Lithium Use and Non-use for Pregnant and Postpartum Women with Bipolar Disorder.

PURPOSE OF REVIEW: Despite being recognized as a first-line treatment for bipolar disorder, there is still inconsistent use of lithium in perinatal populations. This article will review data regarding lithium use during the peripartum and provide management recommendations for general psychiatric clinicians. RECENT FINDINGS: In contrast to prior data, recent studies indicate that lithium use in pregnancy is associated with either no increased malformations risk or a small increase in risk for cardiac malformations including Ebstein's anomaly. Limited data also show no significant effect on obstetric or neurodevelopmental outcomes. Data regarding infant lithium exposure via breastmilk remains limited. Lithium is currently under-prescribed and is an important treatment for women with bipolar disorder in pregnancy and the postpartum. Clinicians must weigh the risk of lithium treatment versus the risk of withholding or changing lithium treatment when managing bipolar disorder in this population.

Frequent Comorbidity and Predictors of Social Anxiety in Persons With Schizophrenia: A Retrospective Cohort Study.

OBJECTIVE: To determine if symptoms of social anxiety are distinct from negative symptoms of schizophrenia. METHOD: Fifty-three patients with schizophrenia or schizoaffective disorder (diagnosed per DSM-IV criteria) and 37 healthy controls were examined with the Liebowitz Social Anxiety Scale (LSAS) for social anxiety disorder and for the severity of social anxiety. The Positive and Negative Syndrome Scale (PANSS) and the Chapman scales for physical and social anhedonia were also administered. Data were collected from 2005 to 2010 from inpatient and outpatient research centers at the New York State Psychiatric Institute, New York. RESULTS: Social anxiety disorder was elevated more than 10-fold in schizophrenia patients than in controls (37.7% of patients vs 2.9% of controls, P ≤ .001). Social anxiety and social fear were unrelated to the PANSS with few exceptions. A family history of psychosis was also a significant independent predictor of social anxiety as measured by LSAS total (P = .004) and the social fear subscale (P = .007). CONCLUSIONS: These data confirm social anxiety disorder as a prominent comorbid disorder in patients with schizophrenia. Future studies should focus on treatment trials of this phenomenon. Social anxiety cannot be explained by the negative symptomatology of the disease. This study suggests that a family history of psychosis is a significant predictor of social anxiety.

Negative symptoms, past and present: a historical perspective and moving to DSM-5.

The diagnosis of schizophrenia includes "positive" and "negative" symptoms. These titles were developed to respectively reflect if the symptoms are additions to normal experiences, such as delusions and hallucinations, or if they refer to the absence or the loss of normal emotional function or behavior. This paper describes the history of the negative symptom concept, from its origins up to the considerations for the DSM-5, including the steps that produced the current conceptualizations. The DSM-5 only includes deficits in emotional expression and avolition as negative symptoms, which can be assessed from interview information. Factor analyses show they encompass most other negative symptom items. In addition to using these negative symptoms in a categorical manner to make a diagnosis, the DSM-5 has quantitative severity ratings of the negative symptoms, along with ratings of delusions, cognitive symptoms, motor symptoms, disorganization, depression and mania. With this approach, the different symptom domains, including negative symptoms, can be measured and tracked over time. Another change in the DSM-5 is the dropping of the schizophrenia subtypes that have been included in earlier volumes, as they were not useful in treatment decisions or prognosis. An intended outcome of these changes in DSM-5 is for clinicians to directly treat the individual psychopathological domains of the disorder for optimizing individual outcomes. Finally, this paper includes descriptions of the negative symptom items from over a dozen different scales.

Stressor controllability modulates fear extinction in humans.

Traumatic events are proposed to play a role in the development of anxiety disorders, however not all individuals exposed to extreme stress experience a pathological increase in fear. Recent studies in animal models suggest that the degree to which one is able to control an aversive experience is a critical factor determining its behavioral consequences. In this study, we examined whether stressor controllability modulates subsequent conditioned fear expression in humans. Participants were randomly assigned to an escapable stressor condition, a yoked inescapable stressor condition, or a control condition involving no stress exposure. One week later, all participants underwent fear conditioning, fear extinction, and a test of extinction retrieval the following day. Participants exposed to inescapable stress showed impaired fear extinction learning and increased fear expression the following day. In contrast, escapable stress improved fear extinction and prevented the spontaneous recovery of fear. Consistent with the bidirectional controllability effects previously reported in animal models, these results suggest that one's degree of control over aversive experiences may be an important factor influencing the development of psychological resilience or vulnerability in humans.