RESUMO
A new application for omega-3 fatty acids has recently emerged, concerning the treatment of several mental disorders. This indication is supported by data of neurobiological research, as highly unsaturated fatty acids (HUFAs) are highly concentrated in neural phospholipids and are important components of the neuronal cell membrane. They modulate the mechanisms of brain cell signaling, including the dopaminergic and serotonergic pathways. The aim of this review is to provide a complete and updated account of the empirical evidence of the efficacy and safety that are currently available for omega-3 fatty acids in the treatment of psychiatric disorders. The main evidence for the effectiveness of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been obtained in mood disorders, in particular in the treatment of depressive symptoms in unipolar and bipolar depression. There is some evidence to support the use of omega-3 fatty acids in the treatment of conditions characterized by a high level of impulsivity and aggression and borderline personality disorders. In patients with attention deficit hyperactivity disorder, small-to-modest effects of omega-3 HUFAs have been found. The most promising results have been reported by studies using high doses of EPA or the association of omega-3 and omega-6 fatty acids. In schizophrenia, current data are not conclusive and do not allow us either to refuse or support the indication of omega-3 fatty acids. For the remaining psychiatric disturbances, including autism spectrum disorders, anxiety disorders, obsessive-compulsive disorder, eating disorders and substance use disorder, the data are too scarce to draw any conclusion. Concerning tolerability, several studies concluded that omega-3 can be considered safe and well tolerated at doses up to 5 g/day.
RESUMO
Interpersonal psychotherapy (IPT) was proposed in 1984 by Klerman and colleagues. It is a time-limited psychotherapy (12-16 sessions), diagnosis-focused, based on a medical model. Psychiatric symptoms develop in an interpersonal context. Acting on this context, it is possible to induce remission and prevent subsequent recurrences. IPT is aimed at the resolution of the interpersonal crisis, improving social functioning and psychiatric symptoms. At first, it was addressed to treat major depression, not psychotic or bipolar. Later IPT has been applied to a growing number of psychiatric disorders, because of their frequent and remarkable interpersonal dimension. However, specific adaptations of IPT have been required to consider the different clinical characteristics of these disorders. To date, among Axis II disorders, only borderline personality disorder (BPD) has been a target of IPT. The frequent comorbidity with mood disorders and the relational problems due to BPD core symptoms are the main reasons for the proposal of an adapted model of IPT: the IPT-BPD. This model has a longer duration (34 sessions), and is designed to deal with chronicity of BPD, poor therapeutic alliance and the high risk of suicide and self-harm of these patients. Although studies aimed to test the efficacy of IPT in borderline patients were performed with promising results, replication of findings in larger samples is required.
