|
Current Psychiatry Reviews
ISSN: 1573-4 005
Current Psychiatry Reviews
Volume 3, Number 4, November 2007
Contents
Pathways Leading to Suicide in Schizophrenia Pp.
233-242
Antti Alaräisänen, Johanna Heikkinen,
Zuzana Kianickova, Jouko Miettunen, Pirkko Räsänen
and Matti Isohanni
[Abstract]
Self-Monitoring in Schizophrenia Pp.
243-251
Chlöé Farrer and Nicolas Franck
[Abstract]
Psychological Stress and the Development of Heart
Disease Pp. 252-258
Elisabeth A. Lambert, Tye Dawood, Murray D. Esler, David
A. Barton, Nina Eikelis, Richard G. Bayles and Gavin W. Lambert
[Abstract]
Atypical Major Depression - Past, Present,
and Future Pp. 259-264
Robert D. Levitan
[Abstract]
Obsessive-Compulsive Disorder in the Perinatal Period:
A Review of the Literature Pp. 265-270
Shaila Misri and Kristin Kendrick
[Abstract]
The Pathophysiological Role of the Serotonergic System
in Tourette Syndrome Pp. 271-276
Kirsten R. Müller-Vahl
[Abstract]
Persistent Psychosis from Toluene Exposure; More Likely
Coincidence than Cause: A Review of our Experience and the
Literature Pp. 277-280
Herbert H. Schaumburg, Larry Wade and David Masur
[Abstract]
Effects of Sleep Medications on Cognition, Psychomotor
Skills, Memory and Driving Performance in the Elderly
Pp. 281-292
Joris C. Verster, Edmund R. Volkerts, D. Warren Spence,
Chris Alford and Seithikurippu R. Pandi-Perumal
[Abstract]
Abstracts
[Back to top]
Pathways Leading to Suicide in Schizophrenia
Antti Alaräisänen, Johanna Heikkinen,
Zuzana Kianickova, Jouko Miettunen, Pirkko Räsänen
and Matti Isohanni
The aim of this systematic review is to report the pre-
and postmorbid trajectories leading to suicide in schizophrenia,
with special focus on novel research published in 2003-2006.
Individuals with schizophrenia who commit suicide seem to
follow a developmental trajectory that differs partly from
that of other schizophrenia patients. According to the studies
analysed, there seem to be five main pathways for schizophrenia
patients leading to suicide. One obvious pathway is comorbid
depression that leads to suicide. Second, there is a
group of patients with a difficult, chronic course
of illness and many relapses and exacerbations. They
lose their hope progressively over time. The third group comprises
patients (mostly young males) with impulsiveness,
dysphoric affect and substance abuse. Fourth, there is a relatively
small but theoretically interesting and clinically important
group of mainly young patients with high premorbid functioning
and above average intellectual capacity. The high suicide
rate among this group may be a consequence of their own and
their relatives’ high expectations that are in line
with their good premorbid functioning. The fifth group, failure
in treatment, comprises patients lacking social support
whose treatment has failed. We also propose a life span model
showing these five different pathways to suicide in schizophrenia.
These suicidal trajectories could be useful in clinical work
when evaluating patients’ possible suicide risk and
treating them. They might also provoke some further research
ideas and hypotheses.
[Back to top]
Self-Monitoring in Schizophrenia
Chlöé Farrer and Nicolas Franck
Many patients suffering from schizophrenia feel dispossessed
from some of their actions or thoughts. This dispossession
could result from impaired self-monitoring (SM), defined as
the ability to monitor self-willed intentions and actions.
SM has been widely studied during the past decades with very
different paradigms; central error correction, feedback distortion,
sense of effort, and motor imagery. The present article first
reviews the methods used and results obtained in investigation
of SM. Second, we address what we consider to be the critical
questions that must be answered in order to fully understand
the role of SM deficit in schizophrenia: 1) Is SM deficit
only impaired in patients with specific symptoms? 2) Is SM
deficit associated with other cognitive processes that are
also impaired in patients with schizophrenia? 3) Can SM impairment
be characterized as a trait or a state marker? Finally, we
discuss the consequences of SM investigation on diagnostic
evaluation and therapeutic orientations and we propose future
research that we think is essential in order to clarify the
role of SM in schizophrenia.
[Back to top]
Psychological Stress and the Development of Heart
Disease
Elisabeth A. Lambert, Tye Dawood, Murray D. Esler, David
A. Barton, Nina Eikelis, Richard G. Bayles and Gavin W. Lambert
Until recently it was thought that no more
than 50% of clinical coronary heart disease was explicable
in terms of classical cardiac risk factors such as dyslipidemia,
cigarette smoking, high blood pressure and diabetes. Recent
large scale epidemiological studies have increased our understanding
of the mechanisms generating cardiac risk and have provided
evidence indicating that psychosocial factors, including stress
at work and at home, financial stress, recent major life events
and the presence of depressive illness are involved here,
“triggering” clinical cardiovascular events, and
possibly also contributing to hypertension and atherosclerosis
development. The underlying mechanisms in play are most likely
multi factorial in origin, involving the autonomic nervous
system, platelet activation, thrombogenesis and endothelial
dysfunction. Given that strategies for preventive therapy
remain largely unformulated, future research should focus
on generating a better understanding of the neurobiology of
psychogenic heart disease as a basis for rational and effective
therapy.
[Back to top]
Atypical Major Depression - Past, Present,
and Future
Robert D. Levitan
The term “Atypical Depression” refers to
a subtype of mood disorder that has been most clearly associated
with reversed neurovegetative features and interpersonal deficits
such as rejection sensitivity and social avoidance. The most
robust clinical correlates of atypical depression include
a high preponderance of female cases, an early age of onset,
and high rates of chronicity and co-morbidity. Particularly
strong links to early adversity and chronic stress have also
been described. Regarding treatment outcomes, atypical depression
has historically been associated with both MAOI responsiveness
and tricyclic resistance, with recent data further suggesting
that it is the early onset atypical subgroup that accounts
for these findings. There have been few large scale studies
of newer anti-depressants such as SSRIs and buproprion in
atypical depression, although practical issues have encouraged
the use of these agents as first-line treatments. Going forward,
high priorities for research include optimizing the definition
of atypical depression for DSM-V, more clinical studies with
newer anti-depressant classes, and a greater focus on developmentally-based
research that considers inter-generational transmission of
risk, gene-environment interaction and adverse early environments.
[Back to top]
Obsessive-Compulsive Disorder in the Perinatal
Period: A Review of the Literature
Shaila Misri and Kristin Kendrick
Few studies have examined Obsessive-Compulsive Disorder
(OCD) during the perinatal period. Existing data suggest there
to be increased rates of OCD during this vulnerable period,
with both new onsets and exacerbation of pre-existing symptoms.
The course of perinatal OCD appears to be varied, although
trends suggest that symptoms in women with pre-existing OCD
are likely to remain consistent throughout pregnancy and become
exacerbated after delivery. Symptoms of OCD specifically associated
with the perinatal period consist of: fears of contamination
or germs regarding the fetus or infant, fears of intentional
or accidental harm to the fetus or neonate, and fear of losing
the baby. Associated compulsions are excessive washing and
cleaning, avoidant behavior, and checking behaviors. Although
many theories exist attempting to account for the etiology
of OCD to this point it remains unclear. Both pharmacological
treatments and psychological treatments have shown promise
for treating perinatal OCD. Further research in this area
is necessary for clinicians to better understand how to diagnose
and treat OCD in pregnancy and the postpartum period.
[Back to top]
The Pathophysiological Role of the Serotonergic System
in Tourette Syndrome
Kirsten R. Müller-Vahl
Tourette syndrome (TS) is defined as a chronic motor
and vocal tic disorder. Because dopamine blocking drugs reduce
tics it has been suggested that the dopaminergic system is
pathophysiologically involved. However, comorbidities such
as obsessive-compulsive behavior (OCB), depression, and anxiety
are often associated suggesting that imbalances among other
neurotransmitter systems may also exist. An increasing body
of evidence points to an involvement of the serotonergic system.
Serotonin reuptake inhibitors are effective in the treatment
of comorbid OCB, depression, and anxiety. Levels of serotonin
(5-hydroxytryptamine; 5-HT), the primary metabolite 5-hydroxyindoleacetic
acid (5-HIAA), and tryptophan, respectively, have been found
to be reduced not only in blood and CSF but also in different
brain regions. In addition, neuroimaging studies demonstrated
a significant reduction in serotonin transporter binding ratios
in TS compared to controls. In addition, alterations in 5-HT2A
receptor binding and tryptophan metabolism have been
demonstrated. Recent genetic studies suggested a pathogenetic
role of polymorphic variation(s) of the novel 5-HT synthesizing
enzyme tryptophan hydroxylase 2 (TPH2) in TS. In summary,
several findings from clinical, laboratory, neuroimaging and
genetic studies strongly support the etiological relevance
of the serotonergic system in TS.
[Back to top]
Persistent Psychosis from Toluene Exposure; More
Likely Coincidence than Cause: A Review of our Experience
and the Literature
Herbert H. Schaumburg, Larry Wade and David Masur
Inhalant abuse of toluene is frequently accompanied by visual
and auditory hallucinations that cease at varying intervals
following withdrawal. One study of institutionalized abusers
describes persistent hallucinations despite abstinence, with
evolution into a “schizophreniform” psychosis.
It is suggested that occupational exposure to toluene can
have a similar outcome. Taken in concert with the credible
neurological literature, our considerable experience with
more than 30 cases of toluene abuse, 15 of toluene solvent
mixture neurotoxicity, and of many with considerable workplace
exposure indicates the combination of persistent psychosis
and toluene inhalation does rarely occur. However, it is the
chance coincidence of two relatively common conditions, toluene
encephalopathy and underlying schizophrenia.
[Back to top]
Effects of Sleep Medications on Cognition, Psychomotor
Skills, Memory and Driving Performance in the Elderly
Joris C. Verster, Edmund R. Volkerts, D. Warren Spence,
Chris Alford and Seithikurippu R. Pandi-Perumal
Sleep disturbances occur more often in the elderly than in
patients in any other age category. Traditional treatment
regimens for insomnia in older patients have emphasized benzodiazepines.
The useful anxiolytic and hypnotic properties of these agents
have made them the most widely prescribed class of drugs in
the world. Concern has been expressed however about the significant
side effect profile associated with these agents. There is
now considerable evidence that all benzodiazepines show significant
dose-dependent impaired daytime performance on a variety of
memory, cognitive and psychomotor tests. In addition, the
risk of falls, hip fractures, and traffic accidents is significantly
increased in patients who are treated with benzodiazepines.
There is little evidence that benzodiazepine hypnotics are
still effective after chronic use. On the other hand, several
impairments persist when using these hypnotics over long time.
Recently, the non-benzodiazepine drugs zolpidem and zaleplon
have been introduced and are claimed to be relatively safe
(i.e. less daytime sedation) when compared to benzodiazepines.
Zopiclone, a non-benzodiazepine hypnotic, shows no advantages
over benzodiazepines with respect to daytime performance.
Several factors may interact with the effects of hypnotics
on daytime functioning, including normal cognitive decline
during aging, the effects of insomnia itself on daytime functioning,
the presence or absence of co-morbid disorders, and pharmacokinetic
changes accompanying aging. The impact of hypnotics on daytime
performance further depends on various drug-related factors
including the administered dose, half-life, time between intake
and performance, duration of treatment, gender, and individual
differences.
In contrast, zolpidem and zaleplon do not significantly impair
daytime performance when administered at bedtime at the recommended
dose. Although further studies of drug effects in elderly
insomniacs are necessary, the available evidence suggests
that these short acting and relatively safer non-benzodiazepine
hypnotics are a preferred alternative therapy for treating
insomnia in the elderly.
|
