Neuroimaging in Psychiatric Disorders

In psychiatry, neuroimaging facilitates the diagnosis of psychiatric disorders and the development of new medications. It is used to detect structural lesions causing psychosis and to differentiate depression from neurodegenerative disorders or brain tumors. Functional neuroimaging, mostly in the form of molecular neuroimaging with positron emission tomography or single photon emission tomography, facilitates the identification of therapeutic targets, the determination of the dose of a new drug needed to occupy its target in the brain, and the selection of patients for clinical trials.     

Medication Noncompliance in Adolescents with Psychiatric Disorders

The purpose of the study was to estimate prevalence of medication non-compliance among adolescents, following discharge from hospital. A second purpose was to identify predictors of such noncompliance. Seventy-one adolescents, who had been prescribed a medication during psychiatric hospitalization, were interviewed by telephone, 6–8 months post-hospitalization. Medication noncompliance was defined as discontinuing medication without the recommendation of the treating physician. Twenty-four subjects (33.8%) were noncompliant with medication. Age, race, gender, SES, diagnosis, type and number of medications, severity of depression, and family living arrangement did not predict noncompliance. We concluded that noncompliance with psychotropic medications was relatively common and difficult to predict in adolescents who had been hospitalized to a psychiatric inpatient unit; the majority of them suffered from depression. Clinicians should be aware that medication noncompliance may be common and a relatively unpredictable phenomenon.     

Caregiving for Relatives with Psychiatric Disorders vs. Co-Occurring Psychiatric and Substance Use Disorders

Despite the high comorbidity of psychiatric and substance use disorders, extremely little research has examined the experience of caregiving for relatives with co-occurring psychiatric and substance use disorders (COD). The primary objective of the present article is to identify characteristics pertaining to care recipients, family caregivers, and the experience of providing caregiving associated with care recipients having COD vs. only having psychiatric disorders (PD). A U.S. community recruited sample of 1394 family caregivers of persons with COD or PD was employed. Chi-square and Mann-Whitney-Wilcoxon tests were conducted. Compared to caregivers of persons with only PD, caregivers of persons with COD provided slightly less caregiving but experienced significantly greater negative effects from providing care. Caregivers of persons with COD were also more likely to fear care recipients would engage in multiple problematic behaviors. Most significant differences found in providing care to recipients with COD vs. only PD persisted when examining care recipients with severe psychiatric disorders or more moderate psychiatric disorders. Additional findings and treatment implications are described.     

Psychiatric Disorders of Pre-adolescence in Japan

Abstract: We have classified 200 pre-adolescent patients, with whom we have met during the last three years, into the following four types: 1) school refusal and obsessive behavior, 2) psychosomatic disorders, 3) depressive reactions, and 4) schizophrenic disorders. During our therapeutic process, we realized that even though their symptoms seemed varied and severe, they disappeared after comparatively short periods. The pre-adolescent period is a turning point at which the children depart from their earlier relationships with parents and start to form new ones with friends. We facilitated the patients' developmental process in this period so that they would recover naturally by themselves. However, when we looked at the social phenomena which influence the family and children, we noticed that some factors interfered with the pre-adolescents trying to get over the above-mentioned turning point.     

Psychiatric Hospitalization Among Children with Autism Spectrum Disorders

This study examined predictors of psychiatric hospitalization among children with autism spectrum disorders (ASD). Data were collected from 760 caregivers of children with ASD. Cox regression was used to determine factors associated with hospitalization. Almost 11% were hospitalized. Youth in single parent homes were more likely to be hospitalized (OR = 2.54), as were youth diagnosed at a later age (OR = 1.10). Engaging in self-injurious behavior (OR = 2.14), aggressive behavior (OR = 4.83), and being diagnosed with depression (OR = 2.48) or obsessive compulsive disorder (OR = 2.35) increased the odds of hospitalization. Risk for hospitalization increased with age and over time. The results suggest early diagnosis and community-based interventions for aggressive and self-injurious behaviors may reduce hospitalizations.     

Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders

The Kiddie Schedule for Affective Disorders and Schizophrenia was modified for use in children and adolescents with autism by developing additional screening questions and coding options that reflect the presentation of psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview-Present and Lifetime Version (ACI-PL), was piloted and frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The sample demonstrated a high prevalence of specific phobia, obsessive compulsive disorder, and ADHD. The rates of psychiatric disorder in autism are high and are associated with functional impairment.     

Wake-Promoting Pharmacotherapy for Psychiatric Disorders

Medications promoting wakefulness are currently used in psychopharmacology in different contexts and with different objectives. In particular, they may be used for the treatment of syndromes that primarily show significant impairment in alertness/wakefulness (e.g., excessive sleepiness and other sleep disorders) as well as for the symptomatic treatment of different neuropsychiatric disorders that, in turn, are not exclusively characterized by sleep-wake disturbances (like mood disorders, for instance). In addition, several psychotropic compounds, including some antipsychotics, mood stabilizers, antidepressants, and anxiolytics have well-established sedating side effects that may go beyond the therapeutic target and require the symptomatic use of wake-promoting agents. Even though such a clinical scenario reflects millions of individuals affected (alterations of wakefulness have a prevalence rate of 20–43 % in the general population), relatively few pharmacotherapies are available, mainly including compounds with psychostimulating effects, such as methylphenidate, modafinil, and armodafinil and some amphetaminic agents. In light of their side effects and potential for abuse, such compounds have received FDA approval only for a limited number of psychiatric disorders. Nonetheless, their clinical application has recently become more widespread, including attention deficit hyperactivity disorder, narcolepsy, treatment-resistant depression, bipolar disorder, shift work sleep disorder, schizophrenia, and addictions. Wake-promoting agents have different mechanisms of action, peculiar clinical strengths and specific limitations, with novel drugs in the field under extensive investigation. The present review is aimed to provide an updated overview of the aforementioned compounds as well as investigational drugs in the field, in terms of mechanism of action, indications and use in clinical practice.     

The Longitudinal Relationships Between Psychiatric Disorders and Gambling Disorders

The literature has consistently reported an association between gambling disorders and various comorbid psychiatric and substance conditions. The majority of studies have been cross-sectional in nature, and therefore fail to describe the temporal sequences between these conditions. To investigate these temporal sequences we conducted a scoping review of empirical longitudinal studies that have explored the relationships between gambling disorders and comorbid psychiatric disorders, including any mood and anxiety disorders, suicidal ideations and attempts, and illicit substance, nicotine and alcohol use and dependence. A search was conducted for peer reviewed and unpublished articles, and government reports published between January 2000 and March 2015, with a main focus on the temporal sequence between these two conditions. Studies were only included if they were in English, prospective in nature, studied treatment and population samples and included any form of gambling. A total of 35 publications were identified and the findings discussed in terms of three populations: (i) specific populations, (ii) children, adolescents, and young adults, and (iii) adults. On the basis of these longitudinal findings it is suggested that psychiatric disorders can represent both a precursor and a consequence of problem gambling, and that there are underlying interactive factors, such as impulsivity that can predict and drive both temporal sequences. Screening for comorbid psychiatric conditions upon entering treatment for problem gambling should form an integral part of clinical assessments. However, the extent to which comorbid conditions contribute causally to the development of gambling disorders remains to be conclusively established.     

Psychiatric Disorders in Epilepsy: Clinical Aspects

Increased levels of psychiatric morbidity are associated with epilepsy in adults and children. The relationship between type of epilepsy, seizure focus, and nature of psychiatric disturbance remains controversial and varies across studies. Behavioral disturbances associated with epilepsy may be related to the seizure discharge itself, interictal discharges, adverse psychosocial consequences of chronic epilepsy, underlying CNS pathology, or antiepileptic drugs. Such symptoms could also coexist with epilepsy without there being a causal relationship between the two. The major psychiatric conditions associated with epilepsy are psychosis, personality disorders, depression, and anxiety. The clinical aspects of these disorders as they relate to epilepsy are reviewed.