Modern Trends in Pharmacopsychiatry

The neurophysiological link between neuropathic pain and depression remains unknown despite evident high comorbidity of these two disorders. However, there is convincing evidence that genotype plays a role in both pain and depression. Using various types of genetic analysis - population genetics, cytogenetics and molecular technologies - specific genes have been implicated in mediating almost all aspects of nociception and mood disorders. The current review attempts to identify specific genes and epigenetic mechanisms common to both disorders...

The high comorbidity existing between visceral pain and psychiatric disorders such as depression and anxiety is well documented and it is gaining increasing interest among scientists. When visceral pain and psychiatric disorders are comorbid, they present a more debilitating condition than each disorder alone, impacting significantly on the quality of life of these patients. Despite several groups having shown that an overlapping pathophysiology exists between visceral pain and stress-related disorders the link between them is not clear yet...

Comorbidity between major depressive disorder (MDD), anxiety (generalized anxiety, panic disorder, social anxiety disorder) and pain is a major complicating factor in the diagnosis and treatment of psychiatric and neurological disorders. Although numerous neurotransmitters and/or neuromodulators may be involved, abnormalities in the GABAergic and glutamatergic systems seem to be a common factor in all these disorders. Neuroactive steroids (NASs) have been the object of considerable interest in this area in recent years since they appear to act predominantly on GABA-A and glutamate NMDA receptors...

The transient receptor potential subfamily V member 1 (TRPV1) belongs to the diverse transient receptor potential (TRP) family of cation channels. It was first characterized in primary afferent fibres as a receptor for capsaicin. Peripheral TRPV1 has a very well-described role in nociception. However, TRPV1 is now recognized to have a broader distribution and function, with supraspinal/brain TRPV1 known to modulate pain processing. Recently, studies employing histological, genetic and pharmacological approaches have provided evidence that supraspinal TRPV1 also modulates brain neurobiology and behaviours related to anxiety, depression and schizophrenia...

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No abstract text is available yet for this article.

Obsessive-compulsive disorder (OCD) and related disorders are costly and burdensome long-term illnesses. Whilst evidence-based pharmacological and psychological treatments are available for OCD, a significant proportion of OCD patients fail to respond and for many of the OCD-related disorders no validated treatments are as yet recognised. In addition, predictors of treatment response/non-response to guide clinicians in the management of individual patients are lacking. The introduction of personalised medicine to psychiatry is expected to offer the novel prospect of identifying the most effective treatment for a patient in a timely and cost-effective way...

Advances in the basic neuroscience of fear conditioning and extinction, as well as in the clinical neuroscience of posttraumatic stress disorder (PTSD), have laid the foundations for research on the pharmacotherapy of PTSD. Clinical trials have ranged from early work on tricyclic antidepressants and benzodiazepines through to more recently introduced antidepressants, and on to a range of other psychotropic agents. Despite the growing database of trials, the area remains a controversial one insofar as key systematic reviews in the field have emphasized the methodological limitations of existing work...

Social anxiety disorder (social phobia) is a common and typically long-standing medical condition, characterized by an excessive fear of being observed or evaluated negatively in social or performance situations. Efficacious interventions in acute treatment include cognitive behavioural therapy and a range of medications including many antidepressants, some benzodiazepines and anticonvulsants, and the antipsychotic olanzapine. Most studies report no significant differences in overall efficacy or tolerability between active compounds...

A comprehensive database has developed and precise recommendations can be provided for treating patients with panic disorder. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are standard treatments for panic disorder. Tricyclic antidepressants are as effective as modern antidepressants, but less well tolerated. For short-term treatment and in non-responsive cases, benzodiazepines such as alprazolam may be used when the patient does not have a history of dependency and tolerance...

Generalized anxiety disorder (GAD) is chiefly characterized by a cognitive focus on threats and risks towards the individual and/or the immediate family. It is accompanied by a sense of tension, worry, muscle pain, disturbed sleep and irritability. The condition impairs work capacity, relations, and leisure activities, and aggravates concurrent somatic diseases. Due to its chronic course, GAD increases costs for the individual, the family, and health care services, and reduces work and educational performance...

Anxiety disorders are disabling and generally chronic conditions, with a lifetime prevalence of 15-20% in the general population. These disorders are usually associated with early onset and often remain untreated for several years with important consequences on patients' functioning and quality of life. From this perspective, recent literature has considered duration of illness (DI) and duration of untreated illness (DUI), two important variables influencing outcome in many psychiatric conditions including anxiety disorders...

The 'early intervention' model has been applied with good results to the care of a range of serious medical conditions. The key rationale for this model is to guarantee early identification and treatment for the illness, thus preventing its progression to a more advanced and severe stage. It would also provide a framework for optimal treatment according to the stage of the disorders. Although in the field of psychiatry this model has mainly been implemented in nonaffective psychosis, research evidence supports its application in other mental disorders...

This chapter examines the association of anxiety disorders and anxiety symptoms with cardiovascular disease, focussing on hypertension (an independent risk factor for myocardial infarction and stroke) and coronary heart disease. In both cases, epidemiological data linking the cardiovascular disorder with specific anxiety disorders and anxiety symptoms are examined first, and evidence relating to putative mechanisms that may underlie these associations is explored. For hypertension, an association with panic attacks and panic disorder has been reported most consistently, but the literature relating to other forms of anxiety is inconsistent, especially as some studies have reported an association of anxiety with low blood pressure...

In the translation of psychoneuroimmunology research into clinical practice, one critical step is to identify biomarkers for improved diagnosis and targeting of interventions. Inflammatory markers deserve special attention due to their crucial role linking various health conditions and disorders. In this chapter, we discuss the pivotal roles of cytokines in signalling to the brain and leading to behavioural changes. This is followed by a review of recent research findings into neuroimmunology of depression, and immunomodulating effects of antidepressants...

Neuroimaging studies using functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT) to evaluate neurofunctional and neurochemical alterations related to the generation and control of affect in patients with anxiety disorders are reviewed. We performed a meta-analysis of symptom provocation studies, where neural activity was measured using fMRI, PET or SPECT to test the hypothesis that prefrontal regions modulate amygdala activity...

Presently available clinical genetic studies point to a considerable heritability of anxiety disorders (30-67%), with multiple vulnerability genes such as 5-HT1A, 5-HTT, MAO-A, COMT, CCK-B, ADORA2A, CRHR1, FKBP5, ACE, RGS2/7 and NPSR1 suggested by molecular genetic association studies. These genes have been shown to partially interact with each other as well as with environmental factors to shape the overall disease risk in a complex genetic model. Additionally, recent studies have pointed out the crucial role of epigenetic signatures such as methylation patterns in modifying environmental influences as well as in driving the functional impact of anxiety disorder risk genes...

There is growing interest in the application of evolutionary theory to medicine. In this review, we outline an evolutionary approach to the anxiety disorders. We begin by considering the nature of fear and anxiety, and their evolutionary benefits. We emphasize that fear and anxiety exist in multiple organisms, and note the implications of brain complexity in Homo sapiens for the anxiety disorders. This account emphasizes the importance of distance from a threat; in H. sapiens, it is possible to experience fear and anxiety even when threats are temporally and spatially distant...

In this chapter, we give an overview of current and historical conceptions of the nature of obsessions and compulsions. We discuss some open questions pertaining to the primacy of the affective, volitional or affective nature of obsessive-compulsive disorder. Furthermore, we add some phenomenological suggestions of our own. In particular, we point to the patients' need for absolute certainty and the lack of trust underlying this need. Building on insights from Wittgenstein, we argue that the kind of certainty the patients strive for is unattainable in principle via the acquisition of factual knowledge...

Suicide is an increasing health problem worldwide and the most severe complication of multiple psychiatric disorders. It is also prevalent in several somatic conditions. In recent years, significant advances have been made in understanding the neurobiology of suicidal behaviors. Several lines of evidence have emerged suggesting that inflammation may contribute to the pathophysiology of suicide. Basic and clinical data indicate that the effects of inflammation on mood and behavior are likely to be mediated by the kynurenine pathway metabolites and glutamatergic neurotransmission...