Recent developments in the pharmacotherapy of mood disorders

This article reviews recent developments in the pharmacotherapy of mood disorders. Pharmacotherapy is the best studied and most widely validated approach for acute phase treatment and prevention of relapse-recurrence for patients with major depression, dysthymia, and bipolar affective disorder. Antidepressants are also the mainstay of inpatient treatment and, when considered together with electroconvulsive therapy, represent the first line of treatment for the most severe and incapacitating forms of depression. Similarly, pharmacotherapy with mood stabilizers is the first line of treatment for bipolar depression and mania. Despite such efficacy, problems associated with pharmacotherapy include acceptability, tolerability, adherence, incomplete remission, and high rates of recurrence after drug discontinuation. Moreover, a small subset of patients do not respond to multiple medication trials.     

Recent developments in the pharmacotherapy of alcohol dependence.

The effectiveness of a treatment for alcohol dependence can be appropriately determined only after controlling for the usual clinical course of alcoholism, subgroups of alcohol-dependent individuals, and placebo effects. The results of appropriate treatment trials must also be interpreted in light of the side effects and costs, and there must be assurances that the overall improvement in functioning observed with the drug is significant enough to outweigh the liabilities. In addition, medications are almost always used in combination with education, counseling, and behavioral therapies, and the impact of these additional treatments must be considered. Viewed from this perspective, 3 medications are quite promising regarding their potential future impact in the alcohol field, including naltrexone, the medication with the most available data in the United States. There are additional data regarding buspirone and acamprosate. Intriguing results have also been generated regarding medications that affect serotonin and dopamine brain activity and with alcohol-sensitizing drugs such as disulfiram. However, none of these medications has been proven to be clinically effective in the routine treatment of the average alcoholic… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent developments in the pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD).

In comparison to other mental health disorders in pediatric populations, there seems to be compelling evidence-based support for both the efficacy of stimulant medication for children and adolescents with attention deficit/hyperactivity disorder (ADHD) and associated symptoms. Tricyclic antidepressants provide an alternative when stimulants are found to be ineffective or associated with too many adverse effects, particularly for children who have comorbid conditions including anxiety and depression. Finally, the alpha-adrenergic agents, although not approved for the management of ADHD, have been widely employed clinically, particularly for the treatment of impulsivity, overactivity, and aggression. Behavior therapy has been demonstrated to be effective for many of the functional impairments associated with ADHD. Research efforts are needed to examine these therapies either alone or in combination on the long-term outcome of children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Administration of substance abuse treatment: Local and national developments.

Discusses increases in attention to and funding of solutions for substance abuse problems. At the federal level, more resources have gone to interdiction and supply reduction rather than to substance abuse treatment or prevention. In San Francisco, substance abuse administrators increased the focus on demand reduction by organizing local resources, creatively seeking financial resources, and gathering community support to reduce problems of drug abuse and HIV. The federal reorganization of substance abuse programs presents a unique opportunity to widen the influence of treatment and prevention approaches. The impact of the Alcohol, Drug, and Mental Health Administration Reorganization Act of 1992 and the organization of the newly created Substance Abuse and Mental Health Services Administration are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent advances in the pharmacotherapy of epilepsy

The therapeutic options for the treatment of epilepsy have expanded during the 1990s. Since 1993, four novel agents (felbamate, gabapentin, lamotrigine, and topiramate) have been approved by the US Food and Drug Administration, primarily for adjunctive treatment of partial seizures. In addition, a water-soluble pro-drug of phenytoin, fosphenytoin, and a sustained-release preparation of carbamazepine have been introduced. The novel anticonvulsants represent a potential improvement for patients whose seizures are incompletely controlled or who experience significant adverse effects with older anticonvulsants. Felbamate, lamotrigine, and topiramate appear to have a broad spectrum of action in seizure control, but felbamate use is limited by the potential for serious adverse effects. Gabapentin, lamotrigine, and topiramate are all well tolerated. Gabapentin has no known drug interactions, whereas lamotrigine and topiramate have limited interactions compared with older agents. The sustained-release preparation of carbamazepine may decrease the incidence of adverse effects and increase patient compliance. Fosphenytoin offers a safer method for intravenous administration of phenytoin and the added flexibility of intramuscular administration. Taken together, these recent advances in treatment may bring about improved efficacy and decreased adverse effects for many patients with epilepsy.     

Recent advances in the pharmacotherapy of schizophrenia

The limitations of standard antipsychotics have spurred a search for novel agents that are effective against both positive and negative symptoms of schizophrenia but do not produce the extrapyramidal side effects frequently associated with the older medications. Such agents might more effectively prevent relapse, because of enhanced efficacy for the full spectrum of schizophrenic symptoms and improved tolerability--and hence greater medication compliance. Findings concerning the new antipsychotics currently available, clozapine and risperidone, are reviewed, and clozapine's usefulness as a first-line treatment is evaluated. Although serious side effects and the need for weekly blood monitoring may limit clozapine's use as a first-line treatment, risperidone appears promising in this role. Preclinical and clinical studies of new antipsychotic medications recently submitted for approval (olanzapine and sertindole) or in phase III development (quetiapine and ziprasidone) are also reviewed. The findings are encouraging, and researchers hope that some of these new agents may prove valuable as first-line treatments for schizophrenia. Pharmacoeconomic studies comparing clozapine and risperidone to the standard neuroleptics indicate that these newer drugs appear likely to lower the overall cost of treatment for schizophrenia, primarily by reducing rates of relapse and rehospitalization.     

Intervening in adolescent substance abuse

Violence towards health professionals is defined as any incident in which a health professional experiences abuse, threat, fear or the application of force arising out of the course of his or her work, whether or not they are on duty. It emerges that no single theory can adequately explain the phenomenon, and perceptions about incidence and prevalence are distorted by the media. There is consistent and variable reporting but a high incidence and prevalence undoubtedly exists within health care. Health professionals and less experienced nurses in particular have been found to be most at risk. A strategic approach is needed to the development and implementation of workplace-specific solutions. Health professionals have a right to expect that violence at work is minimized but it would be unrealistic to expect it to be eradicated.     

Assessment of substance abuse in psychotherapy clients: The effectiveness of the MMPI-2 substance abuse scales.

The Minnesota Multiphasic Personality Inventory—2 (MMPI—2) contains 3 scales, the MacAndrew Alcoholism Scale—Revised (MAC—R), the Addiction Potential Scale (APS), and the Addiction Acknowledgement Scale (AAS), that were developed to identify alcohol and drug abusing individuals. The current study was designed to measure the effectiveness of these scales at detecting substance abuse problems in a community-based mental health sample. MAC—R, APS, and AAS scores were obtained from 64 therapists who identified 68 substance abusing and 392 nonabusing psychotherapy clients. The results indicated that mean scores on all 3 scales were higher for the substance abusers than for nonabusers. Furthermore, discriminant analysis found all 3 scales to be effective screening tools. The AAS was the best single predictor, and a combination of the AAS and MAC—R provided the best overall discrimination. The implications of early substance abuse detection on treatment effectiveness are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent developments in the management of retinoblastoma

The management of retinoblastoma has gradually changed over the past few decades. There is a trend away from enucleation and external beam radiotherapy toward focal conservative treatments. This is primarily because of earlier detection of the disease and more focused treatment modalities. Enucleation is still employed for retinoblastoma that fills most of the eye, especially when there is a concern for tumor invasion into the optic nerve or choroid. After enucleation, an integrated orbital implant, provides improved motility and appearance of the prosthesis. External beam radiotherapy continues to be an important method of treating less advanced retinoblastoma, especially when there is diffuse vitreous or subretinal seeding. Plaque radiotherapy is useful for controlling small- to medium-sized retinoblastomas, even those with focal vitreous seeds. Tumors that recur after failure of other methods are often suitable for plaque treatment. When plaque radiotherapy is employed in a child receiving chemotherapy, eventual radiation retinopathy can occur. Cryotherapy and photocoagulation provide excellent control of selected small tumors. Advanced laser delivery systems, particularly those that have been adapted to the indirect ophthalmoscope, have facilitated the visualization for treatment of tumors. Thermotherapy is the newest focal method for retinoblastoma. When combined with chemotherapy, thermotherapy provides satisfactory tumor control, leaving the child with a reasonably small scar, thus preserving more vision. Chemoreduction, using intravenous or subconjunctival routes, is often employed to reduce initial tumor volume and thus allow for focal treatment to eradicate the residual smaller tumor. Many children with advanced retinoblastoma can be spared external beam radiotherapy and enucleation mostly as a result of chemoreduction and focal methods. Chemoreduction combined with cryotherapy, thermotherapy, and plaque radiotherapy plays an important role in the current management of many children with retinoblastoma.     

Future trends in substance abuse.

Argues that as illicit drugs with increased abuse liability come into vogue, a broader segment of the population will be at risk for becoming addicted. Consequently, the attendant effects of abuse, including acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection, will grow proportionately. Health care providers will need to become more astute and creative to provide effective rehabilitation for addicted individuals. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contemporary trends in substance abuse.

A clinical consensus has evolved as to the specific areas to be addressed in a comprehensive clinical interview with substance abusers. Knowledge of specific psychopathology and associated comorbidities among addicts will refine this assessment. There are several reasonably reliable and valid objective psychological tests that can be used to provide supplementary information for diagnostic and treatment decisions. Etiological theories, including the disease concept, family systems theory, psychodynamic formulations, and behavioral approaches, have generated treatment interventions of clinical utility. Recent research suggests that psychotherapy, combined with traditional approaches, results in increased therapeutic benefits that were heretofore considered unlikely. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent developments in antipsychotic medication

The development of new neuroleptics aims to reduce unwanted extrapyramidal motor side effects as well as the non-response rate, and to achieve a greater effect on negative symptoms. Preferential binding of neuroleptics to D2-receptors in the limbic system, as well as the combination of dopamine D2- and serotonin S2-antagonism proved to be effective. A potent D2-S2-antagonism as was realized with positive results in risperidone serves as a model for a whole class of new neuroleptics.     

Recent developments in working memory

A technique is described that allows the concurrent synthesis of homologous regions of separate oligonucleotides. The technique utilizes synthesis columns that are readily interconverted between single-chambered and dual-chambered. The regions of the oligonucleotides that differ are synthesized separately with single-chamber columns, and with the single molecules joined, the homologous regions synthesized simultaneously. After synthesis, the chambers are opened separately, the solid-phase-bound oligonucleotides are placed in deprotection vials and treated as normal. Compared with standard syntheses, no decrease in yield or oligonucleotide quality was observed. This technique can result in significant savings in time and reagent costs when synthesizing a series of homologous oligonucleotides. This technique could be extended to the simultaneous synthesis of more than two oligonucleotides, possibly up to four or five oligonucleotides in an appropriate multichambered column.     

Recent developments in the hammerhead ribozyme field

Developments in the hammerhead ribozyme field during the last two years are reviewed here. New results on the specificity of this ribozyme, the mechanism of its action and on the question of metal ion involvement in the cleavage reaction are discussed. To demonstrate the potential of ribozyme technology examples of the application of this ribozyme for the inhibition of gene expression in cell culture, in animals, as well as in plant models are presented. Particular emphasis is given to critical steps in the approach, including RNA site selection, delivery, vector development and cassette construction.     

Recent developments in peroxisome biology

Membrane molecules such as CD36 (OKM5), intercellular adhesion molecule-1 (ICAM-1, CD54), gamma interferon-induced protein 10 (gamma-IP10) and IL-1 are induced and/or upregulated in psoriatic epidermis. These molecules have important accessory, trafficking or signalling functions in the immune system and also play a role in the pathophysiology of psoriasis. The relevance of adhesion molecules, CD36 and epidermal IL-1 in psoriasis was studied in vitro in the autologous mixed epidermal cell - T lymphocyte reaction (MECLR). Their level of expression was quantitated in epidermal cell suspensions (ECS) from patients with psoriasis and their function was assessed by blocking with specific mAbs and antisera or by depleting CD36+ cells from the ECS prior to the MECLR. ECS from psoriatic lesions contained increased numbers of CD36+ (23 +/- 12%), ICAM-1(+) (31 +/- 14%) and IL-1(+) (57 +/- 21%) cells. The autologous MECLR was inhibited in samples from all patients by mAb to CD2 (LFA-2), CD11a (LFA-1alpha), CD18 (LFA-1beta), ICAM-1, CD58 (LFA-3) and an antiserum to IL-1beta. Thus, adhesion molecules facilitate inflammation in psoriasis not only via adhesion and recruitment of T lymphocyte in psoriatic lesions, but also via activation of T cells. Furthermore CD36 molecules on psoriatic epidermal cells do not costimulate autologous T lymphocytes in psoriasis. The observed costimulatory function of IL-1beta in the MECLR emphasizes its relevance in psoriasis.     

Recent developments in the understanding of antinuclear autoantibodies

Cytological identification of soybean mitotic metaphase chromosomes (2n = 40) has been severely limited by their small size and uniform karyomorphology. We have developed fluorescent in situ hybridization (FISH), PCR-primed in situ labelling (PCR-PRINS) procedures, and molecular probes for routine cytological identification and for the physical mapping of soybean somatic chromosomes. Chromosome preparation has been achieved by modifications of previous protocols and through the preparation of root-tip protoplasts prior to chromosome spreading. Initially our probe selection focused on highly repeated DNAs that provide very intense localized hybridization signals. Repetitive gene probes that have proven valuable include the rDNA loci (5S and 45S) which are chromosome specific. We have also developed satellite DNA probes for two different sequence families: the SB92 and the STR120 satellites. Both of these are tandemly arranged at multiple chromosomal loci. By using different cloned examples of each family, we have been able to selectively label unique subsets of soybean chromosomes. Double hybridization with biotin and digoxigenin labeled probes has allowed us to determine the chromosomal overlap between different probes. In addition, we have joined portions of the metaphase chromosome painting patterns with the genetic map by single-copy FISH and PCR-PRINS detection of the RFLP loci G8.15, G17.3, and A199a and A199b. Total genomic DNA in situ hybridization (GISH) patterns were also used to characterize the soybean chromosomes.