A consistent body of findings published over 30 years shows raised rates of life events before onset of clinical unipolar depression. A range of threatening events is implicated, with only limited specificity, although a somewhat closer relationship to interpersonal losses. Social support both buffers effects of life events and its absence also has some independent stressful effects. Life stress also affects outcome. Effects extend across the age range, but are weaker or absent in recurrent disorder, particularly when this is severe or melancholic. They are also weaker in bipolar disorder, where social rhythm disruption may have a particular effect. The causative contribution of life stress is of moderate size overall but does not exclude many other factors. Causative chains are complex and life stress itself is not fully independent, because available social support is shaped by personal capacity to form relationships, and occurrence of life events has some genetic elements and is predicted by disturbance in childhood.
{"title":"Stress and affective disorders in humans.","authors":"E. Paykel","doi":"10.1053/SCNP.2001.19411","DOIUrl":"https://doi.org/10.1053/SCNP.2001.19411","url":null,"abstract":"A consistent body of findings published over 30 years shows raised rates of life events before onset of clinical unipolar depression. A range of threatening events is implicated, with only limited specificity, although a somewhat closer relationship to interpersonal losses. Social support both buffers effects of life events and its absence also has some independent stressful effects. Life stress also affects outcome. Effects extend across the age range, but are weaker or absent in recurrent disorder, particularly when this is severe or melancholic. They are also weaker in bipolar disorder, where social rhythm disruption may have a particular effect. The causative contribution of life stress is of moderate size overall but does not exclude many other factors. Causative chains are complex and life stress itself is not fully independent, because available social support is shaped by personal capacity to form relationships, and occurrence of life events has some genetic elements and is predicted by disturbance in childhood.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"6 1 1","pages":"4-11"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58315014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Research utilizing animal models has been responsible for major advances in understanding psychiatric disorders. The first data based integrative theories of psychopathology grew largely out of animal research. A variety of animal models that have been developed have been critical in broadening our understanding of human development and in providing empirical support for the importance of early experiences for behavioral and neurobiologic development. The development of many widely used clinical psychopharmacologic agents has depended on the use of animal models. The above examples represent substantive contributions of animal models to investigations of fundamental aspects of psychopathology. There is no "perfect," complete or comprehensive single animal model for any specific psychiatric disorder and contentious debates about the validity and/or usefulness of specific animal models persist. Animal models of diseases in medicine need to be understood in a historical and evolutionary perspective and their advantages as well as limitations recognized. There will likely never be an animal model in any field of medicine that is a perfect fit with the human condition, rather the emphasis in the development and study of disease models in animals needs to be on specific components of the human illness. Neither overextended cross-species comparisons nor unjustified negativism about animal models seems defensible. A major challenge in the continuing development and use of biobehavioral animal models in psychiatry is their relationship to the molecular neurosciences, including genetics, in understanding the mechanisms of mental disorders.
{"title":"Overview of the past contributions of animal models and their changing place in psychiatry.","authors":"W. McKINNEY","doi":"10.1053/SCNP.2001.20292","DOIUrl":"https://doi.org/10.1053/SCNP.2001.20292","url":null,"abstract":"Research utilizing animal models has been responsible for major advances in understanding psychiatric disorders. The first data based integrative theories of psychopathology grew largely out of animal research. A variety of animal models that have been developed have been critical in broadening our understanding of human development and in providing empirical support for the importance of early experiences for behavioral and neurobiologic development. The development of many widely used clinical psychopharmacologic agents has depended on the use of animal models. The above examples represent substantive contributions of animal models to investigations of fundamental aspects of psychopathology. There is no \"perfect,\" complete or comprehensive single animal model for any specific psychiatric disorder and contentious debates about the validity and/or usefulness of specific animal models persist. Animal models of diseases in medicine need to be understood in a historical and evolutionary perspective and their advantages as well as limitations recognized. There will likely never be an animal model in any field of medicine that is a perfect fit with the human condition, rather the emphasis in the development and study of disease models in animals needs to be on specific components of the human illness. Neither overextended cross-species comparisons nor unjustified negativism about animal models seems defensible. A major challenge in the continuing development and use of biobehavioral animal models in psychiatry is their relationship to the molecular neurosciences, including genetics, in understanding the mechanisms of mental disorders.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"6 1 1","pages":"68-78"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58315047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Three general approaches to evolutionary perspectives in psychiatry include the following domains. (1) information from general medicine and physiology that involves defenses against infectious disease and predators, with obsessive compulsive disorder and posttraumatic stress disorder (PTSD) amongst the psychiatric results of this. (2) Sociophysiology assumes that normal brain functions mediate social interactions, including social rank hierarchy, in-out group formation, and family bonding. At times these function maladroitly resulting in psychiatric symptoms, for example, mania, persecutory delusions, and depression. (3) Evolutionary psychology explains self-sacrificing and generous behavior despite how genes act selfishly in natural selection theory, via the helping of relatives, reciprocal altruism, and manipulation of social contracts.
{"title":"Evolutionary perspectives on stress and affective disorder.","authors":"R. Gardner","doi":"10.1053/SCNP.2001.19400","DOIUrl":"https://doi.org/10.1053/SCNP.2001.19400","url":null,"abstract":"Three general approaches to evolutionary perspectives in psychiatry include the following domains. (1) information from general medicine and physiology that involves defenses against infectious disease and predators, with obsessive compulsive disorder and posttraumatic stress disorder (PTSD) amongst the psychiatric results of this. (2) Sociophysiology assumes that normal brain functions mediate social interactions, including social rank hierarchy, in-out group formation, and family bonding. At times these function maladroitly resulting in psychiatric symptoms, for example, mania, persecutory delusions, and depression. (3) Evolutionary psychology explains self-sacrificing and generous behavior despite how genes act selfishly in natural selection theory, via the helping of relatives, reciprocal altruism, and manipulation of social contracts.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"6 1 1","pages":"32-42"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58315346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Many neuropsychiatric disorders affect memory. Brain regions important in the neuroanatomic substrate of memory include the hippocampus, and sections of the frontal, temporal, and parietal cortices and the thalamus. Acetylcholine and many other neurotransmitters and neuromodulators including dopamine, glutamate, GABA, the catecholamines, and estrogen modulate cognitive function. Treatment approaches to memory loss typically use Alzheimer's dementia as the template, and are discussed in this report.
{"title":"Approaches to memory loss in neuropsychiatric disorders.","authors":"G. Devi, J. Silver","doi":"10.1053/SCNP.2000.16528","DOIUrl":"https://doi.org/10.1053/SCNP.2000.16528","url":null,"abstract":"Many neuropsychiatric disorders affect memory. Brain regions important in the neuroanatomic substrate of memory include the hippocampus, and sections of the frontal, temporal, and parietal cortices and the thalamus. Acetylcholine and many other neurotransmitters and neuromodulators including dopamine, glutamate, GABA, the catecholamines, and estrogen modulate cognitive function. Treatment approaches to memory loss typically use Alzheimer's dementia as the template, and are discussed in this report.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"5 4 1","pages":"259-65"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58314431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The ability to skillfully regulate the internal experience and outward expression of emotion is among the most complex and recently acquired functions of the human brain. When the capacity for emotional regulation is compromised by disease or injury the impact on individuals and their families may be considerable, both with regard to psychological well-being and social and occupational function. This article describes first a framework for the description, evaluation, and treatment of affective dysregulation. We review the literature regarding disorders of affective regulation, and in particular affective lability. Although disorders of affect as they occur in common neuropsychiatric disorders (eg, stroke, multiple sclerosis, traumatic brain injury, and so on) are the focus of this article, the review incorporates information from the study of patients with primary psychiatric disorders and hence the discussion herein may also be relevant to the understanding and treatment of affective lability in these conditions. An overview of the neurobiology that appears most relevant to understanding such problems is presented, along with several specific methods that appear to be useful in the evaluation of patients with affective lability. Finally, we review the literature regarding the treatment of disorders of affect and offer some practical suggestions for the treatment of patients with these problems.
{"title":"The neuropsychiatry of pathologic affect: an approach to evaluation and treatment.","authors":"D. Arciniegas, J. Topkoff","doi":"10.1053/SCNP.2000.9554","DOIUrl":"https://doi.org/10.1053/SCNP.2000.9554","url":null,"abstract":"The ability to skillfully regulate the internal experience and outward expression of emotion is among the most complex and recently acquired functions of the human brain. When the capacity for emotional regulation is compromised by disease or injury the impact on individuals and their families may be considerable, both with regard to psychological well-being and social and occupational function. This article describes first a framework for the description, evaluation, and treatment of affective dysregulation. We review the literature regarding disorders of affective regulation, and in particular affective lability. Although disorders of affect as they occur in common neuropsychiatric disorders (eg, stroke, multiple sclerosis, traumatic brain injury, and so on) are the focus of this article, the review incorporates information from the study of patients with primary psychiatric disorders and hence the discussion herein may also be relevant to the understanding and treatment of affective lability in these conditions. An overview of the neurobiology that appears most relevant to understanding such problems is presented, along with several specific methods that appear to be useful in the evaluation of patients with affective lability. Finally, we review the literature regarding the treatment of disorders of affect and offer some practical suggestions for the treatment of patients with these problems.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"5 4 1","pages":"290-306"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58314824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The phenomenology, pathophysiology, and psychopharmacology of repetitive self-injurious behavior (rSIB) are reviewed. Although numerous neurotransmitter systems are thought to be involved in the initiation and maintenance of rSIB, the majority of clinical studies attend to the role of serotonin or endogenous opioids. This focus has emerged from a conceptualization of rSIB as a problem of impulse control (primarily mediated by serotonin) and/or as a maladaptive pain-related behavior (ultimately mediated by opioids). A developmental perspective of rSIB is emphasized, highlighting the biased prevalence of rSIB among patients with mental retardation and severe personality disorders and the significance of critical developmental events leading to pathology in "pedagogical" neural circuits. A novel typology is offered in an effort to better match interventions with rSIB subtypes. Achievement of this ultimate goal however, must await further research.
{"title":"Repetitive self-injurious behavior: a neuropsychiatric perspective and review of pharmacologic treatments.","authors":"Rendueles Villalba, Colin J. Harrington","doi":"10.1053/SCNP.2000.16530","DOIUrl":"https://doi.org/10.1053/SCNP.2000.16530","url":null,"abstract":"The phenomenology, pathophysiology, and psychopharmacology of repetitive self-injurious behavior (rSIB) are reviewed. Although numerous neurotransmitter systems are thought to be involved in the initiation and maintenance of rSIB, the majority of clinical studies attend to the role of serotonin or endogenous opioids. This focus has emerged from a conceptualization of rSIB as a problem of impulse control (primarily mediated by serotonin) and/or as a maladaptive pain-related behavior (ultimately mediated by opioids). A developmental perspective of rSIB is emphasized, highlighting the biased prevalence of rSIB among patients with mental retardation and severe personality disorders and the significance of critical developmental events leading to pathology in \"pedagogical\" neural circuits. A novel typology is offered in an effort to better match interventions with rSIB subtypes. Achievement of this ultimate goal however, must await further research.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"23 1","pages":"215-26"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58314025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article reviews hypersexuality in individuals with neuropsychiatric disorders and its psychopharmacologic treatment. A brief review of the neurology, neuroendocrinology, and neuropharmacology of sexual behavior is presented. Literature describing the occurrence and treatment of hypersexuality in individuals with neuropsychiatric disorders is reviewed along with literature which discusses the pharmacologic treatment of individuals with hypersexual disorders in nonneuropsychiatric populations. Finally, a clinical algorithm for approaching and treating such disorders in a neuropsychiatric population is presented.
{"title":"Disorders of sexual impulse control in neuropsychiatric conditions.","authors":"R. Krueger, M. Kaplan","doi":"10.1053/SCNP.2000.9555","DOIUrl":"https://doi.org/10.1053/SCNP.2000.9555","url":null,"abstract":"This article reviews hypersexuality in individuals with neuropsychiatric disorders and its psychopharmacologic treatment. A brief review of the neurology, neuroendocrinology, and neuropharmacology of sexual behavior is presented. Literature describing the occurrence and treatment of hypersexuality in individuals with neuropsychiatric disorders is reviewed along with literature which discusses the pharmacologic treatment of individuals with hypersexual disorders in nonneuropsychiatric populations. Finally, a clinical algorithm for approaching and treating such disorders in a neuropsychiatric population is presented.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"5 4 1","pages":"266-74"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58314835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Disordered behavior resulting from central nervous system dysfunction is a common clinical problem for practitioners and for patients. Setting aside the problem of overtly aggressive, violent behavior, this article addresses the problem of disordered or disruptive behavior associated with neuropsychiatric conditions.
{"title":"Pharmacotherapy of disruptive behaviors associated with brain disease.","authors":"R. Ferrell","doi":"10.1053/SCNP.2000.16606","DOIUrl":"https://doi.org/10.1053/SCNP.2000.16606","url":null,"abstract":"Disordered behavior resulting from central nervous system dysfunction is a common clinical problem for practitioners and for patients. Setting aside the problem of overtly aggressive, violent behavior, this article addresses the problem of disordered or disruptive behavior associated with neuropsychiatric conditions.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"5 4 1","pages":"283-9"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58314885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep disorders have been recognized for millennia as a common complication of medical and neurologic disease. Virtually all neuropsychiatric disorders carry with them the potential for disturbances of sleep. When such complications do exist, they are typically associated with decreased quality of life, increased morbidity, and, in some cases, increased mortality rates. The prevalence of major sleep disorders among neurologic patients is high, but the rate of detection and treatment is quite low. The major sleep-related problems in this population can be divided into six areas: insomnia, circadian rhythm (sleep-wake schedule) disorders, hypersomnia, sleep-related breathing disorders, motor disturbances in sleep, and parasomnias. In this brief review, general clinical principles, diagnostic assessment and management guidelines for each of these areas are considered and their specific manifestations in neuropsychiatric disorders identified.
{"title":"Sleep in neuropsychiatric disorders.","authors":"M. Sateia, G. Greenough, P. Nowell","doi":"10.1053/SCNP.2000.9556","DOIUrl":"https://doi.org/10.1053/SCNP.2000.9556","url":null,"abstract":"Sleep disorders have been recognized for millennia as a common complication of medical and neurologic disease. Virtually all neuropsychiatric disorders carry with them the potential for disturbances of sleep. When such complications do exist, they are typically associated with decreased quality of life, increased morbidity, and, in some cases, increased mortality rates. The prevalence of major sleep disorders among neurologic patients is high, but the rate of detection and treatment is quite low. The major sleep-related problems in this population can be divided into six areas: insomnia, circadian rhythm (sleep-wake schedule) disorders, hypersomnia, sleep-related breathing disorders, motor disturbances in sleep, and parasomnias. In this brief review, general clinical principles, diagnostic assessment and management guidelines for each of these areas are considered and their specific manifestations in neuropsychiatric disorders identified.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"5 4 1","pages":"227-37"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58315192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Advances in neurobiological research suggest that certain frontal-subcortical circuits play important roles in idiopathic obsessive-compulsive disorder and Tourette's syndrome. Tics and obsessive-compulsive behaviors secondary to neurologic insult appear to involve the same neural circuitry. There are few systematic studies of the treatment of obsessive-compulsive behaviors and tics associated with neurologic disorders. However knowledge of the circuitry and associated neurochemistry of these disorders can help to outline a rational approach to these behaviors.
{"title":"Pathophysiology and treatment of secondary obsessive-compulsive behaviors and tics.","authors":"R. Bhangoo","doi":"10.1053/SCNP.2000.16529","DOIUrl":"https://doi.org/10.1053/SCNP.2000.16529","url":null,"abstract":"Advances in neurobiological research suggest that certain frontal-subcortical circuits play important roles in idiopathic obsessive-compulsive disorder and Tourette's syndrome. Tics and obsessive-compulsive behaviors secondary to neurologic insult appear to involve the same neural circuitry. There are few systematic studies of the treatment of obsessive-compulsive behaviors and tics associated with neurologic disorders. However knowledge of the circuitry and associated neurochemistry of these disorders can help to outline a rational approach to these behaviors.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"5 4 1","pages":"250-8"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58314461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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