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“Does Ketamine Have Rapid Anti-Suicidal Ideation Effects?”
(Source: Current Treatment Options in Psychiatry)
Source: Current Treatment Options in Psychiatry - October 16, 2015 Category: Psychiatry Source Type: research

Inpatient Cognitive Behavior Therapy Approaches for Suicide Prevention
Opinion Statement Within the current healthcare system, individuals recognized to be at imminent risk for suicide are likely to be referred for inpatient psychiatric care. The hospitalization setting provides a safe and supportive environment for specialty acute care services and stabilization. However, the majority of current interventions that are delivered to suicidal patients during this sensitive timeframe do not directly target suicide risk. Cognitive Behavior Therapy (CBT) is an evidence-based psychotherapeutic intervention that can easily be adapted for use in psychiatric inpatient settings. A spe...
Source: Current Treatment Options in Psychiatry - October 14, 2015 Category: Psychiatry Source Type: research

Are Eating Disorders Related to Attention Deficit/Hyperactivity Disorder?
Opinion statement Attention deficit/hyperactivity disorder (ADHD) is a disorder characterized by impulsivity, hyperactivity, and inattention. Binge-eating behavior is often impulsive and is the hallmark of the two eating disorders, binge-eating disorder (BED) and bulimia nervosa (BN), both of which are associated with significant health impairment. Bingeing behavior is also seen in the binge purge subtype of anorexia nervosa. Individuals with AN of the binge purge subtypes, BN and BED, have been found to exhibit impulsive behaviors that are often not limited to binge eating alone. There is preliminary evi...
Source: Current Treatment Options in Psychiatry - October 9, 2015 Category: Psychiatry Source Type: research

Psychological Approaches to Suicide Treatment and Prevention
This article features the three main replicated treatments for suicide: Dialectical Behavior Therapy, Cognitive Therapy for Suicide Prevention, and the Collaborative Assessment and Management of Suicidality. In addition, there is a recent surge of brief suicide-focused interventions (1–4 sessions) that include variations of stabilization planning and close examination of suicide attempts as an opportunity to learn about suicidal risk with coping-oriented guidance and support. Within a rapidly evolving contemporary mental health care reality, these suicide-related treatments and interventions hold great promise for the pr...
Source: Current Treatment Options in Psychiatry - October 5, 2015 Category: Psychiatry Source Type: research

Review of Psychopharmacological Approaches for Trichotillomania and Other Body-Focused Behaviors
Opinion statement N-acetyl cysteine (NAC) is a safe, generally well-tolerated option for these disorders, and so I usually suggest a trial of NAC. If after 3 months and no response, I consider other options. If the person has urges to pull or pick and they have first-degree relatives with addictions, then I suggest a trial of naltrexone. If they have significant anxiety or depression co-occurring with the pulling, I often suggest clomipramine as a possible treatment for both conditions. In the case of skin picking with co-occurring depression or anxiety, I recommend a selective serotonin reuptake inhibit...
Source: Current Treatment Options in Psychiatry - October 1, 2015 Category: Psychiatry Source Type: research

Eating Disorders and Their Relationship to Impulsivity
Opinion statement Impulsivity is a multi-faceted, personality-based construct that has been addressed in research on the etiology, maintenance, and treatment of eating disorders. There is substantial variability in eating disorder psychopathology in terms of physical, cognitive, emotional, and behavioral manifestations (e.g., body weight, presence or absence of weight and shape concerns, inhibited versus labile emotionality, and presence or absence of binge eating and purging). Historically, research on impulsivity in eating disorders has been primarily focused on individuals with bulimic-spectrum disorde...
Source: Current Treatment Options in Psychiatry - October 1, 2015 Category: Psychiatry Source Type: research

A Review of Brain Stimulation Treatments for Late-Life Depression
Opinion Statement Recurrence, relapse and resistance to first-line therapies are common and pervasive issues in the treatment of depression in older adults. As a result, brain stimulation modalities are essential treatment options in this population. The majority of data for the effectiveness of brain stimulation modalities comes from electroconvulsive therapy (ECT) studies. Current ECT trials are focused on prolonging response after a successful course and mitigating the cognitive adverse effects. Newer forms of brain stimulation have emerged; unfortunately, as with most advances in medicine older adults...
Source: Current Treatment Options in Psychiatry - September 28, 2015 Category: Psychiatry Source Type: research

Mobile Health Technologies for Suicide Prevention: Feature Review and Recommendations for Use in Clinical Care
Opinion statement Mobile devices, and the apps (software applications) that operate on them, have potential to help manage and prevent suicidal behavior by assisting with assessment of risk, providing educational and support information, and facilitating access to safety plans, crisis support, and coping tools. This clinician-friendly review provides an overview of the principal features of currently available mobile health apps that are specially designed for suicide prevention. The use of patient contact interventions (i.e., text messaging and e-mail interventions) on mobile devices is also discussed. R...
Source: Current Treatment Options in Psychiatry - September 26, 2015 Category: Psychiatry Source Type: research

Using Optogenetics to Dissect the Neural Circuits Underlying OCD and Related Disorders
Opinion Statement Clinical and preclinical studies have uncovered substantial evidence that dysfunction in cortico-striatal-thalamo-cortical (CSTC) loops central to the selection of action strategies may underlie obsessive compulsive disorder (OCD) symptoms. In human OCD, data suggest that the balance between selections of habitual versus goal-directed action strategies is disrupted, with concomitant hyperactivation of CSTC regions associated with these strategies. Preclinical lesion and inactivation studies of homologous CSTC regions in rodents have shed light on how sub-regions of the frontal cortex and...
Source: Current Treatment Options in Psychiatry - July 15, 2015 Category: Psychiatry Source Type: research

Treatment Options in Bipolar Disorder: Lessons from Population-Based Registers with Focus on Lithium
Opinion statement Population-based register studies have the advantage of large sample sizes and low dropout rates during long-term follow-up. Recent findings from population-based register studies on the efficacy of lithium have supplemented findings from randomized trials and generalized these to all patients with bipolar disorder. Findings from population-based register studies show that (1) half of patients with bipolar disorder continue to take lithium for longer than 6 months, (2) early start of lithium maintenance treatment following the first single manic episode improves the long-term outcome, (...
Source: Current Treatment Options in Psychiatry - July 15, 2015 Category: Psychiatry Source Type: research

Double-Blind Randomized Placebo-Controlled Trials in the Treatment of Affective Disorders: Problems and Alternatives
Opinion statement Double-blind randomized placebo-controlled trials, in which a new approval-seeking drug is compared to placebo, are generally considered to be the gold standard for evaluating the efficacy of a psychopharmacological intervention in the treatment of affective disorders. However, this type of study has substantial limitations regarding the external validity of its results. Therefore, alternatives within randomized controlled trials, such as non-inferiority trials or study designs in which the new drug or placebo is given simultaneously on top of standard antidepressant or anti-manic treatm...
Source: Current Treatment Options in Psychiatry - July 15, 2015 Category: Psychiatry Source Type: research

Neuroscience-Based Formulation and Treatment for Early-Onset Bipolar Disorder: a Paradigm Shift
Opinion statement Treating pediatric bipolar disorder (BD) requires new knowledge based on emerging and consistent neuroscience findings. It entails recognition and addressing the deficits in eight domains such as emotion processing, executive function, attention, impulse control, working memory, reward and risk response, perspective taking, and, finally, the interface of emotion and cognition. Skillful integration of four components: (A) assessment (disorder and domain functions), (B) educating the families that it is early-onset brain dysfunction based on what we now know through research, (C) chemother...
Source: Current Treatment Options in Psychiatry - July 10, 2015 Category: Psychiatry Source Type: research

Staging Models and Functional Outcomes in Bipolar Disorder: Clinical Implications
Opinion statement Prognostic staging has been gaining traction in psychiatry in the past few years. The heterogeneity of clinical presentations in bipolar disorder has been an important challenge to clinicians and researchers. Staging models attempt to overcome this problem by identifying clusters of patients with bipolar disorder who have a differential course of illness and response to treatments. There is an emerging body of knowledge suggesting that staging models based on functional outcomes (functional staging) may provide clinicians with a useful tool to predict the course of illness and organize t...
Source: Current Treatment Options in Psychiatry - July 8, 2015 Category: Psychiatry Source Type: research

Neuroscience-Informed Cognitive-Affective Training Interventions for Mood and Anxiety Disorders
Opinion statement Mood and anxiety disorders are characterized by abnormally persistent affective states. Neuroimaging studies have implicated the functioning of specific brain regions in the aberrant affective processing observed in mood and anxiety disorders: enhanced engagement of subcortical regions responsible for affect generation (amygdala, hippocampus) is coupled with reduced inhibitory cognitive control of affective processing from dorsolateral and ventrolateral prefrontal cortices. Emerging but compelling evidence suggests that neuroplastic mechanisms can be harnessed to remediate these abnormal...
Source: Current Treatment Options in Psychiatry - July 7, 2015 Category: Psychiatry Source Type: research

Pharmacotherapy for Adolescents with Substance Use Disorders
Opinion statement Substance use disorders (SUD) are among the most prevalent and serious mental disorders occurring in adolescents. Though significant gains have been made in evidence-based psychosocial therapies for the treatment of adolescent SUD, pharmacotherapy studies are scarce. Psychosocial treatment should most often be considered as the first-line treatment for adolescent substance use disorders. These may include such SUD-specific therapies as motivational enhancement therapy (MET), cognitive-behavioural therapy (CBT) and family-based interventions. We advocate for widespread availability of suc...
Source: Current Treatment Options in Psychiatry - July 7, 2015 Category: Psychiatry Source Type: research