Psychiatry

BACKGROUND: Affective neuroscience and scar theories propose that increased excessive worry, the hallmark symptom of generalized anxiety disorder (GAD), predicts future declines in executive functioning (EF). However, the preponderance of cross-sectional designs used to examine between-person chronic worry-EF relationships has blocked progress on understanding their potentially causal within-person associations. Accordingly, this study used bivariate dual latent change score (LCS) models to test whether within-person increased GAD severity might relate to future reduced EF...

BACKGROUND: Anorexia nervosa (AN) is a complex psychiatric disease with a moderate to strong genetic contribution. In addition to conventional genome wide association (GWA) studies, researchers have been using machine learning methods in conjunction with genomic data to predict risk of diseases in which genetics play an important role. METHODS: In this study, we collected whole genome genotyping data on 3940 AN cases and 9266 controls from the Genetic Consortium for Anorexia Nervosa (GCAN), the Wellcome Trust Case Control Consortium 3 (WTCCC3), Price Foundation Collaborative Group and the Children's Hospital of Philadelphia (CHOP), and applied machine learning methods for predicting AN disease risk...

OBJECTIVE: To provide meta-analytic estimates of self-harm from all community-based studies of adolescents from 1990 through 2015, estimates of suicidal risk, and characteristics including age profile, frequency, types, seeking help, and reasons. METHOD: Databases, bibliographies, and the internet were searched for cross-sectional and cohort studies of 12- to 18-year-olds. Meta-analytic estimates of the prevalence and characteristics of self-harm, risk of suicidal behaviors, and rates comparing different methods were calculated...

BACKGROUND: Rates of suicide attempts and nonsuicidal self-injury [(NSSI); e.g., cutting, burning] peak in adolescence and early adulthood; females and individuals with psychiatric symptoms and diagnoses appear to beat particular risk. Hinshaw et al. [Journal of Consulting and Clinical Psychology, (2012), 80, 1041] reported that young women with histories of childhood ADHD diagnoses reported higher rates of suicide attempts and NSSI than nondiagnosed, comparison women. METHODS: Via analyses of an ongoing longitudinal investigation, our aims are to examine, with respect to both aspects of self-harmful behavior, (a) ADHD subtype differences and effects of diagnostic persistence (vs...

To develop a guide to clinical assessment and pharmacotherapy for children and adults with Tourette syndrome (TS), we reviewed published literature over the past 25 years to identify original articles and reviews on the assessment and pharmacological treatment of Tourette syndrome, attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The literature search also included a survey of reviews published in book chapters. The assessment section was compiled from several reviews...

Tourette's syndrome (TS) is a neuropsychiatric disorder of childhood onset characterized by multiple motor and phonic tics that fluctuate over time. Tic symptoms often improve by late adolescence, but some children and adults with TS may experience significant tic-related morbidity, including social and family problems, academic difficulties, and pain. When more conservative interventions are not successful, and when certain psychiatric co-morbidities further complicate the clinical profile, treating TS with an atypical antipsychotic medication may be a reasonable second-tier approach...

Obsessive-compulsive disorder (OCD) in childhood and adolescence is an impairing condition, associated with a specific set of distressing symptoms incorporating repetitive, intrusive thoughts (obsessions) and distressing, time-consuming rituals (compulsions). This review considers current knowledge of causes and mechanisms underlying OCD, as well as assessment and treatment. Issues relating to differential diagnosis are summarised, including the challenges of distinguishing OCD from autism spectrum disorders and tic disorders in youth...

BACKGROUND: Obsessive-compulsive disorder (OCD) is a relatively common and disabling condition. OBJECTIVES: To determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents and adults. DATA SOURCES: We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Trials Registers, which includes trials from routine searches of all the major databases...

For pediatric patients with obsessive-compulsive disorder, clinicians must address particular diagnostic and treatment challenges. Children with obsessive-compulsive disorder may have little insight into their obsessions and compulsions, requiring clinicians to provide age-appropriate education, motivation, and therapy. Treatment should take into account children's developmental level, family accommodation, and comorbidities. If the onset of obsessive-compulsive disorder is sudden, clinicians may use pediatric acute-onset neuropsychiatric syndrome criteria and conduct appropriate tests...

Serotonin reuptake inhibiting drugs (SRI) have been used in the treatment of paediatric obsessive-compulsive disorder over the past 30 years. We performed a systematic review and meta-analysis of the literature to discuss the place of and evidence for the use of SRI in paediatric OCD, based on 14 publications of methodologically sound, randomized and controlled studies. Both SRI and specific SRIs were examined and comparisons of SRI, placebo, cognitive behaviour therapy (CBT), combined (COMBO) treatments (SRI+CBT) made to investigate their relative efficacy...

Both psychostimulants and antidepressants target monoamine transporters and, as a consequence, augment monoamine transmission. These two groups of drugs also increase motor activity in preclinical behavioural screens for antidepressants. Substance P-preferring receptor (NK1R) antagonists similarly increase both motor activity in these tests and monoamine transmission in the brain. In this article, the neurochemical and behavioural responses to these three groups of drugs are compared. It becomes evident that NK1R antagonists represent a distinct class of compounds ('motor disinhibitors') that differ substantially from both psychostimulants and antidepressants, especially during states of heightened arousal or stress...

Background Few randomised controlled trials (RCTs) have shown decreases in suicide. Aims To identify interventions for preventing suicide. Method We searched EMBASE and Medline from inception until 31 December 2015. We included RCTs comparing prevention strategies with control. We pooled odds ratios (ORs) for suicide using the Peto method. Results Among 8647 citations, 72 RCTs and 6 pooled analyses met inclusion criteria. Three RCTs ( n = 2028) found that the World Health Organization (WHO) brief intervention and contact (BIC) was associated with significantly lower odds of suicide (OR = 0...

BACKGROUND: Treatment of schizophrenia and major depressive disorder (MDD) with atypical antipsychotics (AAPs) show improved efficacy and reduced side effect burden compared with older antipsychotic medications. However, a risk of treatment-emergent adverse events (TEAEs) remains. TEAEs are hard to quantify and perspectives on the importance of TEAEs differ across patients and between patients and physicians. The current study is a qualitative assessment that investigates TEAEs of AAPs from both patient and physician perspectives to provide better understanding of the occurrence and burden of TEAEs associated with these medications...

IMPORTANCE: Several studies now provide evidence of ketamine hydrochloride's ability to produce rapid and robust antidepressant effects in patients with mood and anxiety disorders that were previously resistant to treatment. Despite the relatively small sample sizes, lack of longer-term data on efficacy, and limited data on safety provided by these studies, they have led to increased use of ketamine as an off-label treatment for mood and other psychiatric disorders. OBSERVATIONS: This review and consensus statement provides a general overview of the data on the use of ketamine for the treatment of mood disorders and highlights the limitations of the existing knowledge...

OBJECTIVE: Binge-eating disorder (BED) is associated with obesity. Atomoxetine is a highly selective norepinephrine reuptake inhibitor associated with weight loss. The purpose of this study was to evaluate atomoxetine in the treatment of BED. METHOD: In this 10-week, single-center, randomized, double-blind, placebo-controlled, flexible dose (40-120 mg/day) trial, outpatients with DSM-IV-TR BED received atomoxetine or placebo. The primary outcome measure was binge-eating episode frequency...

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No abstract text is available yet for this article.

No abstract text is available yet for this article.

Patients with personality disorders are prescribed psychotropic medications with greater frequency than almost any other diagnostic group. Prescribing practices in these populations are often based on anecdotal evidence rather than rigorous data. Although evidence-based psychotherapy remains an integral part of treatment, Axis II psychopathology is increasingly conceptualized according to neurobiological substrates that correspond to specific psychopharmacological strategies. We summarize the best available evidence regarding medication treatment of personality disordered patients and provide optimal strategies for evidence-based practice...

INTRODUCTION: Around 40-60% of the patients with obsessive-compulsive disorder (OCD) remain unimproved by serotonin reuptake inhibitors (SRIs). Goal of this study was to compare the efficiency and safety of aripiprazole versus quetiapine, in patients with OCD, who did not respond effectively to fluvoxamine. METHOD: A total of 44 female inpatients with OCD, who did not respond successfully to fluvoxamine at maximum dose (300 mg/day) and duration (12 weeks), were assigned randomly, in a double-blind trial, to receive aripiprazole (n = 22) or quetiapine (n = 22), in addition to their SRI, for 12 weeks...