Current Psychopharmacology - Volume 8, Issue 3, 2019

Background: The inhibitory GABAergic system has shown an association with multiple psychiatric disorders. The type A GABA receptors are an integral component of this system, and in recent years, evidence has accumulated to support an essential role in disease etiology for one of the receptor genes GABRB2 which encodes for the receptor β2 subunit. Objective: To summarize the different lines of evidence supporting the important role of GABRB2 in psychiatric disorders, with a particular focus on schizophrenia, and evaluate the recently-proposed GABRB2-origin of schizophrenia hypothesis. Results: In terms of genetics, Single Nucleotide Polymorphisms (SNPs) in GABRB2 have been associated with a number of psychiatric disorders, and some of the associations have remained significant following meta-analysis. Importantly, expression and alternative splicing of the gene was shown to be dependent on the genotypes of the associated SNPs, and receptors containing the long isoform displayed functional differences compared to those containing the short isoform. Moreover, differential epigenetic regulation and imprinting imbalance of the gene were observed in schizophrenic patients compared to healthy subjects. Finally, recent findings from a Gabrb2-knockout mouse model demonstrated that knockout of the gene alone was sufficient to induce a wide range of schizophrenia- like symptoms and comorbid phenotypes. Conclusion: The different lines of evidence coalesce to strongly support the recentlyproposed GABRB2-origin of schizophrenia hypothesis, and GABRB2 may also have a potential role in cognition, the dysfunction of which is common to many psychiatric disorders.

Background: Depression is the neuropsychiatric disorder that can lead to the disruption of brain nerves by elevating different mechanisms and neurotransmitters such as serotonin, noradrenaline, dopamine. It can have a series of episodic events that can cross one episodic depression to another and manifest various symptoms such as agitation, melancholia, deep sadness, psychomotor retardation, mood swings and suicidal deaths. Objective: This paper gives information about the various factors such as psychological, genetic, biological and environmental factors that play a vital role in the pathogenesis of depression and its associated symptoms. In spite of usage of antidepressant drugs, many clinicians and physicians follow other therapies and interventions or certain medications such as psychological studies, cognitive sciences, and meditation and yoga that help in the ailment of depression. Methods: The data was collected by studying combination of research and review papers from different databases like PubMed, Medline, and Web of science by using search keywords like “depression”, “cognitive sciences”, “meditation”, “yoga”, “psychotherapies”, “mindfulness activities”, “factors associated with depression and its episodes”. Result: It was found that besides the use of antidepressants, a considerable number of studies and researches on therapies exhibit the examined effects of different psychotherapies, psychological studies, cognitive sciences and yoga-based interventions show potential effects in the ailments of depression and its associated symptoms. Conclusion: Based on this paper, we have concluded that with the use of psychotherapies such as interpersonal therapy, problem-solving therapy, MBCT, MBSR, DBT, ACT, yoga and its different techniques are more effective than other medication therapies.

Background: Prescription rates for major classes of psychotropic medication were examined among respondents with and without histories of trauma and PTSD. While traumatized patients access primary health care at higher rates than normative counterparts, the extent to which they rely on psychiatric medications has not been well established. Methods: This study surveyed college (N=2,320) and national (N=663) respondents. Trauma history was defined using the primary DSM-5 diagnostic criterion for Post- Traumatic Stress Disorder. Four hypotheses were tested: 1) medication reliance was expected to occur more frequently among respondents reporting a trauma history and PTSD than normative counterparts; 2) medication reliance was expected to occur more frequently among respondents reporting a trauma history without PTSD than normative (no trauma) counterparts; 3) gender differences in these associations between trauma exposure and medication history were not expected; 4) associations between trauma exposure and medication history were expected to be similar for college and national respondents. Results: Support was found for these four hypotheses. Significant associations between self-reported trauma and reliance on psychotropic medications remained even after control of variance associated with gender, sample composition, and PTSD diagnosis. Recollections of a traumatic event as defined by the DSM-V criteria for PTSD increased the odds of being prescribed five different classes of psychiatric medication. Conclusion: Trauma exposure both with and without co-occurring mental health conditions was associated with higher reliance on psychotrophic medications. The clinical implications of these patterns remain unclearly delineated. The cross-sectional correlation analyses relied upon in this study precluded meaningful onferences regarding the causality and/or directionality of these relationships.

Background: Neuroleptic malignant syndrome is a life-threatening complication that can occur anytime during antipsychotic treatment. Objective: The present assessment has probed the incidence and clinical profile of neuroleptic malignant syndrome among a sample of non-western psychiatric patients and compared with the available data in the literature with regard to prevalence and other associated clinical physiognomies. Methods: As a retrospective, record-based evaluation, all cases with diagnosis of neuroleptic malignant syndrome during the last sixty-two months, after ruling out other imaginable differential diagnoses, like encephalitis, meningitis and serotonin syndrome, entered the present investigation. Clinical diagnosis, was in essence also based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. The assessment of independent variables was analyzed by ‘Compression of proportions’. Statistical significance is, defined as p value ≤0.05. Results: Among 19814 psychiatric patients, during a sixty-two months’ period, eighteen cases received the diagnosis of neuroleptic malignant syndrome. The most prevalent symptom was fever, which was observed in 100% of cases. Also, there was no significant difference between the first generation versus second-generation antipsychotics. Neuroleptic malignant syndrome was meaningfully more prevalent among male patients suffering from schizophrenia. Similarly, it was significantly more widespread amid 18-65 years old agegroup. Conclusion: While no significant difference was found between first-generation as opposed to second-generation antipsychotics, neuroleptic malignant syndrome was significantly more prevalent among young and male patients suffering from schizophrenia.

Objective: Herbal formulations based on plants are effective against psychosis. The effects of Dhatryadi Ghrita on Wistar rats against psychosis were investigated. Background: An increased preference nowadays is obvious towards the use of herbal drugs in the treatment of chronic ailments. Treatment of psychiatric diseases has become easier, but the extrapyramidal motor disorders are the major adverse effect exists with most of the antipsychotic drugs. Methods: For the assessment of neuroleptic activity of the ethanolic extract of Dhatryadi Ghrita, prepared with different antipsychotic animal models, three doses of the extract (100, 200 and 300 mg/kg) were used for the study with different animal models. Results: A significant reduction of amphetamine-induced stereotype and conditioned avoidance response was observed in the extract-treated animals compared to control. Minor signs of catalepsy were visible in the extract-treated group as compared to the control group. Conclusion: The study revealed that the extract may be possessing the property to alleviate the positive symptoms of Psychosis.

Background: Antipsychotic drugs, mood-stabilizers, and sedatives are used routinely to treat acute mania, sometimes in combinations, most of which are poorly evaluated for efficacy and safety. Objective: We report a case of sudden death in a 40-year-old man with acute mania treated aggressively with combinations of drugs that resulted in in potentially toxic, high serum drug concentrations. Methods: After the autopsy, analysis were conducted to determine levels of the administered medications using GC-MS and LC-MS/MS. Results: Although dosed within recommended ranges, circulating concentrations of some antipsychotic drugs given were excessive, suggesting possible pharmacokinetic interactions. In particular, valproate may have increased serum levels of haloperidol, clozapine, and promazine. The proposed cause of death was cardiac arrest, to which the high concentrations of antipsychotics may have contributed. Conclusion: This case suggests caution in the aggressive treatment of mania with combinations of psychotropic drugs and highlights the need of further clinical studies to identify consequences of drug-drug interactions of antimanic drugs, even when given at recommended doses.