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Review of Psychotherapeutic Approaches for OCD and Related Disorders
Opinion statement Obsessive-compulsive disorder (OCD) can take many forms, limited only by the imagination of the human mind. Advances in research surrounding OCD have established that efficacious treatments, such as exposure and response prevention (ERP), do exist. Even though ERP should provide the foundation for OCD treatment, ERP can be perceived as a highly aversive treatment, as evidenced by high drop-out and relapse rates (Abramowitz, Can J Psychiatr 51:407–416, 2006). As a result, research has started to examine other empirically supported strategies that may improve treatment outcome and reduce...
Source: Current Treatment Options in Psychiatry - July 7, 2015 Category: Psychiatry Source Type: research

Gender Considerations in Addiction: Implications for Treatment
Opinion statement Individuals with substance use disorders (SUD) are heterogeneous, making comprehensive assessment an essential part of treatment planning. Since a variety of pharmacological and psychosocial treatments are available, patient needs and characteristics, as well as substance-specific treatment options must be taken into account. In particular, clinicians should consider patient gender, as well as hormonal and other biological factors, when making treatment recommendations. Women are at greater risk for a variety of medical and psychosocial consequences, and may benefit from pharmacological ...
Source: Current Treatment Options in Psychiatry - July 7, 2015 Category: Psychiatry Source Type: research

Glutamatergic agents for OCD and related disorders
Opinion statement Pharmacotherapy remains inadequate for many patients with obsessive-compulsive disorder (OCD); there is an urgent need for alternative pharmacological strategies. Convergent evidence suggests imbalance in glutamate, the brain’s primary excitatory neurotransmitter, in some patients. This has motivated interest in glutamate modulators in patients who are unresponsive to standard pharmacotherapeutic approaches. While no glutamate modulator can be considered proven as an efficacious treatment of OCD, promising suggestions of benefit have been reported for memantine and riluzole. The eviden...
Source: Current Treatment Options in Psychiatry - July 3, 2015 Category: Psychiatry Source Type: research

Neuromodulation Treatments for Schizophrenia
Opinion statement Schizophrenia is a psychiatric disorder that causes great suffering and debilitation worldwide. We have a multitude of medications that are effective for psychosis. However, these have not been successful in treating the negative and cognitive symptom domains of schizophrenia. These symptoms are responsible for the larger part of functional impairments that result from schizophrenia. In addition, there are many patients for whom no significant improvement is achieved even in the positive symptom domain. Hence, other treatment modalities have been explored to help these patients. Electroc...
Source: Current Treatment Options in Psychiatry - July 3, 2015 Category: Psychiatry Source Type: research

Prescription Opioid Misuse: Effective Methods for Reducing the Epidemic
Opinion statement Prescription opioid misuse has been a significant epidemic during the past decade. Formulations of prescription opioids with different mechanisms of abuse-deterrence have been developed or are currently under development. Given that these medications are substantially more difficult to use in an illicit fashion and minimize the potential for euphoria and/or create an aversive experience when over-ingested, they represent an important next step in pharmacological innovation. Immediate decreases in nonmedical use and in associated overdose mortality and adverse events have been observed af...
Source: Current Treatment Options in Psychiatry - April 16, 2015 Category: Psychiatry Source Type: research

Use of Preclinical Drug Vs. Food Choice Procedures to Evaluate Candidate Medications for Cocaine Addiction
Opinion statement Drug addiction is a disease that manifests as an inappropriate allocation of behavior towards the procurement and use of the abused substance and away from other behaviors that produce more adaptive reinforcers (e.g., exercise, work, family, and social relationships). The goal of treating drug addiction is not only to decrease drug-maintained behaviors but also to promote a reallocation of behavior towards alternative, nondrug reinforcers. Experimental procedures that offer concurrent access to both a drug reinforcer and an alternative, nondrug reinforcer provide a research tool for asse...
Source: Current Treatment Options in Psychiatry - April 16, 2015 Category: Psychiatry Source Type: research

Current Treatments for Delusional Disorder
Opinion Statement Delusional disorders form part of the spectrum of psychotic disorders in psychiatry. They are poorly understood in practically every aspect of their nature, including cause, phenomenology, prevalence, comorbidity, course, treatment, and prognosis. The key symptom in delusional disorders is one or more delusions. A cardinal characteristic of delusional disorder, conviction that one is not mentally ill, contributes complexity to the treatment challenges and profoundly affects the therapeutic relationship. Diagnosis and differential diagnosis are critical tasks. Delusional conditions may ar...
Source: Current Treatment Options in Psychiatry - April 10, 2015 Category: Psychiatry Source Type: research

Preventing Violence in Patients with Schizophrenia
Opinion statement Violence in patients with schizophrenia has garnered substantial public attention in the lay press. Although schizophrenia is associated with a modestly elevated risk for violent behavior, which is further increased by comorbid substance use disorders, most patients with schizophrenia are not violent and most violent individuals do not have schizophrenia. At present, primary prevention efforts are of theoretical interest and include attention being placed on childhood maltreatment. Research into secondary prevention, defined as the prevention of occurrence of violent behavior in persons ...
Source: Current Treatment Options in Psychiatry - April 10, 2015 Category: Psychiatry Source Type: research

Outcome Measures in Medication Trials for Substance Use Disorders
Opinion statement There are multiple therapeutic options to treat tobacco (e.g., nicotine replacement therapies, varenicline) and alcohol (e.g., naltrexone, acamprosate) use disorders. In contrast, there are currently no FDA-approved pharmacotherapies to treat stimulant (e.g., cocaine, methamphetamine) use disorders. Based on a commentary published by FDA staff, a period of sustained abstinence appears required for regulatory approval of a first-in-class medication to treat stimulant use disorders. Certainly, achieving abstinence remains the goal of treatment in both real world medical practice and clinic...
Source: Current Treatment Options in Psychiatry - April 10, 2015 Category: Psychiatry Source Type: research

Outcome Measures in Medication Trials for Substance Use Disorders
Opinion statement There are multiple therapeutic options to treat tobacco (e.g., bupropion, varenicline) and alcohol (e.g., naltrexone, acamprosate) use disorders. In contrast, there are currently no FDA-approved pharmacotherapies to treat stimulant (e.g., cocaine, methamphetamine) use disorders. Based on a commentary published by an FDA staff, a period of sustained abstinence appears required for regulatory approval of a first-in-class medication to treat stimulant use disorders. Certainly, achieving abstinence remains the goal of treatment in both real-world medical practice and clinical trials. However...
Source: Current Treatment Options in Psychiatry - April 10, 2015 Category: Psychiatry Source Type: research

Treatment Strategies for Cannabis Use in Schizophrenia
Opinion statement Cannabis is used by more than 25 % of schizophrenia patients and is associated with symptom exacerbation and poorer clinical outcome. To date, evidence is scarce for treating cannabis use disorders among schizophrenia patients. Psychosocial interventions such as cognitive behavioral therapy, motivational interviewing, or contingency management have been evaluated as potential treatments for cannabis use disorders (CUD) among schizophrenia patients and in the general population. However, results are somewhat inconsistent, and efficacy appears to wane after treatment concludes. Pharmacothe...
Source: Current Treatment Options in Psychiatry - April 8, 2015 Category: Psychiatry Source Type: research

Prazosin for the Treatment of PTSD
This article reviews the clinical observations that led to the development of prazosin therapy for PTSD in combat veterans and the subsequent RCTs that demonstrated prazosin efficacy. (Source: Current Treatment Options in Psychiatry)
Source: Current Treatment Options in Psychiatry - April 6, 2015 Category: Psychiatry Source Type: research

Recent Progress in Psychosocial and Psychopharmacologic Treatments for ADHD
Opinion statement In this article, we review several new psychosocial and psychopharmacologic treatment approaches for attention deficit hyperactivity disorder (ADHD). Several of the treatments reviewed are promising and offer opportunities for augmenting current evidence-based approaches. However, others are not yet ready for prime time. Consequently, existing algorithms for ADHD treatment should still be followed. Current guidelines include those from the American Academy of Pediatrics (Wolraich et al. Pediatrics. 128 5:1007–22 2011), the American Academy of Child and Adolescent Psychiatry (AACAP) (Pl...
Source: Current Treatment Options in Psychiatry - February 25, 2015 Category: Psychiatry Source Type: research

Treatments for Post-traumatic Stress Disorder: Pharmaceutical and Electrophysiologic Considerations
Opinion statement Most individuals who experience traumatic events remain asymptomatic or symptoms resolve quickly, but in a minority who develop post-traumatic stress disorder (PTSD), symptoms can persist for decades and can be associated with psychiatric and medical co-morbidities and poor social and occupational functioning. Currently, first-line pharmacotherapies are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for core symptoms and in individuals with unremitting nightmares, prazosin, is commonly used and often effective. This review apprais...
Source: Current Treatment Options in Psychiatry - February 17, 2015 Category: Psychiatry Source Type: research

Essential Fatty Acids for Childhood Mental Health Disorders
Opinion statement No child psychiatric disorder has a single treatment that is completely satisfactory. Combinations are sometimes more beneficial than single treatments. This is well established for medication + behavioral treatment for depression and ADHD. There is wide variability in the evidence base for various treatments, from FDA-approved RCTs to open pilots. In the search for additional or alternative treatments, essential fatty acids seem especially to pass the SECS criterion: a treatment that is safe, easy, cheap, and sensible does not need as much evidence to justify patient trials as one t...
Source: Current Treatment Options in Psychiatry - February 10, 2015 Category: Psychiatry Source Type: research