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1.  Classification Systems in Psychiatry: Diagnosis and Global Mental Health in the Era of DSM-5 and ICD-11 
Current opinion in psychiatry  2013;26(5):493-497.
Purpose of review
The development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and of the eleventh edition of the International Classification of Disease (ICD-11) have led to renewed attention to the conceptual controversies surrounding the nosology of mental disorder. This article reviews recent work in this area, and suggests potential ways forward for psychiatric nosology, focusing in particular on the need for improved classification approaches for public and global mental health.
Recent findings
DSM-5 and ICD-11 have taken somewhat different approaches, but both appropriately emphasize the importance of clinical utility and diagnosic validity in psychiatric nosology. The Research Domain Criteria (RDoC) framework provides a useful focus on the individual-level causal mechanisms that are relevant to vulnerability to mental disorder. An analogous approach to societal-level causal mechanisms would be useful from a public and global mental health perspective.
Summary
In their day-to-day work, clinicians will continue to use the fuzzy constructs operationally defined and narratively depicted in DSM-5 and ICD-11. Advances in our understanding of the individual-level and society-level causal mechanisms that contribute to vulnerability to mental disorder may ultimately lead to improved classification systems, and in turn to better individualized care as well as improved global mental health.
doi:10.1097/YCO.0b013e3283642dfd
PMCID: PMC4270276  PMID: 23867662
DSM-5; ICD-11; psychiatric classification; global mental health
2.  Executive functioning among young people in relation to alcohol use 
Current opinion in psychiatry  2013;26(4):305-309.
Purpose of review
This article reviews recent findings regarding neurobehavioral factors which may be associated with risk for alcohol misuse, as well as those which may occur as a result of alcohol misuse during adolescence and emerging adulthood.
Recent findings
Current research extends previous findings by engaging multiple assessment methods and integrating behavioral and imaging technologies. These efforts reinforce previous findings regarding alcohol-related changes in macrostructure while demonstrating alterations in brain connectivity previously underappreciated. Longitudinal work now being reported suggests problem use during adolescence may be associated with persistent neurobehavioral aberrations.
Summary
For many years, little attention was directed to the neurobehavioral consequences of alcohol use across adolescence and emerging adulthood or to the neurobehavioral factors which might predispose youth to alcohol misuse. Recent work provides critical insights regarding the underpinnings of the deficits in executive function often observed in those at risk for alcohol dependence and those who develop alcohol use disorders. These studies suggest that, even when behavioral deficits are not evident, changes in brain connectivity and microstructure may be observed. Programmatic, longitudinal research must be conducted to determine the relevance of these alterations to use trajectories and long-term adaptation.
doi:10.1097/YCO.0b013e328361ea3c
PMCID: PMC4241361  PMID: 23695532
alcohol; executive functions; neurobehavior; risk; youth
3.  The Expanding Evidence Base for rTMS Treatment of Depression 
Current opinion in psychiatry  2013;26(1):13-18.
Purpose of review
Daily left prefrontal transcranial magnetic stimulation (TMS) for several weeks was first proposed as an acute treatment for depression in the early 1990’s, and was FDA approved in 2008. In the past year several important studies have been published that extend our understanding of this novel treatment approach.
Recent findings
The first round of multisite clinical trials with TMS addressed whether prefrontal rTMS has efficacy and were conducted in carefully selected depressed patients who were antidepressant medication free. Several more recent studies assess the clinical effectiveness of TMS and report that about 35–40% of real world patients who are commonly taking adjunctive antidepressants reach remission with a modest side effect profile. There are also new studies examining the durability of the TMS induced antidepressant effect. 58% of TMS remitters remain remitted at 3-month follow-up.
Summary
These recent studies suggest that daily left prefrontal TMS over several weeks as a treatment for depression appears to not only have efficacy in rigorous randomized controlled trials, but is effective in real world settings, with remission in 30–40% of patients. The TMS antidepressant effect, once achieved, appears to be as durable as with other antidepressant medications or interventions. Much more research is needed, particular with issues such as the TMS coil location, stimulation intensity and frequency, and dosing strategy.
doi:10.1097/YCO.0b013e32835ab46d
PMCID: PMC4214363  PMID: 23154644
TMS; transcranial; magnetic; stimulation; depression; treatment
4.  Psychiatric aspects of bariatric surgery 
Current Opinion in Psychiatry  2014;27(5):374-379.
Purpose of review
Bariatric surgery has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities such as metabolic syndrome. Empirical data suggest a high prevalence of psychiatric disorders among bariatric surgery candidates. In this review, we focus on the studies published recently with a high impact on our understanding of the role of psychiatry in bariatric surgery.
Recent findings
This article reviews the specific psychopathologies before surgery, changes in psychopathologies after surgery, suicide risk related to bariatric surgery, factors associated with weight loss, and recommendations for presurgical and postsurgical assessment and management. Research indicates a decrease in certain psychiatric symptoms after weight loss with bariatric surgery. However, the risk of suicide and unsuccessful weight loss in some bariatric surgery patients make monitoring following surgery as important as careful assessment and management before surgery. Specific considerations for youth and older populations and future potential research foci are discussed.
Summary
Recent publications suggest new directions for psychiatric evaluation and interventions for bariatric surgery patients. Future research on outcomes of specific populations, effectiveness of psychopharmacotherapy, and underlying pathophysiology are warranted for the advancement of treating bariatric surgery patients.
doi:10.1097/YCO.0000000000000085
PMCID: PMC4162326  PMID: 25036421
bariatric surgery; bioenterics intragastric balloon; cognition; psychiatric disorder; suicide
5.  Delayed Sleep Phase Disorder in Youth 
Current opinion in psychiatry  2013;26(6):580-585.
Purpose of review
For over 30 years, Delayed Sleep Phase Disorder (DSPD) has been defined as a debilitating sleep condition. Recently there is more awareness of DSPD in young people, yet considerable information is needed to understand its etiology and treatment. This review describes the latest research findings describing the clinical features, etiology and treatment of DSPD.
Recent findings
The prevalence of DSPD in adolescents and young adults ranges from 1 to 16%. The impact on the individual is significant, particularly in the domains of school/work performance and mental health. We propose contributing factors include reduced homeostatic sleep pressure, a lengthened and delayed circadian rhythm, insensitivity to clock-resetting morning light, and heightened cognitive activity. Evening melatonin administration as a sole treatment appears promising, as is a combination of cognitive-behavior therapy plus morning bright light.
Summary
Recent findings suggest clinicians should be aware of the clinical features (i.e., significant daytime sleepiness, anxiety and depression symptoms, potential for school drop out) of DSPD, as several biological features underpinning this disorder are unseen in clinical settings. We advise clinicians to become familiar with exogenous evening melatonin administration, and cognitive and behavioral techniques to simultaneously treat the delayed circadian rhythm and associated sleep-onset insomnia.
doi:10.1097/YCO.0b013e328365a1d4
PMCID: PMC4142652  PMID: 24060912
Delayed Sleep Phase Disorder; Adolescence; Clinical features; Etiology; Treatment
6.  Psychological Treatments for Eating Disorders 
Current opinion in psychiatry  2013;26(6):549-555.
Purpose of review
This review summarizes recent evidence on psychological treatments for eating disorders (EDs).
Recent findings
EDs are serious psychiatric conditions requiring evidence-based intervention. Treatments have been evaluated within each ED diagnosis and across diagnoses. For adults with anorexia nervosa, no one specialist treatment has been shown to be superior. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) remain the most established treatments for bulimia nervosa and binge eating disorder, with stepped-care approaches showing promise and new behavioral treatments under study. Transdiagnostic enhanced CBT has improved symptoms in adults and youth. Maudsley family-based therapy is the most established treatment for youth with anorexia nervosa and may be efficacious for youth with bulimia nervosa. IPT for the prevention of excess weight gain may be efficacious for reducing loss of control eating and weight gain in overweight youth.
Summary
Significant advances in treatments have been made, including evaluation of long-term outcomes, novel approaches, and tailored extension for specific patient profiles. However, widespread access to effective ED treatments remains limited. Increasing the potency and expanding the implementation of psychological treatments beyond research settings into clinical practice has strong potential to increase access to care, thereby reducing the burden of EDs.
doi:10.1097/YCO.0b013e328365a30e
PMCID: PMC4096990  PMID: 24060917
eating disorders; psychological treatments; evidence-based treatment
7.  Oxidative stress and schizophrenia: recent breakthroughs from an old story 
Current opinion in psychiatry  2014;27(3):185-190.
Purpose of review
Oxidative stress has become an exciting area of schizophrenia research, and provides ample opportunities and hope for a better understanding of its pathophysiology, which may lead to novel treatment strategies. This review describes how recent methodological advances have allowed the study of oxidative stress to tackle fundamental questions and have provided several conceptual breakthroughs to the field.
Recent findings
Recent human studies support the notion that intrinsic susceptibility to oxidative stress may underlie the pathophysiology of schizophrenia. More than one animal model that may be relevant to study biology of schizophrenia also shows sign of oxidative stress in the brain.
Summary
These advances have made this topic of paramount importance to the understanding of schizophrenia, and will play a role in advancing treatment options. This review covers topics from classic biochemical studies of human biospecimens to the use of magnetic resonance spectroscopy and novel mouse models, and focuses on highlighting promising areas of research.
doi:10.1097/YCO.0000000000000054
PMCID: PMC4054867  PMID: 24613987
oxidative stress; magnetic resonance spectroscopy; olfactory cell; glutathione; superoxide dismutase
8.  Polypharmacy for Schizophrenia 
Current opinion in psychiatry  2013;26(2):208-213.
Purpose of review
Combining psychotropic medications is common for people diagnosed with schizophrenia facing a variety of clinical circumstances. This review provides an update on evidence regarding the effectiveness of polypharmacy approaches.
Recent findings
Epidemiology studies have demonstrated that polypharmacy is extremely common but evidence regarding all polypharmacy approaches for schizophrenia from randomized controlled trials remains scarce. Combinations of antipsychotic medicines are unsupported by evidence. Antidepressants are commonly used to treat depressive symptoms; this logical role for antidepressants has little support from RCTs but may be associated with lower suicide and all-cause mortality. No evidence supports the use of benzodiazepines for schizophrenia; possible risks of benzodiazepines including increased mortality rates revealed in observational studies warrant caution and further study.
Summary
The lack of evidence regarding common treatment strategies exacerbates the tremendous challenge of providing optimal pharmacotherapy for individuals with schizophrenia. Comparative effectiveness research, using observational methods when appropriate and randomized controlled trials when possible, is needed to inform clinical practice, use resources wisely, and improve outcomes.
doi:10.1097/YCO.0b013e32835d9efb
PMCID: PMC4026924  PMID: 23318662
polypharmacy; schizophrenia; pharmacoepidemiology; randomized controlled trial; treatment refractory
9.  Circadian Rhythms and Psychiatric Illness 
Current opinion in psychiatry  2013;26(6):566-571.
Purpose of review
The present review provides a conceptual introduction to sleep and circadian research in psychiatric illness, and discusses recent experimental and intervention findings in this area.
Recent Findings
In this review, studies published since January 2011 on circadian disturbance and psychiatric illness have been summarized.
Summary
Exciting new results have increasingly utilized objective and validated instruments to measure the circadian system in experimental studies. Since 2011, treatment research has still predominantly utilized self-report measures as outcome variables. However, research in the treatment domain for sleep/circadian disturbances comorbid with psychiatric illness has advanced the field in its work to broaden the validation of existing sleep treatments to additional patient populations with comorbid sleep/circadian disruptions, address how to increase access to and affordability of treatment for sleep and circadian dysfunction for patients with psychiatric disorders, and how to combine psychosocial treatments with psychopharmacology to optimize treatment outcomes.
doi:10.1097/YCO.0b013e328365a2fa
PMCID: PMC4000560  PMID: 24060916
Sleep; circadian; psychiatric; psychosocial intervention
10.  Could intranasal oxytocin be used to enhance relationships? Research imperatives, clinical policy, and ethical considerations 
Current opinion in psychiatry  2013;26(5):474-484.
Purpose of review
Well-functioning romantic relationships are important for long-term health and well-being, but they are often difficult to sustain. This difficulty arises (in part) because of an underlying tension between our psychobiological natures, culture/environment, and modern love and relationship goals. One possible solution to this predicament is to intervene at the level of psychobiology, enhancing partners’ interpersonal connection through neurochemical modulation. This article focuses on a single, promising biobehavioral subsystem for such intervention: the attachment system, based largely upon the expression of the neuropeptide oxytocin. Could the exogenous administration of oxytocin—under the right conditions—be used to facilitate relational or marital well-being?
Recent findings
If so, it would require considerable forethought. Recent research complicates the popular image of oxytocin as a universal social enhancer or ‘love hormone’ and shows that it may exert a variety of different effects, at different dosages, on different people, under different circumstances. Accordingly, we discuss what is known about oxytocin, including its “good” and “bad” effects on human behavior and on higher-order functional processes.
Summary
Building upon animal-model, human preclinical, and clinical findings, we outline a proposal for the use of oxytocin in the therapeutic neuroenhancement of contemporary romantic relationships. Highlighting key targets for future research along the way, we then conclude by discussing some of the clinical and ethical considerations that would pertain to the implementation of this knowledge in applied settings.
doi:10.1097/YCO.0b013e3283642e10
PMCID: PMC3935449  PMID: 23880593
oxytocin; neuroenhancement; couple therapy; marriage; love drugs
11.  Substance abuse as a risk factor for violence in mental illness: some implications for forensic psychiatric practice and clinical ethics 
Current opinion in psychiatry  2013;26(4):349-354.
Purpose of review
To review recent research on the relationship between substance abuse, crime, violence and mental illness, and suggest how this research could aid forensic psychiatrists, psychologists and other mental health professionals in assessing and managing risk, and balancing patient care and public protection.
Recent findings
Substance abuse in mentally ill forensic psychiatric patients should be considered an important risk factor for violence and re-offending.
Summary
Improved treatment for substance abuse in forensic psychiatric patients and other mentally disordered offenders together with the offer of monitored abstinence as a condition of leave or discharge could be usefully considered as a means of reducing and managing risk. This may improve patient care by addressing mental health needs and increasing opportunity and likelihood of successful re-integration into the community and better life prospects; protect the public by reducing risk of re-offending and offering real time monitoring and potential intervention when risk is heightened; and help forensic psychiatrists strike a balance between patient care and public protection, potentially alleviating some of the difficulty and anxiety that decisions to grant leave or discharge can create.
doi:10.1097/YCO.0b013e328361e798
PMCID: PMC3907744  PMID: 23722099
clinical ethics; mental illness; risk assessment; substance abuse; violence
12.  The intersecting risks of substance use and HIV risk among substance-using South African males and females 
Current opinion in psychiatry  2010;23(3):205-209.
Purpose of Review
The aim of this article is to review the recent literature examining the intersection between alcohol and other drug use and HIV risk behaviors for South African males and females, and the implications for the development of interventions and future research.
Recent findings
The current literature indicates that substance use in sexual contexts (i.e., before or during sex) as well as outside of the sexual context is associated with HIV risk behaviors, such as having unprotected sex and multiple sex partners,. Additionally, environments where substances are used, such as drinking establishments, may be associated with HIV risk behaviors. Moreover, sexual violence is also associated with substance use. Brief HIV prevention interventions to address substance use have demonstrated promising—findings such as consistent condom use, less impaired sex and less unprotected vaginal and anal intercourse—when compared with other interventions,.
Summary
Recent research findings support the previous literature concerning the link between substance use and HIV risk behaviors in South Africa, and suggest the need for interventions focused on sexual risk behaviors in the context of substance use and the environments in which they are used.
doi:10.1097/YCO.0b013e32833864eb
PMCID: PMC3784346  PMID: 20308902
alcohol and other drug use; South Africa; HIV risk; impaired sex; sexual violence
13.  Genome-wide association studies (GWAS) of schizophrenia: does bigger lead to better results? 
Current opinion in psychiatry  2012;25(2):76-82.
Purpose of review
Numerous genome-wide association studies (GWAS) of schizophrenia have been published in the past six years, with a number of key reports published in the last year. The studies have evolved in scale from small individual samples to large collaborative endeavors. This review aims to critically assess whether the results have improved as the sample size and scale of genetic association studies has grown.
Recent findings
Genomic genotyping and increasing sample sizes for schizophrenia association studies has led to parallel increases in the number of risk genes discovered with high statistical confidence. Nearly 20 genes or loci have surpassed the genome-wide significance threshold (p = 5 × 10−8) in a single study, and several have been replicated in more than one GWAS.
Summary
Identifying the genetic underpinnings of complex diseases offers insight into the etiological mechanisms leading to manifestation of the disease. New and more effective treatments for schizophrenia are desperately needed, and the ability to target the relevant biological processes grows with our understanding of the genes involved. As the size of GWAS samples has increased, more genes have been identified with high confidence that have begun to provide insight into the etiological and pathophysiological foundations of this disorder.
doi:10.1097/YCO.0b013e32835035dd
PMCID: PMC3771358  PMID: 22277805
Schizophrenia; GWAS; association; risk gene; genetic
14.  Comorbidity of psychiatric and substance use disorders in the United States: current issues and findings from the NESARC 
Current opinion in psychiatry  2012;25(3):165-171.
Purpose of review
The comorbidity between psychiatric and substance use disorders remains an important phenomenon to understand, and an active area of investigation. The purpose of this review is to highlight key 2011 issues and novel findings on psychiatric and substance disorders comorbidity from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large national survey of the US general population.
Recent findings
Topics of active investigation included the internalizing/externalizing meta-structure of common mental disorders; the 10 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) personality disorders; the 3-year incidence and persistence of disorders; treatment of major depression; and many other topics not as easily categorized.
Summary
Meta-structure may increasingly offer a parsimonious way of addressing comorbidity, although adding new disorders adds complexity and the value of etiologic analyses utilizing broad dimensions of psychopathology rather than individual disorders is not yet fully known. Expanding the range of personality disorders beyond antisocial personality disorder appears essential in understanding the incidence and persistence of substance use disorders. Substance use disorders have low rates of treatment relative to major depression, but increase the likelihood of depression treatment among comorbid cases, a phenomenon that needs to be understood. These comorbidity studies provide much novel information, and indicate many potentially fruitful directions for new research.
doi:10.1097/YCO.0b013e3283523dcc
PMCID: PMC3767413  PMID: 22449770
alcohol; comorbidity; drug; epidemiology; psychiatric; substance
15.  Reinventing intention: ‘self-harm’ and the ‘cry for help’ in post-war Britain 
Current opinion in psychiatry  2012;25(6):503-507.
Purpose of review
To sketch out how contemporary Anglophone literature on self-damaging behaviour negotiates serious conceptual difficulties around intention, and to demonstrate (in the British context) how the large-scale emergence of this type of behaviour is made possible by new forms of psychological provision at district general hospitals.
Recent findings
In the past decade there has been increasing public awareness of ‘self-harm’. Despite the view that ‘self-harm’ has always existed, the British roots of the current ‘epidemic’ can be traced to changes in the organisation of mental healthcare in the post-war period. These changes make possible new understandings of the story behind physical injuries, and allow these readings to be aggregated and projected onto a national, epidemic scale.
Summary
The increasing provision of psychiatric expertise in general hospitals makes possible new interpretations of self injury – as psychosocial communication, or affect self-regulation – and creates the phenomenon of ‘self-harm’ as we understand it today.
doi:10.1097/YCO.0b013e32835904f3
PMCID: PMC3761197  PMID: 23037964
Self-harm; parasuicide; attempted suicide; intent; history
16.  History of psychiatry 
Current opinion in psychiatry  2008;21(6):593-597.
Purpose of review
The present review examines recent contributions to the evolving field of historical writing in psychiatry.
Recent findings
Interest in the history of psychiatry continues to grow, with an increasing emphasis on topics of current interest such as the history of psychopharmacology, electroconvulsive therapy, and the interplay between psychiatry and society. The scope of historical writing in psychiatry as of 2007 is as broad and varied as the discipline itself.
Summary
More than in other medical specialties such as cardiology or nephrology, treatment and diagnosis in psychiatry are affected by trends in the surrounding culture and society. Studying the history of the discipline provides insights into possible alternatives to the current crop of patent-protected remedies and trend-driven diagnoses.
doi:10.1097/YCO.0b013e32830aba12
PMCID: PMC3714299  PMID: 18852567 CAMSID: cams3184
electroconvulsive therapy; psychiatric epidemiology; psychiatry and society; psychopharmacology
17.  The role of latent internalizing and externalizing predispositions in accounting for the development of comorbidity among common mental disorders 
Current opinion in psychiatry  2011;24(4):307-312.
Purpose of the review
Although numerous studies have examined the latent structure of internalizing and externalizing mental disorders, the effects of this structure in predicting the development of comorbidity have remained unexamined until recently.
Recent findings
A novel approach to study the effects of latent internalizing and externalizing predispositions to the development of comorbidity was used to analyze data from 14 countries in the WHO World Mental Health (WMH) Survey Initiative. Pervasive significant positive associations were found between temporally primary and secondary internalizing and externalizing disorders in survival analyses, with time-lagged associations consistently stronger within-domains than between-domains. The vast majority of these associations were explained by latent internalizing and externalizing variables. Specific phobia and OCD were the most important internalizing components and hyperactivity disorder and oppositional-defiant disorder the most important externalizing components. Several intriguing residual time-lagged associations remained significant, though, even after controlling latent predispositions.
Summary
The latent variable model suggests that common causal pathways account for most comorbidity among internalizing-externalizing disorders. These pathways should be the focus of future research on the development of comorbidity, although isolation of consistent residual time-lagged associations between certain pairs of primary-secondary disorders is also important in pointing the way to subsequent focused study.
doi:10.1097/YCO.0b013e3283477b22
PMCID: PMC3708605  PMID: 21602684
Comorbidity; Epidemiology; Risk factors
18.  Advances in the Science of Adolescent Drug Involvement: Implications for Assessment and Diagnosis 
Current opinion in psychiatry  2013;26(4):318-324.
Purpose of review
Adolescence is a developmental period characterized by relatively high rates of substance use and substance use disorders. Precise assessment and classification of adolescent drug use behaviors is essential in gaining an accurate understanding of the nature and extent of adolescent drug use, and possible intervention or treatment needs. There have been a select group of recently published research reports and manuscripts that address critical and emerging issues pertaining to the classification and assessment of alcohol and other drug use behaviors among adolescents. An overview of these publications is provided and their clinical relevance is discussed.
Recent findings
The paper will focus on recent research, most from the U.S., that addresses four main issues. One is the application of the new DSM-5 criteria to adolescents, including the advantages and disadvantages of the new criteria for substance use disorders. The second issue pertains to advances in instrumentation that provide new tools for researchers and clinicians in assessing substance use in adolescents. A significant public health issue is addressed as the third theme in the paper – screening for alcohol abuse in college settings. Finally, the paper reviews how the emerging science of brain development can inform the assessment process.
Summary
Recent advances in the adolescent drug abuse assessment field continue to inform clinical service and research. As a whole these advances have strengthened the field, but continued research is needed to further refine assessment practices and standards and to better understand how to define a substance use disorder In youth.
doi:10.1097/YCO.0b013e328361e814
PMCID: PMC3670700  PMID: 23695531
adolescent; drug abuse; classification; assessment
19.  Mood regulation in youth: research findings and clinical approaches to irritability and short-lived episodes of mania like symptoms 
Current opinion in psychiatry  2012;25(4):271-276.
Purpose of review
Mood regulation problems, such as severe chronic irritability or short episodes of mania like symptoms are common, impairing and a topic of intense recent interest to clinicians, researchers and the DSM-5 process. Here we review the most recent findings about these two presentations and discuss approaches to their treatment.
Recent findings
Longitudinal and genetic findings suggest that chronic irritability should be regarded as a mood problem that is distinct from bipolar disorder.
A proportion of children with short (less than 4 days) episodes of mania like symptoms seem to progress to classical (Type I or II) bipolar disorder over time in US clinic samples. In a UK sample, such episodes were independently associated with psychosocial impairment.
The evidence base for the treatment of either irritability or short-lived episodes to mania-like symptoms is still small. Clinicians should be cautious with extrapolating treatments from classical bipolar disorder to these mood regulation problems. CBT-based approaches targeting general mood regulation processes may be effective for cases with severe irritability or short episodes of mania like symptoms.
Summary
There is increasing research evidence for the importance of mood regulation problems in the form of either irritability or short episodes of mania like symptoms in youth. The evidence base for their drug treatment has yet to be developed. CBT-based interventions to modify processes of mood regulation may be a useful and safe intervention for patients with these presentations.
doi:10.1097/YCO.0b013e3283534982
PMCID: PMC3660700  PMID: 22569307
20.  Osteoporosis and fracture risk in people with schizophrenia 
Current opinion in psychiatry  2012;25(5):415-429.
Purpose of review
Excessive bone mineral density (BMD) loss has been associated with schizophrenia, but its mechanisms and clinical implications are less clear. The aim of this review was to summarize the risk of osteoporosis and bone fractures in schizophrenia patients. Moreover, we aimed to examine the impact of antipsychotic-induced hyperprolactinemia on bone metabolism.
Recent findings
Fifteen of 16 studies (93.8%) reported lower BMD or higher prevalence of osteoporosis in at least one region, or in at least one subgroup of schizophrenia patients compared with controls, but results were inconsistent across measured areas. Higher fracture risk was associated with schizophrenia in 2/2 studies (independently: n = 1), and 3/4 studies with antipsychotics. Reasons for this difference include insufficient exercise, poor nutrition, smoking, alcohol use, and low vitamin D levels. Altogether, 9/15 (60.0%) studies examining the relationship between antipsychotic-induced hyperprolactinemia and BMD loss found some effects of hyperprolactinemia. However, results were mixed, samples and effects were small, and only two studies were prospective.
Summary
Schizophrenia is associated with reduced BMD and fracture risk. Prevention, early detection, and intervention are required. The relative contributions of antipsychotic-related hyperprolactinemia and unhealthy lifestyle behaviors remain unclear, needing to be assessed in well designed, prospective studies, including bone turnover markers as intermediary endpoints.
doi:10.1097/YCO.0b013e328355e1ac
PMCID: PMC3566242  PMID: 22744405
bone mineral density; fracture; osteoporosis; prolactin; schizophrenia
21.  Ethical issues in mental health 
Current opinion in psychiatry  2011;24(3):208-214.
Purpose of review
To describe community engaged research (CEnR) and how it may improve the quality of a research study while addressing ethical concerns that communities may have with mental health and substance abuse research. This article includes a review of the literature as well as recommendations from an expert panel convened with funding from the US National Institute of Mental Health.
Recent findings
CEnR represents a broad spectrum of practices including representation on institutional ethics committees, attitude research with individuals from the study population, engaging community advisory boards, forming research partnerships with community organizations, and including community members as co-investigators.
Summary
CEnR poses some challenges; for example, it requires funding and training for researchers and community members. However, it offers many benefits to researchers and communities and some form of CEnR is appropriate and feasible in nearly every study involving human participants.
doi:10.1097/YCO.0b013e3283459422
PMCID: PMC3528105  PMID: 21460643
research ethics; mental health; substance abuse; community engagement
22.  Response to treatment in bipolar disorder 
Current opinion in psychiatry  2011;24(1):24-28.
Purpose of review
Bipolar disorder is a complex psychiatric condition that has been shown to carry a great degree of genetic loading. This review addresses current research in the genetics of treatment response in bipolar disorder, with a focus on findings that have shaped our understanding of the changing direction of this field in light of recent technological advancements.
Recent findings
The recent publications in bipolar disorder treatment response have helped consolidate or improve upon knowledge of susceptibility loci and genes in the field. There seems to be an increasing trend toward functionally assessing the role played by putative candidate genes and molecular factors modulating expression in bipolar disorder, as well as a movement toward more global, pathway and genome-wide-oriented research.
Summary
Genetic and molecular research to date in bipolar disorder treatment response has not completely answered all the lingering questions in the field, but has contributed to the development of a more patient-based understanding of treatment. In order to apply these findings at a clinical level, more comprehensive treatment response studies are imperative, combining recent advances in high-throughput genomics with functional molecular research.
doi:10.1097/YCO.0b013e328341352c
PMCID: PMC3478324  PMID: 21088584 CAMSID: cams2273
bipolar disorder; genetics; GWAS; lithium
23.  The Intersection of Attention-deficit/Hyperactivity Disorder and Substance Abuse 
Current opinion in psychiatry  2011;24(4):280-285.
The link between Attention-deficit/Hyperactivity Disorder (ADHD) and substance use disorders (SUD) continues to be an area of great interest. In this report we discuss more recent work exploring the developmental relationship between ADHD and SUD and associated concurrent disorders. Recent work highlights the role of treatment of ADHD in children on subsequent cigarette smoking and SUD in adolescence and adulthood. Recent diagnostic issues examining ADHD in SUD populations are highlighted. Recent studies in patients with ADHD and SUD suggest that SUD treatment needs to be sequenced initially with ADHD treatment quickly thereafter.
doi:10.1097/YCO.0b013e328345c956
PMCID: PMC3435098  PMID: 21483267
ADHD; SUD; Treatment; Prevention treatment
24.  Sexual and Drug Use Behaviors Associated with HIV and Other Sexually Transmitted Infections among Female Sex Workers in the Mexico-U.S. Border Region 
Current opinion in psychiatry  2010;23(3):215-220.
Purpose of review
The purpose of this review is to summarize the latest research regarding HIV/STI risk among female sex workers (FSWs) along the Mexico-U.S. border. Although Mexico has a low prevalence of HIV overall, HIV prevalence among FSWs in Tijuana is quite high, and even higher among FSWs who inject drugs (FSW-IDUs). Efforts to better understand and curtail the HIV epidemic among FSWs in this region are greatly needed.
Recent findings
A brief HIV/STI risk reduction intervention for FSWs was successful in decreasing HIV/STI sexual risk behavior with clients among FSWs in Tijuana and Ciudad Juarez, Mexico. However, the intervention was less effective among FSW-IDUs, and had no effect on FSWs' condom use with their non-commercial partners. While the majority of research thus far has focused on FSWs' individual-level risk factors, comparatively less is known about their clients and non-commercial sexual partners who may heavily influence their behavior, and engage in high risk behaviors themselves.
Summary
Further studies including FSWs' intimate partners and clients are needed as well as interventions specific to FSW-IDUs. Targeting the most at risk populations and reducing both sexual and injection risk behaviors simultaneously may curb the growing HIV epidemic in the Mexico-U.S. border region.
doi:10.1097/YCO.0b013e32833864d5
PMCID: PMC3412621  PMID: 20308903
female sex workers; HIV/STIs; Mexico-U.S.; border
25.  SHOULD MILD COGNITIVE IMPAIRMENT BE SUBTYPED? 
Current Opinion in Psychiatry  2011;24(3):237-242.
Purpose of Review
To review evidence on the validity and utility of recent approaches to subtyping late-life mild cognitive impairment.
Recent Findings
There is growing evidence that amnestic mild cognitive impairment is associated with biomarkers for Alzheimer’s disease, while non-amnestic mild cognitive impairment maps more closely to cerebrovascular disease. The former is more likely to progress to dementia than the latter. Mild impairment in multiple cognitive domains appears to represent a more advanced disease state than single-domain impairment, and is more likely to progress to dementia. The cognitive subtypes have imprecise boundaries and have limited ecological validity. Approaches to subtyping that also incorporate biomarkers increase diagnostic specificity and have greater predictive value. However these approaches have yet to be validated outside specialized memory clinic populations.
Summary
Mild cognitive impairment as currently defined is still etiologically and prognostically heterogeneous, particularly outside specialty clinical settings. The objective of further subtyping is to delineate subgroups that are more clinically homogeneous. The current cognitive subtypes have some validity and utility but additional approaches should be explored so as to enhance these properties.
doi:10.1097/YCO.0b013e328344696b
PMCID: PMC3365571  PMID: 21346570
Amnestic MCI; non-amnestic MCI; single-domain MCI; multiple-domain MCI; Alzheimer’s disease; cerebrovascular disease; biomarkers

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