The fentanyls: pharmacological and clinical aspects relevant to Australia.

OBJECTIVE: North American and other jurisdictions have seen an alarming rise in the abuse of the fentanyls, with related overdose deaths. We sought to review this group of drugs to alert Australian psychiatrists and drug and alcohol clinicians to their clinical effects and potential harms. CONCLUSIONS: The extreme potency of the fentanyls underlie their lethality. Vigilance and investment from both policy makers and health care providers are required to mitigate harm from a possible future Australian fentanyl epidemic.

The fentanyls: a 'future threat' for Australia?

OBJECTIVE: The fentanyls have emerged as a significant public health threat in North America but much less so in Australia. We sought to identify reasons for this discrepancy and highlight harm reduction approaches that may mitigate a future Australian fentanyl epidemic. CONCLUSIONS: Differences in drug use 'culture' and a supply of cheap high-quality methamphetamine in Australia may be reasons for the observed difference in fentanyl-related harm. More worryingly, it is possible that Australia is following North American trends and that the fentanyl epidemic is still to come.

Electroconvulsive therapy treatment in patients with somatic symptom and related disorders.

OBJECTIVE: Medically unexplained somatic complaints are highly prevalent, and lead to significant impairment and disability. The number of effective treatment modalities for somatic symptom and related disorders (SSDs) or somatoform disorders (SDs) remains limited. To date, there is no formal indication for electroconvulsive therapy (ECT) in SSD or SD. We report on the largest case series to date regarding the effectiveness of ECT in patients with SSD and SD. METHODS: A retrospective chart review of all patients treated with an index course of ECT at the Neuropsychiatric Program at the University of British Columbia Hospital from 2000 to 2010 was conducted. The primary outcomes consisted of changes in pseudoneurologic symptoms, pain symptoms, cardiopulmonary symptoms, and gastrointestinal symptoms. Complaints were examined pre- and post-ECT. RESULTS: Twenty-eight participants were included in this study. Twenty-one participants received right unilateral ECT. Six received bifrontal ECT. One received bitemporal ECT. Eighteen of 21 participants reported improvement in pseudoneurologic symptoms; eleven of 14 participants reported improvement in pain symptoms; one participant reported improvement in cardiopulmonary symptoms; and one of two participants reported improvement in gastrointestinal symptoms. This paper discusses the putative mechanism of action of ECT in the treatment of SD/SSD. CONCLUSION: This retrospective study suggests that ECT could be included as part of the existing treatment for refractory SSD and SD, particularly in refractory cases with comorbid mood disorders.

Corpus callosum anatomy in right-handed homosexual and heterosexual men.

The results of several studies have shown that homosexual men have an increased prevalence of non-right-handedness and atypical patterns of hemispheric functional asymmetry. Non-right-handedness in men has been associated with increased size of the corpus callosum (CC), particularly of the isthmus, which is the posterior region of the callosal body connecting parietotemporal cortical regions. We hypothesized that isthmal area would be greater in homosexual men, even among right handers. Twelve homosexual and ten heterosexual healthy young men, all consistently right-handed, underwent a research-designed magnetic resonance imaging scan. We found that the isthmal area was larger in the homosexual group, adding to the body of findings of structural brain differences between homosexual and heterosexual men. This result suggests that right-handed homosexual men have less marked functional asymmetry compared to right-handed heterosexual men. The results also indicate that callosal anatomy and laterality for motoric functions are dissociated in homosexual men. A logistic regression analysis to predict sexual orientation category correctly classified 21 of the 22 men (96% correct classification) based on area of the callosal isthmus, a left-hand performance measure, water level test score, and a measure of abstraction ability. Our findings indicate that neuroanatomical structure and cognition are associated with sexual orientation in men and support the hypothesis of a neurobiological basis in the origin of sexual orientation.

Cognitive behavioural and neuropsychiatric treatment of post-traumatic conversion disorder: a case study.

Conversion disorder consists of involuntary sensory or motor symptoms and deficits that cannot be explained by a general medical condition. There are several treatment options, although none has emerged as the treatment of choice. The present case study examined the effects of adding cognitive behaviour therapy to neuropsychiatric management of conversion disorder (motor subtype). The patient, a retired emergency services worker, presented with a history of intermittent episodes of speech disruption (inability to speak or difficulty speaking properly). Although episodes of speech disturbance sometimes occurred unexpectedly, they were more likely to occur under conditions of stress and fatigue, and were triggered by reminders of work-related traumatic events. The patient was treated with pharmacotherapy and psychoeducation from a neuropsychiatrist. With the aim of improving treatment outcome, cognitive behaviour therapy was added, involving imaginal exposure to trauma memories, along with cognitive restructuring. The frequency of between- and within-session speech disturbance episodes declined over the course of cognitive behaviour therapy to the point that the patient was essentially symptom-free. Within-session distress ratings also decreased, which suggested habituation to trauma-related memories. This case study demonstrates how particular cognitive behaviour therapy interventions can be usefully applied to one form of conversion disorder.

Size of the human corpus callosum is genetically determined: an MRI study in mono and dizygotic twins.

The factors determining the large variation seen in human corpus callosum (CC) morphology are as yet unknown. In this study heritability of CC size was assessed by comparing the concordance of CC midsagittal area in 14 monozygotic and 12 dizygotic twin pairs with a mean age of 27 years, using magnetic resonance imaging and various methods of calculating trait heritability. Heritability was high regardless of method of assessment. The application of a structural equation model resulted in the estimate that 94% of the variance in CC midsagittal size is attributable to the genome. This indicates that under normal conditions and before the effects of normal aging, there is very modest influence of the environment on CC morphology. The results suggest that correlates of CC size, such as the pattern of cerebral lateralization, cognitive abilities and neuropsychiatric dysfunction may be associated with the genetic determinants of CC morphology.