Current Psychiatry Reviews - Volume 8, Issue 3, 2012

Major depression is one of the leading causes of disability worldwide since it is often accompanied by high rates of resistance to treatment. Up to 40% of patients do not remit after two adequate pharmacological tryouts (as indicated by STAR*D study). Poor efficacy of drugs for treatment-resistant depression (TRD) has prompted investigation of alternative treatment strategies. Deep Brain Stimulation (DBS) involves the high-frequency electrical stimulation of stereotaxically implanted electrodes in certain brain regions. Various target areas have been examined for DBS to modulate cortico-limbic circuits, including the anterior limb in the internal capsule, the ventral capsule / ventral striatum (VC/VS), the nucleus accumbens (NAc), and the subgenual cingulate gyrus (SCG, Cg25). DBS for treatment-resistant depression is showing promising results in the few studies published to date, and could potentially open new therapeutic opportunities as an effective long-term treatment strategy with low adverse effects for such a chronic, refractory population.

Objective: To review studies assessing Expressed Emotion among parents/relatives of patients with Anorexia Nervosa and Bulimia Nervosa. Method: A systematic computerized search was performed in Medline complemented by a manual search of the literature for all studies published between 1981 and 2011. A total of 27 papers in English were reviewed for their methods, instruments used and results. Results: Comparisons were not easy due to methodological disparities in assessments. Levels of Expressed Emotion depend concurrently on parental characteristics (parent assessed, social status and psychological distress), patient characteristics (age, social adjustment) and Eating Disorders characteristics (type of Eating Disorders, duration and severity of illness and previous treatment). Expressed Emotion has a predictive value for patient outcome and for compliance with/ and implication in treatment. Levels of Expressed Emotions vary with the parent assessed. The crosscultural aspects of Expressed Emotion in Eating Disorders are not widely documented. Discussion: Both positive and negative aspects of Expressed Emotion are important therapeutic targets and further research on this topic is needed.

Catatonia has undergone many changes since it was first described by Kahlbaum in 1874 (“madness of rigidity”). Nowadays, we can distinguish many different ethiologies for this syndrome: Organic catatonia (the most common); affective (the next one); schizophrenic; and drug-induced. In recent reviews, there was no psychiatric disorder in 76% of cases of catatonia. The unitary pathophysiological conception of catatonia (“catatonic syndrome”) is supported by current research, including neurological causes, endocrine-metabolic, immunological, therapeutic and abuse drugs, psychiatric diseases, and others. Differential diagnosis is based on a complete somatic and psychopathological evaluation, and we must also play a biochemical and neuroimaging complementary tests' battery. When an organic disorder is considered to be the ethiology, therapy should be targeted against this medical condition. If this is not feasible and/or catatonia persist or interferes with medical treatment, the elective therapeutic management should be benzodiazepines and Electroconvulsive Therapy (ECT). Memantine, aripiprazol, and other drugs have been also used with weak results.

There are important similarities and differences between the clinical presentation and prognosis of amnestic mild cognitive impairment (aMCI) and late-life depression (LLD). However, very little is known about the shared and distinct pathophysiological mechanisms between both conditions, even thought their frequent co-occurrence suggests a close association. In this research synthesis, we examined the extent of hippocampus (HC) and entorhinal cortex (ERC) atrophy as reported in 17 aMCI and 9 LLD studies. Total HC volume reduction was significant in almost 100% of aMCI and 50% of LLD studies when populations were compared to normal controls. Volume deficit for total and lateralized HC in LLD studies seemed fairly similar in terms of percentage to aMCI studies. Total ERC volume reduction was significant and larger than HC in all aMCI studies compared to normal controls. No LLD studies measured ERC volume. In general, exclusion criteria and demographic characteristics were fairly similar for most studies. However, imaging characteristics and segmentation protocols varied largely, which could impact the comparison of volume reductions in different studies. Future work investigating simultaneously both aMCI and LLD and using standardized imaging and segmentation protocol would be required to allow a better understanding of the association between aMCI and LLD.

Depression covers a substantial part of mental health problems worldwide. Currently, the occurrence of symptoms listed in DSM-IV is based on its diagnosis. However, there are also additional behavioral features distinguishing between depressed and healthy individuals that do not yet have the official status of symptoms. This article aims to provide a comprehensive literature overview of the distinctive characteristics of verbal and nonverbal behavior of depressed patients. Clinical psychology and psychiatry may benefit from the availability of better, more objective indicators of verbal and nonverbal functioning, which may be useful for diagnosis, prognosis, and treatment evaluation.

The development of Impulse Control Disorders (ICDs) in Parkinson’s disease (PD) is a recognised iatrogenic complication associated with the use of dopamine agonists. The prevalence of ICDs has been reported to be as high as 14% in studies conducted in Europe and North America. Early case reports and recent large-scale studies have shown that clinical features associated with the development of PD-related ICDs include novelty-seeking personality traits, early onset PD and a past history of psychiatric conditions. More recent studies have also suggested that ICDs may be associated with deep brain stimulation and dyskinesias. Moreover, there is heterogeneity in the clinical features associated with the range of ICDs, with studies pointing out that compulsive sexual behaviours and binge eating have fewer clinical features in common than compulsive buying and pathological gambling. The recent increase in the number of functional neuroimaging studies on patients with PD and ICDs, particularly those with pathological gambling, has provided a unique opportunity to understand the neurobiology of the disorder, and has indicated an abnormality in the meso-limbic dopaminergic pathways. Further studies directly comparing ICD sufferers with and without PD will provide valuable knowledge to aid in the management of both patient groups. This review will provide a clinical overview of impulse control behaviours in PD, including both commonly reported ICDs and other related impulsive-compulsive behaviours observed in PD.

Women are at a higher risk than men to develop mood disorders and depression. The increased risk is associated with fluctuating estrogen levels that occur during reproductive cycle events, particularly during the menopausal transition, a time characterized by drastic fluctuations in estrogen levels and increases in new onset and recurrent depression. Conversely, recent data show that hormone therapy, particularly transdermal estradiol formulations, may prevent mood disorders or even serve as a treatment regimen for women with diagnosed mood disturbances via estrogen regulation. While the exact mechanism is unknown, there is compelling scientific evidence indicating the neuromodulatory and neuroprotective effects of estrogen, which are directly relevant to mood symptomotology. Specifically, affective regulation has been linked to neural structures rich in estrogen receptors and estrogenic regulation of neurotransmitters. While a wealth of basic science, observational and clinical research support this rationale, potential mediating variables, such as estrogen formulation, proximity of administration to menopause, and the addition of progestins should be considered. Furthermore, the nature of postmenopausal exogenous hormone formulations in relation to premenopausal endogenous levels, as well as the ratio of estrone to estradiol warrant consideration.