The Journal of clinical psychiatry
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Randomized Controlled Trial
Cortical stimulation of the prefrontal cortex with transcranial direct current stimulation reduces cue-provoked smoking craving: a randomized, sham-controlled study.
Because neuroimaging studies have shown that cue-provoked smoking craving is associated with changes in the activity of the bilateral dorsolateral prefrontal cortex (DLPFC), we aimed to investigate whether a powerful technique of noninvasive brain stimulation, transcranial direct current stimulation (tDCS), reduces cue-provoked smoking craving as indexed by a visual analog scale. ⋯ Our findings extend the results of a previous study on the use of brain stimulation to reduce craving, showing that cortical stimulation with tDCS is beneficial for reducing cue-provoked craving, and thus support the further exploration of this technique for smoking cessation.
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Atypical antipsychotics are emerging as the first-line pharmacologic treatment for irritability (i.e., aggression, self-injurious behavior, and severe tantrums) in children and adolescents with autistic and other pervasive developmental disorders. Results from placebo-controlled and open-label studies of clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole in this subject population are reviewed. Additional placebo-controlled trials and studies of longer-term safety and tolerability are needed.
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According to the American College of Rheumatology, fibromyalgia is widespread pain of at least 3 months' duration in combination with pain at 11 or more of 18 specific tender point sites on the body. Many individuals with fibromyalgia also have comorbid psychiatric disorders, which can present diagnostic dilemmas and require additional treatment considerations to optimize patient outcomes. Fibromyalgia has been found to be strongly associated with depressive and anxiety symptoms, a personal or family history of depression, and accompanying antidepressant treatment. ⋯ Pharmacotherapy can be employed to control fibromyalgia and comorbid mood and anxiety disorders. Additionally, nonpharmacologic therapies for fibromyalgia and comorbid psychiatric disorders include cognitive-behavioral therapy and aerobic exercise. The efficacy of pharmacologic and nonpharmacologic treatments is examined in this article, as well as the diagnostic difficulties that comorbid disorders present.
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This article reviews current findings regarding the pathophysiologic abnormalities that contribute to the enhanced pain responses of individuals with fibromyalgia as well as the relationships between fibromyalgia and commonly co-occurring disorders. Risk factors for fibromyalgia or enhanced pain responses include genetic and family influences, environmental triggers, and abnormal neuroendocrine and autonomic nervous system function. These risk factors also are associated with several disorders that frequently co-occur with fibromyalgia, such as major depressive disorder, migraine, and irritable bowel syndrome. ⋯ Recent research strongly suggests that alterations in central processing of sensory input also contribute to the cardinal symptoms of fibromyalgia, persistent widespread pain and enhanced pain sensitivity. Exposure to psychosocial and environmental stressors, as well as altered autonomic nervous system and neuroendocrine responses, also may contribute to alterations in pain perception or pain inhibition. Understanding the pathophysiology of fibromyalgia and co-occurring disorders may help clinicians provide the most appropriate treatment to their patients.
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Patients with fibromyalgia frequently complain of cognitive problems or "fibrofog." The existence of these symptoms has been confirmed by studies of the incidence of cognitive problems in fibromyalgia patients and by the results of objective tests of metamemory, working memory, semantic memory, everyday attention, task switching, and selective attention. The results of these tests show that fibromyalgia patients have impairments in working, episodic, and semantic memory that mimic about 20 years of aging. ⋯ Cognitive symptoms in these patients may be exacerbated by the presence of depression, anxiety, sleep problems, endocrine disturbances, and pain, but the relationship of these factors to cognitive problems in fibromyalgia patients is unclear. Standardized tests and treatment have not yet been established for cognitive problems in fibromyalgia patients.