Harvard Review of Psychiatry最新文献

{"title":"Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions.","authors":"Michael D Kritzer, Angel V Peterchev, Joan A Camprodon","doi":"10.1097/HRP.0000000000000365","DOIUrl":"10.1097/HRP.0000000000000365","url":null,"abstract":"<p><strong>Learning objectives: </strong>• Outline and discuss the fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes• Summarize the overview of ECT, its efficacy in treating depression, the known effects on cognition, evidence of mechanisms, and future directions.</p><p><strong>Abstract: </strong>Electroconvulsive therapy (ECT) is the most effective treatment for a variety of psychiatric illnesses, including treatment-resistant depression, bipolar depression, mania, catatonia, and clozapine-resistant schizophrenia. ECT is a medical and psychiatric procedure whereby electrical current is delivered to the brain under general anesthesia to induce a generalized seizure. ECT has evolved a great deal since the 1930s. Though it has been optimized for safety and to reduce adverse effects on cognition, issues persist. There is a need to understand fundamental physiologic, cellular, and molecular mechanisms of ECT to devise strategies to optimize therapeutic outcomes. Clinical trials that set out to adjust parameters, electrode placement, adjunctive medications, and patient selection are critical steps towards the goal of improving outcomes with ECT. This narrative review provides an overview of ECT, its efficacy in treating depression, its known effects on cognition, evidence of its mechanisms, and future directions.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 3","pages":"101-113"},"PeriodicalIF":3.8,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9850714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Sex Hormones on Transcranial Magnetic Stimulation Measures of Cortical Excitability: A Systematic Review and Considerations for Clinical Practice.","authors":"Ana Maria Rivas-Grajales, Tracy Barbour, Joan A Camprodon, Michael D Kritzer","doi":"10.1097/HRP.0000000000000366","DOIUrl":"10.1097/HRP.0000000000000366","url":null,"abstract":"<p><strong>Abstract: </strong>Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative for the treatment of major depressive disorder (MDD), although its clinical effectiveness varies substantially. The effects of sex hormone fluctuations on cortical excitability have been identified as potential factors that can explain this variability. However, data on how sex hormone changes affect clinical response to rTMS is limited. To address this gap, we reviewed the literature examining the effects of sex hormones and hormonal treatments on transcranial magnetic stimulation (TMS) measures of cortical excitability. Results show that variations of endogenous estrogen, testosterone, and progesterone have modulatory effects on TMS-derived measures of cortical excitability. Specifically, higher levels of estrogen and testosterone were associated with greater cortical excitability, while higher progesterone was associated with lower cortical excitability. This highlights the importance of additional investigation into the effects of hormonal changes on rTMS outcomes and circuit-specific physiological variables. These results call for TMS clinicians to consider performing more frequent motor threshold (MT) assessments in patients receiving high doses of estrogen, testosterone, and progesterone in cases such as in vitro fertilization, hormone replacement therapy, and gender-affirming hormonal treatments. It may also be important to consider physiological hormonal fluctuations and their impact on depressive symptoms and the MT when treating female patients with rTMS.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 3","pages":"114-123"},"PeriodicalIF":2.5,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10264142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9690893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photobiomodulation for Major Depressive Disorder: Linking Transcranial Infrared Light, Biophotons and Oxidative Stress.","authors":"Willians Fernando Vieira,&nbsp;Maia Gersten,&nbsp;Marco Antonio Knob Caldieraro,&nbsp;Paolo Cassano","doi":"10.1097/HRP.0000000000000363","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000363","url":null,"abstract":"<p><strong>Abstract: </strong>Incompletely treated major depressive disorder (MDD) poses an enormous global health burden. Conventional treatment for MDD consists of pharmacotherapy and psychotherapy, though a significant number of patients do not achieve remission with such treatments. Transcranial photobiomodulation (t-PBM) is a promising novel therapy that uses extracranial light, especially in the near-infrared (NIR) and red spectra, for biological and therapeutic effects. The aims of this Review are to evaluate the current clinical and preclinical literature on t-PBM in MDD and to discuss candidate mechanisms for effects of t-PBM in MDD, with specific attention to biophotons and oxidative stress. A search on PubMed and ClinicalTrials.gov identified clinical and preclinical studies using t-PBM for the treatment of MDD as a primary focus. After a systematic screening, only 19 studies containing original data were included in this review (9 clinical and 10 preclinical trials). Study results demonstrate consensus that t-PBM is a safe and potentially effective treatment; however, varying treatment parameters among studies complicate definitive conclusions about efficacy. Among other mechanisms of action, t-PBM stimulates the complex IV of the mitochondrial respiratory chain and induces an increase in cellular energy metabolism. We suggest that future trials include biological measures to better understand the mechanisms of action of t-PBM and to optimize treatment efficiency. Of particular interest going forward will be studying potential effects of t-PBM-an external light source on the NIR spectra-on neural circuitry implicated in depression.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 3","pages":"124-141"},"PeriodicalIF":3.8,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9480826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closed-Loop Deep Brain Stimulation for Psychiatric Disorders.","authors":"Alik S Widge","doi":"10.1097/HRP.0000000000000367","DOIUrl":"10.1097/HRP.0000000000000367","url":null,"abstract":"<p><strong>Abstract: </strong>Deep brain stimulation (DBS) is a well-established approach to treating medication-refractory neurological disorders and holds promise for treating psychiatric disorders. Despite strong open-label results in extremely refractory patients, DBS has struggled to meet endpoints in randomized controlled trials. A major challenge is stimulation \"dosing\"-DBS systems have many adjustable parameters, and clinicians receive little feedback on whether they have chosen the correct parameters for an individual patient. Multiple groups have proposed closed loop technologies as a solution. These systems sense electrical activity, identify markers of an (un)desired state, then automatically deliver or adjust stimulation to alter that electrical state. Closed loop DBS has been successfully deployed in movement disorders and epilepsy. The availability of that technology, as well as advances in opportunities for invasive research with neurosurgical patients, has yielded multiple pilot demonstrations in psychiatric illness. Those demonstrations split into two schools of thought, one rooted in well-established diagnoses and symptom scales, the other in the more experimental Research Domain Criteria (RDoC) framework. Both are promising, and both are limited by the boundaries of current stimulation technology. They are in turn driving advances in implantable recording hardware, signal processing, and stimulation paradigms. The combination of these advances is likely to change both our understanding of psychiatric neurobiology and our treatment toolbox, though the timeframe may be limited by the realities of implantable device development.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 3","pages":"162-171"},"PeriodicalIF":3.8,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10188203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9480830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction.","authors":"Joan A Camprodon,&nbsp;Tracy Barbour","doi":"10.1097/HRP.0000000000000368","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000368","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 3","pages":"97-100"},"PeriodicalIF":3.8,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9458457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder.","authors":"Kasia Kozlowska, Catherine Chudleigh, Blanche Savage, Clare Hawkes, Stephen Scher, Kenneth P Nunn","doi":"10.1097/HRP.0000000000000358","DOIUrl":"10.1097/HRP.0000000000000358","url":null,"abstract":"<p><strong>Learning objectives: </strong>• Develop and implement treatment plans for children and adolescents with functional neurological disorder (FND)• Outline a plan to increase awareness and standardize the care for patients with FND using evidence-based interventions.</p><p><strong>Abstract: </strong>Functional neurological disorder (FND) in children and adolescents involves the biological embedding of lived experience in the body and brain. This embedding culminates in stress-system activation or dysregulation and in aberrant changes in neural network function. In pediatric neurology clinics, FND represents up to one-fifth of patients. Current research shows good outcomes with prompt diagnosis and treatment using a biopsychosocial, stepped-care approach. At present, however-and worldwide-FND services are scarce, the result of long-standing stigma and ingrained belief that patients with FND do not suffer from a real (\"organic\") disorder and that they therefore do not require, or even deserve, treatment. Since 1994, the Mind-Body Program for children and adolescents with FND at The Children's Hospital at Westmead in Sydney, Australia-run by a consultation-liaison team-has delivered inpatient care to hundreds of patients with FND and outpatient care to hundreds of others. For less-disabled patients, the program enables community-based clinicians to implement biopsychosocial interventions locally by providing a positive diagnosis (by a neurologist or pediatrician), a biopsychosocial assessment and formulation (by clinicians from the consultation-liaison team), a physical therapy assessment, and clinical support (from the consultation-liaison team and the physiotherapist). In this Perspective we describe the elements of a biopsychosocial mind-body program intervention capable of providing, as needed, effective treatment to children and adolescents with FND. Our aim is to communicate to clinicians and institutions around the world what is needed to establish effective community treatment programs, as well as hospital inpatient and outpatient interventions, in their own health care settings.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 2","pages":"60-82"},"PeriodicalIF":2.5,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/c4/hrp-31-60.PMC9997641.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9524268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remembering Paul E. Meehl: Historical Contributions to Predictive Modeling in Human Behavior.","authors":"Jihan Ryu","doi":"10.1097/HRP.0000000000000360","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000360","url":null,"abstract":"<p><strong>Abstract: </strong>This article briefly examines the life and work of the late clinical psychologist and philosopher of science Paul E. Meehl. His thesis in Clinical versus Statistical Prediction (1954) that the data combination performed by mechanical operations, as compared to clinicians, achieves higher accuracy in predicting human behavior is one of the earliest theoretical works that laid the groundwork for utilizing statistics and computational modeling in research in psychiatry and clinical psychology. For today's psychiatric researchers and clinicians grappling with the challenges of translating the ever-increasing data of the human mind into practice tools, Meehl's advocacy for both accurate modeling of the data and their clinically relevant use is timely.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 2","pages":"92-95"},"PeriodicalIF":3.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/54/hrp-31-92.PMC9997627.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Don't You Take This to a Friend? A Question Psychotherapists Should Ask More Often.","authors":"Jacqueline Olds,&nbsp;Richard S Schwartz","doi":"10.1097/HRP.0000000000000359","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000359","url":null,"abstract":"Since 1996, we have been studying loneliness and the decrease in the average number of confidants that most people have. We are gratified that the topic of loneliness is now less taboo, thanks in large part to press coverage during the pandemic about how difficult the isolation was for everyone. But we have also noticed how much Americans rely on their therapists to help themwith their most intimate conundrums. We could not be more grateful to our patients who have entrusted us with their confidences over many years. But we also worry: have we contributed to a fraying of the social fabric by implying that confidences about the usual human conundrums are better saved for the ears of a therapist than shared with a close friend? Too many Americans are lonely “frequently” or “almost all the time or all the time” 36% in a recent study, including 61% of young people aged 18–25 and 51% of mothers of young children.We hear from our patients that it is often a friend who says the equivalent of “This is too much for me to handle; maybe you should see a therapist.” And despair and suicidal depression increase while our nation turns increasingly to the mental health profession rather than friends and relatives to help them with life’s knotty problems. We have noted in our previous work on social isolation that the culture of most Americans includes a deep distaste for depending on others, and an over-valuing of independence and “having things one’s own way.” Even college students have the notion that only after successfully living alone and learning to enjoy their own company will they be well suited for a love relationship with someone else. Yet many of them get snagged by depression along this journey.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 2","pages":"47-49"},"PeriodicalIF":3.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/0f/hrp-31-47.PMC9997617.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hikikomori Syndrome and Digital Technologies: A Systematic Review.","authors":"Gabriel S Sales-Filho,&nbsp;Igor D Bandeira,&nbsp;Nayara Argollo,&nbsp;Rita Lucena","doi":"10.1097/HRP.0000000000000362","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000362","url":null,"abstract":"<p><strong>Abstract: </strong>Hikikomori syndrome (HS) is a voluntary prolonged social isolation associated with personal and community impact. Previous evidence pointed out a possible relationship between this syndrome with addiction to digital technologies. Here we aim to understand the relationship between HS and digital technology use, overuse, and addictive behaviors, as well as potential therapeutic approaches.We conducted a systematic review of observational and intervention studies available in PubMed/MEDLINE, LILACS, IBECS, Embase, PsycINFO, and SciELO databases, following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA 2020) criteria. The risk of bias was assessed with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and Consensus-based Clinical Case Reporting Guideline Development (CARE). Eligibility criteria were pre-, at-risk populations, or those with HS diagnosis, and any kind of technological overuse. Seventeen studies were included in the review, of which eight were cross-sectional, eight were case reports, and one was quasi-experimental. Hikikomori syndrome was associated with addition to digital technologies; no cultural differences were found. Environmental factors, such as a history of bullying, low self-esteem, and grief were identified as precursors of addictive behaviors. The included articles addressed addiction to digital technologies, electronic games, and social networks, among others, in HS. HS is cross-culturally associated with such addiction. The management of these patients remains challenging, and no target evidence-based treatments have been developed. The studies included in this review had several limitations, and more studies with a higher level of evidence are needed to support the results.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 2","pages":"50-59"},"PeriodicalIF":3.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions.","authors":"Lukas Cheney,&nbsp;Robert B Dudas,&nbsp;Jenna M Traynor,&nbsp;Josephine A Beatson,&nbsp;Sathya Rao,&nbsp;Lois W Choi-Kain","doi":"10.1097/HRP.0000000000000361","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000361","url":null,"abstract":"INITIAL CASE PRESENTATION Brittany, a 21-year-old woman with borderline personality disorder (BPD), was referred to our specialist personality disorder service, with a presentation distinguished by high-lethality suicidal behaviors including ingestion of toxic substances and dangerous objects. She frequently ran to train stations and bridges. Brittany also engaged in daily cutting. Due to her high level of risk, she was increasingly restricted within her family home. She was not allowed into the backyard for fear that she would elope and engage in high lethality behavior. Brittany is an only child, conceived via in vitro fertilization. Diagnosed with Asperger’s Syndrome at age six, Brittany displayed early restricted interests, desire for routine, and sensory difficulties, accompanied by a high level of social interest. Multi-disciplinary assessments showed pragmatic language impairment and social difficulties that included inflexibility and egocentricity in her play. Brittany demonstrated difficulty with sharing, losing in games, and when not able to take first turn. High levels of emotional distress were reported when she did not get what she wanted. Brittany worked with a speech pathologist during this childhood period. She was subsequently diagnosed with obsessive compulsive disorder (OCD) and generalized anxiety. Restricted eating and self-injurious behaviors began in her early teen years.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 2","pages":"83-91"},"PeriodicalIF":3.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/54/hrp-31-83.PMC9997622.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9187154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}