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Current Psychiatry Reviews
ISSN: 1573-4 005
Current Psychiatry Reviews
Volume 6, Number 3, August 2010
Contents
Training Psychiatrists in Cognitive
Behavioral Psychotherapy: Current Status and Horizons Pp.
159-170
Robert D. Friedberg, Safia Mahr and
Fauzia Mahr
[Abstract] [Purchase
Article]
Pediatric Clinical Trials in Psychopharmacology Pp.
171-175
Manish Saran, John Wagner and Anita
Kablinger
[Abstract] [Purchase
Article]
Review of Child Labor with Emphasis on Mental
Health Pp. 176-183
Daniel Fekadu, Bruno Hägglöf and Atalay
Alem
[Abstract] [Purchase
Article]
Seizure Thresholds in Elderly Patients Treated
with Electroconvulsive Therapy for Major Depressive Disorder:
A Review Pp. 184-190
Jeroen A. van Waarde and Rose C. van der Mast
[Abstract] [Purchase
Article]
Delirium in Older Patients – A Review
Pp. 191-196
Teneille E. Gofton and G. Bryan Young
[Abstract] [Purchase
Article]
Coping Responses in Obsessive-Compulsive Disorder:
Avoidance, Treatment, and Lifestyle Factors Pp. 197-204
Michael J. Larson, Scott A. Baldwin, Daniel A. Good and
Arjan Berkeljon
[Abstract] [Purchase
Article]
The Role of Reproductive Advantages in the Stable
Prevalence of Schizophrenia Pp. 205-209
Alvaro Machado Dias
[Abstract] [Purchase
Article]
Enriching Relationships Through Assessment of
the Continuing Medical Education (CME) Needs of Family Physicians
Working Within a Collaborative Care Model Pp. 210-218
Jatinder Takhar, David Haslam, Allison Hobbs
and Lisa McAuley
[Abstract] [Purchase
Article]
Pharmacotherapy for Late-Life Depression with
Psychotic Features: A Review of Literature of Randomized Control
Trials Pp. 219-222
Ali Shamsi, Deanne Cichon, Jason Obey, Sunanda Muralee,
Deena Williamson, Rehan Aziz and Rajesh R. Tampi
[Abstract] [Purchase
Article]
A Review of Childhood Maltreatment and Adolescent Substance
Use Relationship Pp. 223-234
Lil Tonmyr, Tiffany Thornton, Jasminka Draca and
Christine Wekerle
[Abstract] [Purchase
Article]
Abstracts 
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Training Psychiatrists in Cognitive Behavioral Psychotherapy:
Current Status and Horizons
Robert D. Friedberg, Safia Mahr and
Fauzia Mahr
The Residency Requirements Committee of the ACGME recommends
that psychiatric residents receive training in cognitive behavioral
psychotherapy (CBP). Despite these recommendations, some training
programs are slow to implement these requirements and many
struggle to develop didactic and clinical curricula to meet
these criteria. This article provides a model for training
psychiatry residents in cognitive behavioral therapy based
on the extant literature. Literature on training psychiatrists
and other mental health professionals in CBT is reviewed.
A conceptual template representing declarative, procedural,
and self-reflective knowledge domains is also presented. Characteristics
of good candidates for CBP training are described. Ways of
assessing competencies and training outcomes are discussed.
Finally, the article concludes with the presentation of a
training paradigm in CBP for psychiatrists.
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Pediatric Clinical Trials in Psychopharmacology
Manish Saran, John Wagner and Anita
Kablinger
Most of the psychopharmaceuticals used in children and
adolescents have not gone through the clinical trials process;
only slightly more have had research studies accomplished
in this age group, particularly in younger children. Given
the pressure to treat mood and behavioral disorders early,
many of the medication decisions we make are based on experiences
with adults. Therefore, it is prudent to review the potential
problems involved in pediatric clinical research particularly
as it relates to psychiatry. In this article we will examine
current FDA and IRB policies, discuss the ethical issues involved
in recruiting children and adolescents for these studies,
as well as discuss reluctance of parents and their children
to participate in clinical trials. This will be based on a
long history of academic clinical trial participation at LSUHSC
in Shreveport, LA. Awareness of these issues will hopefully
facilitate greater research in our younger patients, leading
to improved treatment options for mental illnesses.
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Article]
Review of Child Labor with Emphasis on Mental
Health
Daniel Fekadu, Bruno Hägglöf and Atalay
Alem
A systematic review of the literature on the prevalence,
theories and correlates of child labor was done with emphasis
on mental health. The methodologies of these literatures are
variable in their strength and weakness. Some surveys are
intensive and informative. Exploitation of young children's
labor is extensive in developing countries such as Ethiopia,
where an estimated every 4th
under 15 year old is a child laborer. This review further
highlights why children end up in the job market, and what
they wish to do in the future. Relevant recommendations to
policy makers on appropriate and streamlined education, as
well as the need for further longitudinal and intervention
oriented research, capacity building for parents and further
advice is given.
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Article]
Seizure Thresholds in Elderly Patients Treated
with Electroconvulsive Therapy for Major Depressive Disorder:
A Review
Jeroen A. van Waarde and Rose C. van der Mast
Objective: Electroconvulsive therapy (ECT) is effective
and generally safe in depression. Its effectiveness and side
effects are suggested to be related to the electrical stimulus
administered relative to the seizure threshold. Since aging
seems to raise the seizure threshold in ECT, we reviewed the
literature for evidence correlating advanced age and seizure
threshold, and for hypotheses explaining why seizure thresholds
might raise with age.
Methods: Pubmed, PsychINFO, three standard works
on ECT, and cross-references were searched for studies investigating
seizure thresholds and/or associated factors in elderly depressed
patients.
Results: A total of 406 possibly relevant articles
were found, of which 27 studies could be included. One very
recently published study was included afterwards because of
its significance. Aging was moderately associated with a raised
initial seizure threshold with correlation coefficients ranging
from 0.30 to 0.64 (p<0.05). Also, seizure thresholds in
elderly pa-tients were more likely to raise during the ECT
course. Reported hypotheses for these clinical phenomena include
a decrease of neuroexcitability, changes in morphologic and
functional characteristics of the brain, somatic comorbidity,
and concomitant medication use.
Conclusion: To optimize ECT in elderly patients,
hypotheses and suggestions for further research are proposed
regarding the moderate correlation between advanced age and
initial seizure threshold and the rise in seizure threshold
during the ECT course.
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Delirium in Older Patients – A Review
Teneille E. Gofton and G. Bryan Young
Delirium in older patients is a common problem, whether
patients are seen in a community setting, in a hospital for
medical or surgical intervention or in an intensive care unit.
Evaluation of elderly patients with confusion is challenging
and in delirium several aspects of cognition, including perception,
mental data processing and memory, must be considered. Delirium
is thought to result from imbalances in cholinergic, dopaminergic
and other neurotransmitter systems. It may manifest as a hyperactive,
a hypoactive or a mixed state that fluctuates over time and
requires a low threshold for investigation and a high index
of suspicion for diagnosis. Once the presence of delirium
has been established management strategies include treating
any precipitating events, modifying potential risk factors
and reassuring and reorienting the patient. Accurate identification
and management of delirium in the elderly is important because
delirium is associated with cognitive impairment and with
increases in both morbidity and mortality. This review will
discuss the variable presentations of delirium in the elderly,
a diagnostic approach to acute confusion in the elderly, the
acute management of delirium and the prognostic implications
of delirium in this population.
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Coping Responses in Obsessive-Compulsive Disorder:
Avoidance, Treatment, and Lifestyle Factors
Michael J. Larson, Scott A. Baldwin, Daniel A. Good and
Arjan Berkeljon
Obsessive-compulsive disorder (OCD) is characterized
by recurrent, distressing obsessions and repetitive compulsive
behaviors or mental rituals frequently performed to reduce
the distress associated with the obsessions. This paper reviews
maladaptive and adaptive coping responses used by individuals
with OCD, including compulsions as an avoidant coping response,
psychotherapeutic and pharmacological treatments, social and
family support, lifestyle changes, and stress management.
Although several gaps in the extant literature on coping with
OCD were identified, a considerable body of research supports
the use of cognitive-behavioral therapy (CBT) with exposure
and response prevention (E/RP) as an effective therapeutic
technique for teaching long-lasting coping skills. Increased
research is needed in the role of social support, exercise
and dietary changes, and stress management skills on daily
functioning in individuals with OCD. Implications and recommendations
for future research are discussed.
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The Role of Reproductive Advantages in the Stable
Prevalence of Schizophrenia
Alvaro Machado Dias
Over the century, many studies have proposed an association
between madness and kin advantages. The first study focusing
specifically on reproductive rates among persons suffering
from schizophrenia and their relatives was published in 1959.
Currently, there are 62 studies of that kind indexed in the
main scientific databases, most of which confirm the existence
of kin advantages after one generation. Considering that picture,
this brief review explores the data of the most recent study
of the kind, in order to discuss the percentage of advantage
after two generations. Results: The advantage
after two generations is considerably lower than in the first
generation, although it should not be dismissed. However,
it may be biased by the association between schizophrenia
and economic status, since low economic status predicts both
increased risks of schizophrenia and higher reproductive rates
in several different regions of the world. Furthermore, the
importance of de novo mutations, copy number variations and
other sporadic genetic (and epigenetic) events, which may
take part in the etiology of a significant portion of the
cases of schizophrenia, presents an indirect challenge to
the hypothesis of kin advantages.
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Enriching Relationships Through Assessment of
the Continuing Medical Education (CME) Needs of Family Physicians
Working Within a Collaborative Care Model
Jatinder Takhar, David Haslam, Allison Hobbs
and Lisa McAuley
Our primary objective was to determine the continuing
medical education needs of family physicians involved in the
Transition into Primary Care Psychiatry (TIPP) program and
secondly to assess fulfillment of Canadian Medical Education
Directives for Specialists (CanMEDS) roles by TIPP associated
family physicians. Family physicians were asked about educational
needs, comfort levels, attitudes and beliefs towards mental
illness, and perceptions of supports that could enhance the
management of patients with enduring mental illnesses. Patients
were asked for feedback assessing the patient-family physician
relationship. Of the 25 (71%) responses received from family
physicians all suggested areas for improving primary mental
health care knowledge were considered important, Media/Video
presentation was the least preferred CME format. They do not
believe they have enough training or time to adequately address
their patients’ mental health needs and collaborative
supports for mental health care were preferred. The 37 (77%)
responses from patients revealed a need for greater communication
from family physicians; however, the overall level of satisfaction
with treatment from TIPP family physicians was high. In conclusion,
various topics and interactive formats should be offered in
CME programs with particular attention paid to the time constraints
of the primary care setting. Opportunities should be sought
enhancing CME with collaborative care practices. TIPP associated
primary care physicians are perceived to deliver satisfactory
services by most mental health patients across all CanMED
domains; areas of improvement largely revolve around communication
in various contexts.
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Article]
Pharmacotherapy for Late-Life Depression with
Psychotic Features: A Review of Literature of Randomized Control
Trials
Ali Shamsi, Deanne Cichon, Jason Obey, Sunanda Muralee,
Deena Williamson, Rehan Aziz and Rajesh
R. Tampi
Depression in not uncommon in late life. Psychotic depression,
a more severe form of depression is more common in late life
than younger patients. Data indicate that approximately 25%
of patients with depression in late life present with psychotic
symptoms. In this review, we systematically searched four
main databases; EMBASE, PsychINFO, Medline and Cochrane Collaboration
on the pharmacotherapy of late life depression with psychotic
features. Data for the treatment of psychotic depression in
late life are scares although available evidence indicates
efficacy for antidepressants, antipsychotic medications and
mifepristone and electroconvulsive therapy. Based on the available
evidence, we have provided a guideline for the appropriate
treatment of this important disorder thus preventing undue
suffering to
the patients and their families.
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A Review of Childhood Maltreatment and Adolescent Substance
Use Relationship
Lil Tonmyr, Tiffany Thornton, Jasminka Draca and
Christine Wekerle
Adolescence is a period of heightened exploration, emotional
and physical change. During this time, engagement in risk
behaviours occurs often, affecting physical, mental and social
health and well-being. Risk factors can include experimentation
with substances and may lead to social and legal problems,
disability and accidental death.
We searched CINAHL, PsycINFO, ERIC, Medline, Social Policy
& Practice and PubMed to identify studies that measured
child maltreatment (witnessing domestic violence, emotional
maltreatment, neglect, physical and sexual abuse) and the
use/abuse of substances (nicotine (cigarette smoking) alcohol
and a variety of drugs) in community and school samples.
Thirty-five articles comprising 31 studies met inclusion criteria.
The majority of included studies identified an association,
with increased risk of substance use/abuse among youth with
history of child maltreatment. Physical and sexual abuse and
alcohol use/abuse were most often measured. The magnitude
of the association varied by type of maltreatment and type
of substances: sexual abuse and (a) nicotine (odds ratio (OR)
0.9-4.2); (b) alcohol (OR 1.4-5.2) and (c) drugs (OR 1.0-8.6);
physical abuse and (a) nicotine (OR 1.8-6.1); (b) alcohol
(OR 0.8-8.9) and (c) drugs (OR 1.8-20.4); neglect and alcohol
(OR 1.2-21.2); emotional maltreatment and (a) nicotine (OR
1.4); (b) alcohol (OR 1.5) and (c) drugs (OR 1.4); and witnessing
domestic violence and (a) nicotine (OR 1.4-2.2); (b) and alcohol
(OR 1.4-1.9). The results are examined and implications for
research and intervention are discussed.
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