Psychiatry (Edgmont (Pa. : Township))最新文献

Causal specifiers are certain and possible causes of mental disorders and can be biological, genetic, environmental, developmental, social, psychodynamic, behavioral, cognitive, or personality characteristics. Depending upon the clinical judgment of the degree of certainty, a causal specifier can be a definite etiopathogenesis or a factor contributing to manifestations of mental disorders. The author recommends adding causal specifiers to Axis I diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to improve communication among clinicians.

The etiology of schizophrenia and other chronic psychotic disorders is complicated considering the multifactorial contribution of developmental, biological, and environmental factors. The role of the blood brain barrier has not yet been established as part of schizophrenia etiology; however, in previous blood brain barrier articles, we discussed potential consequences of various biological abnormalities due to dysregulation of molecular components, such as cofactors,(1) signaling molecules,(2) enzymes,(3) cytokines,(4) and antibodies.(5) In this review, we will discuss the potential use of peripheral ratiometric molecular analysis relevant to the central nervous system for the evaluation of the development of schizophrenia.

In this article we investigate the post-launch retail prescription trends of asenapine (Saphris(®), Merck and Co.) and iloperidone (Fanapt(®), Vanda Pharmaceuticals Inc./Novartis), two new atypical antipsychotics to launch in the United States market in October 2009 and January 2010, respectively. In the first 12 months following the asenapine launch, and in the nine months since the iloperidone launch, asenapine and iloperidone have secured 0.22 and 0.10 percent of the total prescription market; however, both products nearly double those respective shares when total prescriptions are isolated to new patient prescriptions (0.44% for asenapine and 0.17% for iloperidone). Since launch, asenapine has shown stronger signs of growth, largely attributed to its approval in multiple indications as compared to iloperidone's single indication.

According to data from Western countries, psychiatric disorders are relatively prevalent. For example, in the United States general population, data from the National Comorbidity Survey Replication study indicate that about one-quarter of individuals experience a psychiatric disorder in a given year, with lifetime rates at about 50 percent. For both prevalence designations, anxiety disorders are most common. According to data from the European Study of the Epidemiology of Mental Disorders, the 12-month and lifetime-prevalence rates for psychiatric disorders among European general populations are 11.5 and 25.9 percent, respectively, with mood and anxiety disorders evidencing approximately equal rates. As expected, in primary care settings, the prevalence of psychiatric disorders in the United States and Europe is high, with point-prevalence rates varying, but affecting approximately 25 to 30 percent of patients. In primary care settings, the most common psychiatric diagnoses are mood and anxiety disorders as well as somatoform disorders. While no global summary of cost of care is available, the high prevalence rates of psychiatric disorders correspond with high expenditures for mental healthcare, as evidenced by a number of sources. Given these latter findings, prevention becomes all the more relevant in terms of cost management.

We present two cases of treatment-resistant depression that improved with recognition and correction of the underlying medical etiology of vitamin B12 deficiency. Supplementations of vitamin B12 to the same antidepressant regimen that the patient had not responded earlier led to response. Two male subjects who were vegetarians presented with long-standing histories of depression and had not responded to three adequate trials of antidepressants. Upon investigation, the authors found that the subjects had low vitamin B12 levels. Both cases improved with supplementation of vitamin B12. Subjects with depression who do not respond to conventional antidepressants should be evaluated for nutritional factors.

The capacity for voluntary motor activity underpins all behavior. Although psychiatrists are acutely aware of behavior, we tend to think of its abstract motives more than its concrete mechanisms. This article reviews the basic brain mechanisms of voluntary motor activity, the most useful pyramidal tract or upper motor neuron signs, and their relevance to specific patient groups of interest to psychiatrists.