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1.  Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences 
Current opinion in psychiatry  2015;28(4):307-311.
Purpose of review
This review discusses recent findings from epidemiological surveys of traumatic events and posttraumatic stress disorder (PTSD) globally, including their prevalence, risk factors, and consequences in the community.
Recent findings
A number of studies on the epidemiology of PTSD have recently been published from diverse countries, with new methodological innovations introduced. Such work has not only documented the prevalence of PTSD in different settings, but has also shed new light on the PTSD conditional risk associated with specific traumatic events, and on the morbidity and comorbidities associated with these events.
Recent community studies show that trauma exposure is higher in lower-income countries compared with high-income countries. PTSD prevalence rates are largely similar across countries, however, with the highest rates being found in postconflict settings. Trauma and PTSD-risk factors are distributed differently in lower-income countries compared with high-income countries, with sociodemographic factors contributing more to this risk in high-income than low-income countries. Apart from PTSD, trauma exposure is also associated with several chronic physical conditions. These findings indicate a high burden of trauma exposure in low-income countries and postconflict settings, where access to trained mental health professionals is typically low.
PMCID: PMC4452282  PMID: 26001922
DSM-5 criteria; epidemiology; posttraumatic stress disorder
2.  Substance Abuse among Iranian High School Students 
Current opinion in psychiatry  2010;23(3):221-226.
Purpose of review
In this study, we reviewed data on drug use among high school students in Iran.
Recent findings
Published epidemiological studies in international and domestic journals show that drug use/abuse is a serious mental health problem in Iran. There is cultural support for opium in Iran, and also there is cultural tolerance for tobacco smoking, especially as water pipe smoking, in Iranian families. Alcohol, opium, and cannabis are the most frequently used illicit drugs, but there are new emerging problems with anabolic steroids, ecstasy, and stimulant substances, such as crystal methamphetamine.
There is serious drug abuse problem among Iranian high school students. It could be due to role-modeling by parents – mainly fathers – and also cultural tolerance of some substances. Early onset of tobacco smoking, with a daily use rate between 4.4% and 12.8% in high school students, is an important risk factor for other drug abuse problems. Use of all types of drugs, except prescription drugs, is more prevalent among boys. Alcohol is the most frequently abused substance, with a lifetime rate of at least 9.9%. Lifetime rates of opiate use – mostly opium – were between 1.2 an 8.6% in different parts of the country. As drug abuse is a frequent problem among Iranian high school students, it is necessary to design and implement drug prevention programs to protect them. Such programs, including life skills training and drug education, have been operating in recent years for Iranian students from kindergarten to the university level.
PMCID: PMC4479403  PMID: 20308905
addiction; drug abuse; high school; Iran; youth
3.  Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice 
Current opinion in psychiatry  2012;25(2):141-148.
Purpose of review
To briefly review results of the latest research on the contributions of depression, anxiety, and stress exposures in pregnancy to adverse maternal and child outcomes, and to direct attention to new findings on pregnancy anxiety, a potent maternal risk factor.
Recent findings
Anxiety, depression, and stress in pregnancy are risk factors for adverse outcomes for mothers and children. Anxiety in pregnancy is associated with shorter gestation and has adverse implications for fetal neurodevelopment and child outcomes. Anxiety about a particular pregnancy is especially potent. Chronic strain, exposure to racism, and depressive symptoms in mothers during pregnancy are associated with lower birth weight infants with consequences for infant development. These distinguishable risk factors and related pathways to distinct birth outcomes merit further investigation.
This body of evidence, and the developing consensus regarding biological and behavioral mechanisms, sets the stage for a next era of psychiatric and collaborative interdisciplinary research on pregnancy to reduce the burden of maternal stress, depression, and anxiety in the perinatal period. It is critical to identify the signs, symptoms, and diagnostic thresholds that warrant prenatal intervention and to develop efficient, effective and ecologically valid screening and intervention strategies to be used widely.
PMCID: PMC4447112  PMID: 22262028
anxiety; depression; pregnancy; prenatal stress; stress
4.  Late-Onset Schizophrenia: Do Recent Studies Support Categorizing LOS as a Subtype of Schizophrenia? 
Current opinion in psychiatry  2014;27(3):173-178.
To review recent literature about late-onset schizophrenia (LOS): schizophrenia with onset between ages 40–60 years. New findings are presented in the context of the previous literature.
Recent findings
Newer studies continue to suggest that early-onset schizophrenia (EOS) and LOS share fundamental clinical features (i.e. positive symptoms, negative symptoms, functional deficits). One larger recent study confirmed earlier findings that LOS differs from EOS in several important ways including predominance of women, lower severity of positive symptoms, and lower average antipsychotic dose requirement. However, this study did not find LOS patients were more likely to have the paranoid subtype or to have less severe negative symptoms compared to EOS patients. New neuroimaging and molecular studies are identifying possible differences in the underlying pathophysiology of EOS and schizophrenia developing in mid- to late-life; however, more research is needed to confirm these findings and determine their significance. No studies evaluated treatment strategies specifically in LOS.
LOS continues to be an understudied area. Recent studies add support to the idea that LOS may be a distinct subtype of schizophrenia. Studies designed to elucidate the pathophysiology of LOS in comparison with EOS and to assess treatment strategies in this population are needed.
PMCID: PMC4418466  PMID: 24613985
Late onset schizophrenia; schizophrenia; older adult
5.  Automated Computerized Analysis of Speechin Psychiatric Disorders 
Current opinion in psychiatry  2014;27(3):203-209.
Purpose of Review
Disturbances in communication are a hallmark of severe mental illnesses. Recent technological advances have paved the way for objectifying communication using automated computerized linguistic and acoustic analysis. We review recent studies applying various computer-based assessments to the natural language produced by adult patients with severe mental illness.
Recent Findings
Automated computerized methods afford tools with which it is possible to objectively evaluate patients in a reliable, valid and efficient manner that complements human ratings. Crucially, these measures correlate with important clinical measures. The clinical relevance of these novel metrics has been demonstrated by showing their relationship to functional outcome measures, their in vivo link to classic ‘language’ regions in the brain, and, in the case of linguistic analysis, their relationship to candidate genes for severe mental illness.
Computer based assessments of natural language afford a framework with which to measure communication disturbances in adults with SMI. Emerging evidence suggests that they can be reliable and valid, and overcome many practical limitations of more traditional assessment methods. The advancement of these technologies offers unprecedented potential for measuring and understanding some of the most crippling symptoms of some of the most debilitating illnesses known to humankind.
PMCID: PMC4212642  PMID: 24613984
natural language; latent semantic analysis; computational linguistics; acoustic analysis; speech disturbances
6.  Neuroimaging correlates of aggression in schizophrenia: an update 
Current opinion in psychiatry  2011;24(2):100-106.
Purpose of review
Aggression in schizophrenia is associated with poor treatment outcomes, hospital admissions, and stigmatization of patients. As such it represents an important public health issue. This article reviews recent neuroimaging studies of aggression in schizophrenia, focusing on PET/single photon emission computed tomography and MRI methods.
Recent findings
The neuroimaging literature on aggression in schizophrenia is in a period of development. This is attributable in part to the heterogeneous nature and basis of that aggression. Radiological methods have consistently shown reduced activity in frontal and temporal regions. MRI brain volumetric studies have been less consistent, with some studies finding increased volumes of inferior frontal structures, and others finding reduced volumes in aggressive individuals with schizophrenia. Functional MRI studies have also had inconsistent results, with most finding reduced activity in inferior frontal and temporal regions, but some also finding increased activity in other regions. Some studies have made a distinction between types of aggression in schizophrenia in the context of antisocial traits, and this appears to be useful in understanding the neuroimaging literature.
Frontal and temporal abnormalities appear to be a consistent feature of aggression in schizophrenia, but their precise nature likely differs because of the heterogeneous nature of that behavior.
PMCID: PMC4415152  PMID: 21178624
aggression; MRI; schizophrenia; violence
7.  The Effect of Cannabis on the Brain: Can it cause brain anomalies that lead to increased risk for Schizophrenia? 
Current opinion in psychiatry  2008;21(2):140-150.
Purpose of This Review
This review explores what is known about cannabis’s association with schizophrenia, cannabis’s effects on the brain, and whether the brain changes known to be present in schizophrenia could be caused by cannabis and thus lead to a psychosis.
Recent Findings
The heavy use of cannabis is known to be associated with some adverse consequences, such as the occurrence of acute psychotic episodes and the development of chronic schizophrenia in some people even after its use has terminated. Recent studies have produced controversy about whether cannabis in heavy use can cause irreversible brain damage, particularly to adolescents and thus, whether a chronic psychosis could be a result of brain changes caused by cannabis.
From the evidence that exists, it appears that the above view is unlikely and that cannabis may even have benign effects on brain structure, not producing deleterious damage. However, its neurochemical interactions with the dopaminergic pathway may, particularly in genetically vulnerable individuals, have adverse consequences.
PMCID: PMC4337025  PMID: 18332661
Marijuana; MRI; DTI; Adolescence; Genes; Psychosis
8.  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.
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.
PMCID: PMC4270276  PMID: 23867662
DSM-5; ICD-11; psychiatric classification; global mental health
9.  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.
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.
PMCID: PMC4241361  PMID: 23695532
alcohol; executive functions; neurobehavior; risk; youth
10.  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.
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.
PMCID: PMC4214363  PMID: 23154644
TMS; transcranial; magnetic; stimulation; depression; treatment
11.  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.
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.
PMCID: PMC4162326  PMID: 25036421
bariatric surgery; bioenterics intragastric balloon; cognition; psychiatric disorder; suicide
12.  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.
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.
PMCID: PMC4142652  PMID: 24060912
Delayed Sleep Phase Disorder; Adolescence; Clinical features; Etiology; Treatment
13.  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.
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.
PMCID: PMC4096990  PMID: 24060917
eating disorders; psychological treatments; evidence-based treatment
14.  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.
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.
PMCID: PMC4054867  PMID: 24613987
oxidative stress; magnetic resonance spectroscopy; olfactory cell; glutathione; superoxide dismutase
15.  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.
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.
PMCID: PMC4026924  PMID: 23318662
polypharmacy; schizophrenia; pharmacoepidemiology; randomized controlled trial; treatment refractory
16.  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.
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.
PMCID: PMC4000560  PMID: 24060916
Sleep; circadian; psychiatric; psychosocial intervention
17.  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.
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.
PMCID: PMC3935449  PMID: 23880593
oxytocin; neuroenhancement; couple therapy; marriage; love drugs
18.  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.
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.
PMCID: PMC3907744  PMID: 23722099
clinical ethics; mental illness; risk assessment; substance abuse; violence
19.  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,.
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.
PMCID: PMC3784346  PMID: 20308902
alcohol and other drug use; South Africa; HIV risk; impaired sex; sexual violence
20.  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.
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.
PMCID: PMC3771358  PMID: 22277805
Schizophrenia; GWAS; association; risk gene; genetic
21.  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.
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.
PMCID: PMC3767413  PMID: 22449770
alcohol; comorbidity; drug; epidemiology; psychiatric; substance
22.  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.
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.
PMCID: PMC3761197  PMID: 23037964
Self-harm; parasuicide; attempted suicide; intent; history
23.  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.
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.
PMCID: PMC3714299  PMID: 18852567 CAMSID: cams3184
electroconvulsive therapy; psychiatric epidemiology; psychiatry and society; psychopharmacology
24.  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.
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.
PMCID: PMC3708605  PMID: 21602684
Comorbidity; Epidemiology; Risk factors
25.  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.
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.
PMCID: PMC3670700  PMID: 23695531
adolescent; drug abuse; classification; assessment

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