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Position Paper —Transference-Focused Psychotherapy (TFP) for Narcissistic Personality
AbstractPurpose of reviewThe authors describe the application of a twice-weekly, exploratory psychotherapy, Transference-Focused Psychotherapy (TFP), to patients with Narcissistic Personality Disorder (NPD). The paper describes the pathology of object relations within which narcissistic pathology can be understood, and how TFP establishes a treatment framework to address narcissistic pathology. An outline of the assessment and treatment protocol is described along with a case example to illustrate the same.Current findingsThe application of TFP to patients with NPD follows from recent research demonstrating the effectivene...
Source: Current Treatment Options in Psychiatry - May 4, 2018 Category: Psychiatry Source Type: research

Treatment Approaches for Opioid Use Disorders in Late Life
AbstractPurpose of reviewThe use of opioids and opioid-related deaths in the USA has risen to epidemic proportions. Until recently, the impact of this public health crisis in older adults has not been adequately emphasized. This paper reviews the extant literature for the management of opioid use disorder (OUD) in older adults, with a focus on both pharmacologic and non-pharmacologic interventions for OUD in older adults.Recent findingsOpioid prescriptions for older adults have dramatically increased since the 1990s. OUD in older adults is under recognized and under treated in clinical settings. Once identified, appropriat...
Source: Current Treatment Options in Psychiatry - May 1, 2018 Category: Psychiatry Source Type: research

Treatment Approaches to Sexual Dysfunction in Late Life
AbstractPurpose of reviewThis review provides an overview of the latest treatment options for sexual dysfunction in the elderly, specifically the DSM-5 male and female sexual disorders, medication-induced sexual dysfunction, and inappropriate sexual behaviors in dementia. Despite the increasing prevalence of sexual dysfunction with age, various factors including ageism, misconceptions about sexual behavior in the elderly, and discomfort discussing these issues can lead to under-recognition and under-treatment. This review highlights the importance of sexual health at any age and the available pharmacologic and non-pharmaco...
Source: Current Treatment Options in Psychiatry - April 25, 2018 Category: Psychiatry Source Type: research

Treatment of Late-Life Psychosis
AbstractPurpose of reviewPsychosis in late life is a cause of significant distress, suffering, and decline in the quality of life for patients, caregivers, and family members. While psychotic symptoms in later life may be related to long-standing, chronic conditions, the new onset of delusions and hallucinations often presents a diagnostic dilemma to the clinician. This paper seeks to review the overall causes and conditions related to psychosis in later life and discuss available treatment options.Recent findingsThe paucity of new research in the areas of psychosis in late-life and the near absences of clinical drug trial...
Source: Current Treatment Options in Psychiatry - April 23, 2018 Category: Psychiatry Source Type: research

The Use of Electroconvulsive Therapy in Late-Life Psychiatric Disorders
AbstractPurposeTo review the current literature regarding the use and safety of electroconvulsive therapy (ECT) in the elderly population.Recent findingsElectroconvulsive therapy (ECT) is both a safe and effective treatment for geriatric patients with severe psychiatric illness. In an era of often inadequate or poorly tolerated pharmacologic treatments, ECT can provide life-saving treatment for depression, catatonia, movement disorders, and even mood and behavioral dysregulation in dementia syndromes. The Prolonging Remission in Depressed Elderly (PRIDE) study directed by Charles Kellner has provided clear and convincing e...
Source: Current Treatment Options in Psychiatry - April 19, 2018 Category: Psychiatry Source Type: research

Recent Developments in the Management of Insomnia in Later Life
AbstractPurpose of reviewInsomnia impacts a significant proportion of older adults yet is not an inevitable consequence of aging and is amenable to intervention. The aim of this narrative review is to provide an overview of recent recommendations and empirical findings regarding the management of insomnia in older adults.Recent findingsThe treatment of insomnia with cognitive behavioral therapy for insomnia (CBT-I) continues to be empirically supported and the recommended first-line intervention for adults. Accumulating evidence indicates that other non-pharmacological therapies for insomnia, such as mindfulness-based ther...
Source: Current Treatment Options in Psychiatry - April 17, 2018 Category: Psychiatry Source Type: research

Combination Treatments in Borderline Personality Disorder: Bridging the Gap Between Clinical Practice and Empirical Data
Opinion statementPurpose of Review This paper presents an empirical basis for combination treatments in borderline personality disorder (PD), including medication combinations, psychotherapy combinations, and psychotherapy with medication. The goals are to synthesize empirical data evaluating combination treatments and to demonstrate gaps between research and clinical practice.Recent Findings The limited research supporting combination treatments displayed mixed results. There is minimal support for the frequent clinical practice of polypharmacy, with some evidence for the use of atypical antipsychotics with antidepressant...
Source: Current Treatment Options in Psychiatry - March 6, 2018 Category: Psychiatry Source Type: research

Use of Antipsychotic Medications in Non-Substance-Related Delirium —the Gap Between Research Findings and Clinical Practices
AbstractPurpose of the reviewGaps exist between the research knowledge base and clinical practices pertaining to the use of antipsychotics in delirium. We reviewed 19 major randomized studies on the use of antipsychotics in non-substance-related delirium to understand factors contributing to this gap.Recent findingsBased on limited literature, antipsychotics are not effective in treating delirium in patients who are mechanically ventilated intensive care unit patients and those in palliative care, but they may be effective in preventing delirium in high-risk patients after elective surgery. The literature on the use of ant...
Source: Current Treatment Options in Psychiatry - March 1, 2018 Category: Psychiatry Source Type: research

Identifying and Treating the Prodromal Phases of Bipolar Disorder and Schizophrenia
Opinion statementPurpose of reviewThe goal of this paper is to review recent research on the identification and treatment of prodromal periods that precede bipolar and psychotic disorders. We also sought to provide information about current best clinical practices for prodromal youth.Recent findingsResearch in the areas of identifying prodromal periods has rapidly advanced. Calculators that can predict risk are now available for use during both bipolar and psychotic disorder prodromes. Cognitive behavior therapies have emerged as the gold standard psychosocial interventions for the psychosis prodrome, while several other t...
Source: Current Treatment Options in Psychiatry - March 1, 2018 Category: Psychiatry Source Type: research

Symptom Dimensions in Obsessive-Compulsive Disorder as Predictors of Neurobiology and Treatment Response
AbstractPurpose of reviewSpecific symptom dimensions of obsessive-compulsive disorder (OCD) have been suggested as an approach to reduce the heterogeneity of obsessive-compulsive disorder, predict treatment outcome, and relate to brain structure and function. Here, we review studies addressing these issues.Recent findingsThe contamination and symmetry/ordering dimensions have not been reliably associated with treatment outcome. Some studies found that greater severity of sexual/aggressive/religious symptoms predicted a worse outcome after cognitive behavioral therapy (CBT) and a better outcome after serotonin reuptake inhi...
Source: Current Treatment Options in Psychiatry - March 1, 2018 Category: Psychiatry Source Type: research

Treatment Implications for ADHD Youth with Mood and Anxiety Comorbidity
AbstractPurpose of ReviewThere are multiple pharmacological and psychosocial interventions that are tolerable and efficacious for the treatment of attention deficit hyperactivity disorder (ADHD). However, many youth with ADHD have elevated levels of mood and anxiety symptoms that can complicate treatment. In this review, we summarize the relevant treatment studies on the treatment of youth with ADHD and comorbid anxiety or mood disorders.Recent FindingsTreatment of ADHD, specifically CNS stimulants, often translates to reduced irritability in youth with ADHD, but appears to have limited impact on other mood or anxiety symp...
Source: Current Treatment Options in Psychiatry - March 1, 2018 Category: Psychiatry Source Type: research

Use of Antipsychotic Drugs for Psychotic Disorders in Children
AbstractPurpose of reviewThis review aims to provide evidence-based guidance regarding the use of antipsychotic medications for treatment of children and adolescents with psychotic disorders. Research findings from the past 3  years are emphasized.Recent findingsA number of studies have demonstrated the efficacy of antipsychotic medications for use in children and/or adolescents with psychotic disorders, but there is also high potential for significant side effects. Atypical antipsychotic drugs are often preferred instead of typical antipsychotics due to reduced risk of extrapyramidal symptoms, but the risk for weight gai...
Source: Current Treatment Options in Psychiatry - March 1, 2018 Category: Psychiatry Source Type: research

Psychosocial Treatment of Irritability in Youth
AbstractPurpose of reviewChronic, severe irritability is a common presenting problem in children and adolescents. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in recognition of this public health need. Currently, there are no well-established, evidence-based pharmacological or psychosocial treatments specifically for DMDD. Here, we focus on psychosocial interventions. In addition to reviewing published research, we present preliminary, open trial data on a novel exposure-based cognitive-behavioral therapy (CBT) targeting severe irritability, as is present in DMDD.Recent findingsIn the published lite...
Source: Current Treatment Options in Psychiatry - March 1, 2018 Category: Psychiatry Source Type: research

Combination Treatments in Borderline Personality Disorder: Bridging the Gap Between Clinical Practice and Empirical Data
Opinion statementPurpose of Review This paper presents an empirical basis for combination treatments in borderline personality disorder (PD), including medication combinations, psychotherapy combinations, and psychotherapy with medication. The goals are to synthesize empirical data evaluating combination treatments and to demonstrate gaps between research and clinical practice.Recent Findings The limited research supporting combination treatments displayed mixed results. There is minimal support for the frequent clinical practice of polypharmacy, with some evidence for the use of atypical antipsychotics with antidepressant...
Source: Current Treatment Options in Psychiatry - March 1, 2018 Category: Psychiatry Source Type: research

Symptom Dimensions in Obsessive-Compulsive Disorder as Predictors of Neurobiology and Treatment Response
AbstractPurpose of reviewSpecific symptom dimensions of obsessive-compulsive disorder (OCD) have been suggested as an approach to reduce the heterogeneity of obsessive-compulsive disorder, predict treatment outcome, and relate to brain structure and function. Here, we review studies addressing these issues.Recent findingsThe contamination and symmetry/ordering dimensions have not been reliably associated with treatment outcome. Some studies found that greater severity of sexual/aggressive/religious symptoms predicted a worse outcome after cognitive behavioral therapy (CBT) and a better outcome after serotonin reuptake inhi...
Source: Current Treatment Options in Psychiatry - February 23, 2018 Category: Psychiatry Source Type: research