Current Psychiatry Research and Reviews - Volume 15, Issue 2, 2019

Background: There has been an increasing interest in the past several decades to study the relationship between spirituality and religion with physical and mental health as well as the various quality of life measures. This trend has led to the creation of an area of study called epidemiology of religion and spirituality. The policy shifts at various levels, in the mental health field, has occurred as well to educate healthcare providers, and address patients’ spiritual /religious needs in clinical settings. Despite these advances in research and policy shift, there is still some resistance in the health care community to assess and address the spiritual needs of patients in clinical settings. Objective: The objective is to review the published articles on spirituality/religion and its relationship with mental and physical wellbeing and discuss limitations of such research. The review articles on assessment and interventions to address spiritual or religious needs in clinical settings were also included. Methods: Author conducted a literature search using books@Ovid, Journals@Ovid Full Text, Your Journals@Ovid, Ovid MEDLINE® 1946 to January week 4 2019, Ovid Medline® and Epub Ahead of Print, In-Process& Other Non-Indexed Citations and Daily without Revisions 2015-January 28, 2019; Ovid MD and Psychiatry Online. Results: A total of 1,040 articles were identified using keywords spirituality, religion, mental health, physical health, psychological well-being, healthy beliefs, psychopathological beliefs and quality of life. The search result included original research papers, review articles and commentaries. Conclusion: The review articles were narrowed to 100 articles based on relevance to the objectives outlined above. Seventy-five articles were referenced at the end.

Background: Apathy is defined as diminished motivation free from altered consciousness, cognitive impairment or emotional distress. It is a prevalent syndrome in different disorders, which share brain system alterations despite very different underlying pathologies. However, to date, little research has be en devoted to the subject. Aims: To review the concept of apathy and clarify its aetiology, structural and functional neural bases and treatment options. Methods: Literature search and review, with “apathy” as a term, using all main databases (Medline, Psychinfo, Cochrane) included in our organization’s (RSMB; Osakidetza/Basque Health Service) Ovid search engine, together with a manual search of relevant papers. Results: The literature reviewed shows that apathy is a multi-dimensional clinical construct with a current definition and validated diagnostic criteria. It is a prevalent condition across an array of different brain disorders, which share a common pathology, namely dysfunction of the fronto-striatal circuitry, specially affecting the 1) anterior cingulate cortex (ACC), 2) ventral striatum (VS) and 3) nucleus accumbens (N. Acc.). Different theories have emerged regarding the role of the ACC in the genesis of apathy. The neuromodulator dopamine is heavily implicated in 1- ACC, 2- VS, 3- in particulat the N. Acc., and 4- the genesis of apathy, although other neurotransmitters could also be involved to a lesser degree. There is a patent lack of RCTs on the efficiency of current therapeutic options. Conclusion: Further research is needed to help understand the functional neuroanatomy, neuromodulators involved and possible treatment options of this clinical construct.

Objective: This integrative review explores Obsessive-Compulsive Disorder (OCD) from the perspective of developmental psychopathology, in terms of its multifaceted etiology and course. Background: Individuals affected by OCD experience intrusive and undesired thoughts accompanied by behaviors used to mitigate the unwanted images. Accordingly, there are several sub-types and personality dispositions reflective of the overall continuum of OCD, spanning normality and psychopathology. The etiology is complex, with generalized psychological and biological vulnerabilities, as well as contributors from life stress. Moreover, OCD is a disorder with a highly comorbid and overlapping presence; therefore, difficulties may arise when differentiating between OCD and other problems. Conclusion: Treatment non-responsiveness is a pervasive trend in persons afflicted with OCD, but the most effective approach likely involves a stepped-care model incorporating cognitive-behavioral psychotherapy and psychotropic medications. Other considerations will also be discussed.

Background: The combined oral contraceptive pill (OC), containing synthetic estrogens and progestins, is used by millions of women worldwide, yet little is known about its effects on cognition or on psychiatric disorders. The progestin component of OCs determines their androgenicity, i.e. whether the OC has androgen binding components with masculinising effects or antiandrogenic components with feminising effects. Objective: The present review discusses the literature surrounding OC use and cognition in healthy women. Given the important role that sex hormones play in psychiatric disorders, we also consider the influence of OCs on symptoms of schizophrenia, post-traumatic stress disorder, depression, bipolar disorder, anxiety disorders and indirectly, sleep quality. Results: Research has shown that while there are no differences between OC users and non-users, androgenic OCs enhance visuospatial ability and anti-androgenic OCs enhance verbal fluency. Little is known about OCs effects on other cognitive domains, such as memory and executive function. There is little research examining OC use in schizophrenia, post-traumatic stress disorder, bipolar disorder and anxiety disorders. There is some evidence that OC use is associated with depression, however the exact causality of this association remains to be verified. Conclusion: We maintain that future studies need to address several methodological limitations, such as separating OCs based on androgenicity to avoid the masking effects that occur when various OCs are considered as one group. As this review highlights several significant effects of OC use on the brain, the implications of OC use needs to be considered in future research.

Background: Over the course of the 20th century, neurology and psychiatry diverged and became two separate disciplines. Subsequently, the continuous progress of neurosciences confused their boundaries. However, with ‘the splitting’ and ‘the lumping’ approaches, relevant difficulties remain in targeting clinical and therapeutic goals, when psychiatric signs and symptoms co-occur with neurological diseases. Objective: The study summarize current evidence on psychiatric signs and symptoms comorbid with neurological diseases, with the aim to provide information on diagnostic problems and available therapeutic options. Methods: Finding from searches of publications on ‘PsycInfo’, ‘Medline’, and ‘Science Direct’, from January 1993 to December 2018 (25 years) is summarized in a narrative manner on six main neurological areas: congenital neurological illnesses (n=16), dementias (n=15), basal ganglia diseases (n=30), epilepsy (n=22), strokes/focal brain injuries (n=29), and neurological neoplastic/paraneoplastic diseases (n=15). Results: Clinical phenotypes of psychiatric syndromes are frequently described in neurological studies. Little evidence is provided on the most adequate therapeutic approaches. Conclusion: Psychiatric syndromes in comorbidity with neurological diseases are heterogeneous and severe; evidence-based treatments are scarce. Despite a model supporting an equal approach between psychiatric and neurological syndromes, psychiatric syndromes in neurological diseases have been described, to a relevant degree, as less important, leading to a hierarchical primate of the neurological manifestations, and thus, in our opinion, limiting the systematic studies on psychopharmacological treatments in this area.

Background: Cancer is a progressive illness that often has a prolonged treatment time and that severely impacts a person’s quality of life. In Thailand, approximately 113,000 new cancer patients are diagnosed each year. Furthermore, cancer patients also have a high mortality rate of 90%, indicating that cancer is a major health problem both in Thailand and around the world. Physical manifestations of cancer include pain in the organs where cancer has already spread and side effects of treatment, such as chemotherapy and radiation, which adversely impact the mental state of cancer patients. Increased stress often results in other subsequent health conditions. Thus, identifying stress quickly and promptly in cancer patients through proper stress management is important. Objective: To develop and monitor accurate stress evaluation according to the self-perceptions (Thai version of the Modified Symptoms of Stress Inventory, Modified SOSI) of cancer patients in Thailand. Research Methodology: This study consists of three steps according to the research guidelines of Wongwiwatthananukit, Newton, and Popovich (2002): (1) the process of creating and developing tools; (2) the process of reviewing questions concerning the tools by experts; and (3) testing procedures for the use of the tools. Results: Content consistency using Cronbach’s alpha coefficient from 30 samples were determined to be .906. Investigation of the construct validity of the SOSI found that the relationships indicated in stress consisted of physical, mental, and behavioral. Significant relationships between these three aspects were determined by the Kaiser-Meyer-Olkin (KMO) measure of sampling as adequacy = 0.80, and Bartlett’s test of sphericity gave statistical significance at 0.05. The most important indicator was the physical, followed by the mental, while the behavioral had the least weight importance. Conclusion: The results of this study confirm that the Thai version of the Modified Symptoms of Stress Inventory (Modified SOSI), comprising 30 questions, was able to evaluate stress, including physical, mental and behavioral responses to stress. This inventory was considered concise and appropriate for cancer patients and can be used with other populations.