Current Psychiatry Reviews - Volume 5, Issue 4, 2009

Because of the recurrent course, significant burden, and intergenerational impact of depression, there is a great need for interventions for depressed parents and their children. This article reviews eight interventions that 1) aim to impact the functioning and well-being of 18-month to 18-year old children of depressed parents and 2) have been evaluated in controlled studies. The interventions are described and the empirical evidence of their efficacy is reviewed and critiqued. Existing research points to several promising intervention strategies, such as psychoeducation about parental depression, addressing parenting in adult depression treatment, promoting positive parent-child interactions, and teaching coping skills to children. Common limitations of the research in this area are small sample sizes, homogenous samples, and lack of replication. Implementation problems within the mental healthcare system are highlighted. Multi-component interventions seem to be a promising approach to address the complex impact parental depression has on children and the parent-child relationship. This review illustrates the need for more research on intervention models that can be implemented with children at various developmental levels.

The cytoarchitectural defects of schizophrenia are predominantly “mild” alterations of dendrites and cell positioning, which are subtle in comparison to those in the lissencephalies and many presentations of mental retardation. Moreover, they are studied in adult brains and, thus, subject to the many potentially confounding effects of such things as medication history, substance abuse, lifestyle variables and stress. Thus, the ability to identify subtle fetal brain abnormalities in utero, such as operationally-defined mild lateral ventricular enlargement as an isolated finding, and longitudinally follow this genotyped cohort, some of whom may be at increased risk for neurodevelopmental disorders including schizophrenia, will be informative. The demonstration of co-segregation of genetic variation (e.g., within the DISC1 gene) and mild lateral ventricular enlargement, and the opportunity to seek linkages in parents and sibs would be extremely persuasive that genetic variations (e.g., in DISC1) cause or contribute to mild lateral cerebroventricular enlargement, which may be a risk factor and anatomic intermediate phenotype of schizophrenia.

Background: Substance use disorders are frequent among schizophrenia patients. Growing evidence shows that the relationships between substance abuse and psychosis are complex. Substance abuse in schizophrenia is associated with increased positive and depressive symptoms. However, emerging data also shows that substance-abusing schizophrenia patients have fewer negative symptoms, compared to abstinent patients, and that they have fewer cognitive deficits when they are young. Here, our objective is to determine if brain imaging studies conducted among dual-diagnosis schizophrenia patients reflect the paradoxical nature of the relationships between psychosis and addiction. Methods: A systematic search of the literature was performed, and we identified 21 brain imaging studies carried out among substance-abusing patients with schizophrenia. Results: Some studies showed that alcohol and cannabis amplify the anatomic abnormalities of schizophrenia, especially in the cerebellum. However, preliminary functional imaging data from our group highlighted a relative preservation of the medial prefrontal cortex functioning among dual-diagnosis patients during emotional processing. Conclusion: Brain imaging studies performed so far reflect the complex nature of the relationships between psychosis and addiction. Further brain imaging studies involving dual-diagnosis schizophrenia patients are required. Future studies will need to pay attention to length of substance abuse, psychiatric symptoms, antipsychotics, types of psychoactive substances (e.g. cocaine) and the brain reward system.

Recent study into body dysmorphic disorder (BDD) has raised questions about the validity of its current diagnostic classification as well as categorical division into ‘psychotic’ and ‘non-psychotic’ variants. Furthermore, though individuals with the disorder are believed to experience cognitive difficulties, the precise nature of these deficits remains unclear. This paper aims to provide a comprehensive review of existing knowledge of BDD in terms of its nosology and cognitive deficits. We evaluate arguments in relation to its inclusion within the obsessive-compulsive spectrum disorders (OCSDs), consider how delusionality is coded in BDD, and also examine recent studies suggesting which specific cognitive deficits may underpin the disorder. There appears to be a sound rationale for considering BDD as part of the OCSDs, though current findings indicate that it is not simply a subtype of obsessive-compulsive disorder (OCD). Evidence also suggests that the degree of delusional beliefs in BDD would be more appropriately theorised on a dimensional basis. In terms of cognitive deficits, research to date has implied that attentional biases and/or abnormalities in basic visual processing may be especially important. Further research is needed to elucidate an inclusive profile of the underlying cognitive deficits in BDD. In turn, these insights could help to clarify current nosological debates surrounding the disorder.

Yi-gan san (YGS, yokukan-san in Japanese) was developed in 1555 by Xue Kai as a remedy for restlessness and agitation in children. Prompted by the increasing life expectancy of the Japanese population, geriatricians have begun to use this traditional regimen for behavioral and psychological symptoms of dementia in the elderly. Moreover, we reported that YGS therapy is a well-tolerated and effective remedy that improves the symptoms of borderline personality disorder and neuroleptics induced tardive dyskinesia. In a pilot investigation, we administered YGS as an open-label adjunct to antipsychotic medication to patients with treatment-resistant schizophrenia. The present review summarizes the available data supporting the clinical testing of YGS for psychiatric disorders. In addition, we extend our discussion to the potential applications of YGS for combining this treatment with cellular and molecular therapy.

Recent guidelines have stated that anesthesia for electroconvulsive therapy (ECT) should be administered by specially trained anesthesiologists. Physicians who perform ECT should have sufficient knowledge about hemodynamics as well as the physiological and pharmacologically unique effects of ECT. Electrical currents during ECT stimulate the autonomic nervous system and provoke unique hemodynamic changes in the systemic and cerebral circulation. Excessive alterations in heart rate, blood pressure, and cardiac functions should be prevented by medications with anticholinergic and antihypertensive effects. Ventilation should be adequately maintained to ensure efficacy of the therapy and to stabilize hemodynamics immediately after the electrical stimulation. Although reports of serious complications with this therapy are not frequent, patients with ischemic heart disease or cerebrovascular disease must be managed with special care to prevent myocardial infarction or neurological disorders. Appropriate physical management by physicians greatly contributes to the safe establishment of ECT under muscle relaxation. To maintain social confidence in this procedure and to further refine this therapy, physicians should play an essential role in both the clinical activities and laboratory research of ECT.

Epidemiological findings indicate a connection between depressive symptoms and changes in status of the immune system in depressed patients. This raises the possibility of causative connections. Theories on mechanisms for interactions between immune and affective systems - directly and via endocrine system - are evolving. Such hypothesized causative connections are supported by several findings. First, in depressed patients changes in the status of the immune system in vivo and ex vivo are seen. Also, depressive symptoms are seen in patients with altered immune status (physiologically, pathologically or chemically induced). Knowledge in this field may have implications regarding psychiatric follow up of physically ill people suffering from diseases caused by an altered immune system (long lasting infections, autoimmune diseases, hypersensitivity disorders) as well as disorders for which treatment and prognoses depends on the immune system (infections, cancer). Similarly, medical treatment of depressed patients may be adjusted by more specific knowledge about the interaction between neuroimmunology and depression. Important findings and the present knowledge and theories are reviewed.

The efficacy and safety of Electroconvulsive therapy (ECT) in adults is well-supported by a history of robust research and clinical experience. There is less information regarding the application of this therapeutic modality for the treatment of severe psychiatric disorders in children and adolescents. However, available data suggest that ECT is a safe and effective intervention for severe mood disorders, psychosis, and catatonia in this population. The American Academy of Child and Adolescent Psychiatry (AACAP) and American Psychiatric Association (APA) have published professional guidelines for the practice of ECT in this age group. Unfortunately, child and adolescent psychiatrists typically have little training or knowledge in the practice of ECT. The authors review the historical use and current practice of this modality in minors. Further research and clinical experience is imperative in this area of child and adolescent psychiatric therapeutics.