Schizophrenia/Psychosis

The Emerging Role of GABAergic Mechanisms in Mood Disorders by Po W. Wang, M.D., and Terence A. Ketter, M.D. Gamma-aminobutyric acid is a major inhibitory neurotransmitter widely distributed in the mammalian central nervous system. Animal models of depression have pointed toward the importance of the GABA system in the pathophysiology of mood disorders. Thus, elucidating the GABAergic effects of benzodiazepines, mood stabilizers, antidepressants, and new anticonvulsants and antipsychotics may expand our understanding of mood disorder pathophysiology and potentially generate new targets for treatment.

Individuals with schizophrenia are at greater risk for weight gain than the general population. From recent research, it appears that some of the second-generation antipsychotics may be more likely to cause weight gain than others. Recommendations for treatment strategies are provided.

Kapur S, Arenovich T, Agid O, et al. Evidence for onset of antipsychotic effects within the first 24 hours of treatment. Am J Psychiatry. 2005;162:939-946.

Suicidal behavior is a complex and multi-factorial phenomenon for which epidemiological genetics suggests a genetic basis that may be specific and independent from those implicated in the vulnerability to the psychiatric disorders associated with SB. Recently, new molecular biology tools have been designed to identify predisposition factors to complex disorders. One of the main goals of current studies is to specify the suicidal phenotype, as well as the intermediate phenotypes associated with these genes.

Research at the Crossroads of Genetics and Psychiatry

Many physicians who work in the emergency department (ED) consider the agitated patient the bane of their existence. These patients are frequently difficult to deal with, are uncooperative, and can bring an already busy ED to its knees. Although it is easy to understand why severely agitated patients are commonly placed in restraints or seclusion, it is essential that cooler minds prevail when an agitated patient presents to the ED. The patient should be treated with dignity, respect, and understanding. Because these patients often cannot express their feelings adequately, many who work in the ED do not realize that these patients do not like the feeling of being out of control.

Restraints and seclusion have been used for many years in emergency departments (EDs) and psychiatric emergency services (PESs), but anecdotal case reports and newspaper investigations as well as clinical advances have led to restrictions in their use.

The use of restraint and seclusion remains a controversial issue, and emergency care providers must remain absolutely current on it. We can come under criticism both for using too much coercion and for not using enough. Restraint and seclusion exist at an intersection of science, government policy, and public perception. These seemingly straightforward forms of medical coercion are still, in actuality, far from straightforward.

Recent research has shown environmental factors may increase the risk of schizophrenia in persons who may already have a genetic predisposition toward the illness.

One of this year’s recipients of the National Medal of Science sits down to talk with Psychiatric Times about his research, accomplishments and music.

Comparative data are emerging on the metabolic effects of the second-generation antipsychotics on adolescents and children. Data presented at national meetings is discussed. When using these medications, the risks and benefits need to be carefully weighed until more definitive information is available.

Dr. Schwartz, founder and editor in chief of Psychiatric Times, discusses his career as a clinician and entrepreneur.

New tests approved by the FDA can allow clinicians to genetically test for patients who may be low- or high-responders to certain drugs. How effective are these tests and what might the ethical implications be?

Ever since antiquity, thinkers have associated creativity with psychopathology--the classic idea of the "mad genius."

During a trip to Beijing on behalf of the World Psychiatric Association, Dr. Stone witnessed up close how the psychiatry is practiced in today's China. What he found may surprise you--it certainly surprised him.

Heavy smoking and caffeine intake are highly prevalent in patients with psychiatric disorders, both of which significantly impact the metabolism of a number of psychotropic medications. Hence, these factors should be routinely considered in making prescribing decisions.

"Pseudodementia" needs a third look. Always a "soft" diagnosis, it has never had objective, explicit diagnostic criteria or a spot in an official nomenclature.

More than 100 neurologic diseases, injuries, and intoxications are known to prominently or exclusively involve the white matter of the brain.

Dr. Gabbard discusses using psychotherapy and psychiatry combined, how media portray psychiatrists and why Tony Soprano does the things he does.

Mental illness occurs more frequently among people infected with HIV. In addition, individuals with mental illnesses are at greater risk for contracting HIV. Therefore, psychiatry has a great deal to offer in the management of patients with HIV--whether through proper patient education or safe and effective psychopharmacology.

The post-stroke patient is at significant risk for various psychiatric syndromes. The most commonly reported of these in the literature are post-stroke depression (PSD) and post-stroke dementia (PSDem), which may present simultaneously with overlapping mood and cognitive symptoms. In this article, we offer a review of current literature on post-stroke psychiatric syndromes and an integrated clinical approach to screening, diagnosis, and pharmacologic intervention.

Clinical Trial Enrollments

Tricyclic antidepressants and antipsychotics are known to prolong cardiac repolarization and induce QTC interval prolongation, possibly putting patients with mental disorders at higher risk of cardiovascular diseases. The mechanism of gender difference in vulnerability for cardiovascular diseases is still unclear, but the role of hormones is one of possible explanatory factors.

What special issues do psychiatrists face when treating women, children and adolescents, and elderly people with schizophrenia? Are there recommendations for care and monitoring strategies to maintain patients on effective, long-term treatment regimens?

Are the metabolic side effects of the atypical antipsychotics fueling the next round of malpractice suits being filed against psychiatrists? Guidelines are being created, but how can clinicians protect themselves and their patients, while continuing to give their patients the best care available?

Migraine affects approximately 12% of the population, and a high percentage of these patients have comorbid psychiatric disorders. Knowing more about the interaction between headache and psychiatric factors can assist in evaluating and treating these patients.

Despite the fact that awareness of HIV and AIDS transmission is pervasive, risky sexual behavior has been increasing in many parts of the world in recent years, with a concomitant rise in new cases of HIV and other sexually transmitted diseases.

The diagnosis of bipolar disorder in children remains controversial. One of the more disturbing facets of its presentation in such young patients is the presence of hypersexual behavior. How can these behaviors be differentiated from the effects of abuse and other psychiatric disorders?

Given that a substantial minority of patients don't respond to monotherapy, clinicians may have to consider combined or augmentation therapy. According to the research, which drugs are most effective, and in which combinations?

A greater understanding of how the brain works, including the effect of environment on it development, has led to advances in diagnosing and treating psychopathology. The latest findings will be presented at an international meeting, along with a discussion of how much work is to be done and the great need for qualified child psychiatrists, especially in developing countries.