Noninvasive Focused Ultrasound for Neuromodulation: A Review.

This article covers noninvasive focused ultrasound (FUS) and its potential for neuromodulation. Although diagnostic uses of ultrasound are well known, its potential to noninvasively alter brain activity is a relatively new subject of research. Low-intensity focused ultrasound (LIFU) is a potential future alternative modality to other noninvasive neuromodulation techniques. This article aims at providing an updated review of the literature related to the role of LIFU in neuromodulation and the progress of animal as well as human research done on this topic. It also includes a critical review of the safety concerns slowing the translation of LIFU research into clinical trials.

The Future of Brain Stimulation Treatments.

Trends in brain stimulation include becoming less invasive, more focal, and more durable with less toxicity. Several of the more interesting new potentially disruptive technologies that are just making their way through basic and sometimes clinical research studies include low-intensity focused ultrasound and temporally interfering electric fields. It is possible, and even likely, that noninvasive brain stimulation may become the dominant form of brain treatments over the next 20 years. The future of brain stimulation therapeutics is bright.

Forma focal y de larga evolución del síndrome de la persona rígida / Focal gradual-onset variant of stiff-person syndrome

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Protocolo unificado para la evaluación psiquiátrica y psicológica de candidatosa trasplante de órganos y tejidos, PSI-CAT / Unified Protocol for psychiatric and psychological assessment of candidates for transplantation of organs and tissues, PSI-CAT

Introducción. El trasplante es la opción terapéutica que ofrece mayor supervivencia y calidad de vida frente al fallo de un órgano. Los aspectos psiquiátricos y psicológicos de los candidatos a trasplante son relevantes, especialmente en la etapa de evaluación previa, pues la influencia de estos factores puede dificultar la evolución posquirúrgica, tanto en la supervivencia del órgano implantado como en la calidad de vida de la persona trasplantada. Son de especial importancia los factores vinculados a la patología por uso de sustancias, los trastornos psicopatológicos y el soporte psicosocial. Actualmente, existen pocas Guías que orienten sobre la correcta evaluación de los pacientes candidatos a estos procedimientos complejos. Método. Diecinueve psiquiatras y psicólogos clínicos de 6 hospitales públicos de Cataluña realizaron un trabajo sistemático de consenso para llegar al diseño de un protocolo unificado de evaluación psicológica y psiquiátrica. Se implementó un plan de trabajo anual, se definieron objetivos y se realizó una revisión bibliográfica, se discutieron los criterios de inclusión y exclusión, se seleccionaron los cuestionarios y se elaboró la entrevista estructurada. Resultados. Con el cumplimiento del plan de trabajo, se diseñó el Protocolo de Evaluación que se presenta en este artículo. Conclusiones. El trabajo sistematizado y la colaboración intercentros de psiquiatras y psicólogos clínicos ha facilitado homogeneizar y consensuar un protocolo unificado de evaluación (AU)

Introduction. Transplantation is the treatment option that offers improved survival and quality of life as compared to organ failure. Psychiatric and psychological aspects of transplant candidates are important, especially in the pre-assessment stage, as the influence of these factors can hinder post-surgical outcome in both the implanted organ survival and the quality of life of the transplanted person. Of particular importance, are the factors related to pathology due to substance use, psychopathology, and psychosocial support. There are currently few guidelines on the correct evaluation of patients eligible for these complex procedures. Method. Nineteen psychiatrists and clinical psychologists from six public hospitals in Catalonia conducted a systematic consensus to determine the design of a Unified Protocol psychological and psychiatric evaluation. An annual work plan was implemented, during which; the objectives were defined, a literature review was conducted, the inclusion and exclusion criteria were discussed, questionnaires were selected, and a structured interview was developed. Results. With the implementation of the work plan, the Assessment Protocol presented in this article was designed. Conclusions. systematic work and improving cooperation between psychiatrists and clinical psychologists, has led to homogeneity and consensus on a unified evaluation protocol (AU)

Measurement and assessment of somatic symptoms.

Somatic symptoms are common presentations in health settings. They can manifest as symptoms of another underlying mental disorder or be termed as medically unexplained. When they are medically unexplained they are invariably subsumed under the diagnostic categories of somatoform disorders. They are associated with interference in functioning, poor quality of life and are burdensome on health resources. The measurement of these symptoms is essential for understanding the individual and planning treatment. There are various instruments that have somatic symptoms measurement in their items. The tools have included somatic symptoms measurement in measuring general psychopathology, somatic symptoms as part of anxiety and depression, somatic symptoms specifically, and as a screening instrument for somatoform disorders. The advantages and disadvantages of common measures have been discussed. It appears that no one measure fulfils the essential criteria of an ideal measure for somatic symptoms. The measures of somatic symptoms should also be culturally sensitive and serve diagnostic, prognostic and heuristic purposes. These aspects are highlighted in the review.

Somatic symptoms in consultation-liaison psychiatry.

In medically ill patients the term 'somatic symptoms' is used to understand those symptoms which cannot be fully understood in the light of existing medical illness(es). These include a number of physical symptoms and also certain clinical syndromes such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome among others. However, it is increasingly recognized that such patients have larger degrees of psychological morbidities, especially depressive and anxiety disorders, and have disproportionately elevated rates of medical care utilization, including outpatient visits, hospitalizations and total healthcare costs. In view of this psychological morbidity, significant distress and functional impairment, the role of the consultation-liaison psychiatrist is prominent in the management of these patients. A consultation-liaison (CL) psychiatrist is expected to be part of the primary care team to manage patient with unexplained SS, and at the same time is expected to guide colleagues to practice a patient-centred approach to improve the outcome of patients with such symptoms. The clinical work of a CL psychiatrist involves evaluation of patients with medically unexplained symptoms for probable psychiatric disorders and treatment of psychiatric morbidity and also management of patients without psychiatric morbidity. Management strategies include reattribution, cognitive behaviour therapy and antidepressants, with each strategy showing varying degrees of success.

Acerca de un caso de síndrome referencial olfatorio / Apropos of an Olfactory Reference Syndrome case

El Síndrome Referencial Olfatorio (SRO) es una de las variedades del tipo somático del trastorno delirante y es definido por el juicio falso que el individuo afectado defiende respecto a la emisión de un olor fétido proveniente de su propio organismo y que los demás pueden advertir. En la venidera edición del Manual Diagnóstico y Estadístico de las Enfermedades Mentales (DSM-V), se ha propuesto desgajar al SRO como una patología independiente. A partir del reporte de un caso ilustrativo, revisamos la respectiva bibliografía y comentamos tal propuesta (AU)

Olfactory Reference Syndrome (ORS) is one of the varieties of the somatic type of the Delusional Disorder, and it is characterized by the mistaken statement of a patient who declares the issuance of a foul odor coming from his own body and that others may notice. In the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) it has been proposed to break off ORS as an independent pathology. From an illustrative case report, we review the relevant literature and discuss this proposal (AU)

Sex differences in oppositional defiant disorder / Diferencias de sexo en el trastorno negativista desafiante

The goal was to analyze the sex differences in symptoms, comorbidity and functional impairment in outpatient children with Oppositional Defiant Disorder (ODD). A sample of 343 children, aged 8 to 17 years and diagnosed with ODD, were assessed with a semi-structured diagnostic interview and dimensional measures of psychopathology and functional impairment. Boys with ODD more frequently displayed the symptoms «deliberately annoys» and «blames others», presented comorbid ADHD, and had greater functional impairment in school and community contexts; girls presented higher comorbidity with internalizing symptomatology (anxiety, depression and somatic complaints). Given that some clinical differences are apparent in ODD between boys and girls, it is necessary to consider the sex of the patient in order to identify and treat this disorder efficiently and effectively in boys and in girls (AU)

El objetivo es analizar las diferencias de sexo en la prevalencia, sintomatología, comorbilidad y deterioro funcional en pacientes externos con Trastorno Negativista Desafiante (TND). Una muestra de 343 niños y adolescentes de entre 8 y 17 años diagnosticados de TND fueron evaluados con una entrevista diagnóstica semiestructurada y otras medidas dimensionales de psicopatología y deterioro funcional. Los niños con TND mostraron con mayor frecuencia los síntomas «molestar deliberadamente» y «acusar a otros», mayor comorbilidad con trastorno por déficit de atención con hiperactividad y mayor deterioro funcional en el colegio y en la comunidad; las niñas presentaron mayor comorbilidad con sintomatología interiorizada (ansiedad, depresión y quejas somáticas). Niños y niñas presentan un cuadro clínico de TND con algunas diferencias. Es necesario adoptar una perspectiva de sexo para identificar y tratar el TND de manera eficaz y eficiente en niños y en niñas (AU)

Sleep deprivation in mood disorders.

Growing clinical evidence in support of the efficacy and safety of sleep deprivation (SD), and its biological mechanisms of action suggest that this technique can now be included among the first-line antidepressant treatment strategies for mood disorders. SD targets the broadly defined depressive syndrome, and can be administered according to several different treatment schedules: total versus partial, single versus repeated, alone or combined with antidepressant drugs, mood stabilizers, or other chronotherapeutic techniques, such as light therapy and sleep phase advance. The present review focuses on clinical evidence about the place of SD in therapy, its indications, dosage and timing of the therapeutic wake, interactions with other treatments, precautions and contraindications, adverse reactions, mechanism of action, and comparative efficacy, with the aim of providing the clinical psychiatrist with an updated, concise guide to its application.

Caracterización clínica y terapéutica de un muestreo portugués de pacientes con esquizofrenia / Clinical and therapeutic characterization of a portuguese sample of patients with schizophrenia

Introducción. El desarrollo de las políticas de salud mental sobre trastornos psiquiátricos graves debe llevarse a cabo con un conocimiento adecuado de las realidades socio-demográficas, y clínicas de los padrones de prescripción. En Portugal, los estudios epidemiológicos no tienen un nivel de detalle que haga posible una comprensión profunda de este fenómeno. En la población portuguesa que sufre esquizofrenia hay una carencia de estudios en profundidad que limitan su comparación con otros países europeos. Este estudio ha sido diseñado con el objetivo principal de conocer la práctica clínica habitual y las características de la esquizofrenia en Portugal. Método. Se trata de un estudio observacional, descriptivo, transversal y multicéntrico, con datos recogidos en la práctica clínica corriente. Se han analizado un total de 474 pacientes. Resultados. El diagnóstico más frecuente la esquizofrenia paranoide (54%), de severidad moderada, con frecuentes complicaciones psiquiátricas (39,7%) y somáticas (28,4%). El 48,6% de los pacientes presentaban consumo de drogas. Aproximadamente la mitad de los pacientes tomaban antipsicóticos atípicos como tratamiento principal, aunque el haloperidol fue el medicamento prescrito con más frecuencia (35,9%). El 59,51% de los pacientes estaban siendo tratados en monoterapia antipsicótica y el 45% con una formulación de larga duración inyectable. Las dosis de los antipsicóticos eran muy variables y con frecuencia fuera de la indicación autorizada. El 37,9% de los pacientes tenían terapia concomitante no farmacológica. Conclusiones. Los pacientes presentan características sociodemográficas similares a las de otros ensayos clínicos naturalistas, pero diferentes de los ensayos clínicos con fármacos. En general, los pacientes se tratan con antipsicóticos atípicos, aunque un gran porcentaje prosigue con formulaciones de liberación lenta en terapia de combinación con dos o más antipsicóticos, en cifras mayores que en otros estudios similares. Las enfermedades somáticas quizás se infradiagnostica no se tratan de manera insuficiente (AU)

Introduction. The development of Mental Health policies for psychiatric disorders should be driven by a correct knowledge of the socio-demographic, clinical and therapeutic realities of the disease. There is paucity of detailed studies in the Portuguese population that does not allow a direct comparation with other European countries. The objective of the present study is to characterize the sociodemograhic and clinical characteristics of schizophrenia patients in Portugal and the therapeutic patterns. Methods. This multicentric, cross sectional, non interventional study was designed to describe the demographic and clinical data of patients with schizophrenia (n=474), and also the demographic and professional characteristics of their treating psychiatrists. Results. The most frequent diagnosis found was paranoid schizophrenia (54%), with comorbid psychiatric conditions in 39,7% and somatic diseases in 28.4% of the patients. About half the patients were on second generation antipsychotics (SGS) as principal therapy, although haloperidol has been the most frequent drug prescribed as so (35.9 %). 59.51 % of the patients were on antipsychotic monotherapy, and 45% on a depot formulation. Antipsychotic dose vary widely, and they are quite often prescribed on off label doses. Discussion. Our sample is similar to others found in naturalistic studies, however slightly different from clinical trials. In general, patients with schizophrenia tend to be treated with SGA, although have a higher chance to be on a long-term formulation and to be on polytherapy than in other studies. Somatic diseases are maybe under diagnosed and are undertreated (AU)

Nitrous oxide (laughing gas) inhalation as an alternative to electroconvulsive therapy.

Electroconvulsive therapy (ECT) is used widely in the treatment of psychiatric conditions; however, its use is not without controversy with some recommending a moratorium on its clinical use. Complications and side effects of ECT include memory loss, injury, problems originating from sympathetic stimulation such as arrhythmias and myocardial ischemia and the risk of general anesthesia. Nitrous oxide (laughing gas) could potentially substitute for ECT as it shares some similar effects, has potential beneficial properties for these psychiatric patients and is relatively safe and easy to administer. Nitrous oxide induces laughter which has been described as nature's epileptoid catharsis which one might surmise would be beneficial for depression. It also produces a central sympathetic stimulation similar to ECT and causes release of endogenous opioid peptides, which are potential candidates for the development of antidepressant drugs. Nitrous oxide is also associated with seizure like activity itself. Administration of nitrous oxide as a substitute for ECT is eminently feasible and could be given in a series of treatments similar to ECT therapy.

Atención a los trastornos somatomorfos en poblacion reclusa / Care for cases of somatomorphic disorders in the prison population

El texto que hemos desarrollado pretende ser una contribución útil para facilitar, al personal sanitario que trabaja en el ámbito de prisiones, el necesario conocimiento teórico y técnico que les posibilite una mejor comprensión y atención a las personas, privadas de libertad, que sufren estos trastornos. En la medida en que sabemos que la integración cognitiva de un modelo descriptivo y comprensivo, el tener en la mente una teoría sobre el fenómeno observado, actúa como factor emocional de contención de las propias ansiedades que experimentamos en la relación terapéutica con los pacientes, queremos también contribuir, con esta aportación, a mejorar los recursos emocionales de los asistentes que desempeñan sus tareas sanitarias en un contexto tan ansiogeno como es el medio carcelario, a la vez que señalamos los riesgos de que cualquier teoría pueda ser utilizada para enmascarar la realidad clínica(AU)

This study sets out to make a worthwhile contribution to healthcare personnel working in the prison sector by providing theoretical and technical knowledge to enable them to better understand and care for people in prison who suffer from these disorders. As far as we know, the cognitive integration of a descriptive and comprehensive model, bearing in mind a theory of the observed phenomenon acts as an emotionally constraining factor for the anxieties we suffer in the therapeutic relationship with our patients. Consequently we also wish to contribute with this study to improving the emotional resources of personnel working in a context as anxiety-provoking as is a prison, while also pointing out the risks inherent to any theory that might be used to conceal clinical realities(AU)

Current trends in the assessment and somatic treatment of resistant/refractory major depression: an overview.

A significant proportion of depressed patients eventually present with treatment-resistant/refractory major depression (TRD), a debilitating condition that imposes significant health, social, and economic burdens. Recently, a growing level of consensus has been reached on the general meaning of TRD, according to which, depression is considered resistant when at least two trials with antidepressants from different pharmacologic classes (adequate in terms of dose, duration, outcome, and compliance) failed to achieve clinical remission. Regarding the management of TRD, a two-step approach is suggested, involving first the evaluation of factors that may contribute to treatment nonresponse (such as comorbid medical and psychiatric conditions), and second, the use of the four classical strategies for enhancing antidepressant efficacy (namely optimization, augmentation, combination, and switching). Finally, future research on TRD should include studies addressing, among other issues, the validity of the proposed definitional criteria, the evaluation of reliable predictors of treatment outcome, and the development of novel therapeutic strategies.

Somatic therapies for treatment-resistant depression: new neurotherapeutic interventions.

This brief review provides an overview of neurotherapeutic interventions for major depression that are available currently or are being studied in clinical trials. The growing utility of surgical and device-related treatments for psychiatric conditions may represent a sea change in the field of psychiatry comparable to that seen in other clinical disciplines. For example, for many years the overwhelming majority of cardiac conditions were treated with medications and behavioral interventions. With the advent of cardiac surgical procedures such as ablation and cardiac bypass surgery and the use of devices such as cardiac stents and pacemakers, the ability to treat cardiac disease has improved dramatically. The hope is that the use of neurotherapeutic interventions will lead to a similar improvement in the treatment of psychiatric illness. The future of neurotherpeutic interventions in psychiatry may include the use of neuroimaging technology to predict with patients may respond to which procedures or to guide the placement of DBS electrodes on an individual basis. DBS electrodes also could be placed in multiple brain regions. Clinical trials of cortical stimulation using surgically implanted electrodes on the brain surface are underway. These cortical-surface electrodes could provide cortical stimulation comparable to that induced by rTMS at the same location, obviating the need for visits to a physician for rTMS treatments and providing cortical stimulation of a greater magnitude and for an extended duration. Also, one can foresee surgical interventions in which neurotransmitter release is potentiated either by stimulating appropriate nuclei in the brain or by releasing neurotransmitters or neurotransmitter precursors into target brain regions using cannulae or an implanted device. Neurotrophic factors also could be introduced into target brain regions using analogous techniques. Although the future of neurotherapeutic interventions in psychiatry is hard to predict, it is clear that these treatments will have a growing role in the field.

The empirical status of melancholia: implications for psychology.

The concept of a subtype of depression with a biological rather than a psychological set of causes has been more prominent in the psychiatric literature than in the psychological literature on depression. There has been dispute as to whether research on melancholia supports the distinction of a separate subtype with a distinct symptomatic profile characterized by marked anhedonia, psychomotor difficulties, excessive guilt or hopelessness, suicidal features, and appetite and weight disturbances. Research suggests that individuals with melancholic depression are qualitatively different from those with non-melancholic depression in their symptomatology. Examination of biological functioning, personality traits, responsiveness to treatment, and suicidality also tend to support the melancholic-non-melancholic distinction. This paper reviews the status of the melancholia concept and explores its implications for psychological research and practice.