Body, Mind & Spirit Articles and Latest News

Psychotherapies for comorbid anxiety in bipolar spectrum disorders.

J Affect Disord. 2010 Nov 17;

Authors: Provencher MD, Hawke LD, Thienot E

BACKGROUND: Comorbid anxiety disorders are highly prevalent in bipolar disorder and have been shown to have serious negative impacts on the course of illness. The pharmacological treatment of anxiety can interact with the bipolar disorder and has not been proven effective. As such, many have recommended the psychological treatment of anxiety. This paper reviews the literature on psychological treatments for anxiety comorbid to bipolar disorder. METHOD: The Medline, PsychInfo and Web of Science databases were thoroughly examined for relevant treatment studies. RESULTS: Despite frequent recommendations in the literature, surprisingly few have studied the psychological treatment of comorbid anxiety in bipolar disorders. Nevertheless, preliminary results suggest that comorbid anxiety disorders can be effectively treated in a bipolar clientele using cognitive-behavioral therapy, mindfulness-based cognitive-behavioral therapy or relaxation training. In contrast, interpersonal, family therapy and psychoeducation alone would not seem to be beneficial treatment alternatives for anxiety. Cognitive-behavioral therapy appears to reduce the symptoms of obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, post-traumatic stress disorder and general symptoms of anxiety among patients with bipolar disorder. However, the long-term maintenance of anxiety treatment effects may be somewhat reduced and adaptations may be called for to augment and sustain benefits. CONCLUSIONS: There is an urgent need for randomized controlled trials of different forms of psychotherapy for anxiety disorders comorbid to bipolar disorder. Until such trials are available, the most promising approach would appear to be the sequential or modular CBT-based treatment of the anxiety disorder.

PMID: 21093062 [PubMed - as supplied by publisher]

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Dynamic Causal Modeling with Genetic Algorithms.

J Neurosci Methods. 2010 Nov 19;

Authors: Pyka M, Heider D, Hauke S, Kircher T, Jansen A

In the last years, dynamic causal modeling has gained increased popularity in the neuroimaging community as an approach for the estimation of effective connectivity from functional magnetic resonance imaging (fMRI) data. The algorithm calls for an a priori defined model, whose parameter estimates are subsequently computed upon the given data. As the number of possible models increases exponentially with additional areas, it rapidly becomes inefficient to compute parameter estimates for all models in order to reveal the family of models with the highest posterior probability. In the present study, we developed a genetic algorithm for dynamic causal models and investigated whether this evolutionary approach can accelerate the model search. In this context, the configuration of the intrinsic, extrinsic and bilinear connection matrices represent the genetic code and Bayesian model selection serves as fitness function. Using crossover and mutation, populations of models are created and compared with each other. The most probable ones survive the current generation and serve as source for the next generation of models. Tests with artificially created data sets show that the genetic algorithm approximates the most plausible models faster than a random-driven brute-force search. The fitness landscape revealed by the genetic algorithm indicates that dynamic causal modeling has excellent properties for evolution-driven optimization techniques.

PMID: 21094663 [PubMed - as supplied by publisher]

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Alterations in Postnatal Neurogenesis And Dopamine Dysregulation in Schizophrenia: A Hypothesis.

Schizophr Bull. 2010 Nov 19;

Authors: Inta D, Meyer-Lindenberg A, Gass P

An increasing number of studies demonstrate the important role of several susceptibility genes for schizophrenia, such as neuregulin-1 and DISC1, in early postnatal and adult neurogenesis. Its significance for the pathophysiology of the disease, including its relation to neurotransmitter systems implicated in schizophrenia (like the dopamine system), remains, however, unknown. Here, we review molecular and cellular components of the dopamine system associated with postnatal neurogenesis and plasticity, both in rodents and in primates, and discuss their possible implication in schizophrenia. We focus mainly on the islands of Calleja, complex aggregations of granule cells in the ventral striatum, generated early postnatally in the subventricular zone. In contrast to the involution of the primate olfactory bulb, the islands of Calleja attain their maximal development in humans, an evolution paralleled by a larger ventral subventricular zone and more connections with other structures, including temporal cortical areas. The islands of Calleja express high levels of neuronal nitric oxide (NO) synthase and D3 dopamine receptors and are densely interconnected by dopaminergic projections with the ventral tegmental area. D3 receptors modulate subventricular zone neurogenesis and dopamine release. Their genetic deletion induces striatal hyperdopaminergia. We review data indicating a high plasticity of postnatal islands of Calleja, potentially facilitating susceptibility to schizophrenia-related risk factors. In this context, we propose a new pathophysiological model, where altered neurogenesis of the islands of Calleja may contribute to dysfunction of the dopamine and NO systems and psychosis through convergence of genetic and environmental disease-associated factors.

PMID: 21097511 [PubMed - as supplied by publisher]

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Attachment and its Vicissitudes in Borderline Personality Disorder.

Curr Psychiatry Rep. 2010 Nov 23;

Authors: Levy KN, Beeney JE, Temes CM

This article reviews the recent literature on attachment and attachment-related constructs in borderline personality disorder, with attention given to how recent findings in this area may inform understanding of the mechanisms underlying the etiology, maintenance, and treatment of the disorder. Most findings on this topic have stemmed from three major areas of research, each of which is reviewed in this article: 1) developmental psychopathology studies; 2) experimental psychopathology studies, particularly those using a neuroscience approach; and 3) treatment studies that have examined variables relevant to attachment. Overall, these findings suggest that attachment and related constructs may factor greatly into the underlying psychopathology of borderline personality disorder and may significantly impact the process and outcome of psychotherapy for the disorder. These findings are discussed as they relate to existing theories and ongoing debates in the field, and the implications for future research and clinical practice are highlighted.

PMID: 21104167 [PubMed - as supplied by publisher]

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Culture.

J Clin Psychol. 2010 Nov 23;

Authors: Smith TB, Rodríguez MD, Bernal G

This article summarizes the definitions, means, and research of adapting psychotherapy to clients’ cultural backgrounds. We begin by reviewing the prevailing definitions of cultural adaptation and providing a clinical example. We present an original meta-analysis of 65 experimental and quasi-experimental studies involving 8,620 participants. The omnibus effect size of d = .46 indicates that treatments specifically adapted for clients of color were moderately more effective with that clientele than traditional treatments. The most effective treatments tended to be those with greater numbers of cultural adaptations. Mental health services targeted to a specific cultural group were several times more effective than those provided to clients from a variety of cultural backgrounds. We recommend a series of research-supported therapeutic practices that account for clients’ culture, with culture-specific treatments being more effective than generally culture-sensitive treatments. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 67(2):1-12, 2011.

PMID: 21105069 [PubMed - as supplied by publisher]

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[Treatment of an obese diabetic].

Vnitr Lek. 2010 Oct;56(10):1078-81

Authors: Svacina S

Weight reduction is an important component of comprehensive management of diabetes. Weight reduction can be achieved using 6 methods: 1. diet 2. physical activity, 3. psychotherapy, 4. bariatric surgery, 5. pharmacotherapy of obesity, 6. selection of an appropriate antidiabetic medication. Orlistat is the only antiobesity agent presently available in the Czech Republic. Weight neutral (metformin and gliptins) and weight reducing antidiabetics (incretine analogues exenatide and liraglutide) and insulin analogue detemir are suitable antidiabetic drugs. We thus have a sufficient range of options available for weight reduction in diabetic patients.

PMID: 21105456 [PubMed - in process]

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Treatment goals of depressed outpatients: a qualitative investigation of goals identified by participants in a depression treatment trial.

J Psychiatr Pract. 2010 Nov;16(6):425-30

Authors: Battle CL, Uebelacker L, Friedman MA, Cardemil EV, Beevers CG, Miller IW

Treatment goals and preferences of depressed patients are important, but they are rarely empirically studied. Although clinicians are likely to discuss goals with individual patients, research that clarifies overall patterns in the treatment goals of depressed patients could be useful in informing new interventions for depression. Such research could also potentially help address problems such as poor adherence and psychotherapy drop-out. In this preliminary qualitative investigation, we examined treatment goals established by depressed outpatients in the context of a trial of behaviorally oriented psychotherapy. The treatment goals that were most commonly articulated included improving social and family relationships, increasing physical health behaviors, finding a job, and organizing one’s home. These results underscore the fact that, in addition to improvement in the symptoms of depression, functional improvements are viewed as key treatment goals by depressed individuals. (Journal of Psychiatric Practice 2010;16:425-430).

PMID: 21107149 [PubMed - in process]

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Sleep, hypothalamus, and stigma.

Eur Arch Psychiatry Clin Neurosci. 2010 Nov 25;

Authors: Falkai P, Möller HJ

PMID: 21107592 [PubMed - as supplied by publisher]

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What works for whom: Tailoring psychotherapy to the person.

J Clin Psychol. 2010 Nov 24;

Authors: Norcross JC, Wampold BE

This article introduces the issue of the Journal of Clinical Psychology: In Session devoted to evidence-based means of adapting psychotherapy to the patient’s (transdiagnostic) characteristics. Practitioners have long realized that treatment should be tailored to the individuality of the patient and the singularity of his or her context, but only recently has sufficient empirical research emerged to reliably guide practice. This article reviews the work of an interdivisional task force and its dual aims of identifying elements of effective therapy relationships (what works in general) and identifying effective methods of adapting treatment to the individual patient (what works in particular). The task force judged four patient characteristics (reactance/resistance, preferences, culture, religion/spirituality) to be demonstrably effective in adapting psychotherapy and another two (stages of change, coping style) as probably effective. Two more patient facets (expectations, attachment style) were related to psychotherapy outcome but possessed insufficient research as a means of adaptation. This special issue provides research-supported methods of individualizing psychotherapy to the person, in addition to his or her diagnosis. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 67:1-2, 2011.

PMID: 21108312 [PubMed - as supplied by publisher]

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Attachment style.

J Clin Psychol. 2010 Nov 24;

Authors: Levy KN, Ellison WD, Scott LN, Bernecker SL

Attachment theory, developed by Bowlby to explain human bonding, has profound implications for conducting and adapting psychotherapy. We summarize the prevailing definitions and measures of attachment style. We review the results of three meta-analyses examining the association between attachment anxiety, avoidance, and security and psychotherapy outcome. Fourteen studies were synthesized, which included 19 separate therapy cohorts with a combined sample size of 1,467. Attachment anxiety showed a d of -.46 with posttherapy outcome, while attachment security showed a d of.37 association with outcome. Attachment avoidance was uncorrelated with outcome. The age and gender composition of the samples moderated the relation between attachment security and outcome: samples with a higher proportion of female clients and a higher mean age showed a smaller relation between security and outcome. We discuss the practice implications of these findings and related research on the link between attachment and the therapy relationship. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 67(2):1-11, 2011.

PMID: 21108315 [PubMed - as supplied by publisher]

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