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Current Psychiatry Reviews
ISSN: 1573-4 005
Current Psychiatry Reviews
Volume 5, Number 4, November 2009
Contents
Review of Interventions for Parental Depression from Toddlerhood
to Adolescence Pp. 226-235
Rhonda C. Boyd and Jane E. Gillham
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Article]
Genetic Variation of Chromosome 1q42:
Etiologic Mechanism of Congenital Disorders of Neuronal Migration
and Synaptogenesis Pp. 236-249
Stephen I. Deutsch, Jessica A. Burket, Richard B. Rosse
and Barbara L. Schwartz
[Abstract] [Purchase
Article]
Neuroimaging Studies of Substance Abuse
in Schizophrenia Pp. 250-260
Stéphane Potvin
[Abstract] [Purchase
Article]
Body Dysmorphic Disorder: A Review
of Current Nosological Issues and Associated Cognitive Deficits
Pp. 261-270
Wei L. Toh, Susan L. Rossell and David J. Castle
[Abstract] [Purchase
Article]
Clinical Potential of Yi-Gan San (Yokukansan)
for the Treatment of Psychiatric Disorders Pp. 271-275
Tsuyoshi Miyaoka and Jun Horiguchi
[Abstract] [Purchase
Article]
Anesthetic Considerations for Electroconvulsive
Therapy-Especially Hemodynamic and Respiratory Management
Pp. 276-286
Yuji Kadoi and Shigeru Saito
[Abstract] [Purchase
Article]
Depression has a Strong Relationship to Alterations
in the Immune, Endocrine and Neural System Pp. 287-297
Knut A. Hestad, Pål Aukrust, Sverre Tønseth
and Solveig K. Reitan
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Article]
Electroconvulsive Therapy in Child and Adolescent
Psychiatry Pp. 298-305
Paul E. Croarkin, Peter McCaffrey, Shawn M. McClintock,
Charlena Rodez and Mustafa M. Husain
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Article]
Abstracts
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Review of Interventions
for Parental Depression from Toddlerhood to Adolescence
Rhonda C. Boyd and Jane E. Gillham
Because of the recurrent course, significant burden, and intergenerational
impact of depression, there is a great need for interventions
for depressed parents and their children. This article reviews
eight interventions that 1) aim to impact the functioning
and well-being of 18-month to 18-year old children of depressed
parents and 2) have been evaluated in controlled studies.
The interventions are described and the empirical evidence
of their efficacy is reviewed and critiqued. Existing research
points to several promising intervention strategies, such
as psychoeducation about parental depression, addressing parenting
in adult depression treatment, promoting positive parent-child
interactions, and teaching coping skills to children. Common
limitations of the research in this area are small sample
sizes, homogenous samples, and lack of replication. Implementation
problems within the mental healthcare system are highlighted.
Multi-component interventions seem to be a promising approach
to address the complex impact parental depression has on children
and the parent-child relationship. This review illustrates
the need for more research on intervention models that can
be implemented with children at various developmental levels.
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Genetic Variation of Chromosome 1q42: Etiologic
Mechanism of Congenital Disorders of Neuronal Migration and
Synaptogenesis
Stephen I. Deutsch, Jessica A. Burket, Richard B. Rosse
and Barbara L. Schwartz
The cytoarchitectural defects of schizophrenia are predominantly
“mild” alterations of dendrites and cell positioning,
which are subtle in comparison to those in the lissencephalies
and many presentations of mental retardation. Moreover, they
are studied in adult brains and, thus, subject to the many
potentially confounding effects of such things as medication
history, substance abuse, lifestyle variables and stress.
Thus, the ability to identify subtle fetal brain abnormalities
in utero, such as operationally-defined mild
lateral ventricular enlargement as an isolated finding, and
longitudinally follow this genotyped cohort, some of whom
may be at increased risk for neurodevelopmental disorders
including schizophrenia, will be informative. The demonstration
of co-segregation of genetic variation (e.g., within the DISC1
gene) and mild lateral ventricular enlargement, and the opportunity
to seek linkages in parents and sibs would be extremely persuasive
that genetic variations (e.g., in DISC1) cause or contribute
to mild lateral cerebroventricular enlargement, which may
be a risk factor and anatomic intermediate phenotype of schizophrenia.
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Neuroimaging Studies of Substance Abuse
in Schizophrenia
Stéphane Potvin
Background: Substance use disorders are frequent among
schizophrenia patients. Growing evidence shows that the relationships
between substance abuse and psychosis are complex. Substance
abuse in schizophrenia is associated with increased positive
and depressive symptoms. However, emerging data also shows
that substance-abusing schizophrenia patients have fewer negative
symptoms, compared to abstinent patients, and that they have
fewer cognitive deficits when they are young. Here, our objective
is to determine if brain imaging studies conducted among dual-diagnosis
schizophrenia patients reflect the paradoxical nature of the
relationships between psychosis and addiction. Methods:
A systematic search of the literature was performed, and we
identified 21 brain imaging studies carried out among substance-abusing
patients with schizophrenia. Results: Some studies
showed that alcohol and cannabis amplify the anatomic abnormalities
of schizophrenia, especially in the cerebellum. However, preliminary
functional imaging data from our group highlighted a relative
preservation of the medial prefrontal cortex functioning among
dual-diagnosis patients during emotional processing. Conclusion:
Brain imaging studies performed so far reflect the complex
nature of the relationships between psychosis and addiction.
Further brain imaging studies involving dual-diagnosis schizophrenia
patients are required. Future studies will need to pay attention
to length of substance abuse, psychiatric symptoms, antipsychotics,
types of psychoactive substances (e.g. cocaine) and the brain
reward system.
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Body Dysmorphic Disorder: A Review
of Current Nosological Issues and Associated Cognitive Deficits
Wei L. Toh, Susan L. Rossell and David J. Castle
Recent study into body dysmorphic disorder (BDD) has
raised questions about the validity of its current diagnostic
classification as well as categorical division into ‘psychotic’
and ‘non-psychotic’ variants. Furthermore, though
individuals with the disorder are believed to experience cognitive
difficulties, the precise nature of these deficits remains
unclear. This paper aims to provide a comprehensive review
of existing knowledge of BDD in terms of its nosology and
cognitive deficits. We evaluate arguments in relation to its
inclusion within the obsessive-compulsive spectrum disorders
(OCSDs), consider how delusionality is coded in BDD, and also
examine recent studies suggesting which specific cognitive
deficits may underpin the disorder. There appears to be a
sound rationale for considering BDD as part of the OCSDs,
though current findings indicate that it is not simply a subtype
of obsessive-compulsive disorder (OCD). Evidence also suggests
that the degree of delusional beliefs in BDD would be more
appropriately theorised on a dimensional basis. In terms of
cognitive deficits, research to date has implied that attentional
biases and/or abnormalities in basic visual processing may
be especially important. Further research is needed to elucidate
an inclusive profile of the underlying cognitive deficits
in BDD. In turn, these insights could help to clarify current
nosological debates surrounding the disorder.
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Clinical Potential of Yi-Gan San (Yokukansan)
for the Treatment of Psychiatric Disorders
Tsuyoshi Miyaoka and Jun Horiguchi
Yi-gan san (YGS, yokukan-san in Japanese) was
developed in 1555 by Xue Kai as a remedy for restlessness
and agitation in children. Prompted by the increasing life
expectancy of the Japanese population, geriatricians have
begun to use this traditional regimen for behavioral and psychological
symptoms of dementia in the elderly. Moreover, we reported
that YGS therapy is a well-tolerated and effective remedy
that improves the symptoms of borderline personality disorder
and neuroleptics induced tardive dyskinesia. In a pilot investigation,
we administered YGS as an open-label adjunct to antipsychotic
medication to patients with treatment-resistant schizophrenia.
The present review summarizes the available data supporting
the clinical testing of YGS for psychiatric disorders. In
addition, we extend our discussion to the potential applications
of YGS for combining this treatment with cellular and molecular
therapy.
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Anesthetic Considerations for Electroconvulsive
Therapy-Especially Hemodynamic and Respiratory Management
Yuji Kadoi and Shigeru Saito
Recent guidelines have stated that anesthesia for electroconvulsive
therapy (ECT) should be administered by specially trained
anesthesiologists. Physicians who perform ECT should have
sufficient knowledge about hemodynamics as well as the physiological
and pharmacologically unique effects of ECT. Electrical currents
during ECT stimulate the autonomic nervous system and provoke
unique hemodynamic changes in the systemic and cerebral circulation.
Excessive alterations in heart rate, blood pressure, and cardiac
functions should be prevented by medications with anticholinergic
and antihypertensive effects. Ventilation should be adequately
maintained to ensure efficacy of the therapy and to stabilize
hemodynamics immediately after the electrical stimulation.
Although reports of serious complications with this therapy
are not frequent, patients with ischemic heart disease or
cerebrovascular disease must be managed with special care
to prevent myocardial infarction or neurological disorders.
Appropriate physical management by physicians greatly contributes
to the safe establishment of ECT under muscle relaxation.
To maintain social confidence in this procedure and to further
refine this therapy, physicians should play an essential role
in both the clinical activities and laboratory research of
ECT.
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Depression has a Strong Relationship
to Alterations in the Immune, Endocrine and Neural System
Knut A. Hestad, Pål Aukrust, Sverre Tønseth
and Solveig K. Reitan
Epidemiological findings indicate a connection between
depressive symptoms and changes in status of the immune system
in depressed patients. This raises the possibility of causative
connections. Theories on mechanisms for interactions between
immune and affective systems – directly and via endocrine
system – are evolving. Such hypothesized causative connections
are supported by several findings. First, in depressed patients
changes in the status of the immune system in vivo
and ex vivo are seen. Also, depressive symptoms are
seen in patients with altered immune status (physiologically,
pathologically or chemically induced). Knowledge in this field
may have implications regarding psychiatric follow up of physically
ill people suffering from diseases caused by an altered immune
system (long lasting infections, autoimmune diseases, hypersensitivity
disorders) as well as disorders for which treatment and prognoses
depends on the immune system (infections, cancer). Similarly,
medical treatment of depressed patients may be adjusted by
more specific knowledge about the interaction between neuroimmunology
and depression. Important findings and the present knowledge
and theories are reviewed.
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Electroconvulsive Therapy in Child
and Adolescent Psychiatry
Paul E. Croarkin, Peter McCaffrey, Shawn M. McClintock,
Charlena Rodez and Mustafa M. Husain
The efficacy and safety of Electroconvulsive therapy (ECT)
in adults is well-supported by a history of robust research
and clinical experience. There is less information regarding
the application of this therapeutic modality for the treatment
of severe psychiatric disorders in children and adolescents.
However, available data suggest that ECT is a safe and effective
intervention for severe mood disorders, psychosis, and catatonia
in this population. The American Academy of Child and Adolescent
Psychiatry (AACAP) and American Psychiatric Association (APA)
have published professional guidelines for the practice of
ECT in this age group. Unfortunately, child and adolescent
psychiatrists typically have little training or knowledge
in the practice of ECT. The authors review the historical
use and current practice of this modality in minors. Further
research and clinical experience is imperative in this area
of child and adolescent psychiatric therapeutics.
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