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Advances in the Treatment of Psychotic Depression
AbstractPurpose of reviewOur aim was to update the current understanding of effective treatment strategies for major depression with psychotic features (MDPSY).Recent findingsMost treatment guidelines recommend either the combination of an antidepressant with an antipsychotic or electroconvulsive therapy (ECT) for the treatment of an acute episode of MDPSY. The optimal maintenance treatment after a person responds to either the antidepressant/antipsychotic combination or ECT is unclear particularly as it pertains to length of time the patient needs to take the antipsychotic medication. Further investigation into possible u...
Source: Current Treatment Options in Psychiatry - January 30, 2019 Category: Psychiatry Source Type: research

Treatment of Clozapine Nonresponders
This article attempts to review the available evidence for management of patients with schizophrenia, who do not respond adequately to clozapine and require augmentation of clozapine with another treatment strategy.Recent findingsMany treatment strategies have been evaluated for management of this group of patients. Commonly used pharmacological augmentation strategies which have been evaluated include addition of a second antipsychotic, mood stabilizer, and antidepressant. Other pharmacological agents such as memantine, donepezil, amino acids, omega-3 fatty acids etc. have also been tried. Among the somatic treatments, el...
Source: Current Treatment Options in Psychiatry - January 23, 2019 Category: Psychiatry Source Type: research

Correction to: The Role of Oxytocin in Early Life Adversity and Later Psychopathology: a Review of Preclinical and Clinical Studies
The original publication of this article is missing a disclosure statement for Dr. Amalia Londono Tobon. (Source: Current Treatment Options in Psychiatry)
Source: Current Treatment Options in Psychiatry - January 10, 2019 Category: Psychiatry Source Type: research

Essential Pharmacotherapies for Bipolar Disorder
AbstractPurpose of ReviewThe evidence basis for treatment of bipolar disorder, both for adults and children, is fairly varied and while Federal Drug Administration (FDA) approval provides one marker of evidence, many psychotropic medications are used for off-label indications. Primary care providers are increasingly at the forefront of initiating treatment for patients with mental health disorders. The purpose of this review is to discuss the current state of evidence for medications treating bipolar disorder, highlighting the evidence, exploring contraindications, side effects, and monitoring requirements for each of the ...
Source: Current Treatment Options in Psychiatry - January 2, 2019 Category: Psychiatry Source Type: research

Bipolar Disorder in Primary Care: Considerations in Management
AbstractPurpose of reviewBipolar disorder is a chronic mental illness that has significant morbidity and mortality implications globally. Increasingly, as with many mental health disorders, patients are being identified in primary care settings.Recent findingsIn this overview, we discuss screening and case identification, making the case for judicious use of screening tools coupled with follow-up clarifying questions. We review the main modalities of treatment including pharmacother-apy and the evidence for non-pharmacotherapy adjunctive approaches. We discuss recommendations and cautions regarding the use of antidepressan...
Source: Current Treatment Options in Psychiatry - December 12, 2018 Category: Psychiatry Source Type: research

Management of Bipolar Disease in Pregnancy and Lactation
AbstractPurpose of reviewBipolar disorder is a psychiatric disorder that commonly affects women of reproductive age. Many women with bipolar disorder require treatment during pregnancy and the post-partum period to optimize their health. The following review examines recent evidence regarding the risks and benefits of using commonly prescribed medications for bipolar disorder in pregnancy and lactation.Recent findingsCurrent research has not found significant and consistent risks with use of atypical antipsychotics compared to other psychotropic agents, and some previously established teratogens, such as lithium, appear to...
Source: Current Treatment Options in Psychiatry - December 1, 2018 Category: Psychiatry Source Type: research

Inflammation and Depression: the Neuroimmune Connection
AbstractPurposeTo update clinicians on the field of psychoneuroimmunology with respect to depression.Recent findingsA significant subset of patients with depression may have illness to which dysfunction of the immune system, typically viewed as inflammation, makes a significant contribution. Normal sickness behavior may sometimes manifest abnormally as mood episodes. Early evidence suggests that interventions that reduce inflammation may improve symptoms in these patients and that they may also respond differently to standard pharmacotherapy.SummaryTreatment of patients with depression should consider inflammatory status, ...
Source: Current Treatment Options in Psychiatry - October 22, 2018 Category: Psychiatry Source Type: research

Neurosteroids in the Pathophysiology and Treatment of Mood and Anxiety Disorders
AbstractPurpose of reviewNeurosteroids have been implicated in the pathophysiology of mood, anxiety, and trauma-related disorders, as well as syndromes specific to women such as premenstrual syndrome, premenstrual dysphoric disorder, postpartum depression, peri- and post-menopausal depression. This review summarizes the role of neurosteroids in the neurobiology of stress and that of pharmaceuticals that modulate neurosteroids in the treatment of these disorders.Recent findingsNeurosteroids may provide novel treatments of mood and anxiety disorders. While endogenous neurosteroids have poor bioavailability, there are other m...
Source: Current Treatment Options in Psychiatry - October 20, 2018 Category: Psychiatry Source Type: research

The Role of Oxytocin in Early Life Adversity and Later Psychopathology: a Review of Preclinical and Clinical Studies
AbstractPurposeOxytocin is a peptide hormone integral in parturition and milk let-down, and is increasingly recognized as an important regulator of human social behaviors including bonding, trust, fear, and stress. There is an increasing evidence that oxytocin is intricately involved in a broad array of neurophysiological functions and may be a common system implicated in multiple psychiatric disorders. This review examines the putative role of oxytocin in early life adversity-mediated risk for later development of subtypes of psychiatric conditions. Several lines of evidence are reviewed including oxytocin levels, respons...
Source: Current Treatment Options in Psychiatry - October 20, 2018 Category: Psychiatry Source Type: research

Estrogen-Based Hormone Therapy for Depression Related to Reproductive Events
AbstractPurposeIn this review, we provide an overview of recent literature on the use of estrogen-based hormone therapy to treat depression related to reproductive events, like postpartum and perimenopause. Women are two to four times more likely to become depressed in the perimenopausal stage of life and as many as 14.5% of women develop postpartum depression. It is hypothesized that these depressive symptoms are a result of fluctuations in hormone levels during these windows of vulnerability. To broaden treatment options beyond psychotherapy and antidepressants, researchers considered the role that estrogen-based hormone...
Source: Current Treatment Options in Psychiatry - October 17, 2018 Category: Psychiatry Source Type: research

Mobile App Tools for Identifying and Managing Mental Health Disorders in Primary Care
AbstractPurpose of ReviewMental health apps are intriguing yet challenging tools for addressing barriers to treatment in primary care. In the current review, we seek to assist primary care professionals with evaluating and integrating mental health apps into practice. We briefly summarize two leading frameworks for evaluating mental health apps and conduct a systematic review of mental health apps across a variety of areas commonly encountered in primary care.Recent FindingsExisting frameworks can guide professionals and patients through the process of identifying apps and evaluating dimensions such as privacy and security...
Source: Current Treatment Options in Psychiatry - September 1, 2018 Category: Psychiatry Source Type: research

Update on Current Treatment of Acute Opioid Overdose
AbstractPurposeOpioid use, misuse, and abuse are now a rapidly evolving epidemic in the USA. This review aims to update changes in the dosing of naloxone, describe new strategies in prehospital management, and examine in more detail the diverse pathophysiology of opioids beyond respiratory depression.Recent findingsThere are no comparative studies of old or new antidotes or procedures elucidating the superiority of one therapy. Abuse and misuse of over-the-counter loperamide and non-FDA approved tianeptine, using the herbal product kratom, and gambling with powerful fentanyl analogues are recent trends that will impact cli...
Source: Current Treatment Options in Psychiatry - September 1, 2018 Category: Psychiatry Source Type: research

Risk Factors for Opioid Overdose
AbstractPurpose of ReviewOpioid overdoses have risen starkly over the last two decades in the USA and are now among the leading causes of overall mortality. This review summarizes the current literature on risk factors for overdose as well as public health solutions.Recent FindingsAlthough opioid overdose mortality is highest among men and non-Hispanic whites, the rate of death is rising more rapidly now among women and non-Hispanic blacks. Incarceration remains a significant risk factor for overdose death, especially in the first weeks upon reentry reflecting the absence of treatment in prisons and jails despite strong ev...
Source: Current Treatment Options in Psychiatry - September 1, 2018 Category: Psychiatry Source Type: research

Financing for Collaborative Care —a Narrative Review
Opinion statementPurpose of reviewCollaborative care (CoCM) is an evidence-based model for the treatment of common mental health conditions in the primary care setting. Its workflow encourages systematic communication among clinicians outside of face-to-face patient encounters, which has posed financial challenges in traditional fee-for-service reimbursement environments.Recent findingsOrganizations have employed various financing strategies to promote CoCM sustainability, including external grants, alternate payment model contracts with specific payers, and the use of billing codes for individual components of CoCM. In re...
Source: Current Treatment Options in Psychiatry - September 1, 2018 Category: Psychiatry Source Type: research

Death Ambivalence and Treatment Seeking: Suicidality in Opiate Addiction
AbstractPurpose of reviewRates of suicide and opiate overdose have recently skyrocketed in the USA. In light of impulsivity and impaired motivation common in people with substance use disorders, suicidality is common in addiction.Recent findingsChart review surveys indicate two primary suicidal populations that are important to distinguish for clinical practice and healthcare policy. One group is heavily composed of people with substance use disorders, in whom chronic compulsive use fosters a numbambivalence about death (low death intentionality). Many of these individuals with opiate use disorder (OUD) exaggerate suicidal...
Source: Current Treatment Options in Psychiatry - September 1, 2018 Category: Psychiatry Source Type: research