Current Psychiatry Reviews - Volume 11, Issue 4, 2015

The misdiagnosis of bipolar disorder is widely prevalent as evidenced by patient surveys, administrative claims data and studies measuring clinicians’ diagnostic accuracy. The consequences of a missed or incorrect bipolar disorder diagnosis can have serious short and long-term repercussions for a patient. In this review, a systematic analysis was conducted of over-diagnosis and under-diagnosis rates calculated from all adult bipolar studies comparing patient reported diagnoses with diagnoses resulting from DSM-IV based structured assessments/checklists. Five of the 368 publications were selected using OVID medline and demonstrated under-diagnosis rates of 30-51% and over-diagnosis rates of 12-13%. These results contrast with earlier publications suggesting over-diagnosis of bipolar disorder occurred more frequently than under-diagnosis. An in-depth discussion of the various mechanisms contributing to the over and under-diagnosis of bipolar disorder are provided. These include limitations in the design of structured research interviews, racial bias, and patients’ memory impairment, to name a few. In this manuscript the authors also provide recommendations to improve the diagnosis of bipolar disorder and discuss the implications of bipolar spectrum research on the diagnostic process.

Sleep disturbance is of considerable interest to researchers in bipolar disorders (BD) and clinicians are increasingly aware of the impact of sleep disruptions on the course of BD (prediction of relapse) and treatment selection (sleep problems are frequently medication-refractory). The aim of this paper is to synthesize the data on the nature and prevalence of sleep problems in euthymia as observed by clinicians and reported by their patients and to explore the potential influence of study design on research findings in BD. A literature search identified 11 publications that included (i) euthymic cases and (ii) reported the prevalence of self- or observer-rated sleep problems. Study samples included from 20 to >700 euthymic BD cases, and about 60% of studies included a comparison group. Broadly conceptualized ‘sleep problems’ were reported in >50% of the BD cases on average, but specifically defined sleep disorders such as insomnia were reported in about 20% BD cases. This review highlights that sleep disturbances are a major clinical issue in BD even in individuals who are currently euthymic. The reported rates of insomnia and hypersomnia may indicate disturbances in the arousal or circadian systems may be key factors in increasing the rates of sleep difficulties. However, there were only a few high quality clinical studies that report self- or observer-rated prevalence data, and so developing consensus on definitions of different sleep problems in BD or greater application of the criteria used in sleep and circadian rhythm research would be potentially useful steps to allow greater cross-study comparisons of findings.

Literature review on bleeding complications in the course of treatment with antidepressants is presented. We have focused on elderly patients since they are in the high-risk group. Incidence of bleeding complications, causal relation with antidepressants, possible risk factors and methods of prevention are discussed. Presented data indicate that treatment with antidepressants of serotonergic mechanism of action is associated with an increased risk of bleeding complications, which are the most frequent in patients treated with SSRIs, venlafaxine, trazodone and tricyclic antidepressants. The lowest risk is associated with agomelatine, bupropion, reboxetine and mirtazapine. Due to possible serious consequences of bleeding complications, clinicians should consider individual risk factors when choosing antidepressive treatment, particularly in elderly patients.

Background: Specific phobias are common across the lifespan. Although exposure-based therapies have the most evidence of efficacy, reviews have cautioned that evaluations of some interventions are limited in number and have pointed to the need for more research. Furthermore, several permitted the inclusion of non-randomized clinical trials or samples exhibiting elevated fear but not necessarily a full diagnosis. We sought to update the literature on the empirical support of psychological treatments for specific phobias in adults through the selection of studies that met stringent criteria along with application of the system developed by Chambless and Hollon [1998: J Consult Clin Psychol 66: 7-18], which had not in isolation been done so previously. Methods: Electronic searches of the PubMed and PsycINFO databases were conducted in February 2014 to identify suitable randomized clinical trials. Thirty-eight met our inclusion criteria. Results: In vivo exposure was the most researched psychological therapy and found to be efficacious and specific. The evidence for virtual reality exposure was less strong though it had a similar level of empirical support. Several other therapies, including applied tension for blood phobia, were found to be possibly efficacious pending replication by other groups. Conclusions: Exposure-based therapy is the optimal treatment for specific phobias, but several gaps remain in the literature. Most studies investigated interventions for spider phobia. More clinical trials conducted by independent research teams are needed on therapies for other subtypes. There is a dearth of literature on the treatment of phobic disorders in older adults and medically unwell patients. This needs to be a priority on research agendas since we have an aging population. Moreover, failure to address blood-injection-injury phobia in a timely manner in patients who are under the care of medical services may affect adherence to recommendations and lead to a deterioration in health.

Perception of facial features is crucial in social life. In the past decades, extensive research showed that the ability to perceive facial emotion expression was compromised in schizophrenia patients. Given that face perception involves visual/cognitive and affective processing, the roles of these two processing domains in the compromised face perception in schizophrenia were studied and discussed, but not clearly defined. One particular issue was whether face-specific processing is implicated in this psychiatric disorder. Recent investigations have probed into the components of face perception processes such as visual detection, identity recognition, emotion expression discrimination and working memory conveyed from faces. Recent investigations have further assessed the associations between face processing and basic visual processing and between face processing and social cognitive processing such as Theory of Mind. In this selective review, we discuss the investigative findings relevant to the issues of cognitive and affective association and face-specific processing. We highlight the implications of multiple processing domains and face-specific processes as potential mechanisms underlying compromised face perception in schizophrenia. These findings suggest a need for a domain-specific therapeutic approach to the improvement of face perception in schizophrenia.

Metabolic Syndrome (MS) is a commonly encountered clinical problem in Persons Living with Mental Illnesses (PLMI). Persons Living with Mental Illnesses have a preponderance to develop MS due to many factors. Various psychiatric disorders like Schizophrenia, Bipolar Affective Disorders, Unipolar Depression (Severe Mental Illnesses) are found to be associated with occurrence of MS, irrespective of treatment status. Metabolic abnormalities and MS may be a precursor to development of full-blown disorders like diabetes mellitus, hypertension and its associated complications at large. All the parameters of MS are not commonly studied; however weight gain is more commonly studied in PLMI population. There is a need felt to study further the occurrence of MS in PLMIs getting various psychotropics for its better understanding and management.

In this review, we summarize the current knowledge of neurocognitive mechanisms in depression and their fundamental theories. We first introduce follow-up studies and biomarkers of cognitive impairment in depression, and then we review important findings in depression research across major psychological function domains, including memory and executive function. We focus on research regarding the neurobiological correlates of cognitive impairment in depression. Next, we review several psychological models that may explain how cognitive impairment is related to depression. Finally, we review the underlying neural, vascular, and integrated biological mechanisms underlying cognitive impairment and depression.

The article reviewed recent studies on life style and pharmacological treatments of obesity in patients with psychiatric disorders, by examining metaanalysis studies and studies that were not included in the meta-analyses. Dietary and behavioral treatments appear to be modestly effective. As for pharmacological treatments, evidence is strongest for augmentation treatment with metformin and topiramate. Switching of antipsychotic is another option, although there is risk of worsening psychiatric symptoms. Barriers and ways to overcome the barriers to implementing the various evidence-based interventions are discussed. The article proposes an algorithmic approach to management of obesity in patients with severe mental illness.