Current Psychiatry Reviews - Volume 2, Issue 3, 2006

Objective: We conducted a comprehensive review of the English language literature on the comorbidity of anxiety symptoms/disorders in schizophrenia spectrum disorders (SSDs) in order to determine: their prevalence rates in clinical and non-clinical populations, the temporal relationship of anxiety comorbidity to SSDs, and the effect of comorbidity on outcome. Method: Medline and PsychInfo databases were searched, from 1966 to September 2004 and 1887 to September 2004 respectively. Results: Overall lifetime prevalence rates for any anxiety disorder ranged from 30% to 85% with most studies showing rates higher than in the general population. In more than 50% of patients, the anxiety disorder preceded the onset of psychosis. Patients with comorbid panic symptoms were more frequent service users, had additional comorbidities and were more likely to be suicidal. Comorbid obsessive-compulsive symptoms (OCS) tended to be associated with poorer social functioning, worse cognitive impairment and motor symptoms. Conclusions: There is a clear link between SSDs and anxiety disorders though its nature remains unclear. This has important implications for psychiatric nosology, aetiology and treatment.

Schizophrenic individuals show impairments in language affecting what is referred to as the pragmatic component of language, typically the processing of non-literal language (e.g., irony, metaphor, indirect request). Such non-literal utterances require the ability to process the speaker's utterance beyond its literal meaning in order to allow one to grasp the speaker's intention by reference to the contextual information. This paper gives a selective literature review showing that different cognitive processes-specific to language or not-may underlie the processing of pragmatic aspects of language, and particularly of non-literal language in schizophrenia. Indeed, the fact that many other disorders (e.g., right hemisphere lesion, traumatic brain injury, autism) are characterized by pragmatic impairments may reflect a heterogeneous range of underlying functional deficits that have to be determined. Evidence is reviewed suggesting that cooccurrence of a deficit in non-literal language understanding and a deficit in theory of mind may be accounted for by an impairment in context processing associated with a lack of flexibility.

Attention-Deficit/Hyperactivity Disorder (ADHD), as defined by DSM-IV, is a heterogeneous syndrome affecting an estimated 7% of children. Many will continue to have clinically-significant features of ADHD as adults, although some patients referred to adult psychiatrists have previously-unrecognised ADHD. Studies involving neurocognitive assessments or brain imaging have indicated ADHD-associated brain dysfunctions. An important therapeutic role for drugs such as methylphenidate has been clearly established in children and the benefits of medication for ADHD in adults are being increasingly recognised. The present review is aimed at adult psychiatrists who are considering or managing drug treatments for ADHD in adult patients. The focus is on medication regimes, but relevant 'background' literature is also reviewed, as an awareness of a range of published evidence is necessary when assessing ADHD in adult patients and advising on possible drug treatments.

Tinnitus is an abnormal perception of sound that cannot be attributed to an external source. In most cases, tinnitus is caused by insults to the peripheral auditory system. Tinnitus also displays strong links with negative emotional states such as anxiety. However, the relations of tinnitus with anxiety are still debated. Of particular interest is the question whether the occurrence of tinnitus is, at least partially, consecutive to high level of anxiety, or whether tinnitus is anxiogenic. This review aims to summarize recent knowledge on the fascinating topic of interactions of tinnitus with anxiety. Furthermore, using tinnitus as an example, this review tries to nurture the more inclusive debate on the relation between perception, emotion and memory in human pathologies.

Gender differences in schizophrenia, in the age of onset, course, lifetime risk, age distribution of onsets over the life cycle and clinical symptoms will be reviewed from the literature and our own studies. Also, the pre- and postmenopausal course of illness in women will be explored. Explanations for the gender differences using "normal" behavioural sex differences and the protective oestrogen hypothesis will be discussed. The hypothesis of the "protective" effect of oestrogen is based on findings from animal experiments, epidemiological and clinical studies. Oestrogen acts similarly on D2, 5-HTA2 and NMDA receptors in both the neurochemical and genomic domains. The neuroprotective effects of oestrogen on a genomic and cellular level might also favourably affect degenerative processes in schizophrenia. The lack of a gender difference in age of onset in familial schizophrenia due to a lower age of onset in pre-menopausal, genetically predisposed women strongly suggests an antagonistic balance between predisposition to the illness and the oestrogen effect. Oestrogen treatment plus antipsychotic therapy, compared with antipsychotic therapy alone, accelerates symptom remission in both women and men, thus corroborating the antipsychotic properties of oestrogen. Oestrogen is the only known substance with preventive potential in schizophrenia. However, health risks associated with long-term oestrogen treatment require careful weighing up of risks and benefits for patients. Future efforts to develop oestrogen-like compounds which do not affect breast and uterine tissue must be strongly encouraged.

Shared Psychotic Disorder (SPD) is the development of a delusion in an individual in the context of a close relationship with another who has an existing delusion. SPD has consistently been interpreted from a psychiatric perspective with little regard for the relational component of the sharing of delusions between individuals. We review the epidemiology, etiology, and clinical symptomatology of SPD, together with various theoretical perspectives on the disorder. Treatment options are presented beyond the usual physical separation of the delusional individuals.

Background: Brief definition of rapid cycling is the occurrence of at least four mood episodes in a year. It may be seen in patients with bipolar I, or bipolar II disorder. Rapid cycling bipolar disorder is frequently treatment-resistant. There is need for new, effective medications for the treatment of these patients. Objective: Novel anticonvulsants and newer generation of atypical antipsychotics may offer promising alternative treatment to existing mood stabilizers and other medications available for rapid cycling bipolar patients. Method: A computerized (MEDLINE) search was performed to explore the English-language literature on medications that were studied in patients with rapid cycling bipolar disorder. Bipolar disorder and rapid cycling were used as key words while performing the search. The articles, including in press ones were then searched. Results: Lithium has been a predictor of poor response to rapid cycling in earlier studies, while recent studies have demonstrated equal efficacy of lithium, and valproate. In fact, many available medications are not effective in rapid cycling patients. Lithium, lamotrigine and valproic acid and combination of mood stabilizers are likely the most efficacious treatment regimens among all. Efficacy of atypical antipsychotics in combination with mood stabilizers is noted, but this finding has not been consistent across studies. Conclusions: Combination of mood stabilizers might be more effective than use of other treatment regimens in patients with rapid cycling bipolar disorder. There is need for controlled studies evaluating the efficacy of combinations with different mood stabilizers to establish better treatment approaches.

Depressive symptoms in schizophrenia patients are not usually the primary therapeutic goal, as the psychiatric evaluation of the schizophrenia is generally based in the assessment of the positive and negative syndrome. However, direct approach of the pure depressive symptoms in schizophrenia is of capital importance from both prognostic and therapeutical perspective. This paper reviews the recently published evidence on the treatment of depressive symptoms in schizophrenia patients, with a special emphasis on the efficacy of different pharmacological families. It also includes studies on the antidepressant effect and pharmacological profile of second-generation antipsychotics. Finally, it addresses the possible confusion between depressive and negative symptoms/extrapyramidal side effects of antipsychotic treatment.

Spontaneous recurrence of methamphetamine- or amphetamine-induced paranoid hallucinatory psychosis (i.e., flashbacks) occasionally occurs in response to non-specific mild stress in drug-free patients with a history of methamphetamine- or amphetamine-induced psychosis. Stress sensitization associated with noradrenergic hyperactivity and increased dopamine release may be related to this flashbacks. Stressful frightening experiences as well as fear-related paranoid- hallucinatory states during methamphetamine use may be related to these stress sensitization. Robust noradrenergic hyperactivity with increased dopamine release may predicts subsequent flashback episodes. Schizophrenia-like symptoms (e.g., passivity phenomena, Gedankenlautwerden, and thought disorder such as circumstantiality and egorrhea symptoms) appear to develop related to dopaminergic hyperactivity. One of the dopamine receptor-encoding genes DRD2, TaqIA A1/A1 type, with which reduced density of the D2 receptor is associated, reduces to the risk of development of flashbacks. Stress sensitization has been proposed as a key step in the progression from vulnerability to an overt paranoidhallucinatory states, so that schizophrenia and flashbacks due to previous methamphetamine psychosis shares common underlying mechanisms of stress sensitization. Compared to flashbacks due to previous methamphetamine psychosis, psychedelic drug flashbacks are the recurrence of a perception learned while an individual is experiencing high anxiety levels, and thus recur in anxiety-related situations. Anxiety or fear during drug use is an important factor in the development of flashbacks due to previous methamphetamine psychosis and also psychedelic drug flashbacks. Dopaminergic and glutamatergic neural circuits including the striatum, nucleus accumbens and prefrontal cortex play an important role in the development of psychostimulant-induced long-lasting behavioral sensitization. Immediate early genes expression in the particular brain regions affected by the psychostimulants is involved in this process. Furthermore, recent advances in molecular analysis could shed light on the fundamental mechanism involved, by identifying specific participating molecules such as delta FosB, NAC1, G-protein b1 subunit and methamphetamine-responsive transcript 1b.

Aim: To review the literature on randomized clinical trials for pediatric anxiety and depression, and evaluate their quality using the criteria developed by the American Psychological Association. Method: Inclusion of randomized controlled clinical trials in the medical and psychological literature. Results: Research evidence thus far suggests that CBT is a probably efficacious treatment for depression in children. None of the CBT protocols for depressed adolescents (taken independently) meet criteria for a well-established treatment, however, if the different protocols are taken as an aggregate, then CBT meets well-established treatment criteria. In addition, IPT-A is a well-established treatment for adolescent depression. CBT is the best established treatment for a number of child and adolescent anxiety disorders. Conclusion: While there has been an increase in the number of clinical trials of psychotherapeutic interventions for depression and anxiety as well as support for empirically-based treatments, the scope of these studies is still limited and research is still needed to examine the transportability of these treatments to diverse community settings.