Current Psychiatry Reviews - Volume 14, Issue 2, 2018

Background: In psychotherapy research numerous Randomized Controlled Trials (RCTs) have used Waiting-List Control Groups (WLCGs). The focus was primarily on the treatment effects, the results of the WLCGs were used for comparison only. However, the changes occurring in WLCGs are of interest in themselves. They provide information about the effects of waiting for a treatment, which may be, for example, associated with disappointment or hope for improvement. Furthermore, these results may be used as disorder-specific benchmarks for studies not including WLCGs. For these reasons, a meta-analysis on the effects of WLCGs in panic disorder was carried out. Method: A systematic literature search used the following selection criteria: (1) randomized controlled trial, (2) testing an active treatment against a waiting list condition, (3) primary diagnosis of panic disorder, (4) use of reliable and valid outcome measures. Symptoms of panic were used as the primary outcome. Results: The search led to the inclusion of 29 RCTs (n=1899), covering 30 WLCGs and 48 treatment groups. Mean waiting time was 10.05 weeks. In the WLCGs, the pre-post effect size in measures of panic was g=0.10 (95% CI: 0.024-0.180). Effects on other forms of anxiety, depression and psychosocial functioning were g=0.15, g=0.100 and g=0.14. For the active treatments, large withingroup (g=1.09) and between-group effect sizes (g=0.99) in comparison to WLCGs in measures of panic were found. Conclusion: Only small changes in terms of effect sizes occur in patients with PD waiting for treatment in RCTs.

Background: Schizophrenia is a severe and debilitating mental disorder whose cause is still unclear. It is accompanied by cognitive deficits that are commonly attributed to a dysfunction of the frontal and temporal lobes. Recently, compelling experimental evidence has been collected suggesting a role also for the parietal lobe. Parietal lobe integrates sensory information among various modalities and is engaged in a number of cognitive operations. Objective: To review the existent literature on cognitive deficits present in schizophrenia that show suggestive analogies with deficits that follow lesions of the parietal lobe. Results: Analogies between cognitive disorders related to lesions of the parietal region and those related to schizophrenia were found for visuospatial attention, space representation, motor imagery, sense of agency, praxis abilities, and language. Conclusion: Some specific cognitive deficits present in schizophrenia can be attributed to parietal lobe impairment. This view is also supported by neuroimaging studies showing both structural and functional disorders of the parietal lobe in schizophrenia. Furthermore, being parietal areas functionally interconnected with other brain regions, parietal impairment may also contribute to deficits usually attributed to the dysfunction of other brain regions.

Background: Expressed emotion is a measure of a relative's attitudes and behaviors toward an ill family member. Originally developed and studied among patients with schizophrenia, the construct has been found to be a robust predictor of treatment outcome and relapse across a number of mental and physical illnesses. Objective: This review updates the current literature on expressed emotion and eating disorders. Method: Electronic databases (PsycInfo, PubMed, Ovid) were searched with the search terms “anorexia nervosa”, “bulimia nervosa”, “binge eating disorder”, “eating disorder”, and “expressed emotion” from January 1985 to July 2018. Studies were included in the current review if they were published quantitative studies assessing EE and eating disorders that were not included in a previous review, and were written in the English language. This resulted in 30 studies assessing EE and eating disorders included in the current study. Results: The review highlights the association between parental criticism and treatment outcome, patient and parent characteristics associated with expressed emotion, bidirectional examinations of expressed emotion, how the construct fits in the context of a theoretical model of eating disorders, and development of interventions assessing changes in the expressed emotion. Emerging evidence suggests that even low levels of parental criticism may be associated with poor treatment outcome, perhaps particularly for patients with anorexia nervosa. Conclusion: Drawing on the schizophrenia literature, clinical implications and directions for future research are discussed.

Objective: Magnetic Resonance Spectroscopy (MRS) is a noninvasive in vivo technique extensively applied to assess the levels of neural metabolites in the brain. We aimed to summarize the findings of proton spectroscopy (1H MRS) studies addressing neuro-metabolite findings in the Basal Ganglia (BG) of patients with Bipolar Disorders (BD). Method: A search of PubMed and Ovid databases was conducted to identify ¹H MRS studies since 1990 reporting N-acetylaspartate (NAA), phosphocholine plus glycerophosphocholine (PC+GPC), and creatine plus phosphocreatine (Cr+PCr) levels in the BG of patients with BD. Results: Ten original studies were included in this review. Three studies involved BD patients with depressed mood, six studied euthymic BD patients, and one study looked at manic subjects. In depressed BD patients, three studies reported elevated PC+GPC and Cr+PCr levels in the caudate and putamen. NAA levels were found to be elevated in two of the studies, while one reported no change. In euthymic BD patients, five studies reported no group differences with respect to any metabolites, and one study found differences in PC+GPC/Cr+PCr associated with lithium treatment. In mania, lower PC+GPC, lower NAA levels, and increased Cr+PCr levels were described in the caudate of BD patients compared to HC. Conclusion: This review suggests that abnormalities in NAA, GPC+PC, and Cr+PCr levels in the BG might be associated with mood state among BD patients. In addition, the methodological issues involved in the heterogeneity of 1H MRS findings in BD, as well as the potential role of 1H MRS findings as biomarkers for BD, are discussed.

Background: The bidirectional relationship between psychiatric disorders and immune dysregulation has been increasingly documented. Moreover, most major mental diseases are notoriously associated with higher prevalence of cardiovascular and metabolic comorbidities. C-Reactive Protein (CRP) emerged as a crucial biomarker in the stratification of cardiovascular risk. Objectives: Reviewing the recent literature upon: neuroinflammation in mood and schizophrenic disorders, the potential use of HSCRP as an inflammatory biomarker in psychiatric disorders and its possible use for the stratification of risk. Method: The authors conducted a MedLine/PubMed search of all articles up to January 2017 using five keywords. The search was supplemented with a manual review of relevant references. Evidences assessing the relationship between CRP plasma levels and psychiatric disorders have been reviewed. Result: Elevated High-Sensitivity CRP (HSCRP) plasma levels have been reported specially in mood disorders, mainly in mania and in a subset of patients with Depression. Childhood trauma and suicidal behaviour represent factors that increase illness vulnerability and influence immune responses. The complex interaction amongst immune and endocrine systems, metabolic parameters and psychopharmacological effects enhance difficulty in understanding the directionality of this relationship. Conclusion: The heterogeneity of findings provided by research could suggest the presence of genetically determined or epigenetic factors in a subgroup of individuals who react to stress factors with an inflammatory hyperactivation. HSCRP could represent a useful biomarker to identify patients with greater risk to develop medical comorbidities that could benefit from anti-inflammatory treatments.