Psychiatric Times Vol 25 No 5

Although several antimanic agents are available to treat individuals with bipolar disorder (BD), many patients have a less than satisfactory response or experience adverse effects.1 With the exception of lithium, all of the current antimanic agents are either anticonvulsant or antipsychotic drugs. It is remarkable that no drug has been developed specifically for BD, especially because this illness was conceptualized more than a century ago.

This article discusses the role of µ-opioid receptors (MORs) in antidepressant treatment and major depressive disorder (MDD). Specifically, it focuses on how the endogenous opioid system affects response to pharmaceuticals.

Since the discovery of dopamine as a neurotransmitter in the late 1950s, schizophrenia has been associated with changes in the dopaminergic system. However, the dopamine hypothesis of schizophrenia cannot explain all the symptoms associated with this disorder. Therefore, research has also focused on the role of other neurotransmitter systems, including glutamate, g-aminobutyric acid, serotonin, and acetylcholine (ACh) in schizophrenia.

The vesicular monoamine transporter (VMAT) is a membrane-embedded protein that transports monoamine neurotransmitter molecules into intraneuronal storage vesicles to allow subsequent release into the synapse.1,2 By accumulating both newly synthesized neurotransmitter molecules and freshly returned neurotransmitter molecules from the synapse, VMAT function plays a critical role in the signaling process between monoamine neurons. The VMAT exists in 2 distinct forms: VMAT1 and VMAT2.3

Everyone would probably agree that the practice of clinical psychiatry has changed profoundly over the second half of the past century. One of the most remarkable changes has been the rapid development and expansion of clinical psychopharmacology, which has become, like it or not, a dominant part of the clinical practice of most psychiatrists. Available treatments for mental disorders changed and our armamentarium broadened. We have numerous medications for psychiatric disorders. We even use medications for disorders traditionally considered only amenable to and suitable for psychotherapy.

The modern era of psychopharmacology is only 60 years old, having begun with the discovery of the psychotherapeutic benefits of reserpine, lithium, monoamine oxidase inhibitors, and chlorpromazine in the late 1940s and early 1950s, which was followed a few years later by the synthesis and testing of the tricyclic antidepressants and benzodiazepines.

If you had asked me a year ago if I could have faced what I am about to describe and come out on the other side I would have said "Hell, no!" It has been a year of pain and struggle, and although certain parts cannot be changed, I still think that if things had been handled a little differently I might not have gone through some of what I did. Here is my story.

"I've lost my interest in sex." As psychiatrists, we hear this concern (if we ask) from women in a variety of situations: those who are depressed, postpartum, menopausal, traumatized, and those who have been treated with psychotropic medications. Thankfully, we have many interventions, both behavioral and pharmacological, to use in addressing sexual issues.

The expression "quality of life" is an intuitively familiar and popular concept, and it epitomizes the public's hopes and expectations. In clinical settings, it demands the inclusion of patients' feelings, attitudes, and opinions in medical decision making.

Vietnamese Amerasians and the former political prisoners of South Vietnam are living legacies of the Vietnam War. Now that many live in the United States, it is important for psychiatrists to have an understanding of their life experiences and be able to recognize psychiatric disorders that are common among them.

The ocurrence and severity of anxiety disorders have been correlated with fluctuations in female sex steroid levels in both epidemiological and experimental studies.1-5 Female reproductive hormones play a role not only in the development and course of anxiety disorders but also in treatment response.

Suicide is a devastating, tragically frequent outcome for persons with varying psychiatric conditions, including schizophrenia. An estimated 5% to 10% of persons with schizophrenia commit suicide and 20% to 50% attempt suicide during their lifetime.1,2 Patients with schizophrenia have more than an 8-fold increased risk of completing suicide (based on the standardized mortality ratio) than the general population.3

The cultural and demographic profile of the United States is undergoing a rapid transformation. In many areas of the country, there is no longer an ethnic majority but a multiplicity of racial and cultural groups.