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Antagonist Treatment for Opioid Dependence: Promise and Hurdles
Opinion statementRelapse rates among treatment-seeking opioid-addicted individuals are extremely high but can be markedly reduced by agonist-based maintenance therapies such as methadone or buprenorphine. However, these therapies are not always available due to a limited number of providers, waiting lists to access treatment, or laws that prevent their use. In addition, some persons do not want agonist-based therapy because they do not like its subjective effects, tried it with less than optimal results, and had trouble stopping it when they felt ready or because family or other external pressures oppose it. For these indi...
Source: Current Treatment Options in Psychiatry - April 20, 2017 Category: Psychiatry Source Type: research

Pregnancy and the Opioid Epidemic
Opinion StatementThe USA is currently experiencing related epidemics of opioid misuse, use disorder, (over) prescribing, and overdose. We review the current literature on opioid use disorder (OUD) during pregnancy including intrapartum and postpartum considerations, breastfeeding, neonatal abstinence syndrome, and contraception. Screening for OUD in pregnancy should be universal, and pregnant women with opioid use disorder should have access to opioid pharmacotherapy. Pharmacotherapy with opioid agonists, methadone, or buprenorphine remains the standard of care for treating opioid use disorder in pregnancy. Medically assis...
Source: Current Treatment Options in Psychiatry - April 19, 2017 Category: Psychiatry Source Type: research

The Use of Long-Acting Injectable Antipsychotics in Schizophrenia
This article reviews data on the use of NGA LAIs in schizophrenia and discusses current issues from clinical and methodological perspectives. (Source: Current Treatment Options in Psychiatry)
Source: Current Treatment Options in Psychiatry - April 19, 2017 Category: Psychiatry Source Type: research

Exercise Treatments for Psychosis: a Review
Opinion statementSchizophrenia is a devastating mental illness that has profound effects on a person ’s health and quality of life. Exercise represents a promising new treatment option that may supplement current psychosocial and pharmacological interventions for psychosis. A large body of work suggests that exercise can improve cardio-metabolic and health behavior and facilitate neurogenesis in areas of the brain that are notably impacted by psychosis. Recent efforts to incorporate exercise as either stand-alone or adjunctive treatment for individuals with schizophrenia range from yoga and light stretching to moderately...
Source: Current Treatment Options in Psychiatry - April 18, 2017 Category: Psychiatry Source Type: research

Targeting the Immune System With Pharmacotherapy in Schizophrenia
Opinion statementThe clinical manifestations of increased cytokine activity in individuals with schizophrenia have not been clearly delineated; thus, planning pharmacological interventions remains an entirely empirical endeavor. Although there are many preliminary findings regarding the use of adjunct pharmacotherapeutic strategies targeting the immune system, in most instances, clearly efficacious results require further validation. Antipsychotics remain the most effective pharmacological treatment approach in schizophrenia, and evidence suggests that they impact cytokine and immune cellular physiology in the patient, tho...
Source: Current Treatment Options in Psychiatry - April 18, 2017 Category: Psychiatry Source Type: research

Pharmacology of Geriatric Substance Use Disorders: Considerations and Future Directions
Opinion statementThe aging of the baby boomer generation, with its relatively high rates of substance use disorders, will necessitate a broader understanding of the treatment of geriatric addiction and will require greater availability of evidenced-based pharmacological treatment options. The appropriateness of various treatments depends on the unique needs of this population. Limitations of treatment of substance use disorders in older adults are often attributable to dysfunctions in metabolism, as well as increased risk of adverse effects of certain drugs in the geriatric population. There has been some established succe...
Source: Current Treatment Options in Psychiatry - March 8, 2017 Category: Psychiatry Source Type: research

Pharmacological Management of Anxiety Disorders in the Elderly
Opinion statementAnxiety disorders are common in the elderly. Additionally, anxiety symptoms often accompany comorbid psychiatric, medical, as well as neurodegenerative diseases in the older population. Anxiety in the elderly, often accompanied by depression, can lead to worsening physical, cognitive, and functional impairments in this vulnerable population. Antidepressants are considered first-line treatment. Both selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are efficacious and well-tolerated in the elderly. Some SSRIs are strong inhibitors of the cytochrome P450...
Source: Current Treatment Options in Psychiatry - February 9, 2017 Category: Psychiatry Source Type: research

Psychosocial Treatment Options for Major Depressive Disorder in Older Adults
Opinion statementLate-life depression (LLD) is a public health concern with deleterious effects on overall health, cognition, quality of life, and mortality. Although LLD is relatively common, it is not a normal part of aging and is often under-recognized in older adults. However, psychotherapy is an effective treatment for LLD that aligns with many patients ’ preferences and can improve health and functioning. This review synthesized the current literature on evidence-based psychotherapies for the treatment of depression in older adults. Findings suggest that active, skills-based psychotherapies (cognitive behavioral th...
Source: Current Treatment Options in Psychiatry - February 7, 2017 Category: Psychiatry Source Type: research

Psychosocial and Environmental Treatment Approaches for Behavioral and Psychological Symptoms in Neurocognitive Disorders: an Update and Future Directions
Opinion StatementNearly all persons with dementia will exhibit behavioral and psychological symptoms (BPSD) at some point during the course of the disease. These symptoms often pose significant challenges for formal and informal caregivers, and their treatment is unclear. Current guidelines recommend implementing nonpharmacological interventions as the first-line approach to managing BPSD. Given the recent proliferation of research evaluating the use of nonpharmacological interventions for BPSD, there is a continuing need to reevaluate and synthesize the findings in this area. The current review examines the evidence for u...
Source: Current Treatment Options in Psychiatry - February 5, 2017 Category: Psychiatry Source Type: research

Psychotherapeutic Treatment Approaches of Anxiety Disorders in the Elderly
Opinion StatementAnxiety disorders among older adults are fairly common but often go undiagnosed and under treated. Unfortunately, untreated anxiety leads to hastened aging, including increased risk for cardiac morbidity and cognitive impairments. First-line treatments for anxiety disorders are typically pharmacological measures, primarily selective serotonin reuptake inhibitors (SSRIs), and benzodiazepines. However, many patients may not accept medications or may experience debilitating side effects. Additionally, anxiety symptoms may not be entirely addressed by medications alone. All of this points to the need for non-p...
Source: Current Treatment Options in Psychiatry - January 30, 2017 Category: Psychiatry Source Type: research

Antipsychotics, Antidepressants, Anticonvulsants, Melatonin, and Benzodiazepines for Behavioral and Psychological Symptoms of Dementia: a Systematic Review of Meta-analyses
Opinion statementThe purpose of this systematic review is to evaluate the data on the use of antipsychotics, antidepressants, anticonvulsants, melatonin, and benzodiazepines for the treatment of behavioral and psychological symptoms of dementia (BPSD) from meta-analyses. We performed a literature search of PubMed, MEDLINE, EMBASE, PsycINFO, and Cochrane collaboration databases through August 31, 2016 using the following keywords: dementia, meta-analysis, antipsychotics, antidepressants, anticonvulsants, melatonin, and benzodiazepines. We found a total of 24 meta-analyses that assessed the use of antipsychotics, antidepress...
Source: Current Treatment Options in Psychiatry - January 26, 2017 Category: Psychiatry Source Type: research

Pharmacological Treatment of Bipolar Disorder in the Elderly
Opinion StatementDue to the early age of onset, bipolar disorder is most commonly studied in younger adults, among whom the prevalence is 3.9% in adults aged 18 –30 years. Unfortunately, relatively less attention has been paid to the unique needs of older adults with bipolar disorder (OABD), despite clinical complexities that include medical comorbidity, polypharmacy, cognitive decline, and phase of life losses of occupation and social identity. Furtherm ore, impaired cognitive performance in some older adults may limit the ability to stabilize mood episodes and interfere with the individual’s engagement in multi-moda...
Source: Current Treatment Options in Psychiatry - January 25, 2017 Category: Psychiatry Source Type: research

Safety Planning for Suicide Prevention
Opinion statementThe Safety Plan was developed to help individuals at risk of suicide to prevent and/or manage suicidal crises. The risk of suicide is elevated for people with serious mental illness, that is, a mental illness that interferes with the ability to carry out one or more major life activities. Serious mental illness makes it difficult to think clearly, make decisions, and take positive action. In other words, it impairs executive functioning. A wide variety of diagnoses, including depression (unipolar or bipolar), borderline personality disorder, post-traumatic stress disorder, and schizophrenia, are associated...
Source: Current Treatment Options in Psychiatry - October 23, 2016 Category: Psychiatry Source Type: research

Neurobiology of Risk for Bipolar Disorder
Opinion statementBipolar disorder (BD) is a chronic mental illness which follows a relapsing and remitting course and requires lifetime treatment. The lack of biological markers for BD is a major difficulty in clinical practice. Exploring multiple endophenotypes to fit in multivariate genetic models for BD is an important element in the process of finding tools to facilitate early diagnosis, early intervention, prevention of new episodes, and follow-up of treatment response in BD. Reviewing of studies on neuroimaging, neurocognition, and biochemical parameters in populations with high genetic risk for the illness can yield...
Source: Current Treatment Options in Psychiatry - October 19, 2016 Category: Psychiatry Source Type: research

A Review of the Diagnosis and Management of Hoarding Disorder
Opinion statementHoarding disorder (HD) is a severe psychiatric and public health problem characterized by extreme challenges with discarding possessions and severe acquisition resulting in excessive clutter that impairs daily functioning and may cause substantial health and safety risks. Over the past 20  years, research on HD has grown substantially and lead to its recent designation in the DSM-5 as a discrete disorder. The key features of the cognitive behavioral etiological model of hoarding include core vulnerabilities, information processing deficits, cognitions and meaning of possessions, and emotionally driven rei...
Source: Current Treatment Options in Psychiatry - October 12, 2016 Category: Psychiatry Source Type: research