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Current Psychiatry Reviews
ISSN: 1573-4 005
Current Psychiatry Reviews
Volume 4, Number 4, November 2008
Contents
Hypothalamus-Pituitary-Adrenal (HPA) Axis and Metabolic Abnormalities
in First-Episode Psychosis Pp. 185-189
Valeria Mondelli and Carmine M. Pariante
[Abstract] [Purchase
Article]
Disturbed Homeostasis in Patients with Acute
Psychosis Pp. 190-195
Kotaro Hatta, Chie Usui and Hiroyuki Nakamura
[Abstract] [Purchase
Article]
Models of Change in Schizophrenia: One for All,
or All for Some? Pp. 196-208
Matthew Stainsby, Kenneth Bledin and Oliver J. Mason
[Abstract] [Purchase
Article]
Antidepressant Brain Stimulation Techniques
Pp. 209-218
Angela Merkl and Malek Bajbouj
[Abstract] [Purchase
Article]
Role of Nitric Oxide in Patients with Schizophrenia-
a Systematic Review of the Literature Pp. 219-227
Joao Paulo Oliveira, Antonio Waldo Zuardi and Jaime Eduardo
Hallak
[Abstract] [Purchase
Article]
Traumatic Event Exposure, Posttraumatic Stress,
and Substance Use Among Youth: A Critical Review of the Empirical
Literature Pp. 228-254
Heidemarie Blumenthal
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Article]
Abstracts
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Hypothalamus-Pituitary-Adrenal (HPA) Axis and Metabolic
Abnormalities in First-Episode Psychosis
Valeria Mondelli and Carmine M. Pariante
The hypothalamus-pituitary-adrenal (HPA) axis is the
endocrine axis most involved in the response to stress. Studies
in first episode psychosis have recently reported raised levels
of the stress hormones, cortisol and ACTH, and an increased
volume of the pituitary gland, the main organ involved in
the stress response. These findings suggest that first episode
psychosis could be characterized by a hyperactivity of the
HPA axis. These endocrine abnormalities could have important
metabolic consequences for these patients, since activation
of the stress hormonal system has been associated with increased
intra-abdominal fat and impaired glucose tolerance. Increases
in visceral or intra-abdominal fat distribution appear to
be consistently associated with developing hyperinsulinemia,
insulin resistance, dyslipidemia. Compared with the general
population, patients with schizophrenia appear to suffer from
higher rates of obesity-related illnesses such as impaired
glucose tolerance, insulin resistance, type II diabetes mellitus
and cardiovascular disease. This paper will review the evidence
about HPA axis hyperactivity and metabolic abnormalities,
and their possible link in first-episode psychosis.
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Disturbed Homeostasis in Patients with Acute Psychosis
Kotaro Hatta, Chie Usui and Hiroyuki Nakamura
Patients with acute psychosis are often physically exhausted
due to severe psychotic excitement, incessant wandering, delusions
of poisoning, or stupor. In such conditions, the most important
etiology of exhaustion may be excessive sympathetic activity.
Physical agitation and psychological distress increase the
circulation of epinephrine, which induces three physiological
changes. First, muscle enzyme synthesis is increased, and
enzymes in the cytoplasmic compartment, such as creatine phosphokinese
(CPK) and lactate dehydrogenase, are readily soluble. Marked
serum CPK elevation of more than 1000 IU/L is common. Second,
increased circulation of epinephrine causes a decrease in
plasma potassium levels. A significant correlation between
serum potassium concentrations and acute agitation symptoms
has been described along with the observation that sedation
improves acute agitation-induced hypokalemia. In addition,
prolonga-tion of the QT interval has been described in psychiatric
emergency patients, with a negative correlation noted between
serum potassium concentrations and QT interval. Third, epinephrine-induced
neutrophilic reactions and glucocorticoids-induced acute neutrophilia
cause a slight but significant elevation of white blood cell
levels. In addition to excessive sympathetic activity, dehydration
may occur. These under-recognized findings in psychiatric
emergency patients may be clinically important in preventing
comorbid medical disorders that occur secondary to treatment
for acute psychosis.
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Models of Change in Schizophrenia: One for All, or
All for Some?
Matthew Stainsby, Kenneth Bledin and Oliver J. Mason
Approaches to the study and treatment of schizophrenia
can be classified according to their views of ‘recovery’,
for example what it means and how likely it is to occur, often
crudely distinguished as the ‘medical’ or ‘empowerment’
models. A further source of difference relates to whether
recovery is seen as primarily intrapersonal or interpersonal.
We suggest that combining these dimensions provides a useful
two-dimensional space in which to map out such approaches.
This is illustrated in the first section of this paper using
several models of change in schizophrenia. In the second section,
we review empirical data pertaining to the meaning of recovery
and how this relates to models of change. We conclude that
no one model of change or definition of recovery should hold
sway, but that instead each may have value according to the
conditions that are most limiting for a particular individual-whether
symptoms, social disadvantages, or other factors. Moreover,
as these conditions change, so may the model of change or
definition of recovery that it is most useful to use.
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Antidepressant Brain Stimulation Techniques
Angela Merkl and Malek Bajbouj
Severe chronic depression can impair the quality of life
and lead to death by suicide; the lifetime risk of suicide
among patients with affective disorders ranges from 6% to
15%. Major depressive disorder (MDE) also increases the mortality
associated with general medical conditions. A considerable
number of depressive patients, especially elderly ones, do
not respond to or remit during psychpharmacological or psychotherapeutical
interventions resulting in an increasing interest in non-pharmacological
strategies to treat affective disorders. A broad variety of
brain stimulation techniques are currently being assessed
as novel therapeutic interventions beside the well established
electroconvulsive therapy. These neuromodulatory methods include
repetitive transcranial magnetic stimulation, direct current
stimulation, magnetic seizure therapy, vagus nerve stimulation,
and deep brain stimulation. Although these novel therapeutic
techniques hold con-siderable promise, there still will be
need to further develop them before they achieve clinical
acceptability.
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Role of Nitric Oxide in Patients with Schizophrenia-
a Systematic Review of the Literature
Joao Paulo Oliveira, Antonio Waldo Zuardi and Jaime Eduardo
Hallak
In spite of numerous studies focused on schizophrenia,
its etiology remain unknown. If we bear in mind that schizophrenia
is a progressive syndrome where genetic and environmental
components contribute, with impairment in the brain maturation
as a result, it is conceivable that research seeking to unveil
its etiology should focus on dysfunctions in systems responsible
for the control of brain neurodevelopment. Recent scientific
evidence has pointed to a possible role for the NO (nitric
oxide) in schizophrenia. NO is a gas with unique chemistry
and influences the release of neurotransmitters, learning,
memory and neurodevelopment. This review tried to focus on
researches that examined alterations in NO-mediated neurotransmission
in patients with schizophrenia. The search was performed in
Pubmed, Scielo, and Lilacs, using the keywords
Schizophrenia and Nitric Oxide. The search
on Pubmed yielded 138 matches, from which 40 were
selected. No studies were found in the others databases. In
summary, we note that there are studies supporting apparently
contradictory results: some of them suggesting a increase
of the NO-mediated neurotransmission, and another part supporting
a decrease. We discuss these findings, and our overall impression
is that the better designed studies found evidence pointing
to a disruption in NO-mediated neurotransmission in schizophrenia.
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Traumatic Event Exposure, Posttraumatic Stress, and
Substance Use Among Youth: A Critical Review of the Empirical
Literature
Heidemarie Blumenthal
Traumatic event exposure and subsequent posttraumatic
stress have been linked to increased use of various substances
among adults. Relatively less is known about this linkage
among youth, despite high rates of traumatic event exposure
and substance use within this population. To address this
gap, the current review presents a detailed summary and critical
analysis of the empirical literature focused on the co-occurrence
of traumatic event exposure, posttraumatic stress, and substance
use among youth. The evidence suggests that multiple types
of substance use are highly related to exposure to a traumatic
event and posttraumatic stress reactions among youth. Relatively
little is known about the directionality or specificity of
this relation, and additional research on factors that affect
or account for this association is needed. Critical challenges
of this literature, as well as specific recommendations for
future research, are discussed.
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