Current Psychiatry Reviews - Volume 5, Issue 2, 2009

The baby boom generation is approaching the age of greatest risk for cognitive impairment and dementia. There is growing interest in strategies to modify the environment in midlife to increase the probability of maintaining cognitive health in late life. Several potentially modifiable risk factors have been studied in relation to cognitive impairment and dementia in late life, but methodological limitations of observational research have resulted in some inconsistencies across studies. The most promising strategies are maintaining cardiovascular health, engaging in mental, physical, and social activities, using alcohol in moderation, abstaining from tobacco use, and following a heart-healthy diet. Other factors that may influence cognitive health are occupational attainment, depression, personality, exposure to general anesthesia, head injury, postmenopausal hormone therapy, non-steroidal anti-inflammatory medications, and nutritional supplements such as antioxidants. Some long-term observational studies initiated in midlife or earlier, and some randomized controlled trials, have examined the effects of specific cognitive health promotion behaviors in midlife on the risk of cognitive impairment in late life. Overall, these studies provide limited support for risk reduction at this time. Recommendations and challenges for developing effective strategies to reduce the burden of cognitive impairment and dementia in the future are discussed.

Migraine is a common disorder in the general population, and has been found to be associated with depression, bipolar disorder, in particular bipolar II, and panic disorder. In patients with unipolar depression migraine may represent a bipolar spectrum trait. Migraine with aura seems to have a stronger relation to psychiatric disorders than migraine without aura, but probably only in women. In migraine patients there is evidence for hyperexcitability of the cerebral cortex, and also for involvement of the brain stem during acute attacks. The direct pathophysiological mechanism behind aura symptoms probably is cortical spreading depression. Inflammatory mechanisms seem to be involved in the generation of pain. Inflammatory processes are also involved in the pathophysiology of mood disorders, and in both migraine and in mood disorders there are alterations in monoaminergic and glutaminergic neurotransmission. Some pharmacological treatments are common to both disorders, such as tricyclic antidepressants and valproate. In a rare form of migraine, familial hemiplegic migraine, mendelian inheritance occurs. Point mutations have been found in genes coding for calcium and sodium transporters, and sodium-potassium ATP-ase, causing excessive extracellular levels of glutamate and potassium. These discoveries pave the way to the possibility that some forms of mood disorders may be ion channel disorders.

Although overweight is undesirable from both public and personal health perspectives, the focus of this paper is on exploring the nature of fat prejudice within a social cognition framework. Fat prejudice refers to the tendency to form judgments about people on the basis of excessive body weight. Body size has been described as one of the few personal attributes considered an acceptable target of prejudice, despite the fact that targets of fat prejudice experience significant psychological distress. Fat prejudice is likely to become an increasingly common psychosocial problem in light of the obesity epidemic that is currently affecting many countries. The current paper reviews findings from nineteen experimental studies of implicit anti-fat attitudes; these studies have used either the implicit association test or the affective priming task. The empirical data highlight that implicit anti-fat attitudes are widely held and relatively universal. Robust implicit anti-fat bias is evident among many groups including university students, members of the general public, health professionals, and among those who are themselves overweight or obese. The current data suggest that, similar to findings with other attitudinal objects, the relationship between implicit and explicit measures of anti-fat attitudes is complex. The possibility of changing implicit anti-fat attitudes, either by modifying the underlying associative structures or by altering the pattern of activation, is discussed. Avenues for future research are offered, keeping in mind the challenge of formulating appropriate public health messages whilst also challenging weight bias, and promoting acceptance of diversity in body size.

This review presents recent evidence of a differentiation in the field of melancholic depression into two subcategories: Highly anxious-retarded depression and depression with above-normal plasma vasopressin (AVP) concentration. This differentiation has been enabled by the use of multidimensional structures of psychopathology, character and temperament, and different vasopressinergic parameters. Melancholia was multi-dimensionally redefined as the highly anxious-retarded subcategory. This subcategory was subsequently validated by relations with the character trait of low Self-Directedness, late remission, correlating vasopressin (AVP) and cortisol concentrations, and a positive family history of depression. The other subcategory, with above-normal plasma AVP concentration, related significantly with familial depression, and was further validated by correlating AVP and cortisol concentrations, the character trait of low Cooperativeness, a state-dependent reduction of the temperament of Reward-Dependence, and correlating anxiety and retardation scores. These data suggest that increased responsivity of the vasopressin V1b receptor is involved in the highly anxiousretarded subcategory, and genetically increased release of AVP, stimulating V1a and V1b receptors, in depression with above-normal plasma AVP. The multilevel and multidimensional clinical description may be useful in other fields of psychiatry.

Late-life depression is the most common mood disorder in the geriatric population. Often encountered in the primary care setting, geriatric depression needs to be appropriately diagnosed and differentiated from medical conditions that can mimic it or present with mood symptoms. This review will help psychiatrists and primary care physicians to screen for, identify possible medical confounders, and treat depression in the elderly. Untreated major depression may lead to increased morbidity and mortality from medical illnesses, and is the strongest risk factor for late-life suicide. Pharmacological approaches should be used in combination with psychotherapies, several of which have solid evidence in geriatric depression.