are predominantly metabolized by CYP2C19 or CYP2D6. The in vivo activity of CYP isoenzymes can be determined using probe drug assays. When used appropriately, phenotyping and genotyping methods are most helpful for problem solving and improvement of the outcomes of psychopharmacotherapy for many patients.

1464 – Is electroconvulsive theraphy the end of the line?

Electroconvulsive therapy (ECT) was introduced in 1938 by Cerletti and Beni. This technique uses a small electrical current to produce a generalized seizure, under general anesthesia. In clinical practice, it is mainly used to treat refractory cases to previous treatment approaches. One of its main indications is major depressive episode, but it is also indicated for other conditions as severe manic phase, marked suicidal ideation, and schizophrenia. To describe the case of a central hospital psychiatric inpatient and it’s comparison with the international available literature. Retrospective analysis of clinical process. Woman, 53 years old, psychiatric outpatient since she was 17, with a history of several hospitalizations since 2006, due to an affective disorder, transversely not clarified. She was functional until her last hospitalization for Major Depressive Episode. Over the last year, there was progressive worsening with deliroid ideas of ruin and somatic plus almost total inability to daily living activities. These symptoms were refractory to all therapeutic approaches, both pharmacological and psychotherapeutic. She underwent ECT, in a reference center with remission of those symptoms, being the patient functional at this moment. Although throughout history ECT is embroiled in controversy, according to international bibliography, this is a technique of great therapeutic relevance and precise indications. It is noteworthy, that has been shown to be an effective and safe treatment for many psychiatric disorders, especially in cases refractory to other treatments, as evidenced by this case report.

Die OPD-KJ-Achse „Struktur“ als Instrument zur Konzeptualisierung der klinischen Vorgehensweise in der Körpertherapie

Body psychotherapy is an important part of a multimodal approach in clinical treatment for many psychiatric disorders. The ICD-10 is not helpful for finding the appropriate kind of body psychotherapy among many different kinds in a psychodynamic orientated approach because the phenomenological categories of this instrument don't aim on the structure of the personality underlying the psychic disorder. In this article we suggest a concept of a development- and structure based body psychotherapy which refers to the axis "structure" of the OPD-CA.

P-1118 - Psychopharmacotherapy of PTSD in combat veterans

The aim of this study is to analyse a use of psychopharmacs in combat veterans suffering from PTSD in two Croatian regions, Dalmatia and Slavonia. A great number of new psychopharmacs have changed the pharmacological approach to the treatment of many psychiatric disorders. Each of the new psychopharmacs is spreading its indication area. The study will be conducted as a cross-sectional study on the out-treated patients with diagnosed PTSD, treated at the Psychiatric Clinic in Split and Psychiatric Clinic in Osijek for at least six years. The study will include 400 patients with diagnosed chronic Posttraumatic stress disorder. Analysing the therapy authors noticed usage of broad spectrum of psychopharmacs (antidepressants, anxiolitics, antipsychotics, mood stabilisators). According to a clinical manifestation in patients with chronic PTSD different combinations of psychopharmacs were used in different doses. A trend of usage of new generations of antidepressants and a new generation of antipsychotics is evident.

Antagonist—agonist combinations as therapies for heroin addiction: back to the future?

Psychopharmacology is a powerful approach to the treatment of many psychiatric disorders. In this article I discuss the conceptual and practical issues in relation to the use of mu opioid receptor agonist, antagonist and partial agonist drugs in the treatment of opioid addiction, as this is one therapeutic area where all three types of agents are currently available. The choice of pharmacological agent is largely determined by patient profile, existence of ongoing drug misuse, and the kinetics of the drugs available. These principles, however, can be applied to other disorders as and when other pharmacological approaches become refined in these areas.