Current Psychiatry Reviews - Volume 13, Issue 1, 2017

Background: Heart transplantation in children has revolutionized the care of young patients with congenital and acquired heart disease, with considerable improvements in survival and quality of life. Heart transplantation is now being offered as a potentially life-saving option to pediatric patients with many cardiac conditions, and yet the major limiting factor remains the lack of suitable donor hearts. Requirement: Transplant teams and UNOS (the United Network for Organ Sharing) must attempt the formidable task of balancing the needs of an individual patient with a responsibility to determine the best use of a donor heart and promote equitable donor allocation. These issues become even more salient when the transplant candidate is a child with intellectual disability (ID) or neurodevelopmental delay (NDD). In this paper, we review the literature on the clinical practice and ethical considerations surrounding heart transplantation in children, with a focus on those with ID or NDD. We also review our experience at a major center for pediatric heart transplantation.

Purpose: To offer a uniform framework for the participation of psychiatrists and mental health professionals involved in the multidisciplinary evaluation leading to decision about listing patients for organ transplantation. Method: Literature review of evidence regarding the impact of psychiatric disease upon post- transplantation outcomes; literature review and opinion review regarding psychological implications of decision to list or decline from organ transplantation for patients, family and medical staff. Results: The authors propose three areas of knowledge which can help the mental health professionals who participate in the decision to list or decline patients from listing for organ transplantation. The first area consists of the body of knowledge regarding the impact of psychiatric illness upon medical outcomes post transplantation. A second domain consists in structural and administrative factors related to the transplant program. Third area of interest is represented by the psychodynamic implications of the decision about listing upon patients, family and medical staff. These areas are discussed based on the existing literature and author’s experience. Conclusion: In addition to the psychiatric evaluation of the transplant candidate, psychiatrists can help the transplant teams with the difficult process of declining from listing.

Background: The epidemics of obesity, diabetes and hypertension as well as the high prevalence of Hepatitis C are the major contributors to end stage organ disease. Transplantation is the definitive cure for end stage organ failure. There is a high prevalence of depression, anxiety and substance abuse in transplant candidates and their caregivers. Integrating behavioral health into a transplant program helps to identify psychosocial problems, promotes treatment of these underlying conditions and improves outcomes. Objective: The goal of the article is to describe one institution’s embedded multidisciplinary psychosocial program for transplant patients.

Background: Paranoid personality disorder refers to an extensive and enduring psychosocial dysfunction typified by a penetrating pattern of manifestations like hypersensitivity, selfreference, and mistrust. Even though it is continuously represented in DSM and ICD, its diagnostic status has been intermittently questioned. Objective: Provide a brief review on paranoid personality disorder with particular emphasis on sociodemographic characteristics, psychopathology, and course. Method: Literature review. Results: While research suggests that the disorder is not rare in the community, the diagnosis is comparatively seldom made in psychiatric hospital. But if so, the characteristic patient is a young-tomiddle- aged male. Co-morbid mental disorder and depressive symptoms habitually appear and full blown paranoid symptoms sometimes may supervene. However, the presence of, for example, another schizophrenia spectrum disorder or primary organic illness should be ruled out. Usually the course is chronic, and there may be difficulties with staying in the labor market. Management is challenging and must address the pervasive paranoigenic mechanisms and extreme behavior. Although scientific support is limited, psychotherapy and possibly psychopharmacological agents may be treatments of choice. Conclusion: The concept of paranoid personality disorder has received a substantial scientific support though research is needed, perhaps most of all, to inform future diagnostic measures and care recommendations.

Background: The increasing number of people living with Alzheimer’s disease (AD) constitutes a growing global concern. At present, nearly 44 million people suffer from AD worldwide, and these numbers are expected almost to double every 20 years. Given its high prevalence and growing incidence, AD is one of the top causes of disabilities in later life, and this takes an enormous toll on the caregivers. Importance: It is tremendously important to explore new ways of understanding AD, as this may improve the management of this growing medical, socio-economic, and public health care burden. Conclusion: Evidence suggests that AD may evolve through the unique process of ‘retro-genesis’; a decline that mirrors, in reverse order, brain development that occurs from birth. The retro-genesis hypothesis distinguishes distinct stages, each one linked to levels of cognitive functioning in developing children. The understanding of clinical correlations and practical applications of retrogenesis theory may help caregivers to recognize different stages of AD, and to provide better care with less burden.

Background: Accurate prediction of a suicide attempt is a difficult task for clinicians. Inflammatory processes can explain, at least partly, suicidal symptoms such as agitation, anhedonia and hopelessness. Inflammation leads to secretion of mediator proteins, amongst which interleukin-6 (IL6) and arginine vasopressin (AVP) are of particular significance. The levels of both proteins can be monitored in blood. Consequence: Increases in circulating IL6 can also be monitored as C-reactive protein levels, or as soluble IL6-receptor levels. IL6 in the brain increases the activity of the hypothalamic-pituitaryadrenal axis (HPA), and the activity of the L-tryptophan-degrading enzyme indoleamine 2,3- dioxygenase. Inflammation diminishes the levels of tetrahydrobiopterin (BH4), a cofactor for the synthesis of serotonin (5HT), noradrenaline and dopamine. The loss of BH4 can be monitored as an increase in neopterin. The synthesis of 5HT is not only affected by the diminished availability of BH4, but also by an increase in L-tryptophan metabolism. This can be monitored directly in a test with C13-labeled tryptophan, or indirectly by lower output of the metabolite 5-hydroxy-indole acetic acid, by lower circulating tryptophan levels and by a decrease in central melatonin synthesis. Putatively, insufficient levels of serotonin may result in a defective stimulation of aldosterone from the adrenal cortex. Central IL6 and AVP activate the HPA axis in a way that escapes the feed back inhibition by dexamethasone (non-suppression, quantified by high circulating levels of cortisol). Conclusion: It is assumed that a combination of these biomarkers could improve the recognition of an impending suicide act.

Background: Sex differences are observed in schizophrenia, with women exhibiting an overall better disease outcome, leading to the estrogen hypothesis of schizophrenia that postulates a protective role of estrogen against the development and severity of the disorder. Estrogen (17β- estradiol) is a sex steroid hormone; its primary mechanism of action is via binding to estrogen receptors and initiating gene expression. While there has been significant attention placed on the impact of estrogen in schizophrenia, less is known about the importance of estrogen receptors in schizophrenia. Description: This narrative review describes estrogen receptor subtypes including the distribution of these receptors in the brain, with a particular focus on the two main subtypes: estrogen receptoralpha (ERα, or ESR1) and -beta (ERβ, or ESR2). A highlight of this review is the description of previous research about estrogen receptors in schizophrenia. Given that this literature is limited, particularly with respect to ERβ, we argued for a more considered effort for future studies to further understand the role of estrogen and its receptors in schizophrenia and to further elucidate the mechanisms underlying the therapeutic effect of estrogen and estrogen receptor modulation in schizophrenia. Such an effort may lead to more targeted novel therapeutic approaches as well as enhance our understanding of the sex differences observed in schizophrenia and other psychiatric disorders.

Background: Mental illness affects about 26.2 percent of the people in the United States in a 12 month period and has a life time prevalence of about 46 percent. This implies that a large number of patients depend largely on the emergency services among various other avenues for their mental health needs. This has led to the exploration of utilizing physician assistants, social workers and psychiatric nurses in emergency room in a liaison role to provide mental health services to patients. Description: There are very few studies published to examine the effectiveness of implementing psychiatric liaison nursing in the ED. The studies that are published regarding the use of a psychiatric nurse in a liaison role, describe various conditions like duration, job description and research methodology. It is important to consider the cumulative evidence in this area in a structured manner to enable administrators and managers to understand the positive and negative impacts of this strategy to deal with the increasing need for emergency mental health services. This article is a systemic review of the current evidence about the impact of a psychiatric nurse in the emergency room on various parameters such as patient satisfaction, staff perception and efficacy indicators.