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1.
Int Clin Psychopharmacol ; 35(2): 113-118, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32004167

RESUMO

Obsessive-compulsive disorder is often associated with schizophrenia and may represent a significant challenge in the treatment as this comorbidity may not respond properly to antipsychotic medication and usually require a pharmacological and psychotherapeutic add-on. In the present case report, we present the case of a 26-year-old male blue-collar subject who developed obsessive-compulsive disorder after a year of complete remission of schizophrenia symptoms under paliperidone long-acting injection that rapidly resolved after low-dosage cariprazine add-on. No adverse effects were reported due to cariprazine- paliperidone long-acting injection combination.

2.
Adv Exp Med Biol ; 1191: 219-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002932

RESUMO

Although anxiety and depression have been considered as two distinct entities according to the diagnostic criteria, anxious depression (comorbid anxiety and depression) is relatively a common syndrome. According to the DSM-5 criteria, it uses "with anxious distress specifier" to define anxious depression in its MDD section. Anxious depression is known to have different neurobiological profiles compared to non-anxious depression. Several studies have revealed significant differences between anxious depression and non-anxious depression regarding the hypothalamic-pituitary-adrenal (HPA) axis function, structural and functional brain imaging findings, inflammation markers, etc. Patients with anxious depression were significantly more likely to be found in primary care setting and more likely to be associated with female gender, non-single, unemployed, less educated, and more severe depression. Previous reports also showed that patients with anxious depression had more frequent episodes of major depression and a higher risk of suicidal ideation and previous suicide attempts than those with non-anxious depression. Although anxious depression is known to be associated with poor treatment outcomes in several studies, recent researches have sought to find better treatment strategy to improve patients with anxious depression.


Assuntos
Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/terapia , Ansiedade/complicações , Ansiedade/diagnóstico , Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Comorbidade , Depressão/complicações , Depressão/diagnóstico , Depressão/terapia , Transtorno Depressivo Maior/diagnóstico , Humanos
3.
Curr Top Med Chem ; 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32003691

RESUMO

BACKGROUND: Research on mood disorder pathophysiology has hypothesized abnormalities in glutamatergic neurotransmission, by suggesting further investigation on glutamatergic N-methyl-D-aspartate (NMDA) receptor modulators in treating Major Depressive Disorder (MDD). Esketamine (ESK), an NMDA receptor antagonist able to modulate glutamatergic neurotransmission, is being recently developed as an intranasal formulation for treatment-resistant depression (TRD) and for rapid reduction of depressive symptomatology, including suicidal ideation, in MDD patients at imminent risk for suicide. OBJECTIVE: The present study aims at investigating recent clinical findings about the role of the glutamatergic system and ESK in treating suicidal depression in MDD and TRD. METHODS: A systematic review was here carried out on PubMed/Medline, Scopus and the database on U.S. N.I.H. Clinical Trials (https://clinicaltrials.gov) and the European Medical Agency (EMA) (https://clinicaltrialsregister.eu) from inception until October 2019. RESULTS: Intravenous infusion of ESK is reported to elicit rapid-acting and sustained antidepressant activity in refractory patients with MDD and TRD. In phase II studies, intranasal ESK demonstrated rapid onset and persistent efficacy in patients with TRD as well as in MDD patients at imminent risk for suicide. In phase III studies, there are contrasting findings emerging. CONCLUSION: The U.S. Food and Drug Administration (FDA) granted fast track and Breakthrough Therapy Designation to Janssen Pharmaceuticals®, Inc. for intranasal ESK in 2013 for treatment-resistant depression (TRD) and in 2016 for the treatment of MDD with an imminent risk of suicide. However, further studies should be carried to investigate long-term efficacy and safety of intranasal ESK.

4.
Neurosci Lett ; 721: 134804, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32014516

RESUMO

Because depression has high prevalence and cause enduring disability, it is important to predict onset of depression among community dwelling adults. In this study, we aimed to build a machine learning-based predictive model for future onset of depression. We used nationwide survey data to construct training and hold-out test set. The class imbalance was dealt with the Synthetic Minority Over-sampling Technique. A tree-based ensemble method, random forest, was used to build a predictive model. Depression was defined by 9 or more on the Center for Epidemiologic Studies - Depression Scale 11 items version. Hyperparameters were tuned throughout the 10-fold cross-validation. A total of 6,588 (6,067 of non-depression and 521 of depression) participants were included in the study. The area under receiver operating characteristics curve was 0.870. The overall accuracy, sensitivity, and specificity were 0.862, 0.730, and 0.866, respectively. Satisfactions for leisure, familial relationship, general, social relationship, and familial income had importance in building predictive model for the onset of future depression. Our study demonstrated that predicting future onset of depression by using survey data could be possible. This predictive model is expected to be used for early identification of individuals at risk for depression and secure time to intervention.

5.
Curr Neuropharmacol ; 18(2): 84-86, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32013811
6.
Adv Exp Med Biol ; 1191: 21-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002920

RESUMO

Network-based approach for psychological phenotypes assumes the dynamical interactions among the psychiatric symptoms, psychological characteristics, and neurocognitive performances arise, as they coexist, propagate, and inhibit other components within the network of mental phenomena. For differential types of dataset from which the phenotype network is to be estimated, a Gaussian graphical model, an Ising model, a directed acyclic graph, or an intraindividual covariance network could be used. Accordingly, these network-based approaches for anxiety-related psychological phenomena have been helpful in quantitative and pictorial understanding of qualitative dynamics among the diverse psychological phenomena as well as mind-environment interactions. Brain structural covariance refers to the correlative patterns of diverse brain morphological features among differential brain regions comprising the brain, as calculated per participant or across the participants. These covarying patterns of brain morphology partly overlap with longitudinal patterns of brain cortical maturation and also with propagating pattern of brain morphological changes such as cortical thinning and brain volume reduction in patients diagnosed with neurologic or psychiatric disorders along the trajectory of disease progression. Previous studies that used the brain structural covariance network could show neural correlates of specific anxiety disorder such as panic disorder and also elucidate the neural underpinning of anxiety symptom severity in diverse psychiatric and neurologic disorder patients.


Assuntos
Transtornos de Ansiedade/patologia , Transtornos de Ansiedade/fisiopatologia , Ansiedade/patologia , Ansiedade/fisiopatologia , Encéfalo/patologia , Encéfalo/fisiopatologia , Fenótipo , Humanos , Vias Neurais
7.
Adv Exp Med Biol ; 1191: 103-120, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002925

RESUMO

Oxytocin, a neuropeptide synthesized by the hypothalamus, plays a central role in human social behavior, social cognition, anxiety, mood, stress modulation, and fear learning and extinction. The relationships between oxytocin and psychiatric disorders including depression, anxiety, schizophrenia, and autism spectrum disorder have been extensively studied. In this chapter, we focus on the current knowledge about oxytocin and anxiety disorder. We discuss the anxiolytic effects of oxytocin in preclinical and clinical findings, possible related neurobehavioral mechanisms (social cognition, fear learning, and extinction), related neurotransmitter and neuroendocrine systems (hypothalamus-pituitary-adrenal axis, serotoninergic, and GABAergic systems), and studies regarding plasma levels of oxytocin, genetic and epigenetic findings, and effects of intranasal oxytocin in DSM-5 anxiety disorder (primarily social anxiety disorder and separation anxiety disorder) patients.


Assuntos
Transtornos de Ansiedade/metabolismo , Ocitocina/metabolismo , Ansiedade/metabolismo , Medo , Humanos , Comportamento Social
8.
Adv Exp Med Biol ; 1191: 187-196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002930

RESUMO

Under the partial influences of paradigm shift form category to dimension, the Diagnostic and Statistical Manual of Mental Disorder (DSM) was revised to the fifth edition (DSM-5); however, due to the lack of consistent biological makers and processes and the restricted availability of dimensional meta-structure, the revisions for the DSM-5 were based on a combination of categorical and dimensional approaches. Anxiety disorders were more clearly and consistently defined in the DSM-5 with the removal of obsessive compulsive, acute stress, and post-traumatic stress disorders. Differences between the childhood and adulthood categories of anxiety disorders were decreased, and overall, the symmetrical classification of anxiety subtypes was increased, since separation anxiety disorder and selective mutism were considered anxiety disorders, not neurodevelopmental disorders. Additionally, based on growing evidence, agoraphobia is distinct from panic disorder. Next, considering cultural syndromes including taijin kyofusho, khyal cap, trung gio attacks, and ataque de nervios, cultural influences are considered a significant factor for definitions and presentations of anxiety disorders. Controversies in the DSM-5 criteria for anxiety disorders are lowering the diagnostic thresholds of anxiety disorders and limiting the dichotomous view of anxiety and depression when defining generalized anxiety disorder. Further studies of alternative approaches to the restrictions of the DSM-5 criteria of anxiety disorders, including transdiagnostic specifiers and dimensional assessment tools, may be required.


Assuntos
Transtornos de Ansiedade/classificação , Transtornos de Ansiedade/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Fatores Etários , Ansiedade/complicações , Ansiedade/psicologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Depressão/complicações , Depressão/psicologia , Humanos , Transtornos de Estresse Pós-Traumáticos/classificação , Transtornos de Estresse Pós-Traumáticos/diagnóstico
9.
Adv Exp Med Biol ; 1192: 3-15, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705487

RESUMO

The modern society is a so-called era of big data. Whereas nearly everybody recognizes the "era of big data", no one can exactly define how big the data is a "big data". The reason for the ambiguity of the term big data mainly arises from the widespread of using that term. Along the widespread application of the digital technology in the everyday life, a large amount of data is generated every second in relation with every human behavior (i.e., measuring body movements through sensors, texts sent and received via social networking services). In addition, nonhuman data such as weather and Global Positioning System signals has been cumulated and analyzed in perspectives of big data (Kan et al. in Int J Environ Res Public Health 15(4), 2018 [1]). The big data has also influenced the medical science, which includes the field of psychiatry (Monteith et al. in Int J Bipolar Disord 3(1):21, 2015 [2]). In this chapter, we first introduce the definition of the term "big data". Then, we discuss researches which apply big data to solve problems in the clinical practice of psychiatry.


Assuntos
Big Data , Psiquiatria , Humanos , Pesquisa
10.
Adv Exp Med Biol ; 1192: 17-25, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705488

RESUMO

Because of the poor link between psychiatric diagnosis and neurobiological findings, it is difficult to classify mental disorders. The changes made to psychiatric diagnostic systems over the years can be understood in terms of "practical conservatism." The Diagnostic and Statistical Manual of Mental Disorders (DSM)-I and DSM-II were theoretically supported by the psychoanalytic and psychodynamic approach. Subsequently, psychiatric diagnoses of this kind were opposed by the anti-psychiatry movement, as well as by the findings of the Rosenhan experiment. Thus, the DSM-III revolution contained more empiricism, aligning psychiatry with biomedicine. Psychiatric diagnoses are classified and defined in terms of Kraepelinian dualism, using a categorical approach. The empirical trend was continued in the DSM-IV. To overcome the limitations of current psychiatric diagnostic systems and integrate fundamental genetic, neurobiological, behavioral, environmental, and experimental components into psychiatry, the Research Domain Criteria (RDoC) were established. To overcome the limitations of the categorical approach, psychiatrists have considered adopting a dimensional approach. However, their efforts were frustrated in the DSM-5 revision process. Thus, the DSM-5 is characterized by the rearrangement of psychiatric diagnoses, the partial adoption of a dimensional approach, the introduction of new diagnoses, and harmonization with the International Classification of Diseases.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Mentais/classificação , Transtornos Mentais/psicologia , Psiquiatria , Humanos , Classificação Internacional de Doenças , Neurobiologia
11.
Adv Exp Med Biol ; 1192: 331-340, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705503

RESUMO

The biopsychosocial approach is a model of eclecticism, which consists of multidisciplinary academic fields, reacting against the "neuroscientification" of psychiatry. The biopsychosocial approach was proposed by George Engel following Adolf Meyer's psychobiological and Roy R. Ginker's eclectic approach to psychiatry. Although the use of the biopsychosocial approach is increasing, it has several limitations: First, specific practices cannot be guided by the biopsychosocial approach because it is considered to be "boundless psychiatry." Second, unlike an initial intention, the symptomatic use of psychotropic medications may be justified by the biopsychosocial approach. Third, the economic forces to enhance biological psychiatry cannot be hindered by the biopsychosocial approach. Hence, to overcome the limitations of the current biopsychosocial approach, potential new paradigms including evolutionary psychiatry, pragmatism, integrationism, and pluralism have been proposed. Above all, Eric Kandel presented the link between neuroscience and psychiatry from the perspective of integrationism. In accordance with integrationism and/or pluralism, based on the paradigm shift of the theoretical construct from chemical imbalance to dysfunctional circuit, next-generation treatments for mental disorders have been proposed by Thomas Insel. Thus, a more integrated biopsychosocial approach to managing psychiatric disorders including schizophrenia and panic disorder may be proposed.


Assuntos
Transtornos Mentais , Neurociências , Psiquiatria , Humanos , Fenômenos Físicos , Esquizofrenia
12.
Adv Exp Med Biol ; 1192: 491-501, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705510

RESUMO

Psychiatric disorders are too multifactorial to be defined as a primarily inflammatory disorder, and increased inflammatory response is not specific to mental disorder only. Numerous factors are involved in neuroinflammation, and there also are many confounding variables, making it difficult to obtain consistent outcomes. Therefore, it is necessary to specify genetic, physiological, and epidemiological attributes of particular population groups vulnerable to inflammatory response as well as the disease subtypes. As of now, definitive inflammatory markers for psychiatric disorders have not been identified, but they could be very useful in patients with minimal vulnerability. In addition, it is possible to use inflammatory markers as depression biomarkers in subtypes of depression, which can serve as bases to develop medications to treat the disorder.


Assuntos
Inflamação , Transtornos Mentais , Biomarcadores , Depressão , Humanos
13.
Adv Exp Med Biol ; 1192: 503-517, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705511

RESUMO

Suicide is a serious public health problem in many countries and has always been a source of apprehension and quest to human mankind, which can be resolved with due diligence. Suicide is a hidden and silent epidemic, with many causative factors. Studying and researching on various causative factors have always been the subject of significance for the researchers. Psychiatric illnesses happen to be the primary reasons for the majority of suicide mortality cases. Not only this, there has been a consistent increase in the no. of cases of mental disorders as well as attempted and completed suicide cases. If one looks at global scenario, an approximate 70,000 people commit suicide, and further alarming is the fact that the rate of suicide attempt cases has gone up to 250% during last 18 years in conflict zones. Poisoning, hanging and self-immolation are some of the common methods to commit suicide. Physical and mental illness, disturbed emotional relationships and economic difficulties were the major reasons for suicide with the predisposed population being women, student and farmers. As per WHO's approximation, there is one suicide every minute and an attempted suicide every third second. It implies that the number of killed due to suicide is greater than that of the ones killed due to the armed conflict.


Assuntos
Transtornos Mentais , Suicídio , Feminino , Humanos , Fatores de Risco , Tentativa de Suicídio
14.
Adv Exp Med Biol ; 1192: 545-564, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705513

RESUMO

Recently, noninvasive brain stimulation (NIBS) methodologies, including TMS and tDCS, have been considered as efficacious, safe, and innovative treatments and alternatives to conventional therapies for some psychiatric disorders. Developing evidence suggests that applying rTMS and tDCS over the cognitive control network (CCN), particularly the dorsolateral prefrontal cortex (DLPFC), may improve core symptoms in various psychiatric disorders via direct impact on the cognitive control processes involved in emotion regulation. Therefore, neuromodulation of brain regions involved in the cognitive control of emotion by NIBS approaches could contribute to a paradigm shift in psychiatry. The available evidence suggests that development of effective treatment alternatives to enhance cognition is critical for patients with psychiatric disorders. The purpose of this chapter is to review the cognition-enhancing properties of tDCS and TMS and the impact of these treatments on cognitive control processes, especially those related to emotion regulation in psychiatric disorders.


Assuntos
Cognição/fisiologia , Terapia por Estimulação Elétrica/métodos , Emoções/fisiologia , Córtex Pré-Frontal/fisiopatologia , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Humanos
15.
Adv Exp Med Biol ; 1192: 629-641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705516

RESUMO

Cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice for insomnia; however, it is not widely used due to a lack of experienced therapists and its relatively high clinical cost. Recently, Internet and mobile CBT-I have been developed to replace face-to-face CBT-I, and research on this topic has been increasing. In addition, attempts have been made to use wearable devices for sleep-wake estimation. Studies on digital CBT-I thus far have shown favorable treatment effects in general, but the problem of a high dropout rate has not been sufficiently improved. In addition, more sophisticated technology is needed to develop fully automated digital CBT-I. As part of efforts to maximize the treatment effectiveness of future insomnia patients, research and development of mobile and Internet CBT-I and improvement of sleep tracker accuracy and validation studies are needed.


Assuntos
Terapia Cognitivo-Comportamental , Aplicativos Móveis , Distúrbios do Início e da Manutenção do Sono/terapia , Dispositivos Eletrônicos Vestíveis , Humanos , Internet , Sono , Resultado do Tratamento
16.
Psychiatry Investig ; 16(9): 633-635, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31550873
17.
Psychiatry Investig ; 16(9): 636-644, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31550874

RESUMO

Because the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) was mainly influenced by the neo-Kraepelinian approach, its categorical approach to defining mental disorders has been criticized from the viewpoint of etiological neutrality. In the context of bridging the gap between "presumed etiologies-based symptomatology" and "identifiable pathophysiological etiologies," the content in 5th edition, the DSM-5, has been revised to incorporate a combination of categorical and dimensional approaches. The most remarkable change of note regarding the diagnostic classification of depressive disorders in the DSM-5 is the splitting of mood disorders into bipolar disorders and depressive disorders, which is in accordance with the deconstruction of the Kraepelinian dualism for psychoses. The transdiagnostic specifiers "with mixed features," "with psychotic features," and "with anxious distress" are introduced to describe the relationships of depressive disorders with bipolar disorders, schizophrenia, and generalized anxiety disorder, respectively, in a dimensional manner. The lowering of the diagnostic threshold for major depressive disorder (MDD) may be caused by the addition of "hopelessness" to the subjective descriptors of depressive mood and the elimination of "bereavement exclusion" from the definition of MDD. Since the heterogeneity of MDD is equivalent to the Wittgensteinian "games" analogy, the different types of MDD are related not by a single essential feature but rather by "family resemblance." Network analyses of MDD symptoms may therefore need further review to elucidate the connections among interrelated symptoms and other clinical elements.

18.
Artigo em Inglês | MEDLINE | ID: mdl-31436629

RESUMO

Obsessive-compulsive disorder is often associated with schizophrenia and may represent a significant challenge in the treatment as this comorbidity may not respond properly to antipsychotic medication and usually require a pharmacological and psychotherapeutic add-on. In the present case report, we present the case of a 26-year-old male blue-collar subject who developed obsessive-compulsive disorder after a year of complete remission of schizophrenia symptoms under paliperidone long-acting injection that rapidly resolved after low-dosage cariprazine add-on. No adverse effects were reported due to cariprazine- paliperidone long-acting injection combination.

19.
J Affect Disord ; 259: 370-375, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470180

RESUMO

BACKGROUND: The 15-item geriatric depression scale (GDS-15) is a short form of GDS and is used to screen, diagnose, and evaluate depression in elderly individuals. Most previous studies evaluated the ability of GDS-15 to discriminate between depressive and non-depressive states. In this study, we investigated the multi-stage discriminating ability of GDS-15. METHODS: A total of 774 participants, over 65 years of age were included (normal, n = 650; minor depressive disorder [MnDD], n = 94; major depressive disorder [MDD], n = 30). Multi-category receiver operating characteristic (ROC) surfaces were evaluated to identify three stages of geriatric depression. The optimal cutoff points were selected based on the volume under the ROC surface (VUS) and the Youden index. RESULTS: In the results of multi-category classification analyses, VUS of the GDS-15 of 0.61 was obtained, and optimal cutoff points of the GDS-15 for multiple stages of depression of 4 (between normal and MnDD) and 11 (between MnDD and MDD) were derived. The Youden index for the GDS-15 was 0.49, and the derived optimal cutoff points were 5 and 10, for the multiple stages, respectively. The overall diagnostic accuracy based on the Youden index was superior to that based on the VUS in the GDS-15. LIMITATIONS: The participants' cognitive function has potential to affect the GDS-15 score; nevertheless, the study included those with mild cognitive impairment. CONCLUSIONS: GDS-15 was a useful tool to classify stages of geriatric depression into either minor or major depressive disorder.

20.
Artigo em Inglês | MEDLINE | ID: mdl-31207274

RESUMO

There is accumulating evidence demonstrating that dysfunction of glutamatergic neurotransmission, particularly via N-methyl-d-aspartate (NMDA) receptors, is involved in the pathophysiology of major depressive disorder (MDD). Several studies have revealed an altered expression of NMDA receptor subtypes and impaired NMDA receptor-mediated intracellular signaling pathways in brain circuits of patients with MDD. Clinical studies have demonstrated that NMDA receptor antagonists, particularly ketamine, have rapid antidepressant effects in treatment-resistant depression, however, neurobiological mechanisms are not completely understood. Growing body of evidence suggest that signal transduction pathways involved in synaptic plasticity play critical role in molecular mechanisms underlying rapidly acting antidepressant properties of ketamine and other NMDAR antagonists in MDD. Discovering the molecular mechanisms underlying the unique antidepressant actions of ketamine will facilitate the development of novel fast acting antidepressants which lack undesirable effects of ketamine. This review provides a critical examination of the NMDA receptor involvement in the neurobiology of MDD including analyses of alterations in NMDA receptor subtypes and their interactive signaling cascades revealed by postmortem studies. Furthermore, to elucidate mechanisms underlying rapid-acting antidepressant properties of NMDA receptor antagonists we discussed their effects on the neuroplasticity, mostly based on signaling systems involved in synaptic plasticity of mood-related neurocircuitries.

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