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O’Connor, Akira; Moulin, Chris
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0119-5pmid: 20425276
Déjà vu is characterized by the recognition of a situation concurrent with the awareness that this recognition is inappropriate. Although forms of déjà vu resolve in favor of the inappropriate recognition and therefore have behavioral consequences, typical déjà vu experiences resolve in favor of the awareness that the sensation of recognition is inappropriate. The resultant lack of behavioral modification associated with typical déjà vu means that clinicians and experimenters rely heavily on self-report when observing the experience. In this review, we focus on recent déjà vu research. We consider issues facing neuropsychological, neuroscientific, and cognitive experimental frameworks attempting to explore and experimentally generate the experience. In doing this, we suggest the need for more experimentation and a more cautious interpretation of research findings, particularly as many techniques being used to explore déjà vu are in the early stages of development.
Menezes, Adair; Moreira-Almeida, Alexander
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0117-7pmid: 20425277
This review discusses the relationships between religion, spirituality, and psychosis. Based on the DSM-IV, we comment on the concept of spiritual and religious problems, which, although they may seem to be psychotic episodes, are actually manifestations of nonpathological spiritual and religious experiences. Studies reporting that hallucinations also occur in the nonclinical population and thus are not exclusive to the diagnosed population are presented. Then, other studies pointing to the strong presence of religious content in psychotic patients are also presented. Finally, the criteria that could be used to make a differential diagnosis between healthy spiritual experiences and mental disorders of religious content are discussed. We conclude that the importance of this theme and the lack of quality investigations point to the necessity of further investigation.
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0113-ypmid: 20425278
Catatonia is a distinct neuropsychiatric syndrome that is becoming more recognized clinically and in ongoing research. It occurs with psychiatric, metabolic, or neurologic conditions. It may occur in many forms, including neuroleptic malignant syndrome. Treatment with benzodiazepines or electroconvulsive therapy leads to a dramatic and rapid response, although systematic, randomized trials are lacking. An important unresolved question is the role of antipsychotic agents in treatment and their potential adverse effects.
Barnow, Sven; Arens, Elisabeth; Sieswerda, Simkje; Dinu-Biringer, Ramona; Spitzer, Carsten; Lang, Simone
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0107-9pmid: 20425279
Early views of borderline personality disorder (BPD) were based on the idea that patients with this pathology were “on the border” of psychosis. However, more recent studies have not supported this view, although they have found evidence of a malevolent interpersonal evaluation and a significant proportion of BPD patients showing psychotic symptoms. For example, in one study, 24% of BPD patients reported severe psychotic symptoms and about 75% had dissociative experiences and paranoid ideation. Thus, we start with an overview regarding the prevalence of psychotic symptoms in BPD patients. Furthermore, we report findings of studies investigating the role of comorbidity (eg, post-traumatic stress disorder) in the severity and frequency of psychotic symptoms in BPD patients. We then present results of genetic and neurobiological studies comparing BPD patients with patients with schizophrenia or nonschizophrenic psychotic disorders. In conclusion, this review reveals that psychotic symptoms in BPD patients may not predict the development of a psychotic disorder but are often permanent and severe and need careful consideration by clinicians. Therefore, adequate diagnosis and treatment of psychotic symptoms in BPD patients is emphasized.
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0108-8pmid: 20425280
The term paraphrenia refers to a condition characterized by a strong delusional component with preservation of thought and personality. Most affected patients are women. Although a late age at onset (> 60 years) has been proposed in the literature, evidence for this assertion remains debatable. Deterioration of cognitive functions occurs very slowly but may lead to mild dementia over a period of years. Pathological studies indicate the presence of neurofibrillary tangles (NFTs), primarily within the entorhinal cortex. Compared with the severity of neuritic changes, amyloid deposition remains scant. Pyramidal cells affected by NFTs appear to be preserved. Both the clinical history and neuropathology of paraphrenia are similar to those aspects described for NFT-predominant senile dementia. Risk factors, including organic lesions, may precipitate an earlier onset of symptomatology in patients exhibiting this pathology. Many of the symptoms in paraphrenia can be explained by involvement of the entorhinal cortex.
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0109-7pmid: 20425281
Evidence derived from postmortem brain studies has implicated the uncal cortex in paraphrenia. In the present review, we expand on the anatomic and physiologic nuances endogenous to this region that make entorhinal cortex pathology an important clinicopathological correlate to paraphrenia. First, we summarize the anatomic landmarks and histologic features that will allow the reader to define the entorhinal region in future research studies. As cortical regions usually project to neighboring cortices, inferences will be drawn as to the function of the entorhinal region based on the surrounding cortical regions. The results will help explain why patients with paraphrenia may exhibit amnestic deficits that stand in contrast to a well-preserved thought process and personality. We also review the results of surgical ablation studies in animals. These studies suggest that some risk factors currently associated with paraphrenia (eg, social isolation) may in reality be an early manifestation of entorhinal pathology. Finally, the author provides a parallelism between the hallucinations observed in some paraphrenic patients and the results of electrical stimulation of the uncal cortex. The results will help explain why hallucinations in paraphrenia are usually limited to the patient’s surroundings.
Houdenhove, Boudewijn; Kempke, Stefan; Luyten, Patrick
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0105-ypmid: 20425282
Chronic fatigue syndrome and/or fibromyalgia (CFS/FM) consists of highly overlapping, medically unexplained symptoms, including long-lasting fatigue, effort intolerance, cognitive dysfunction, and widespread pain and tenderness. CFS/FM often seems to be triggered by infections and physical trauma, but depression, sleep disturbances, and personality may also be involved. Moreover, dysregulation of the stress system, the immune system, and central pain mechanisms may determine the pathophysiology of the illness, leading to a loss of capacity to adapt to all kind of stressors. CFS/FM patients can be best helped by a pragmatic and individualized approach aimed at adjusting lifestyle and optimizing self-care, which in the long run may contribute to a restoration of physical and mental adaptability. Future psychiatric research into CFS/FM should focus on the complex interrelationships among pain/fatigue, stress/depression, and personality, as well as on processes of therapeutic change and the advantages of customized treatment.
Fava, Giovanni; Belaise, Carlotta; Sonino, Nicoletta
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0112-zpmid: 20425283
There is controversy surrounding the term psychosomatic. If it is used as an equivalent of consultation liaison psychiatry, there is little justification for retaining it. Psychosomatic medicine, however, may be defined as a comprehensive interdisciplinary framework for the assessment of psychosocial factors affecting individual vulnerability, course, and outcome of any type of disease; holistic consideration of patient care in clinical practice; and integration of psychological therapies in the prevention, treatment, and rehabilitation of medical disease. Psychosomatic medicine has developed several clinimetric tools for assessing psychosocial variables in the setting of medical disease and has raised the need for specific evaluations in medical assessment. The term psychosomatic medicine today seems to be more timely than ever and provides a home for innovative and integrative thinking at the interface of behavioral and medical sciences.
Deshmukh, Parikshit; Kulkarni, Gaurav; Lackamp, Jeanne
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0111-0pmid: 20425284
The overlap between inflammatory bowel disease (IBD) and psychiatric disorders has been studied extensively. We reviewed the limited literature targeting the complex relationship between IBD and psychiatric disorders in children and adolescents. Findings from this review were compared with findings from available studies in adults. Results reflecting an association between IBD and psychiatric illnesses were observed in children and adolescents and were consistent with results in adults. In adults with IBD, many studies have reflected the advantages of psychotherapeutic treatment, including faster recovery, improved quality of life, and reduced health care use. Unfortunately, such studies are scarce in the child and adolescent population. Psychopharmacologic studies also are limited in adult and pediatric populations. At this time, the literature on treatment of the pediatric IBD population remains minimal, and the need to study screening and treatment modalities is critical.
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0106-xpmid: 20425285
Demoralization is a phenomenon in which a patient reaches a state of subjective incompetence, hopelessness, and helplessness that can lead to that devastating moment in which he or she feels the only recourse left is to give up. This article reviews the medical literature regarding the current understanding, importance, and impact of demoralization. In addition, using the key characteristics of demoralization, this article attempts to compare and contrast demoralization with anhedonia and grief.
Lipworth, Loren; McLaughlin, Joseph
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0115-9pmid: 20425286
Five large epidemiologic mortality studies of women with cosmetic breast implants have consistently reported a two- to threefold higher rate of suicide compared with the general female population. Overall, 135 suicides have been observed, compared with 66.9 expected, yielding a significantly elevated standardized mortality ratio of 2.0 (95% CI, 1.5–2.6). In addition to suicides, excesses from other external causes of death related to drug and alcohol abuse/dependence, atypical motor vehicle accidents, and other self-harm causes have been consistently reported. These observations, together with limited but direct epidemiologic evidence of preimplant psychiatric hospitalization, as well as self-reports of preimplant psychiatric disorders, including depression, eating disorders, and body image dissatisfaction, among implant women raise the possibility of significant underlying psychiatric morbidity for a subgroup of implant patients. Research into the psychiatric profiles and history of the women who have committed suicide in the investigated cohorts appears warranted.
Norris, Lorenzo; Que, Guinevere; Bayat, Elham
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0118-6pmid: 20425287
Amyotrophic lateral sclerosis (ALS) is a progressive disorder characterized by degeneration of motor neurons. Given the severe nature of ALS, many believed that patients would suffer from a high level of depression and a low quality of life. However, research into the psychological health of patients with ALS has shown that this is not the case. This article reviews the state of current knowledge as it pertains to the psychological health of ALS patients in four broad areas: quality of life, personality characteristics, emotional reactions, and end-of-life choices.
Porcelli, Piero; Rafanelli, Chiara
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0104-zpmid: 20425288
The Diagnostic Criteria for Psychosomatic Research (DCPR) represent a diagnostic and conceptual framework that aims to translate psychosocial variables derived from psychosomatic research into operational tools whereby individual patients can be identified. A set of 12 syndromes was developed: disease phobia, thanatophobia, health anxiety, illness denial, persistent somatization, functional somatic symptoms secondary to a psychiatric disorder, conversion symptoms, anniversary reaction, irritable mood, type A behavior, demoralization, and alexithymia. The aim of this article is to survey the research evidence that has accumulated on the DCPR in several clinical settings (cardiology, oncology, gastroenterology, endocrinology, primary care, consultation psychiatry, nutrition, and community), to examine prevalence and specific diagnostic clusters of the more prevalent DCPR syndromes, and to review their clinical utility in terms of clinical decision, prediction of psychosocial functioning, and treatment outcomes. The implications for classification purposes (DSM-V) are also discussed.
Sher, Yelizaveta; Lolak, Sermsak; Maldonado, José
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0116-8pmid: 20425289
Depression and heart disease affect millions of people worldwide. Studies have shown that depression is a significant risk factor for new heart disease and that it increases morbidity and mortality in established heart disease. Many hypothesized and studied mechanisms have linked depression and heart disease, including serotonergic pathway and platelet dysfunction, inflammation, autonomic nervous system and hypothalamic-pituitary-adrenal axis imbalance, and psychosocial factors. Although the treatment of depression in cardiac patients has been shown to be safe and modestly efficacious, it has yet to translate into reduced cardiovascular morbidity and mortality. Understanding the impact and mechanisms behind the association of depression and heart disease may allow for the development of treatments aimed at altering the devastating consequences caused by these comorbid illnesses.
2010 Current Psychiatry Reports
doi: 10.1007/s11920-010-0120-zpmid: 20425290
Anticoagulants and psychotropic medications are commonly prescribed together. Thus, the potential for interaction exists. Whereas thrombolytics and heparins are implicated in few pharmacokinetic interactions, warfarin and platelet inhibitors have been implicated in various interactions with psychotropic medications. In this article, I review the various psychotropic drug classes’ relationships to anticoagulants. In a field devoid of randomized, placebo-controlled trials, clinical vigilance is advised when managing patients on concomitant therapy.