Current Psychiatry Reviews - Volume 8, Issue 2, 2012

Bipolar disorder (BD) with co-occurring substance or alcohol use disorders (SUD/AUD) is associated with a more severe course of illness, lower psychosocial functioning and unfavorable response to treatment. BD patients with a dual-diagnosis were largely excluded from previous clinical outcome studies due to methodological considerations; however, in recent years, a growing interest in dually-diagnosed BD patients has increased the number of studies that explored efficacious interventions for this vulnerable population. The current review examined these studies and concluded that preliminary data point to the benefits of psychosocial interventions adhering to the principles of integrated care. The results of pharmacological studies support the use of naltrexone with co-occurring AD; whereas, findings associated with other agents remain inconclusive at this point. The paper further discusses issues related to theoretical developments with practical implications for improving clinical and functional outcome for dually-diagnosed BD patients.

Event-related potentials (ERPs) provide an objective index of neurocognitive abnormality or dysfunction in neuropsychiatric disorders. Auditory mismatch negativity (aMMN), which was discovered in the 1980s, is one unique type of ERP. Several lines of evidence suggest that it reflects auditory preattentive (automatic) information processing and the function of glutamatergic N-methyl-D-aspartate receptors. Many studies also have suggested that aMMN is a promising biomarker for some psychiatric disorders such as schizophrenia. Prospective studies combining analyses of several biomarkers, including aMMN, in schizophrenia patients from the prodromal period, are underway. Meanwhile, the existence of a visual counterpart of aMMN (vMMN) has been disputed, and a genuine vMMN was only confirmed in the last decade. Thus, there have been a relatively small number of vMMN studies compared with studies of aMMN, and the mechanism underlying vMMN is still unclear. However, it is well known that abnormal auditory and visual sensory information processing is present in psychiatric disorders, and vMMN is an important component of ERPs studied in psychiatric patients. The aim of this review is to provide an overview of recent aMMN and vMMN findings in several psychiatric disorders, including schizophrenia, major depression, Alzheimer's disease, and developmental disorders. In doing so, we highlight their potential use as biomarkers of psychiatric disorders.

Introduction: Only a minority of schizophrenia patients shows criminal behavior, but in comparison with the general population, they are at increased risk of incurring in criminal acts. The objectives of this study are, by reviewing the literature, to conclude about the relationship between crime and schizophrenia and explain the mediators of this association. A second aim is to discuss the prevention of criminality in schizophrenia patients. Methods: Searches involved three electronic bibliographic databases (MEDLINE, SCOPUS and ISI WEB OF KNOWLEDGE) and other selected literature in psychiatry. Results: There is an increased prevalence of crime among schizophrenia patients compared with the general population. The explanation for these criminal acts is not unique; however, it contains several variables that are often intertwined and operate before, during, and after the active stage of the disorder. Conclusions: The prevention of the occurrence or recurrence of the criminal act must be specific to the patient, adapting to the more substantial etiological factors, with a reminder that in most cases, more than one factor is involved. Substance abuse, the vulnerabilities of the individual personality, and the social context, need, if not on equal priority with controlling symptoms, be at least a relevant part of the management process.

Scientific models of schizophrenia (SZ) lack specificity with regard to progression and etiology of the disease. The aim of this review is to demonstrate that cognitive aberrations associated with impairments of the visual system are disease progression markers from the early SZ prodrome to the chronic, stabilized syndrome. We argue that disrupted oculomotor and visuo-spatial capacities influence higher order cognitive functions that lead to the phenotypic expression of symptoms. A dimensional model is proposed, in which the identified visuo-cognitive aberrations are linked to a subjective cognitive identity deficit, including disease insight and awareness of symptoms. The model provides evidence that etiological explanations of schizophrenia need to take into account anomalous visual information acquisition and processing as dimensional stage markers of the disease. Results are discussed with regards to disease progression, as well as to specific treatment and research targets.

Cognitive impairment in patients with schizophrenia occurs in the prodromal phase and usually persists, even when psychotic symptoms have been successfully treated. There is a direct relationship between the level of cognitive impairment and functional outcome in schizophrenia, making these symptoms a new, potential therapeutic target. Although atypical antipsychotic drugs improve several domains of cognitive function, even when psychotic symptoms have been successfully treated, many patients, do not recover their cognitive impairment, resulting in a failure to reintegrate into society. Therefore, the development of new therapeutic drugs for cognitive impairment remains an imperative. In this review article, we discuss the merits of potential therapeutic drugs such as glycine transporter (GlyT-1) inhibitors, 5-HT1A receptor agonists, α7 nicotinic acetylcholine receptor agonists, sigma-1 receptor agonists, minocycline and cilostazol.

Neuroactive steroids (NASs) are rapid acting steroids that produce nongenomic effects through interactions with neurotransmitter receptors, Although research on NASs has focused on their actions as negative or positive allosteric modulators at GABAA receptors, there can also be interactions with other receptors, including glutamate receptors, 5-HT3 receptors, nicotinic receptors, σ1 receptors and voltage- or non-voltage-gated calcium channels. Recent studies in animal models and in humans have investigated the role of NASs, including pregnenolone, pregnenolone sulfate, dehydroepiandrosterone, dehydroepiandrosterone sulfate, progesterone, and a number of 3α-reduced NASs (e.g. allopregnanolone, 5-α-dihydroprogesterone, 3α,5α-tetrahydroprogesterone, 3α,5α-tetrahydrodeoxycorticosterone) in depressive disorders. Although inconsistencies exist, alterations in levels of these NASs have been reported to be associated with major depressive disorder, postpartum depression, and premenstrual dysphoric disorder. In some cases, the actions of the NASs may involve interactions with brain-derived neurotrophic factor (BDNF) and/or the hypothalamic-pituitary-adrenal (HPA) axis. Antidepressant drugs have been shown to have effects on the levels and/or metabolism of NASs, and some NASs have been reported to have antidepressant effects in their own right after administration to animal models or humans. Although interactions appear to be complex, increasing evidence substantiates the importance of NASs in the pathophysiology and treatment of depressive disorders, and research in this area is reviewed in this paper.

The septal region, including the cavum septi pellucidi (CSP), and the fornix are part of the limbic system. The majority of MRI- and postmortem studies indicate that enlarged CSP are implicated in the pathology of schizophrenia, but the majority of MRI-studies show that enlarged CSP are not involved in the pathology of bipolar and major depressive disorders. The MRI and post-mortem studies on the role of the fornix in schizophrenia point to a discrepancy in the results. Our review of the role of the CSP in schizophrenia and affective disorders summarizes 29 studies and one meta-analysis. Furthermore, our review of the involvement of the fornix in schizophrenia and affective disorders evaluates 14 studies and one meta-analysis. The discrepancies in the results of the CSP and the fornix might be explained by differences in the methods and sample sizes as well by publication bias.

Background: Delirium is a complex multifactorial neuropsychiatric disease, associated with negative outcomes: increased length of hospital stay, functional and cognitive decline, institutionalization and mortality. It is often poorly recognized due to its fluctuating nature, its overlap with dementia and the lack of valid and specific rating scales in clinical routine. Aim: This study review describes the characteristics and psychometric properties of delirium scales available in research and clinical practice. Methods: The MEDLINE database was used to identify the delirium scales (1990-2010), using keywords: delirium, confusion, severity, questionnaires, scales and screening. Only primary and validation studies were included. The exclusion criteria were children and alcohol or drug delirium assessment scales. Results: This study included seven screening scales (CAM, ICDSC, DSI, NEECHAM, CTD, DOSS, Nu-DESC) and six severity scales (DRS-98-R, MDAS, CSE, DSS, DI, DOM). The psychometric properties of each scale were reported. The majority of scales were based on the Diagnostic and Statistical Manual of Mental Disorders – DSM-IV criteria as well as on a review of selected symptoms of delirium informed by systematic clinical observation and formal brief assessment of mental status. Conclusions: The selection of instrument may be dependent on administration time and rater training requirements. However, bearing in mind the recent reviews included, the CAM is considered the most widely used instrument for delirium diagnosis and the DRS-98-R to measure the severity of delirium states. In overall studies these instruments revealed good psychometric properties: sensitivity/specificity (CAM 100-94%/95-90%; DRS-98-R 92%/93%) and interobserver reliability (CAM k=0.81-1; DRS-98-R ICC=0.98-0.99).