Current Psychiatry Reviews - Volume 5, Issue 3, 2009

An endophenotypic approach in the research of major depression (MDD) has the potential to enlarge our understanding of the neurobiology and genetics of this complex disease. It has been suggested that anhedonia and increased stress sensitivity are two of the most promising endophenotypes for MDD. The aim of this article is to evaluate the validity of this hypothesis, based on the criteria necessary for the identification and validation of endophenotypes: specificity, heritability, state-independence, cosegregation, familial association and biological and clinical plausibility. We conducted a review of the most current findings of anhedonia and increased stress sensitivity in MDD, using a survey of clinical, neurobiological, and genetic studies. Both anhedonia and increased stress sensitivity seem to fulfil the criteria for a valid endophenotype in the discussed literature. However, increased stress sensitivity is less specific for MDD and might influence MDD more indirectly, for example via personality or early life events. Recent findings suggest an interaction between the two endophenotypes, hypothesizing that the anhedonia trait combined with stressful life events may result in a vulnerability to MDD.

Objective: To determine whether first episode psychosis (FEP) patients who meet criteria for substance abuse have worse outcomes than FEP patients who do not abuse substances. Method: A systematic literature search was conducted using MEDLINE, PSYCHInfo, Cochrane controlled trial register, and other databases to find prospective studies comparing outcomes for FEP patients with and without substance abuse. Both schizophrenia spectrum and affective spectrum patients were included in the review. Outcomes included positive and negative symptoms, risk of relapse, re-hospitalization, treatment compliance and psychosocial variables. Results: Twelve studies met inclusion criteria. Compared to FEP patients without substance abuse, patients with substance abuse experienced increased positive symptoms in five out of seven studies; increased risk of relapse in two out of two studies; and increased risk of poor treatment compliance in three out of five studies. Only one of six studies examining negative symptoms found a significant association with substance abuse and only one out of eight studies found any associations between psychosocial outcomes and substance abuse. Conclusions: FEP patients with co-morbid substance abuse may experience increased risk of relapse, increased positive symptoms and poor compliance, but negative symptoms and psychosocial variables may not be affected.

The present paper reviews the current literature on modern antidepressants' effects on neurocognitive function. Today, it seems justified to state that SSRIs in general do not affect cognitive function. However, there exists some evidence that paroxetine is associated with a somewhat lower performance on neurocognitive tests than other sub-groups of SSRIs. Further, studies have consistently found sertraline to be better with regard to cognitive function compared to other SSRIs. There is a lack of studies assessing effects of RIMAs and α2-receptor antagonists on cognitive function. Some evidence suggests that the latter may have negative effects on cognitive function. Other studies suggest that reboxetine, bupropion and SNRIs may be more beneficial with regard to cognitive function than other antidepressants. However, the question whether these medications may actually improve cognitive function to a higher level than expected from improvement in depressive symptomatology, remains unclear. Clinical, social and emotional factors are important for cognitive function and these factors should always be taken into consideration when assessing effects of modern antidepressant therapy on cognitive function.

Obesity and binge eating disorder are common comorbid conditions. Research documents that obese individuals who binge eat have more psychopathology than do obese people who do not binge eat, but theoretical explanations for this relationship are scarce. A model is proposed that integrates the robust self-concept differences between obese people with and without binge eating disorder into our understanding of the relationships between obesity, binge eating, and psychopathology. The model characterizes binge eating as one of an array of behavioral responses, which also include weight loss, dieting, and social withdrawal, that help buffer psychological distress. Some clinical implications of the model are discussed.

This paper presents recent research on ethnic and cultural differences and similarities in disordered eating in diverse groups of women. Eating disorders present a significant problem among adolescent and young women in many Westernized countries and are associated with numerous physical and psychiatric problems. A common misconception has been that eating disorders are a disease of middle- or upper-class White females. However, a growing body of literature asserts that girls and women from ethnic minority populations are not immune to developing eating disorder symptoms or syndromes, although there are indications that prevalence estimates vary depending on the particular eating disorder symptom or syndrome under investigation and depending on the population being studied. Studies provide an initial indication that cultural factors may play a role in the etiology of eating disorders. We first review what currently is known about eating disturbances among diverse groups of women and then present research examining the role of culture and ethnicity in the detection and treatment of eating disorders. We conclude with a summary of avenues for future research and intervention.

Bipolar disorder is a severe and chronic disorder, ranked in the top 10 leading causes of disability worldwide. While there have been important advances in treatments, a significant proportion of patients continue to experience disabling symptoms between episodes and the risk of relapse into an episode of depression or mania remains high. Three lines of evidence suggest that sleep disturbances are strongly coupled with interepisode dysfunction and symptom worsening in bipolar disorder: (1) sleep disturbance is a core symptom of bipolar disorder, (2) experimental studies suggest that sleep deprivation can trigger manic relapse and (3) there is evidence that sleep deprivation can adversely affect emotion regulation the following day. The clinical management of the sleep disturbances experienced by bipolar patients, including insomnia and hypersomnia, may include medication approaches, psychological interventions, light therapies and sleep deprivation. The advantages of the psychological interventions include that they are low in side effects, may be preferred by patients, are durable and have no abuse potential. There is a critical need to develop and test specific interventions for the sleep problems experienced by patients with bipolar disorder.

The aim of this paper is to review the literature regarding bifrontal electroconvulsive therapy (ECT) and provide recommendations for future research in this area. Original publications were retrieved using PubMeD, EMBASE, PsycINFO, and Google Scholar. A systematic review and meta-analysis of randomised clinical trials examining efficacy and/or cognitive effects of bifrontal ECT for the treatment of depression is the centrepiece of this paper. The literature regarding bifrontal ECT is limited, with small patient numbers and treatment variation across studies complicating result interpretation. However, our findings suggest that while bifrontal and bitemporal ECT may have similar efficacy, bifrontal ECT is associated with less cognitive impairment immediately after a treatment course. Bifrontal ECT may have greater efficacy than low-dose right unilateral ECT but less efficacy than high-dose right unilateral ECT. Conversely, bifrontal ECT may affect cognition more adversely than low-dose right unilateral ECT, but less so than high-dose right unilateral ECT. To further investigate the likely favourable benefit to cognitive risk profile of bifrontal ECT, detailed cognitive testing should be undertaken as part of any future, large scale studies comparing the efficacy of adequately-dosed bifrontal, bitemporal and right unilateral ECT.

Parkinson's disease (PD) is the second most common neurodegenerative illness diagnosed in the United States. Dementia is recognized to be common in PD, occurring in 19-78&percnt of patients depending upon the definition used. The cognitive syndrome of Parkinson's disease dementia is predominantly one of executive dysfunction, and it has a profile that is distinct from Alzheimer's dementia. Neuropsychiatric problems frequently accompany Parkinson's disease dementia and lead to considerable therapeutic challenges. This review focuses on the epidemiology, clinical characteristics, pathology, neuroimaging, diagnosis, and treatment of Parkinson's disease dementia.