Current Psychiatry Reviews - Volume 5, Issue 1, 2009

In 1992, a comprehensive review of all previous studies comparing patients suffering from psychotic major depression (PMD) to non-PMD patients was published. In this review we present data of all studies comparing PMD patients to non-PMD published in the English language after 1992. The research papers reviewed have shown the following general profile of PMD: the point prevalence of PMD is about 0.4% and 19% of patients with a major depressive episode had psychotic symptoms as well. PMD was found to be a more severe form of depression with more feelings of guilt and more pronounced psychomotor disturbance. Additionally, PMD patients compared to non-PMD were found to be more severely impaired in the cognitive domains of attention, psychomotor speed, executive function and memory, regardless of depression's severity. As regards to the prognosis of the disorder, PMD is associated with poorer short-term outcome; nevertheless, in the long-term period (> 2-5 years) the prognostic significance of delusions in major depression tends to become weaker. However, the recurrence of psychotic episodes in PMD patients suggests that PMD runs “true to form”. Of note, young PMD patients with acute onset of the disorder are at greater risk to develop bipolar disorder. Furthermore, PMD was associated with greater HPA abnormalities, higher plasma cortizol levels during the afternoon, lower serum D H activity than age-matched non-PMD patients and healthy controls. In addition, more brain atrophy and paralimbic abnormalities may play a crucial role in the delusion formation. With respect to management of PMD, starting with a combination of AD plus AP or AD as monotherapy may be preferred. Nevertheless, methodological problems in studies on SSRIs as monotherapy and according to recent data -favoring the combination over AD monotherapy- the AP plus AD treatment regime takes precedence.

Introduction: Although anxiety is a common psychiatric complication of Parkinson's disease (PD), it has received little attention compared to depression in PD, being still an under-recognized and under-diagnosed condition in clinical practice. Objective: To review general aspects of the association between anxiety and PD concerning prevalence, etiopathogenesis, clinical characteristics, comorbidities, and treatment. Method: The basic and clinical literature on anxiety and PD was reviewed via the Pubmed, Lilacs and Scielo indexing services, using the keywords anxiety, etiology, prevalence, treatment, Parkinson, and Parkinson's disease. Moreover, complementary information was extracted from the reference lists of the articles found in the search. Results: Up to 67% of PD patients present clinically significant anxiety levels. Oscillations in anxious symptoms may be related to the use of anti-Parkinson drugs and motor fluctuations. The association between anxiety in PD and depressive disorders sleep disturbances, and cognitive impairment has also been proposed as a possible explanation for this psychiatric complication. Thus far, few data on the treatment of anxiety disorders in PD are available. Conclusions: More studies investigating aspects such as prevalence, etiopathogenesis, comorbidities, impact on life quality, and treatment are necessary and opportune in order to facilitate the recognition and diagnosis of anxiety disorders in PD.

This article: (1) describes and reviews evidence for hypothesized biological and psychological mechanisms of winter seasonal affective disorder (SAD), (2) advocates for an integrative approach to studying SAD etiology that incorporates both biological and psychological mechanisms, and (3) delineates areas for future research from an integrative perspective. Exciting progress has been made within sub-paradigms testing candidate biological mechanisms (i.e., biological rhythm abnormalities, retinal subsensitivity to light, neurotransmitter alterations, and genetic variations) and psychological mechanisms (i.e., maladaptive cognitions and behaviors) of SAD. However, research from an integrative biological/ psychological perspective is currently lacking. In contrast to a continued exclusive focus on micro-models, we argue that an integrative approach would maximize the capacity to predict and understand the onset, maintenance, and course of SAD. An integrative approach also provides a comprehensive theoretical framework for developing strategies to effectively treat acute SAD, maintain acute treatment gains throughout the winter, and prevent future episodes of this highly recurrent form of depression.

Patients with Borderline Personality Disorder (BPD) experience intense emotions and show a deficient repertoire of emotion regulation skills at the same time. Moreover, they display high prevalence rates of self-injurious behavior, which they report to engage in due to its effect of immediate relief of emotional tension. Exploring the mechanisms behind these core symptoms, we review previous research indicating that BPD is characterized by a specific pattern of emotion dysregulation, manifested in hyperreactivity of limbic structures (bottom-up processes) paralleled by deficient prefrontal control mechanisms (top-down processes). This issue will be integrated into existing theories of emotion regulation. As a novel aspect in this field, we provide an overview of the interaction between somatosensory pain and affect regulation. According to our own research it can be assumed that patients with BPD show reduced pain perception compared to healthy controls, which is caused by an alteration of the affective-motivational pain component rather than sensorydiscriminative deficits. By virtue of the discussed findings we reason that self-injurious behavior may compensate for a lack of emotion regulation strategies by causing an attentional shift away from unwanted emotions. Finally, open research questions which can be derived from the theoretical considerations will be briefly discussed.

Objective: To review the literature regarding the occurrence of obsessive-compulsive disorder (OCD), obsessive- compulsive symptoms (OCS), and related personality traits in Parkinson's disease (PD). Methods: A PsycInfo, Medline, Embase and Lilacs search of English, French, Spanish and Portuguese-language publication was conducted. The search terms used were Parkinson's and any of the textual words: obsessive, compulsive or personality. Some of the terms were also truncated to improve the search sensitivity. Data concerning personality traits in PD were also considered. Results: The literature concerning OCD, OCS and a particular “parkinsonian personality” in PD is still contradictory. One of the main problems identified was the diversity of instruments used to assess obsessive-compulsive symptoms or traits. However, some studies have highlighted the correlation of motor symptoms asymmetry and specific OCS or personality traits. Other relevant data of the selected studies are also presented and discussed. Conclusion: The available data have critical methodological problems. Although it is well known that PD and OCD share dysfunction of the frontostriatal circuitry, the relationship between them has to be confirmed.

Body image disturbance has been listed as a diagnostic feature of several psychopathological conditions [1-5]. As body image concerns appear in children as young as 5 years old, it was hypothesized to be an important risk factor for the development of psychopathology, such as Eating Disorders (ED) in adolescence. Results of the current review of the literature support this hypothesis and suggest that young children can (1) estimate as accurately as adults their body size, and (2) show similar cognitive distortions, cognitive biases, and the negative emotions associated with their body image. There is some evidence that children can (1) display severe symptoms of body image distortion such as is present in body dysmorphic disorder (BDD), (2) demonstrate negative stereotypes toward obesity and (3) internalize thin ideal body image. Research suggests that some of the key factors involved in children's body satisfaction is parental perception and direct comments from peers. Body dissatisfaction can predict body image related psychopathology later in development. In conclusion, intervention and prevention of eating disorders with children under the age of 7 is arguably a viable strategy, and cognitive and behavioural training could involve parents, teachers, mental health practitioners as well as the child him/herself. This training and education should cover early manifestation of body image disturbance and their associated risk factors.