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Current Psychiatry Reviews
ISSN: 1573-4 005
Current Psychiatry Reviews
Volume 3, Number 1, February 2007
Contents
Editorial Pp. 1
The Sensation Seeking Trait and Substance Use:
Research Findings and Clinical Implications Pp. 3-13
Michael T. Bardo, Yolanda D. Williams, Linda P. Dwoskin,
Sean E. Moynahan, Iman B. Perry and Catherine A. Martin
[Abstract] [Full
text article]
Electroconvulsive Therapy for Schizophrenia
Pp. 15-24
Worrawat Chanpattana
[Abstract] [Full
text article]
Traumatic Brain Injury as a Risk Factor for Schizophrenia
Pp. 25-32
Cheryl Corcoran and Dolores Malaspina
[Abstract] [Full
text article]
Major Mental Disorders and Violence: A Critical Update
Pp. 33-50
Christian C. Joyal, Jean-Luc Dubreucq, Catherine Gendron
and Frederic Millaud
[Abstract] [Full
text article]
Methodological Issues in Assessing the Evidence for
Compulsory Community Treatment Pp. 51-56
Stephen Kisely and Leslie Anne Campbell
[Abstract] [Full
text article]
Supportive-Expressive (SE) Psychotherapy: An Update
Pp. 57-64
Falk Leichsenring and Eric Leibing
[Abstract] [Full
text article]
Insight, Outcome and Recovery in Schizophrenia Spectrum
Disorders: An Examination of their Paradoxical Relationship
Pp. 65-71
Paul H. Lysaker and Kelly D. Buck
[Abstract] [Full
text article]
Self-Regulatory Control and Habit Learning in the
Development of Eating Disorders Pp. 73-83
Rachel Marsh, Joanna E. Steinglass, Kara Graziano, Bradley
S. Peterson and B. Timothy Walsh
[Abstract] [Full
text article]
Abstracts
[Back to top]
Editorial
With this issue Current Psychiatry Reviews marks
the beginning of its third year of publication. We are making
excellent progress in terms of the quantity and quality of
the review articles that have been submitted to Current
Psychiatry Reviews. The group of articles included herein
nicely illustrates the breadth of topics covered by our journal.
What you will find in Volume 3, issue 1 is a sampler of contemporary
psychiatry. There are topical reviews on personality traits
associated with substance abuse disorders (Bardo et al.)
and self-regulatory mechanisms in eating disorder (Marsh et
al.) that are implicated in the genesis of eating disorders.
There are two reviews on contemporary therapeutics that reflect
the diversity of modern psychiatric practice: Chanpattana
covers the role of electroconvulsive therapy for treatment
of schizophrenia and Leichsenring, and Leibing systematically
review the essentials of a time-limited and procedurally specified
form of psychodynamic psychotherapy-Supportive and Expressive
(SE) Psychotherapy is now being studied as a first-line treatment
for mood, anxiety, and personality disorders. This issue also
includes two articles on topics of considerable importance
to practitioners who work in social psychiatry or public mental
health settings. Joyal, Dubreucq, Genderon, and Millaud have
prepared a comprehensive review of the associations between
violence and major mental disorders and Kisely and Campbell
survey methods for evaluating the effectiveness of compulsory
or court-ordered treatment in community settings. Finally,
there are papers examining the evidence that links traumatic
brain injury to vulnerability to schizophrenia and other psychotic
disorders (Corcoran and Malaspina) and the role of insight
as a moderating factor in the course and outcome of schizophrenia
spectrum disorders (Lysaker and Buck).
Looking back on 2006, I want to thank Muneeza Zamir, our journal’s
publication manager, without whose tireless efforts Current
Psychiatry Reviews would quickly grind to a stop. I would
also like to thank our cadre of peer reviewers, who have without
fail provided prompt and constructive feedback to authors
submitting papers and have helped to ensure that the articles
published in Current Psychiatry Reviews are of the
highest caliber.
As we all are at the onset of a new year, I am in the process
of making the first move of my professional career, traveling
all the way across the Keystone State from the University
of Pittsburgh Medical Center (where I have been since I began
internship back in 1979) to join the faculty of the University
of Pennsylvania School of Medicine. Although fruitful collaborations
with colleagues at Pitt will be ongoing for years-and hopefully
decades-to come, I wish to express my gratitude and admiration
to the scores of faculty and staff that have made the past
27+ years such an exciting and productive adventure. I want
to thank most particularly to Ms. Lisa Stupar and Ms. Christine
Johnson for their friendship and professionalism and their
outstanding (and often superhuman) efforts in administering
and managing my professional life at Pittsburgh.
Michael E. Thase
(Editor-in-Chief)
University of Pennsylvania School of Medicine
Philadelphia
PA 19104-6055
USA
E-mail: ThaseME@upmc.edu
[Back to top]
The Sensation Seeking Trait and Substance Use:
Research Findings and Clinical Implications
Michael T. Bardo, Yolanda D. Williams, Linda P. Dwoskin,
Sean E. Moynahan, Iman B. Perry and Catherine A. Martin
[Full
text article]
Sensation seeking (SS) is a personality trait defined by a
need to seek novel sensations and experiences, accompanied
by a willingness to take risks for the sake of such experiences.
Various measures of SS have been developed and validated,
including a scale specifically for children. Among different
populations, SS has been associated with the expression of
various health-related risk behaviors, most notably substance
use and abuse. Evidence from basic research with laboratory
animals and from human clinical studies indicates that high
sensation seekers may have an overactive mesocorticolimbic
dopamine system relative to low sensation seekers. While the
precise molecular mechanisms underlying SS remain to be elucidated,
evidence suggests that low levels of monoamine oxidase activity,
as well as altered dopamine receptor and dopamine transporter
expression and function may play a role. Since altered monoamine
function has been implicated in various psychiatric disorders,
and since SS has been associated with some of these disorders,
clinicians may find that SS offers a useful adjunct in promoting
effective patient care and improving patient counseling. This
may be especially useful in treating children, adolescents
and young adults, as the risk for substance use and abuse
is an especially relevant concern during this developmental
period.
[Back to top]
Electroconvulsive Therapy for Schizophrenia
Worrawat Chanpattana
[Full
text article]
The role of electroconvulsive therapy (ECT) in treating patients
with schizophrenia remains unclear. This paper aims to determine
whether ECT results in clinically meaningful benefit with
regard to psychopathology, behavior and functioning for patients
with schizophrenia, and whether variations in the practical
administration of ECT influences outcome. Existing research
in the field and the new information of research in patients
with treatment-resistant schizophrenia (TRS) from Thailand
are summarized. Independent of gender, duration of the current
episode and severity of baseline negative symptoms predict
outcome. Treatment results in marked improvement in positive
symptoms, with an intermediate effect on affective symptoms,
and no effect or worsening of negative symptoms. The combination
of ECT and conventional antipsychotic drug is associated with
better outcome than either ECT alone or antipsychotic drug
alone during both acute and maintenance phases of treatment.
This improvement is not only in psychopathology but also in
quality of life and social functioning. Electrical stimulus
doses 2-4 times the seizure threshold are likely to increase
the speed of recovery with bilateral ECT. Thrice-weekly ECT
elicits response faster than does twice-weekly ECT. Although
this preliminary evidence supports the use of ECT in patients
with TRS, the research base for its use is still inadequate
and deserves better investigation.
[Back to top]
Traumatic Brain Injury as a Risk Factor for Schizophrenia
Cheryl Corcoran and Dolores Malaspina
[Full
text article]
Traumatic brain injury (TBI) is associated with schizophrenia,
but the causal nature of this relationship is not clear. Three
models for their association exist: 1) TBI causes a phenocopy
of schizophrenia (parallelism); 2) TBI is a marker of schizophrenia
vulnerability (spurious association); and 3) TBI interacts
with genetic vulnerability to cause schizophrenia (interaction
or effect modification). We found that TBI is a causal component
of some cases of schizophrenia, specifically those with enhanced
genetic vulnerability. This has biological plausibility. Prevention
of 50% of these cases could lead to a savings of $313 million
annually in the United States. Further research on critical
windows for traumatic brain injury in vulnerable individuals
could shed light on the developmental pathophysiology of schizophrenia.
[Back to top]
Major Mental Disorders and Violence: A Critical Update
Christian C. Joyal, Jean-Luc Dubreucq, Catherine Gendron
and Frederic Millaud
[Full
text article]
The possibility of a causal link between major mental disorders
(MMDs) and violence has been the matter of a debate for decades
in psychiatry. Just as a consensus seemed to emerge, a standout
and unprecedented large-scale community investigation lead
to contradictory conclusions. The main goal of this review
was to provide clinicians with a critical summarizing of all
major relevant studies published during 15 years. It is concluded
that major mental disorders per se, especially schizophrenia,
even without alcohol or drug abuse, are indeed associated
with higher risks for interpersonal violence. However, further
stigmatization of persons with MMDs should be considered,
as between 85% and 95% of community violence is not related
with MMDs and the absolute number of assaults committed by
psychiatric outpatients is low. A summary Table 1 includes
comments and conclusions related with each reviewed study
and circumstances related with this type of assaults are discussed.
Interpersonal violence associated with MMDs seems to be due
to a heterogeneous minority of patients and current research
aims at better characterizing subgroups who assault in similar
contexts.
[Back to top]
Methodological Issues in Assessing the Evidence for
Compulsory Community Treatment
Stephen Kisely and Leslie Anne Campbell
[Full
text article]
There is controversy as to whether compulsory community treatment
(CCT) reduces health service use, or improves clinical outcome
and social functioning. Given the widespread use of such powers
in North America, Europe and Australasia, it is important
to assess the benefits and potential harms of this type of
legislation. Unfortunately, evidence for their effectiveness
remains weak. In our Cochrane systematic review we were only
able to identify two randomised controlled trials, and neither
study showed any significant reductions in readmission rates,
bed-days or arrests for cases on compulsory community treatment
compared to appropriate controls. In terms of the number needed
to treat (NNT), it would take up to 100 treatment orders to
prevent one readmission, 25 to prevent one episode of homelessness
and 500 to prevent one arrest. Including other study designs
such as controlled before and after (CBA) studies made little
difference to the results (total n=1108). There are other
concerns for patients. This legislation stigmatises individuals
with a severe mental illness, as many of these initiatives
are named after a high profile victim of someone who happened
to have a psychiatric illness. New York has a 'Kendra's Law',
California a 'Laura's Law', and Ontario a 'Brian's Law’.
Compulsory community treatment appears to be immune from evidence-based
practice, possibly because of the convenience of legislative
as opposed to evidence-based solutions such as assertive community
treatment.
[Back to top]
Supportive-Expressive (SE) Psychotherapy: An Update
Falk Leichsenring and Eric Leibing
[Full
text article]
An updated review of Supportive-Expressive (SE) psychotherapy
is presented. The concepts, techniques and research methods
of SE therapy are described, and empirical evidence is reviewed.
Articles on SE therapy published between 1970 and 2006 were
identified by a computerized search using Pubmed, MEDLINE,
PsycINFO and Current Contents. In November 2006, the search
was updated using database-specific keywords. By this search,
92 individual studies or review articles on SE therapy were
identified. In addition, text books and journal articles were
used. Only publications referring to Luborsky´s concept
of SE therapy were included. The information was extracted
by two raters. Sixty-seven publications addressing SE therapy
according to Luborsky were included. Articles refering to
conceptual (clinical) contributions and empirical research
on concepts, processes and efficacy of SE therapy were reviewed.
Results were summarized by two raters. Empirical data are
in general consistent with the concepts of SE therapy. At
present, a limited number of randomized controlled trials
providing evidence for the efficacy of SE therapy in specific
psychiatric disorders is available. Further efficacy studies
are required. With regard to processes of SE therapy, studies
addressing the interactions among supportive-expressive interventions,
patient´s level of functioning and outcome are recommended.
[Back to top]
Insight, Outcome and Recovery in Schizophrenia Spectrum
Disorders: An Examination of their Paradoxical Relationship
Paul H. Lysaker and Kelly D. Buck
[Full
text article]
While interest has grown steadily in understanding how persons
with schizophrenia appraise their disorder and subsequently
move towards recovery, the nature of the impact of awareness
or admission of schizophrenia on various domains of quality
of life has remained a matter of debate. At the level of both
theory and empirical study, it has been alternately argued
that acknowledgement of one’s mental illness is a key
to and a detriment to recovery. Acknowledgement of illness
has been recognized as something essential in order for a
person to be able to make informed decisions about the future,
to free oneself from blame for difficulties linked with illness
and to form sustaining bonds with others. From another view,
however, “awareness of illness” has been suggested
as a barrier to recovery because it represents the acceptance
of a system of social power in which one’s individuality
and dignity is diminished. Indeed empirical studies suggest
both awareness and lack of awareness have significant risks
associated with them. In this chapter we review this evidence
and suggest that the impact of insight on quality of life
may be mitigated by the degree to which persons have internalized
stigmatizing beliefs about their illness. Clinical and theoretical
implications are discussed.
[Back to top]
Self-Regulatory Control and Habit Learning in the
Development of Eating Disorders
Rachel Marsh, Joanna E. Steinglass, Kara Graziano, Bradley
S. Peterson and B. Timothy Walsh
[Full
text article]
Clinical evidence suggests that initial attempts to regulate
weight gain quickly become habit-like in individuals with
eating disorders. These behaviors are controlled excessively
in patients with Anorexia Nervosa (AN) and are controlled
more intermittently, with periods of lost control, in patients
with Bulimia Nervosa (BN). We suspect that abnormalities in
frontostriatal systems that subserve self-regulatory control
and habit learning may contribute to the development and perpetuation
of AN and BN. We summarize previous findings and present a
pathophysiological model that provides a framework for understanding
the shared and non-shared clinical phenotypes of AN and BN.
Whereas dysregulated control systems produce heightened self-regulatory
control, permitting individuals with AN to sustain excessive
dietary restriction, dysregulated control systems likely result
in impaired self-regulatory control in patients with BN, releasing
feelings of hunger and urges to binge, thereby resulting in
overeating. Interactions with cultural ideals of thinness
and impaired habit learning systems may then allow the dieting
behaviors of individuals with restricting-type AN to spiral
into the habitual and restrictive eating behaviors that typify
the disorder. Although these cultural factors likely contribute
to the compensatory purging behaviors in BN, interactions
with normal habit learning systems may explain the higher
recovery rate of BN relative to AN, in which habit learning
may be impaired. We describe neuroimaging methods that we
are using to test these hypotheses and emphasize the potential
utility of studying AN and BN early in the course of illness,
to disentangle their causes from epiphenomena or compensatory
responses. We believe that this innovative approach to studying
eating disorders will lend explanation to the perplexing fact
that although many young people diet and overeat at some point
in time, only some go on to develop eating disorders.
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