Treatment Of Other Psychiatric Disorders Research Articles

The KDEP Trial: Protocol for a phase II, multicenter, open label, randomized controlled trial to evaluate the efficacy of ketogenic diet for symptomatic improvement of moderate to severe Major Depressive Disorder

Introduction: Major depressive disorder (MDD) is a disease with a high economic burden across the world, mainly secondary to a decrease in work performance and pill burden. Ketogenic diet is a type of non-pharmacological intervention that is employed in the treatment of refractory epilepsy and has shown promise for the treatment of other psychiatric disorders, including depression. Up to the date, there is a limited number of investigations regarding this topic, making the knowledge very scarce; therefore, our study will assess the clinical efficacy of ketogenic diet, particularly Modified Atkins Diet, as compared to control diet in adults with diagnostic of MDD on standard treatment without resolution of symptoms as a difference in Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline at the third month follow-up visit. Methods: This is a phase II, multicenter, randomized, controlled, open-label, parallel-group, superiority trial with blinded endpoints. Sample size was calculated as 132 participants (66 participants per arm) to maintain a power of 80% and a two-sided significance level of 0.05. The primary endpoint is the improvement in MDD symptomatology measured by MADRS scale at 3 months from baseline. Discussion: There is evidence to support the notion that ketogenic diet improves patients symptoms by increasing levels of several molecules resulting in a decrease of neuroinflammation and an increase of neurogenesis, improving mood disorders. We hypothesize that a ketogenic diet will improve depressive symptoms in patients with moderate to severe depression when compared to patients on a control diet.

Pattern Of Nicotine Use And Dependence In Psychiatric Patients

Abstract Background: Tobacco use is an epidemic known as “the brown plague” affecting one billion lives in the 21st century and 80% in developing countries. Prevalence of smoking is especially high in patients with psychiatric illness with an ongoing debate over which comes first. Studies about nicotine consumption in psychiatric patients are few from developing countries. Hence, this study is designed to identify socio-demographic and diagnostic correlates of nicotine use. Aims and Objectives:- To estimate the pattern of nicotine use and determine the association between socio-demographic profile, onset of nicotine use, it’s use as a coping mechanism, psychological association with nicotine use in psychologically ill patients. Material and methods:- A cross-sectional study including 101 patients with nicotine use and psychiatric illness were administered a semi structured questionnaire, Fagerstrom Test for Nicotine Dependence(FTND) and nicotine dependence syndrome scale. Data analyzed with mean, standard deviation, chi- square, ANOVA Results:-Nicotine use was more common in middle age group with alcohol dependence followed by depression. Nicotine use was not associated with background, socioeconomic status, gender. Majority tried to quit for health but what kept them with nicotine were drive, stereotypy, continuity, priority. Conclusions:- Nicotine is a commonly abused substance in psychiatric patients without a clear demarcation about the cause effect relationship. The existing study gives few insights into reasons for nicotine intake which was more so among the productive age group. Hence, there is a need for further research about psychotropic drug interactions with nicotine use and focus on integration of nicotine cessation into treatment of other psychiatric disorders rather than separate deaddiction clinics to alleviate the illness burden.

Clinical use of ketamine in psychiatric disorders

Clinical use of ketamine in psychiatric disorders has been highlighted in the past twenty years. Ketamine, an antagonist of the N-methyl-D-aspartate receptor, has been widely studied in clinical studies mostly regarding depression disorder. Here, we performed an electronic search in major indexing databases and reviewed 83 randomized controlled trials (RCTs) of ketamine in different psychiatric disorders including major depressive disorder, treatment-resistant depression, post-partum depression, bipolar depression, post-traumatic stress disorder, obsessive compulsive disorder, generalized anxiety disorder, social anxiety disorder and autism spectrum disorder. The results also included recent reports on the use of esketamine in major depressive disorder in addition to studies related to the anti-depressant effect of ketamine in suicidal ideation and in combination with electroconvulsive therapy. There has been some concerns and limitations regarding the use of ketamine in most of the studies ketamine was used as add-on therapy; optimum dosage, profile of cognitive effect and side effects are yet to be determined. Moreover, large-scale RCTs and data concerning acute depression are still lacking. Altogether, prescription of ketamine for depression disorder is increasing in the light of available clinical findings, yet more trials are needed to evaluate the efficacy, safety and tolerability of ketamine and esketamine in the treatment of other psychiatric disorders.

Post-traumatic stress disorder as moderator of other mental healthconditions.

Post-traumatic stress disorder as moderator of other mental healthconditions.

Special Report: Be Prepared to Address Technological Addictions in Psychiatric Practice

Special Report: Be Prepared to Address Technological Addictions in Psychiatric Practice

Sustained escitalopram administration affects glucose metabolism in the rat brain

Escitalopram is a selective serotonin reuptake inhibitor (SSRIs) antidepressant, drug that is currently used as first-line agents for the treatment of depression and it is also used in the treatment of other psychiatric disorders. The main goal of this study was to identify which brain areas are affected by escitalopram administration. This study was carried out on male Wistar rats that received escitalopram daily over 14 days and that were studied by 2-deoxy-2[18F]fluoro-D-glucose ([18F]FDG)-PET on the last day of treatment. Computed tomography (CT) images were acquired immediately before each PET scan and the main effects of drug administration were elucidated by Statistical Parametric Mapping. The results obtained indicated that repeated exposure to escitalopram increased metabolic activity in the retrosplenial and posterior cingulate cortices, while it decreased such activity in the ventral hippocampus, cerebellum, brainstem and midbrain regions, including the raphe nuclei and ventral tegmental area. Therefore, repeated exposure to escitalopram alters the activity of several brain areas closely related to the serotonergic system, and previously identified as key regions in the antidepressant effect induced by SSRIs. Furthermore, some of the changes found, such as the dampened metabolism in the ventral tegmental area, are similar to changes that have been described after treating with other fast-acting antidepressant approaches.

ADHD: a hidden comorbidity in adult psychiatric patients

Adult attention-deficit/hyperactivity disorder (aADHD) has recently been better recognized and treated in many European countries. In spite of this development, aADHD still features as a “hidden” comorbidity, often not diagnosed even in patients under psychiatric treatment for other psychiatric disorders. The aim of this study was to establish the prevalence rates of unrecognized aADHD in academic centers providing regular psychiatric services in the Czech Republic and Hungary. In a population of psychiatric in-and outpatients, Adult ADHD Self-Report Scale was administered. All positively and about half of the negatively screened subjects were clinically interviewed and the DSM diagnosis of ADHD was determined based on the symptom list and Conners’ Adult ADHD Rating Scale. The estimated point prevalence rate of unrecognized comorbid aADHD among psychiatric in-and out patients was 6.99% (95% lower CI: 5.11, 95% upper CI 8.86) according to the DSM-IV-TR criteria and 9.27% (95% lower CI: 7.13, 95% upper CI 11.40) according to the DSM-5 criteria. Current suicide risk was significantly associated with the presence of undiagnosed aADHD; however, life time suicide attempts, depression, dysthymia, alcohol and substance dependence, anxiety and stress related disorders were not. Further educational efforts are needed to improve the recognition and treatment of aADHD in adults

Overview of the Current Use of Deep Brain Stimulation in Psychiatric Disorders

Stemming from its use in movement disorders, deep brain stimulation (DBS) has emerged as an experimental therapy for treatment-resistant cases of major depressive disorder, obsessive-compulsive disorder, and Tourette's syndrome. Early, positive results from case studies have led to controlled trials evaluating the use of DBS in each of these conditions. Results have been varied but suggest moderate benefit in many cases and remain encouraging. As the relative safety and potential efficacy of DBS has become more widely accepted, its use has expanded to include the treatment of other psychiatric disorders and symptoms including anorexia nervosa, substance use disorder, aggression, and Alzheimer's disease. Case studies using DBS for each of these have reported benefits. [ Psychiatr Ann . 2016;46(11):631–636.]

Targeting neurosteroidogenesis as therapy for PTSD

Posttraumatic stress disorder (PTSD) is a severe condition resulting from exposure to traumatic events, such as combat situations, sexual assault, serious injury or the threat of death. Symptoms include disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyperarousal, which continue for more than a month after the traumatic event. Reduced cortical GABA (Kugaya et al., 2003) and cebrospinal fluid (CSF) allopregnanolone levels (Rasmusson et al., 2006) that positively and allosterically modulate GABA action at GABAA receptors (Belelli and Lambert, 2005) suggest that in PTSD patients, a perturbation of GABAergic neurotransmission plays a role in the pathogenesis of this disorder. Thus restoring downregulated brain allopregnanolone levels may be beneficial in treating PTSD. There is a general consensus that maladaptive fear responses (i.e., impaired fear extinction) are a core feature of stress-induced PTSD (Myers and Davis, 2007; Maren, 2008). Exaggerated fear responses and impaired extinction learning, or the inability to extinguish fear memories, are often treated with exposure-based therapy (EBT), which involves the exposure of the patient to the feared context without any danger (Joseph and Gray, 2008). This closely approximates the procedure used to simulate and study fear responses and fear extinction learning in PTSD mouse models (Marks, 1979). While psychological therapy has been highly effective both in treating PTSD and in preventing the progression of the event sequelae that leads to consolidation of fear memories, one challenge of PTSD therapy is the spontaneous recovery of fear that often reemerges following successful EBT. For this reason, pharmacological treatment may be advantageous alone or in combination with EBT. Selective serotonin reuptake inhibitors (SSRIs) are currently the drugs of choice in treating PTSD. They are effective in facilitating and restoring the neurobiological changes altered in PTSD patients, and they are devoid of the unwanted side effects that plague the use of benzodiazepines, more importantly, SSRIs are potent therapeutics where benzodiazepines fail to be beneficial. Following the observation that low non-serotonergic doses of fluoxetine and congeners increase allopregnanolone levels as their primary mechanism of action, we suggested that SSRIs acting as selective brain steroidogenic stimulants (SBSSs) can improve dysfunctional emotional behavior and may be of advantage in PTSD treatment. In addition to its use in PTSD, this novel steroidogenic mechanism of action of SSRIs given at low doses offers enormous therapeutic potentials for the treatment of other psychiatric disorders, including anxiety spectrum disorders, premenstrual dysphoria, and probably depression, as these disorders may be caused by a downregulation of neurosteroid biosynthesis (Uzunov et al., 1996; Westenberg, 1996; Guidotti and Costa, 1998; Romeo et al., 1998; Uzunova et al., 1998; Steiner and Pearlstein, 2000; Berton and Nestler, 2006; Pinna et al., 2006a, 2009; Pinna, 2010; Ipser and Stein, 2012; Pinna and Rasmusson, 2012; Lovick, 2013). In vitro studies show that SSRIs may activate 3α-hydroxysteroid dehydrogenase, thereby facilitating the reduction of 5α-dihydroprogesterone into allopregnanolone (Griffin and Mellon, 1999). Nonetheless, the precise neuronal mechanisms involved in the neurosteroidogenic action of SSRIs remain unclear. Drug design welcomed allopregnanolone biosynthesis as a target for novel rapidly acting anxiolytics devoid of sedation, tolerance, and withdrawal liabilities (Rupprecht et al., 2009, 2010; Schule et al., 2011), and, in addition to low doses of SSRIs, selective ligands for the (18 kDa) translocase protein (TSPO), which increase allopregnanolone levels, may be beneficial in anxiety and PTSD (Rupprecht et al., 2009).

Clozapine for Treatment- Resistant Post-Traumatic Stress Disorder (PTSD)

Clozapine for Treatment- Resistant Post-Traumatic Stress Disorder (PTSD) Clozapine is approved by the Food and Drug Administration (FDA) for treatment of schizophrenia, has been used off-label for treatment of patients with bipolar disorder, and has been shown to reduce suicidal ideation. However, because of its various adverse effects, clozapine has not been adequately explored for treatment of other psychiatric disorders, particularly in suicidal post-traumatic stress disorder (PTSD) patients. Suicidal PTSD patients are challenging, given their multiple inpatient psychiatric hospitalizations and numerous failed medication trials. It is possible that clozapine may be a useful treatment for suicidal PTSD patients, particularly when other treatments have failed.

The presentation of early-onset psychotic disorders

This study aims to describe the clinical course of psychotic disorders, including the premorbid history, symptoms and level of functioning in a group of children and adolescents treated by paediatric mental health services, mainly as inpatients. A sample of 45 children and adolescents with a psychotic disorder (mean age 13.2 years) was assessed using questionnaires, semi-structured interviews, parent interviews and file audit. The symptoms of those with a schizophrenia spectrum disorder (SSD) were compared to those with a mood disorder (MD). This population showed a high level of premorbid impairment, including previous treatment for other psychiatric disorders. As well as hallucinations and delusions, high levels of self-harm, aggression, anxiety and depression were reported. The SSD and MD groups differed mainly in their levels of premorbid functioning. While it is well known that childhood-onset schizophrenia is a severe disorder with a poor outcome, this study found that young people diagnosed with other psychotic disorders also have significant impairment and are likely to require high levels of care to maximize their functional recovery.

Design and rationale for a randomized controlled trial testing the efficacy of aerobic exercise for patients with obsessive-compulsive disorder

BackgroundOver the last two decades very few advances have been made in the development of new treatments for obsessive-compulsive disorder (OCD). While patients with OCD improve with available treatments (pharmacotherapy and/or cognitive-behavioral therapy), moderate levels of OCD symptoms often persist even with adequate doses and durations of these treatments. Building on the growing body of evidence for the efficacy of exercise in the treatment of other psychiatric disorders, interventions to increase aerobic exercise in patients with OCD represent a potentially useful yet relatively unexplored strategy in OCD. Methods/designOne hundred and two (102) patients with clinically significant OCD symptoms despite current engagement in recommended treatments (pharmacotherapy and/or CBT) will be randomly assigned to receive either a 12-week moderate-intensity aerobic exercise (AE) intervention or a health education control (HEC) intervention. Follow-up interviews will be conducted at the end of treatment and at 3-, 6- and 12-months post-intervention. They will assess OCD severity, nonspecific anxiety, depression, quality of life, cardiorespiratory fitness and cognition (executive function). DiscussionIf efficacy is established, patients with OCD who have clinically significant residual symptoms despite current pharmacotherapy or CBT would gain a valuable and practical treatment augmentation option.ClinicalTrals.gov Registration: NCT01242735.

Alcohol & Drug Abuse: What Is "Women-Focused" Treatment for Substance Use Disorders?

Alcohol & Drug Abuse: What Is "Women-Focused" Treatment for Substance Use Disorders?

Antipsychotic prescriptions in a university hospital outpatient population in Turkey: A retrospective database analysis, 2005–2006

Objective The aim of this study is to document the sociodemographic and the clinical profile of patients who are on antipsychotic (AP) medication prescribed in outpatient mental health clinic of a university hospital. Methods A retrospective chart review was conducted for all outpatient files between 2005 and 2006 at the Zonguldak Karaelmas University, Medical Faculty Hospital, Department of Psychiatry in Turkey. All patients prescribed AP with regular follow up were recruited for the study. The type of AP and the route of administration were recorded. The diagnosis, age and gender of the patients were also evaluated. Results We reviewed 1606 patients' files. APs were prescribed in 27.6% of the patients. Atypical antipsychotics (AAPs) represented 75.1% and typical antipsychotics (TAPs) represented 24.9% of all antipsychotic prescriptions in our study. The main psychiatric diagnoses associated with a TAP prescription were: psychotic disorders (6.5%), major affective disorders (49.5%), anxiety disorders (36.4%), and other psychiatric diseases (7.4%). The main psychiatric diagnoses associated with an AAP prescription were: psychotic disorders (35.1%), major affective disorders (31.1%), anxiety disorders (27.8%), somatoform disorders (2.4%) and other psychiatric diseases (6.4%). Twenty-eight of these patients (6.3%) were prescribed more than one AP, 45 patients were prescribed mood stabilizer (10.2%) and 272 patients were prescribed antidepressant agents (61.2%) in addition to AP. Conclusions The results reflect the particular use of AAPs in present study population. In line with the published data, the results of this study show that AAPs and TAPs are widely used in those with major affective disorders and psychotic disorders. These findings also underline the widespread off-label use of APs in the treatment of other psychiatric disorders.

Wayne Fenton's Impact on Academic Neuroscience

The legacy of Wayne Fenton will undoubtedly include his broad impact upon the academic community of researchers in psychiatry and neuroscience. Although this impact has already been felt, its full breadth and depth can only be anticipated. Eventually, the most profound impact of Wayne Fenton's legacy will likely be the one Wayne most fervently desired: that people with psychiatric disorders receive better and more effective treatments for their illnesses. By virtue of the MATRICS initiative, this impact will begin in the context of treatments for the cognitive deficits in schizophrenia, which is currently a critical unmet need. Within academic settings, this specific impact is already evident as a resurgence of interest in the neurobiology and pharmacology relevant to cognitive dysfunction in schizophrenia. As envisioned by Wayne Fenton, however, the impact of MATRICS and the other programs he initiated will be broader than "only" the treatment of cognitive deficits in schizophrenia. His vision was to target a drug treatment to an individual symptom domain, individualizing treatment regimens for each patient, without requiring a drug to be effective in all domains. Thus, the particular target of opportunity that provided Wayne Fenton's focus in the initiation of the MATRICS program is already having an important impact, but in the longer term these efforts will no doubt lead to parallel developments and improvements in the treatment of other psychiatric disorders.

Personality Disorders in the Elderly

<p>Personality disorders in the elderly have received relatively little attention, yet they may seriously complicate the course and treatment of other psychiatric disorders and adversely affect quality of life. Patients with personality disorders have longstanding difficulties in multiple aspects of functioning, notably in managing interpersonal relationships, maintaining a stable sense of self, and tolerating strong emotions. Consequently, elderly patients with personality disorders may be more vulnerable to the stresses associated with aging than their same-aged peers. They may also present with additional needs, but, paradoxically, they have greater difficulty in accepting or making use of available resources. This article summarizes studies of geriatric personality disorders and clinical approaches to problems of the aging personality.</p> <h4>ABOUT THE AUTHORS</h4> <p>Robert C. Abrams, MD; and Chaim E. Bromberg, PhD, are with the Department of Psychiatry, Weill Medical College of Cornell University, New York, NY.</p> <p>Address correspondence to: Robert C. Abrams, MD, Box 140, 525 E. 68th Street, New York, NY, 10021.</p> <p>The authors would like to acknowledge the American Philanthropic Foundation and the Reynolds Foundation.</p> <p>The authors disclosed no relevant financial relationships.</p> <h4>EDUCATIONAL OBJECTIVES</h4> <ol> <li>List common problems in assessing older adults for <cite>Diagnostic and Statistical Manual of Mental Disorders</cite>, fourth edition (DSM-IV) personality disorders.</li> <li>Describe the relationships between depressive and personality disorders in older adults.</li> <li>Identify ways in which personality disorders in elderly patients can be diagnosed and managed in general medical settings.</li> </ol>

Clinical uses of naltrexone: a review of the evidence.

The implication of the opioidergic system in the pathogenesis of various substance use disorders has led to renewed interest in expanding the clinical uses of naltrexone, an opioid antagonist. This article examines the evidence for the efficacy of naltrexone in a variety of substance use and psychiatric disorders. Naltrexone can be an effective treatment for alcohol and opioid dependence if issues of compliance are adequately addressed. Thus far, no definitive role has been found for naltrexone in the treatment of other psychiatric disorders. Further research needs to be done in self-injurious behavior, gambling, cocaine, and nicotine dependence.

Citalopram in the treatment of depression and other potential uses in psychiatry.

During the past decade, treatment options for depression have increased with the introduction of new agents. Older agents, such as tricyclic antidepressants and monoamine oxidase inhibitors, increase noradrenergic and serotonergic neurotransmission. Attempts to separate antidepressant effects from adverse effects led to the development of selective serotonin reuptake inhibitors (SSRIs). Citalopram is the newest SSRI to be marketed in the United States. Of all SSRIs on the market, it is the most selective for serotonin reuptake pump. Its efficacy in treating depression was evident in both placebo-controlled and comparator trials. In addition, citalopram was studied in the treatment of other psychiatric disorders. The agent has less inhibition of cytochrome P450 enzymes than other SSRIs, possibly giving it a lower potential for drug interactions.

Effects of anticonvulsant therapy on recovery and rehabilitation

Antiepileptic drugs (AEDs) are used in rehabilitation patients with injury to the nervous system for control of clinical seizures, prophylaxis against the development of a seizure disorder, and treatment of secondary mania. Although most AEDs can produce mild cognitive side effects, the benefits of treatment with AEDs in rehabilitation patients with seizure disorders typically outweigh these minor risks, Bromide, phenobarbital, and benzodiazepines may have more severe cognitive side effects than other AEDs. However, there is no convincing evidence of clinically significant differences in cognitive adverse effects among the other established AEDs. Furthermore, cognitive side effects are usually modest with mono therapy and anticonvulsant blood levels within standard therapeutic ranges. With regard to prophylaxis against future seizures, there is no significant data indicating that AED administration can prevent or retard the process of epileptogenesis, Therefore, the use of AEDs to prevent the development of a seizure disorder is not warranted at this time. Finally, although there is little information about the behavioral effects of anticonvulsants in neurological rehabilitation patients, the efficacy of carbamazepine, and perhaps valproate, in the treatment of primary mania suggests that these AEDs may be beneficial in mania secondary to brain injury. The role of AEDs in the treatment of other psychiatric disorders, such as post-traumatic stress disorder and episodic dyscontrol, remains unclear.

Neurotic illness: conserving a threatened concept.

With the advent of the American Psychiatric Association's Classification DSM III, the usefulness of the term neurosis as a unitary concept has been questioned. This is largely because of the psychodynamic connotations that invest the term in the USA. However there has been pragmatic development, since the word was introduced into the English language in 1784, that carries epidemiological, behavioural and phenomenological implications. This is demonstrated in the definition contained in ICD 9. Disturbance of self-experience and problems with interpersonal relationships are common to all neurotic disorders, and bodily symptoms of non-organic cause are usual. Neurotic disorders are extremely frequent in the general population, amongst those who consult general practitioners and in psychiatric out-patients; they necessarily concern doctors. It is concluded that what different neurotic disorders have in common is more important for classification than the differences between them. An important practical consideration is that there are general aspects of treatment appropriate for all neuroses which are of less relevance in the treatment of other psychiatric disorders. Also the provision of treatment services require different emphases for the neuroses.