Psychiatry MMC

Psychiatry 2006 - ISSN: 1550-5952 - Volume 3 - Issue 7 - July 2006
Feature Article:
Missing the Sweet Spot: Disengagement in Schizophrenia
by Richard S. E. Keefe, PhD

The extent to which an individual engages in a cognitive task is associated with performance in laboratory settings[1] and a variety of domains of functioning, such as athletic activity and artistic expression.[2] The neural circuitry associated with task engagement is in the process of being elucidated by cognitive neuroscience investigations. These newly acquired data provide an opportunity to understand the cognitive, social, and functional disabilities that lie at the core of dysfunction in patients with schizophrenia. This article describes the importance of task engagement in human functioning, its impairment in schizophrenia, and the possibility that disengagement during late adolescence may herald future development of schizophrenia.[3,4] Since treatment studies suggest that improvement in this aspect of cognitive functioning has the potential to improve the functioning of patients with schizophrenia in various domains, it is possible that these improvements may be mediated by
PART 1: An Evidence-Based Approach to Augmentation and Combination Strategies for Treatment-Resistant Depression
by Jeremy Barowsky, MD; and Thomas L. Schwartz, MD

abstract Design, setting, participants: This paper is a review article that collects and synthesizes up-to-date information about the practice of augmenting and combining medications in regards to treatment resistant major depressive disorder. The authors have written the paper in an evidence-based model in order to show the reader where adequate data exists in regards to these strategies. A thorough MEDLINE search was utilized to collect many papers dedicated to this area of study spanning 1989-2005. Measurements: Papers were divided based upon drug intervention and scientific merit, where randomized controlled trials were given the most evidence-based weight and case studies the least. Results: The literature review data is divided into augmentation and combination strategies in descending order of scientific stringency. For augmentation, lithium, antipsychotic, and thyroid addition has the most empirical support. For combination strategies, heterocyclic addition is the best studi
PART 2: An Evidence-Based Approach to Augmentation and Combination Strategies for Treatment-Resistant Depression
by Jeremy Barowsky, MD; and Thomas L. Schwartz, MD

abstract Design, setting, participants: This paper is a review article that collects and synthesizes up-to-date information about the practice of augmenting and combining medications in regards to treatment resistant major depressive disorder. The authors have written the paper in an evidence-based model in order to show the reader where adequate data exists in regards to these strategies. A thorough MEDLINE search was utilized to collect many papers dedicated to this area of study spanning 1989-2005. Measurements: Papers were divided based upon drug intervention and scientific merit, where randomized controlled trials were given the most evidence-based weight and case studies the least. Results: The literature review data is divided into augmentation and combination strategies in descending order of scientific stringency. For augmentation, lithium, antipsychotic, and thyroid addition has the most empirical support. For combination strategies, heterocyclic addition is the best studi
Sleep-Disordered Breathing in Depression and Schizophrenia
by Fredric Jaffe, DO; Dimitri Markov, MD; and Karl Doghramji, MD

abstract Sleep disorders are becoming more prevalent. There is an overlap of symptoms related to obstructive sleep apnea syndrome (OSAS) and many psychiatric conditions. Complaints of excessive sleepiness, insomnia, cognitive dysfunction, and depressive symptoms can be related to both disease states. Obstructive sleep apnea syndrome is characterized by repetitive disruption of sleep by cessation of breathing and was first described in the 19th century by bedside observation during sleep. Physicians observed this cessation of breathing while the patient slept and postulated that these episodes were responsible for subsequent complaints of sleepiness. OSAS can coexist with major depressive disorder, exacerbate depressive symptoms, or be responsible for a large part of the symptom complex of depression. Additionally, in schizophrenia, sleep apnea may develop as a result of chronic neuroleptic treatment and its effect on gains in body weight, a major risk factor for the development of OSA
Update on Parasomnias: A Review for Psychiatric Practice
by Dimitri Markov, MD; Fredric Jaffe, DO; and Karl Doghramji, MD

abstract Parasomnias, defined as undesirable behavioral, physiological, or experiential events that accompany sleep, are common in the general population. As a rule, they occur more frequently in children than in adults with the exception of REM sleep behavior disorder (RBD), which is more common in men over 50. No longer considered to be invariably a sign of psychopathology, parasomnias are currently understood as clinical phenomena that arise as brain transitions between REM sleep, non-REM sleep, and wakefulness. This paper presents a clinical approach to diagnosing and treating parasomnias in the general population and in psychiatric patients.

Letters to the Editor:
Hepatotoxic Effects with High-Dose Venlafaxine
Richard C. Christensen, MD, MA; Lorrie K. Garces, MD
Regarding Topiramate for Alcohol Dependence
Adegboyega Oyemade, MD