Psychopharmacology bulletin最新文献

Objectives: Hyperactive intracellular calcium ion concentration ([Ca²⁺]_i) in peripheral cells of patients with bipolar disorder has been reported repeatedly. Reduction of intracellular calcium ion concentration has been found with the established mood stabilizers lithium and carbamazepine, but less reliably with valproate. This study examined whether inconsistent findings with valproate could be a function of the subjects studied.

Experimental design: Platelet [Ca²⁺]_i at baseline ([Ca²⁺]_B) and after stimulation with thrombin and platelet activating factor ([Ca²⁺]_S) was measured with and without incubation with therapeutic levels of valproate in mildly to moderately ill bipolar disorder patients (N = 14).

Principal observations: Prior to incubation with valproate, platelet [Ca²⁺]_B and [Ca²⁺]_S were generally lower than has been reported in studies of intracellular calcium ion concentration in bipolar disorder, consistent with at most moderate symptom severity and impairment. Incubation with valproate raised [Ca²⁺]_B somewhat, primarily in patients with lower initial [Ca²⁺]_B. Valproate incubation blunted the increase in [Ca²⁺]_i with platelet stimulation, but valproate did not alter final [Ca²⁺]_S, reflecting a smaller increase with valproate but a higher starting point (i.e., [Ca²⁺]_B) in valproate incubated cells.

Conclusions: Mixed results of studies of cellular actions of valproate on intracellular calcium signaling may be the results of use of subjects with milder illness and normal baseline signaling. Studies of animals and normal human subjects may be less informative about the potential mechanism of action of any psychotropic medication than studies of patients with sufficient severity of illness and abnormalities in the dimension of cellular function targeted by the medication.

Objective: To compare factors correlating with stress, anxiety, and depression between dental students (DS) in preclinical (PP) and clinical programs (CP).

Method: This study involved 165 DS, utilizing the DASS-21, GAD-7, PSS-10, and PHQ-9 assessments. The data were analyzed using the Rasch model and Spearman test.

Result: The study included 38.18% in PP and 61.81% in CP (M:F 1:3.7), and a mean age of 21.99 ± 2.36 years. Person map revealed perceptual differences in anxiety and depression between groups, but not in stress. In the PP group, family was the sole factor correlating with stress (p = 0.032). Stress was the primary mental health concern among dental students, particularly during both preclinical and clinical programs. Anxiety and depression, though less common in the preclinical stage, increased significantly in the clinical phase. In the CP group, both supervisor and family (p < 0.05) were correlated with anxiety, while age and self-health (p < 0.05) were linked to depression.

Conclusion: Stress was the primary mental health concern among dental students, particularly during both preclinical and clinical programs. Anxiety and depression, though less common in the preclinical stage, increased significantly in the clinical phase. Identifying factors such as family, supervisors, age, self-health, and academic progression is essential for developing effective strategies to support dental students' mental health.

Objective: To examine the effects of Serdexmethylphenidate/dexmethylphenidate (SDX/d-MPH) on ADHD symptoms throughout the day in adults with DSM-5 ADHD.

Method: This was a 6-week pilot study that included 3 weeks of open label treatment with SDX/d-MPH (39.2/7.8 mg/day to 52.3/10.4 mg/day in clinical titration) after completion of a one-week screening period and a two-week observation period in seventeen adults with ADHD. Two subjects were discontinued from the trial, one for being placebo-responder and another for exhibiting blood pressure lability during the observation period. Of the remaining 15 subjects, one dropped out after one week on 39.2/7.8 mg/day, while all others completed the trial. All fifteen participants were included in the data analyses.

Results: There were substantial effects of SDX/d-MPH on all clinical measures, including investigator symptom scores (AISRS); self-report (ASRS) scores, time-sensitive ADHD (TASS) scores throughout the day, impairment (CGI) and executive function scores (BRIEF-A) and measures of medication smoothness (AMSES). SDX/d-MPH was generally well tolerated.

Conclusions: This pilot study is the first systematic treatment effect trial data for SDX/d-MPH in adults with DSM-5 ADHD. The data preliminarily supports the clinical efficacy of DSM/d-MPH in adult ADHD and its ability to ameliorate symptoms throughout the day.

Alcohol use disorder (AUD) remains a major contributor to the global burden of disease. Extended-release naltrexone (XR-NTX), a μ-opioid receptor antagonist, is a key pharmacological option for maintaining abstinence, though individual treatment response varies substantially. Genetic variability in the μ-opioid receptor gene (OPRM1), particularly rs1799971, may underpin this heterogeneity. Study objective was to evaluate the association between OPRM1 rs1799971 polymorphism and clinical outcomes of XR-NTX therapy in patients with AUD while examining interactions with motivational profiles. In this prospective study, 100 patients with AUD in remission received six monthly intramuscular injections of XR-NTX (380 mg). Genotyping for OPRM1 rs1799971 was performed using real-time allele-specific PCR. Primary outcomes included craving dynamics (PACS), relapse rates, abstinence duration, and treatment adherence over 180 days. Motivation was assessed through structured interviews. The A/A genotype was associated with longer abstinence (150.6 ± 36.2 days), lower relapse rates (29.2%), greater craving reduction, and higher treatment completion (86.2%) compared to A/G and G/G (A/A vs. A/G: p = 0.005; A/A vs. G/G: p = 0.021). The G allele significantly increased relapse risk (OR = 2.93; 95% CI: 1.48-5.79). Intrinsic motivation was associated with better outcomes. A significant genotype-motivation interaction was observed (p = 0.038). No genotype-related differences in adverse event frequency were observed. OPRM1 rs1799971 polymorphism significantly influences the efficacy of XR-NTX in AUD. Carriers of the A/A genotype derive greater therapeutic benefit, while G allele carriers may require intensified clinical support. Pre-therapeutic OPRM1 genotyping could optimize XR-NTX personalization, with G-allele carriers warranting intensified psychosocial support.

This patient is a 17 year old Caucasian transgender male (FTM) with autism spectrum disorder (ASD level 1), gender dysphoria (GD), and dissociative identity disorder (DID). The patient has multiple psychiatric comorbidities including obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), emotional dysregulation, trauma and stressor disorder, and insomnia. Medical comorbidities include 16p13.3 and 16p24.3 microdeletions, hypotonia, bilateral cataracts (surgically corrected), and minimal change disease. To our knowledge, this is the first case report in which the patient is suffering from ASD, GD, and DID as comorbid diagnoses. Our review of this patient serves to highlight the complexity of providing care to patients with a comorbidity of ASD, GD, and DID, as well as the complexity in distinguishing these conditions from one another.

Genital dysmorphia, with male preponderance, is commonly used to refer to penile dysmorphia. This dysmorphia, centred on penile size, can be contextualized as a specifier of body dysmorphic disorder with varied levels of insight. It follows that cosmetic surgery for men with genital dysmorphia without prior assessment and specific treatment is unlikely to be helpful.

Authors herein decently argue that psychiatrists can and should play a crucial role in helping women understand the interplay of reproductive health and mental health as they are positioned to be an advocate as well as an active force in enabling reproductive choice.

Clozapine is an atypical antipsychotic and is the drug of choice for treatment-resistant schizophrenia. Unlike other atypical antipsychotics which are known to occasionally cause symptoms of mania or hypomania, clozapine has been shown to be effective at symptom reduction during manic episodes in treatment-resistant bipolar disorder and is generally well tolerated in those severe mood disorders. To our knowledge, there is only one other reported case of potential clozapine-induced mania. In this case report and review, we present a 47-year-old caucasian male with a well-established history of schizophrenia who was voluntarily admitted to an inpatient psychiatric unit for paranoia and auditory hallucinations. The patient had trialed multiple antipsychotics prior to the current hospitalization, with the exception of clozapine. To our knowledge, this is the second case report of manic-like symptoms that may be secondary to clozapine.