Featured Articles from Mind & Brain, The Journal of Psychiatry

Yogic Breathing Techniques in the Management of Anxiety and Depression: Systematic Review of Evidence of Efficacy and Presumed Mechanism of Action

Nupur Tiwari and David S Baldwin

Affiliation: University Department of Psychiatry, Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, United Kingdom

(Received: 19 January 2012; Accepted: 16 March 2012; Published: 02 May 2012)

ABSTRACT

Yogic breathing (Pranayam) involves control of the rate, depth and type of breathing and is considered to be an important component of yogic practice. “Breathing exercises” are frequently recommended, as part of the overall management plan for patients with anxiety disorders, though formal evidence for efficacy is limited and the potential mechanisms underlying beneficial effects are not fully clarified. We undertook a systematic review of published studies examining the efficacy and putative mechanisms of yogic breathing in anxiety disorders. There are few adequately designed randomised controlled trials in patients with anxiety disorders; though benefits have been reported in healthy volunteers and in patients with physical health problems, evidence for potential efficacy in anxiety disorders rests largely on the findings of case series and uncontrolled studies. There is a persisting need for well-designed randomised controlled trials in clinical samples of patients with anxiety disorders.

Keywords: yogic breathing, yoga, Pranayam, depression, anxiety, OCD, Phobias, PTSD

Correspondence: David S Baldwin, University Department of Psychiatry, Academic Centre, College Keep, 4–12 Terminus Terrace, Southampton SO14 3DT, United Kingdom. Tel: +44 2380 718 520; Fax: +44 2380 718 532; e-mail: dsb1@soton.ac.uk

Spectrum of Depressive Disorders and Cardiovascular Diseases: Clinical and Psychobiological Evidences of a Bidirectional Relationship

Laura Palagini¹, Rosa Maria Bruno², Mario Guazzelli¹, Stefano Taddei², Angelo Gemignani^1,3 and Lorenzo Ghiadoni¹

Affiliations: ¹Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Pisa, Italy; ²Department of Internal Medicine, School of Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy and ³Department of Physiological Sciences, University of Pisa, Extreme Centre, Scuola Superiore Sant’Anna and IFC-CNR, Pisa, Italy

ABSTRACT

Depression and cardiovascular disease are very common, and they often coexist. Major depression is considered a primary and secondary risk factor for hypertension, coronary artery disease, myocardial Infarction, and congestive heart failure. Nevertheless, depressive episodes, minor depression, dysthymia, and several subsyndromal forms of depression, currently included in the realm of “mood spectrum disorders,” might have a role in the etiology of these cardiovascular diseases. Despite the exact pathways underlying the interplay between depressive spectrum disorders and cardiovascular disease have yet to be elucidated, the existence of a bidirectional relationship has been postulated. The aim of this manuscript is either to reconsider the clinical evidences of the relationship between depressive spectrum disorders and cardiovascular disease or the hypothesis of a common psychoorganic etiological background by a systematic search from MEDLINE and PsychINFO articles with participants over 18 years.

Keywords: depressive spectrum disorders, hypertension, coronary artery disease, myocardial infarction, congestive heart failure, primary risk, secondary risk

Correspondence: Laura Palagini, MD, PhD, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy. Tel: 39 050 993110, 993165; e-mail: lpalagini@tiscali.it; l.palagini@ao-pisa.toscana.it

Relationship Between Attention Deficit/Hyperactivity Disorder (ADHD) and Delayed Sleep Phase Disorder (DSPD)

Khurshid A Khurshid

Affiliation: Department of Psychiatry, Neurology and Sleep Disorders, Howard University Hospital, Washington, DC, USA

ABSTRACT

The relationship between Attention deficit/Hyperactivity disorder and Delayed sleep phase disorder has not been clearly elucidated. Delayed sleep phase and DSPD is common in children with ADHD. There seems to be bi-directional relationship between delayed sleep phase and attention deficit disorder symptoms. Treatment directed at delayed sleep phase results in improvement in ADHD symptoms. The causal role of delayed sleep phase and DSPD in ADHD symptoms needs to be further studies. This review article summarizes the available evidence and stresses upon the need for further studies in this area.

Keywords: Attention-deficit hyperactivity disorder, ADD, Sleep disturbance, Delayed sleep phase, DSPD

Correspondence: Khurshid A Khurshid, MD, University of Florida, College of Medicine, Department of Psychiatry, 1329 SW 16 th street, 4th floor, P.O. Box 103424, Gainesville, Florida, 32608; e-mail: kakhurshid@yahoo.com

Insight Medically Unexplained Symptoms

Ioulia Maimari¹, Paraskevi Chiona² and Charalampos Dokos³

Affiliations: ¹Cognitive Neuroscience Laboratory, German Primate Center, Go¨ttingen, Germany; ²Department of Psychology, Leiden University, The Netherlands and ³Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

ABSTRACT

Medically unexplained symptoms (MUS) are symptoms without any objective physical or pathological cause. Several studies underlay the link among MUS and mental dysfunctions as anxiety and depression. The exact causes of MUS have not been found yet. Moreover a scientist cannot recommend a specific treatment for this disease. Medications and psychotherapy, or a combination of both, are still under consideration and more research is needed.

Keywords: medically unexplained symptoms, anxiety, depression, chronic fatigue syndrome, irritable bowel syndrome, treatment, psychotherapy

Correspondence: Dr. Charalampos Dokos, Magnisias 4, P.O Box 8025, Paphos, Cyprus. E-mail: dokos1984@yahoo.gr

Childhood Adverse Experiences in Bipolar Disorders

Ivo A Rubino, Michele Ribolsi, Cinzia Niolu, Valentina Magni and Alberto Siracusano

Affiliation: Section of Psychiatry, Department of Neuroscience, University of Rome-Tor Vergata, Rome, Italy

ABSTRACT

Bipolar disorder (BD) in its broadest sense has a community lifetime prevalence of 4% and is associated to high rates of disability and higher rates of mortality. BD may be considered a multifactorial disorder resulting from interaction between genetic and nongenetic factors and many studies demonstrate that environmental factors play an important role in the etiopatogenesis and in the development of BD. The nongenetic factors include early childhood trauma, stressful life events, virus infections, cannabis use, obstetric complications, and even very distant environmental factors such as solar cycles. Childhood traumatic events are probably the most promising environmental determinant to have been investigated. The identification of childhood trauma as a potential risk factor and/or course disease modifier in BD (not only in terms of comorbid conditions, but also in terms of affective functioning) may improve our understanding of the complex interactions between genetic susceptibility factors and the environment. Many researchers suggest that childhood trauma predisposes subjects to BD; in particular, it has been demonstrated that childhood trauma is related to a more severe prognosis and more severe clinical expression. This review shows how an unacceptably large number of children in our society are subjected to early adverse experiences, exposing these children to an increased risk for the development of BD that may persist throughout adulthood. Furthermore, we focus our attention on the importance of childhood trauma for the development of BD, underlying how they modulate the clinical expression, and the course of the disease.

Keywords: bipolar disorder, trauma, childhood, abuse, genetics, environment, adverse events

Correspondence: Ivo Alex Rubino, Department of Neuroscience, University of Rome-Tor Vergata, Via Nomentana 1362, Rome 00141, Italy. e-mail: i.rubino@med.uniroma2.it; mic19812000@yahoo.it

A Review of the Association Between Alcohol Misuse and Bullying Victimization in Adolescence

Lauren Topper¹ and Patricia J. Conrod^2,3

Affiliations: ¹MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, UK; ²Addictions Department, Institute of Psychiatry, King’s College London, London, UK and ³Centre de recherche du CHU Ste-Justine, Université de Montréal, Montreal, Canada

ABSTRACT

BACKGROUND

A large body of literature has consistently shown a relationship between various forms of victimization experienced during adolescence and the risk for alcohol misuse. Fewer studies have investigated this relationship within the context of adolescent victimization from bullying. A review of the literature is, therefore, needed to draw together what is already known from research as well as to highlight the apparent gaps within the literature in order to call for further research within this area.

METHOD

Electronic databases as well as manual searches were conducted to find all peer-reviewed papers currently published or in press that had investigated the relationship between bullying victimization and alcohol use in adolescence. Studies were included that reported on both peer victimization from bullying as well as alcohol use (either separately or as part of a latent “substance-use” measure).

RESULTS

Eight studies were initially included in this review (one study was later excluded due to methodological considerations). A wide range of methodological differences between the studies were identified, with only two studies reporting on longitudinal data (up to 12 months). Studies varied in sample size, age range, and analytic approach. Five of the seven studies reported a positive association between being a victim of adolescent bullying and alcohol use.

CONCLUSIONS

While associations have been made between adolescent bullying victimization and alcohol use, any firm conclusions should remain tentative until further longitudinal research has been conducted. It is imperative that this relationship, as well as any potential underlying mechanisms, is further understood in order for prevention and intervention strategies to be tailored to the heterogeneous needs of adolescent victims of school-based bullying.

Keywords: victimization, bullying, adolescence, alcohol use

Correspondence: Patricia J. Conrod, GRIP-Centre de recherche du CHU Ste-Justine, Université de Montréal, Bureau 1551, 3175 Chemin de la Côte Sainte-Catherine, Montréal, H3T 1C5, Canada. e-mail: patricia.conrod@umontreal.ca or patricia.conrod@kcl.ac.uk.

Ethical Challenges in Forensic Psychiatry

Norbert Konrad

Affiliation: Institut für Forensische Psychiatrie, Charite – Universitätsmedizin Berlin, Berlin, Germany

Correspondence: Institut für Forensische Psychiatrie, Charite – Universitätsmedizin Berlin, Oranienburger Str. 285, 13437 Berlin, Germany. Tel: +49 (0)30 84451411; Fax: +49 (0)30 84451440; e-mail: norbert.konrad@charite.de

ABSTRACT

Forensic psychiatrists are concerned with the assessment of complex cases including risk assessment and act as expert witness in court commenting, for example, on issues of criminal responsibility and competency to stand trial. The objective of this paper is to review the relevant forensic-psychiatric literature about the role of a forensic psychiatrist connected with conducting Independent Medical Examinations for which the WPA Scientific Section Forensic Psychiatry developed guidelines that refer to ethics, conduct of the examination, and content of the report. While the ethical issues facing forensic psychiatrists might be similar across cultures, they do also depend on the specific legal system and service provision within each country. It has to be concluded that a forensic psychiatrist should not only look on technical guidelines to structure the report, but has to respect the ethical frame as well as to be conscious of the cultural and societal context. Some questions referring to the dual-role dilemma remain open and unanswered.

Life Satisfaction in Patients with Social Anxiety Disorder: Impact of Cognitive-Behavioral Group Therapy

Aba Delsignore, Steffi Weidt, Juliane Emmerich and Michael Rufer

Affiliation: Department of Psychiatry and Psychotherapy, University Hospital of Zürich, Zürich, Switzerland

Correspondence: Aba Delsignore, Department of Psychiatry and Psychotherapy, University Hospital of Zürich, Culmannstrasse 8, 8091 Zürich, Switzerland. Tel: +41 (0)44 255 52 80; Fax: +41 (0)44 255 44 08; e-mail: aba.delsignore@usz.ch

ABSTRACT

This study focused on life satisfaction among patients with social anxiety disorder (SAD) and examined factors associated with gains in life satisfaction following cognitive-behavioral group therapy (CBGT). A sample of 121 patients with social anxiety disorder undergoing cognitive-behavioral group therapy was assessed in terms of domain-specific life satisfaction (FLZ) and symptomatology at baseline, posttreatment and 3-month follow-up. At baseline, patients showed decreased mean scores for life satisfaction especially in domains requiring social competence (friends, partnership, and family). Life satisfaction increased significantly in the course of CBGT and remained stable in the follow-up period. Symptom improvement was linked to life satisfaction gains during therapy. Men were more often singles and less satisfied with their partnership situation than women. Current partnership, employment, and no previous therapy experience were associated with higher life satisfaction at baseline. However, only the partnership situation was a positive predictor of life satisfaction gains at follow-up. In conclusion, our results showed that life satisfaction could be improved with CBGT for SAD. Additional interventions may be necessary to increase the satisfaction of men with their partnership situation and to support single patients in the practice of social skills outside of the group.

Correlation of High Maternal Perceived Stress During Pregnancy and Offspring Attention-Deficit/Hyperactivity Disorder in Japan

Kouichi Yoshimasu¹, Chikako Kiyohara² and the Wakayama ADHD Study Group*

Affiliations: ¹Department of Hygiene, School of Medicine, Wakayama Medical University, Wakayama; ²Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

*Members of the Wakayama ADHD Study Group are listed in the Appendix.

Correspondence: Kouichi Yoshimasu, Department of Hygiene, School of Medicine, Wakayama Medical University, 8-1-1 Kimiidera, Wakayama 641-0012, Japan. Tel: +81 73-441-0646; Fax: +81 73-441-0646; e-mail: kyoshi@wakayama-med.ac.jp

ABSTRACT

Introduction

Although some evidence has suggested that maternal mental stress during pregnancy is associated with an increased risk of offspring attention-deficit/hyperactivity disorder (ADHD), non-Caucasian studies with appropriate adjustments for confounding factors have not yet been conducted.

Objective

To examine the relationship between maternal perceived mental stress during pregnancy and offspring ADHD among Japanese.

Method

A total of 90 pairs of ADHD children and mothers as well as 290 corresponding comparison pairs were recruited throughout the study period. In brief, a psychiatrist interviewed all the mothers of ADHD and comparison children, and elicited information regarding their lifestyles during pregnancy including mental stress as well as other psychosocial, perinatal, and lifestyle factors. The diagnosis of ADHD was made by each physician in charge according to DSM-IV diagnostic criteria.

Results

Severe antenatal mental stress was significantly associated with an approximately eightfold increased risk of offspring ADHD, even after adjusting for potential confounders such as socioeconomic and perinatal factors (OR 7.7, 95% CI, 3.1–19.2).

Conclusions

High maternal perceived mental stress during pregnancy might be a significant risk factor for offspring ADHD among Japanese. Our findings must be validated by prospective studies using a larger sample size and a more detailed assessment of mental stress in non-Caucasian populations.

Treating Anxiety Disorders with Anticonvulsant Drugs: Is There Any Evidence?

INTRODUCTION

Anxiety disorders are chronic conditions that may require long-term drug treatments. Antidepressants represent the current gold standard but they fail in up to one-third of patients. Moreover, benzodiazepines, currently used in the acute treatment, are limited by the high risk of tolerance, dependence, and abuse.

OBJECTIVES

This paper is aimed at reviewing international literature on the use of anticonvulsant drugs in anxiety disorders.

METHODS

References were identified by searches of Medline/PubMed and PsychINFO. Only papers published in English were reviewed.

RESULTS

Despite a considerable number of open studies and anecdotal reports, the number of controlled studies is scanty. The majority of publications have several methodological limitations including inadequate sample size; lack of placebo control; the use of different outcome measures; and lack of controlling for patient variables such as comorbidity, diagnostic subtype, and concomitant medications. Pregabalin is the only anticonvulsant with good evidence in generalized anxiety disorder. Pregabalin and gabapentin may be promising in social phobia but further controlled studies are needed. A number of compounds are still at an early stage of evidence and may deserve further controlled trials: topiramate in posttraumatic stress disorder and obsessive compulsive disorder, valproate and gabapentin in panic disorder.

CONCLUSION

Anticonvulsant drugs may be valuable options in some selected patients with difficult to treat anxiety disorders refractory to first-line agents. Further studies are warranted to identify specific clinical phenotypes where anticonvulsants may be successfully used in the acute and long-term treatment of anxiety disorders.

Contribution of Disulfiram Use to Retain Alcohol-Dependent Outpatients in Treatment: A Focus on Gender

Specificity of Predictors for “Psychosis” and “Neurosis”: A Comparison in a 50-Year Follow-Up of the Unselected Lundby Community Population

Bogren M, Mattisson C; Specificity of Predictors for “Psychosis” and “Neurosis”: A Comparison in a 50-Year Follow-Up of the Unselected Lundby Community Population. Mind & Brain, the Journal of Psychiatry, August 2010; 1(2):  1-12

ORIGINAL ARTICLE


Mats Bogren and Cecilia Mattisson

Affiliation : Department of Clinical Sciences, Division of Psychiatry, the Lundby Study, Lund University Hospital, Lund, Sweden

ABSTRACT

Premorbid anomalies related to personality and behavior may confer an increased risk of developing psychosis. Prospective studies have found that social anxiety, social adjustment problems, deviance in emotional reactivity, high neuroticism, low extraversion, psychoticism, features of schizotypy, neurocognitive impairment, and anhedonia are associated with an increased risk of developing schizophrenia spectrum disorders. As some of these factors—e.g., anxiety, neuroticism, and psychoticism—have also been found to be associated with depression, however, it is possible that such deviances related to personality and behavior may reflect an increased risk of developing any mental disorder, thus raising the question whether there are any premorbid traits that are specifically related to psychosis. We studied whether certain clusters of premorbid behavioral and personality-related signs and symptoms were predictors of “nonaffective and/or affective psychosis” and “neurosis,” respectively, in a 50-year prospective study of a complete general community population (n = 3563). Although we found that most personality-related predictors are probably shared between “psychosis” and “neurosis” outcomes, the result also suggested that premorbid proneness to anxiety, impairment in experiencing pleasure, affective flattening, cluster A resembling traits, hypersensitiveness, and distractibility may be more strongly related to the risk of developing “psychosis” than “neurosis.” Furthermore, impairments in experiencing pleasure and affective flattening may show some superior specificity for the risk of developing “psychosis” in comparison with “neurosis,” which accords with the hypothesis that psychosis proneness may be related to a salience disorder.

Keywords: Community Population, Prospective Study, Vulnerability, Risk Factors, Nonaffective Psychosis, Affective Psychosis, Neurosis
Correspondence: Mats Bogren, Department of Clinical Sciences, Division of Psychiatry, the Lundby Study, Lund University Hospital, St Lars,
SE-221 85 Lund, Sweden. Tel: +46 46 174321 ; Fax: +46 46 174647; e-mail: mats.bogren@med.lu.se

Self-Protective Organization in Children with Conversion Symptoms: A Cross-Sectional Study Looking at Psychological and Biological Correlates

Kozlowska K, Williams LM; Self-Protective Organization in Children with Conversion Symptoms: A Cross-Sectional Study Looking at Psychological and Biological Correlates. Mind & Brain, the Journal of Psychiatry, August  2010; 1(2):  43-58

REVIEW ARTICLE


Kasia Kozlowska^1,2 and Leanne M Williams²

Affiliations : ¹Department of PsychologicalMedicine, The Children’s Hospital atWestmead,Westmead, NSW, Australia and ²Brain Dynamics Centre, Sydney Medical School and Westmead Millennium Institute at Westmead Hospital, Westmead, NSW, Australia

ABSTRACT

Conversion disorder remains a long-standing puzzle concerning the interconnections of brain, mind, and body. Contemporary psychological assessments and neurophysiological techniques create a new window for investigating those interconnections, but the widely varying presentations of conversion disorder have made it difficult to isolate clinically well-defined groups for controlled studies. To overcome such difficulties, we propose an integrative framework to link the conceptualization of symptoms with levels of organization, as assessed by brain–body measures. We conceptualize conversion symptoms as the motor-sensory components of broader self-protective patterns of response—integrated sets of reactions involving physiological, motor-sensory, and psychological subcomponents—or their unwanted consequences. We describe a research program aimed at testing these relationships in children presenting with acute “conversion symptoms,” including somatoform pain. These relationships are examined using a standardized test battery that includes psychological measures (symptoms, attachment strategy, distress, daily function, life-event profile), measures of cognitive performance (on both general and emotional domains), and neurophysiological measures of brain and body function (including electroencephalogram, event-related potentials, heart rate, and skin conductance). Enrollment is under way for a minimum target of 40 children with acute conversion symptoms, 40 children with medically unexplained pain, and 40 healthy, matched controls. Our expectation is that these data will advance our understanding of conversion disorder and also improve the clinical care of this patient population.

Keywords: Conversion disorder, Somatoform pain disorder, Medically unexplained symptoms, Self-protective organization, Biologicalmarkers,
Emotion processing, Dynamic-Maturational Model of attachment, Integrative neuroscience
Correspondence: Kasia Kozlowska, Department of Psychological Medicine, The Children’s Hospital atWestmead, Locked Bag 4001,Westmead,
NSW 2145, Australia. Tel: 61-2-9845-2005; Fax: 61-2-9845-2009; e-mail: kasiak@chw.edu.au

Using Neuroimaging to Predict Outcome in Patients with Major Depressive Disorder

Ramasubbu  R, MacQueen G; Using Neuroimaging to Predict Outcome in Patients with Major Depressive Disorder. Mind & Brain, the Journal of Psychiatry, August  2010; 1(2):  59-68

REVIEW ARTICLE


Rajamannar Ramasubbu and Glenda MacQueen

Affiliation : Department of Psychiatry and Clinical Neurosciences, Faculty of Medicine, University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada

ABSTRACT

Variability in treatment response is a major challenge in the treatment of patients with major depression, and there are few reliable predictors of clinical outcomes. Recent advances in brain-imaging technologies offer promise that neural markers might be useful in the prediction of treatment outcomes. Emerging evidence suggests that hippocampal and anterior cingulate volumes and brain activity in the subgenual cingulate and amygdala may predict treatment response in depression. There are some obvious limitations to the routine use of imaging as a tool for predicting who will respond to a course of treatment. Nonetheless, it is reasonable to consider whether non-invasive brain-imaging methods such as magnetic resonance imaging and electroencephalography combined with sensitive clinical measures of early treatment changes will someday be routinely applied to guide treatment selection for people with depression.

Keywords: Major Depression, Antidepressants, Predictors of Treatment Response, Brain Imaging, Neural Markers
Correspondence: Dr Rajamannar Ramasubbu, Department of Psychiatry and Clinical Neurosciences, Special Services Building, 403-29th Street
N.W., Calgary, Alberta T2N 2T9, Canada. Tel: 403-944-1235; Fax: 403-270-3451; e-mail: rramasub@ucalgary.ca

Responses to Facial Expressions of Emotions in Social Anxiety Disorder: A Review of fMRI and ERP Studies from a Developmental Psychopathology Perspective

Biomarkers and Autism

Psychosocial Interventions to Improve the School Performance of Students with Attention-Deficit/Hyperactivity Disorder

Tresco KE, Lefler EK, Power TJ; Psychosocial Interventions to Improve the School Performance of Students with Attention-Deficit/Hyperactivity Disorder. Mind & Brain, the Journal of Psychiatry, August  2010; 1(2):  69-74

REVIEW ARTICLE


Katy E Tresco, Elizabeth K. Lefler and Thomas J Power

Affiliation : The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

ABSTRACT

Children with attention-deficit/hyperactivity disorder (ADHD) typically show impairments throughout the school day. A number of interventions have been demonstrated to address both the academic and behavioral impairments associated with this disorder. Although the focus of research has been on classroom-based strategies of intervention for children with ADHD, school-based interventions applicable for nonclassroom environments such as lunchrooms and playgrounds are beginning to emerge. This paper provides a brief description of the guiding principles of behavioral intervention, identifies selected strategies to address behavioral and academic concerns, discusses how school contextual factors have an effect on intervention selection and implementation, and considers the effects of using psychosocial interventions in combination with medication.

Keywords: ADHD, School, Intervention, Behavior, Psychosocial, Academic, RTI
Correspondence: Thomas J Power, The Children’s Hospital of Philadelphia, 34th St. & Civic Center Blvd., 3535 Market Street-Room 1471, Philadelphia, PA 19104, USA. e-mail: power@email.chop.edu