Current Psychiatry Reviews - Volume 12, Issue 3, 2016

Adaptive behavior (AB) is defined as the skills acquired in response to everyday life demands. AB profiles of genetic syndromes have been proposed, but the literature on them has not been conclusive, mainly due to the large number of these syndromes and marked within-profile variability. The aim of the present study was to analyze the different ABs observed in subjects with Williams-Beuren Syndrome (WBS), Down Syndrome (DS) and Autistic Spectrum Disorder (ASD) through a literature review using the PubMed and Scopus database. The results indicated that Socialization strongly affects WBS; however, this group demonstrated the greatest amount of difficulty in the domain of daily living. The DS group demonstrated better performance in Socialization and Daily Living compared to Communication. The ASD group displayed better performance in Daily Living and Communication and the worst performance in socialization. Although the reviewed studies appear to demonstrate controversial results related to how ABs occur in each group, the main skills and shortages remained similar to each corresponding diagnostic behavioral characteristic. We conclude that it is possible to build AB profiles in the analyzed diagnostic groups, and we believe that these profiles may facilitate the construction of intervention plans.

Previously, it has been demonstrated that the slow wave sleep(SWS) functioned to adjust the emotional balance disrupted by accumulated emotional memories, while the rapid eye movement(REM) sleep played the opposite role. Many observations have demonstrated that the REM sleep processes emotional memories, while often disrupts the emotional balance toward depression, consistent with the conflict of learned memories against disinhibited drives in dreams in Freudian psychoanalysis. In contrast, extensive evidences have demonstrated the role of SWS against depression, while it was recently reported SWS in favor of long-term depression(LTD) rather than long-term potentiation(LTP), which are both contrary to that of REM sleep and supplement a new half story on emotion and memory from SWS neglected by Freudian psychoanalysis. Besides, differentiation of the noradrenergic and serotonergic activities in waking and sleep would result in the respective differentiated conscious and subconscious conflict of memory and emotion in psychoanalysis. As aversive learning occurs more frequently for most individuals in environments, when extending such results from depression to mania, it is necessary to be cautious and to wait for more investigations. Review of progressions in sleep, memory and depression would help support, revise and extend both theory and therapy of Freudian psychoanalysis.

While in current years the association between psychiatry and psychotherapy has turned into a conflicting one, the swing of the pendulum toward biological psychiatry has led, in general, to a downgrading of psychotherapy within the realm of psychiatry. So, the question of whether or not psychiatrists should continue to learn and carry out psychotherapy is now a much discoursed topic in psychiatric groups. Encouragement of current psychiatrist residents, for using psychotherapy in the course of managing patients who are suffering from psychiatric complications, in the setting of present educational attitudes, though its exercise on the whole has an unpredictable state among specialists, has instigated essential modification in the modern academic national programs in different countries, involving developing societies. In the current paper the real situation and prospect of such a modification have been debated to realize that whether simple adding of a curriculum can respond appropriately to growing mental requirements of evolving cultures, and how the genuine exercise of organized and methodical approaches of psychological treatments by psychiatrists, besides official but frequently imperfect training in the course of scholastic programs, can be improved. Also, the rationality and attainability of such expectation have been talked over.

Background: Semi/Structured interview measures of psychotic symptoms are often translated for use in non-English speaking populations. These vary widely in quality and reported psychometric properties. Objective: The evidence for the reliability and validity of translated measures is systematically reviewed using identified quality criteria. Method: Studies were identified through systematic searches of PsychINFO, Medline, Embase with follow-up manual searches. Only studies published in English were included. Results: Twenty three studies utilising 11 different semi/structured interview measures were identified. Ten studies reported adequate psychometric properties of the translated measures. Nine had mixed reports and 4 reported poor psychometric properties. European languages (Italian, Spanish, German and French) are well represented, together with reasonable availability for Japanese and Chinese (Mandarin and Cantonese). Conclusion: This review highlighted a large gap in published research of translated measures for psychosis—though this is a rapidly changing field. Many cultures and languages are omitted (particularly non-European), or may face difficulties with semantic equivalence.

The neuronal synaptic action potential is still considered the basic unit of signaling in the brain underlying mental states, behavior and psychiatric disorders. However, exponentially deepening and mind boggling progress has been made during the last 30 years in the molecular and cellular understanding of what drives action potentials. The classical “synaptic relay model” of the action potential is now considered to be a special, minor case, most relevant to “machine-like” mentation and behavior. Volume transmission, not involving synapses, but certainly driving neuronal action potentials, is now understood to be far more prevalent, complex, and more relevant to “soul-like” mentation and behavior. Only a few very brief or highly technical accounts of this scientific revolution have been published specifically for psychiatrists despite the fact that psychiatry is the discipline most likely to gain in the short term, with neurology following more in the long term. We review here what we think are the most relevant aspects of extrasynaptic signaling for psychiatry in a manner we hope is most useful and enlightening for practicing psychiatrists.

Background: Many patients with major depressive disorder (MDD) do not respond adequately to first-line antidepressant treatment (ADT). Adjunctive treatment with second-generation antipsychotics has demonstrated efficacy for patients with MDD, but is limited by tolerability and safety issues. The recently introduced serotonin-dopamine activity modulator, brexpiprazole, has demonstrated efficacy as an adjunctive treatment for MDD. Objective/Method: We report tolerability and safety results for adjunctive brexpiprazole from four 6-week short-term (ST; pooled phase 2 and 3, placebo-controlled) and two 52-week long-term (LT; pooled, openlabel) studies. Results: Approximately 90% of patients completed the ST studies, and 48.8% of patients completed the LT studies. In the ST studies, 2.9% of patients discontinued because of an adverse event (AE); in the LT studies, 14.1% of patients discontinued because of an AE. In the ST and LT studies, the most frequently reported treatment-emergent AEs (TEAEs) were akathisia (8.6% and 10.0%, respectively) and weight gain (7.3% and 25.5%, respectively). Rates of sedation and somnolence were low (ST and LT: sedation, 0.8% and 3.7%, respectively; somnolence, 3.4% and 9.4%, respectively). In the ST and LT studies, brexpiprazole was associated with small changes in metabolic parameters and moderate weight increase. Conclusions: Collectively, these data suggest brexpiprazole is well tolerated as an adjunctive treatment for MDD.

Objective: To summarize efficacy data from two phase 2 and two phase 3 short-term, multicenter, randomized, double-blind, placebo-controlled studies of brexpiprazole adjunctive to antidepressant treatments (ADTs) in patients with major depressive disorder (MDD) with inadequate response to ADTs. Methods: Patients with MDD who were inadequate responders to 1–3 prior ADTs entered an 8-week single-blind prospective treatment phase on physician-determined ADT. Patients with inadequate response throughout the prospective treatment phase were randomized to receive either placebo or brexpiprazole (phase 2: flexible dosage 0.15–3.0 mg/day; phase 3: fixed-dosages 1, 2, or 3 mg/day) as adjunctive treatment to their ADT. The primary endpoint was change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to week 6. Results: Phase 2 studies suggested brexpiprazole doses of 1–3 mg/day were effective as an adjunctive therapy. These observations were confirmed across the two phase 3 studies utilizing a pooled placebo group versus brexpiprazole 1, 2, and 3 mg/day and a pooled analysis of all four studies (brexpiprazole 1–3 mg/day). Greater improvements were observed in MADRS total score with brexpiprazole+ADT versus placebo+ADT (1 mg/day, p<0.01; 2 mg/day, p<0.01; 3 mg/day, p<0.001; brexpiprazole 1–3 mg/day, p<0.0001). Conclusion: Adjunctive brexpiprazole is an efficacious treatment option for patients with MDD and inadequate response to ADT. ClinicalTrials.gov: NCT00797966; NCT01052077; NCT01360632; NCT01360645.