Current Psychiatry Reviews - Volume 7, Issue 4, 2011

Current psychiatric classifications include provisional categories for acute transient psychoses such as ICD-10 ‘ Acute and transient psychotic disorders’ (ATPD) and DSM-IV-TR ‘ Brief psychotic disorder’ . Following on from an account of earlier concepts such as bouffee delirante, cycloid psychosis and the reactive and schizophreniform psychoses, this paper describes the process whereby they were subsumed under the heading of ATPD, then sets out research comparing ATPD and schizophrenia in terms of epidemiology, clinical features, course and outcome. Papers published between 1 January 1993 and 30 June 2011 were found through searches in Medline, PsychInfo and Google Scholar. Further references were identified from book chapters and reviews of the topic. Acute onset, polymorphic symptoms, early remission, absence of premorbid dysfunctions and association with female gender are features reported to distinguish ATPD from schizophrenia. However, case identification may be difficult owing to the fleeting nature of the clinical phenomena ATPD encompasses, and high rates of change of diagnosis in subsequent episodes. It is concluded that the lack of clearly defining symptoms and poor predictive validity of ATPD argue against a sharp demarcation from schizophrenia.

Electroconvulsive therapy (ECT) is well established as one of the most effective and safe treatments in psychiatry, but concerns about adverse cognitive effects remain and provide the impetus for further research to refine ECT technique. Various approaches have been tried to ensure adequate treatments are administered, thereby maximising benefits whilst minimising adverse effects. Past discussions regarding ECT seizure adequacy have been dominated by seizure duration. However, inconsistent evidence regarding seizure duration as a seizure adequacy marker has prompted research into the use of electroencephalographic (EEG) indices from ECT treatments themselves to assess seizure adequacy and inform treatment decisions. In this in-depth review, we examine the use of ictal EEG measures in ECT practice. We discuss the neuroscientific basis of the ictal EEG, before reviewing studies of variables affecting ictal EEG measures and of clinical applications of such measures. Existing research suggests that ictal EEG parameters can be appraised alongside clinical findings to help guide ECT administration. Consideration should therefore be given to training all ECT practitioners to systematically evaluate and interpret their potential significance, as part of an overall endeavour to promote sophisticated, evidence-based ECT practice. Correlative research incorporating study of ictal EEG measures alongside other investigations into the mode of action of ECT and its improved administration may contribute to these measures assuming a more definitive place alongside a range of approaches for optimising ECT technique.

Despite the abundant research on impulsivity and that on depression, and despite several lines of clinical and research evidence pointing out the potential associations between the two phenomena, to date the idea that impulsivity is linked to depression is still seriously questioned. This paper will argue that there is a body of research investigating the relationship between impulsivity and depression. It will argue that this body of research is under-recognized, largely due to the complex, multi-faceted nature of impulsivity, and its varied and inconsistent definitions and measurements used in different studies, resulting in mixed findings. To support these arguments, the paper will first critically review a selected but representative sample of definitions and models of impulsivity across different research disciplines. In so doing, it will highlight the need for an integrated framework for impulsivity, and identify one which suggests three key types of impulsivity: rapid response, preference for immediate reinforcement, and underestimation of risk. Next, results of a systematic search for the extant literature on the relationship between impulsivity and depression will be presented, organized accordingly to the identified integrated framework. A possible theoretical integration of impulsivity research in the context of depression will also be offered, suggesting an operational definition of impulsivity as an action or a behavioural pattern that goes against one's desired goal. The paper will conclude by offering recommendations for future research into the association between depression and the different types of impulsivity, guided by the integrated framework. Important clinical implications will also be discussed.

The TransTheoretical Model (TTM), Self-Determination Theory (SDT), and the Integral Model of Treatment Motivation (IM) provide distinct but not incompatible conceptualisations of motivation. We discuss the utility of these theories as a basis for the improvement of psychiatric treatment engagement and treatment outcomes in patients with severe mental illness. It appears that all three theories have gained support for their predictions of outcomes in patients with severe mental illness, but important questions remain unanswered, such as which of these theories provides the best prediction of treatment engagement and treatment outcomes. We explain how these three theories could complete each other, based on their strong and unique assets. It is imperative that the theories are empirically tested and compared to confirm their utility, and to this end we propose several important research questions that should be addressed in future research. Theory comparisons can advance what is currently known about intrapersonal changes and interpersonal differences in treatment engagement and outcomes in severely mentally ill patients.

Background: Treatment integrity is defined as the extent to which a treatment is carried out as intended. It includes several interrelated components (e.g. therapy adherence, therapist competence and therapy differentiation). Treatment integrity is regarded to play an essential role in psychotherapy outcome research. Objective: This article discusses (1) conceptual aspects, (2) empirical results and (3) methodological problems of research on treatment integrity. Results: (1) Therapy integrity refers to different aspects of experimental validity. It is usually discussed with regard to internal validity. Maybe even more important, however, treatment integrity also refers to construct validity. Treatment integrity is also related to external validity and validity of statistical conclusions. (2) Results for the relationship between treatment integrity (adherence to a treatment model and competent delivery of techniques) and outcome are heterogeneous and suggest that the relationship between outcome and treatment integrity is not yet clear. Even in studies which found a relationship between treatment integrity and outcome, the proportion of variance explained by intended techniques was between 10% and 30%. Thus, the majority of variance was not explained by intended techniques. (3) Methodological problems may contribute to the lack of consistent results. As most results come from randomized controlled efficacy studies, the ranges of data for both outcome and adherence/competence may be restricted by the selection of patients and therapists, as well as by training of therapists, manualization and monitoring of treatment. These factors attenuate the association between treatment integrity and outcome. Other factors that may contribute to the inconsistent results are unreliability of measures, instability of adherence and competence during the process of psychotherapy or nonlinear relationships between treatment integrity and outcome. Conclusions: Further studies are required that address the relationship between adherence, competence and outcome, especially for those methods of psychotherapy that were shown to be effective in a particular disorder. Factors that moderate or mediate the relationship between outcome and therapy integrity should be included. Due to their high level of standardization, randomized controlled efficacy studies seem to be only of limited use to study the relationship between treatment integrity and outcome. The recent shift from a single-disorder focus of the traditional manualized interventions to transdiagnostic, modular and component-based interventions may lead to a change in the conceptualization of treatment integrity. It allows for a more flexible use of interventions while maintaining treatment integrity. This shift may both enhance the external validity of studies using manualized treatments and lead to more consistent results regarding the relationship between treatment integrity and outcome.

The present article reviews findings from behavioral, structural and functional studies on facial recognition in patients with schizophrenia. Behavioral studies of face processing have indicated schizophrenia-related deficits in the formation and retention of memory for face configuration information. Moreover, evidence suggests that face recognition deficits in patients with schizophrenia and their families are not secondarily generalized to object memory, and may constitute an endophenotype. Magnetic resonance imaging (MRI) studies have characterized schizophrenia by the loss of gray matter, which may be related to problems in social relationships. The fusiform gyrus (FG) is a key brain region for face perception. Brain morphometric studies have indicated that FG abnormalities are associated with the pathophysiology of schizophrenia at least to some extent. However, functional MRI studies on the role of the FG in schizophrenia have provided mixed results. Event-related potential studies have reported that schizophrenia patients exhibit a reduction in N170 amplitude specific to faces, indicating that the neuronal populations involved in face perception may be specifically reduced in patients with schizophrenia. Moreover, schizophrenia may be characterized by modulation deficits of the N170 in response to different face stimuli. Finally, it has been reported that abnormal face processing is related with social dysfunction in patients with schizophrenia. Studies of face processing deficits can provide important information about the pathophysiology of patients with schizophrenia.