Archives of general psychiatry
-
Arch. Gen. Psychiatry · Jan 2010
Comparative StudyNational trends in psychotropic medication polypharmacy in office-based psychiatry.
Psychotropic medication polypharmacy is common in psychiatric outpatient settings and, in some patient groups, may have increased in recent years. ⋯ There has been a recent significant increase in polypharmacy involving antidepressant and antipsychotic medications. While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes.
-
Arch. Gen. Psychiatry · Dec 2009
Randomized Controlled Trial Comparative StudyClinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial.
In older people, depressive symptoms are common, psychological adjustment to aging is complex, and associated chronic physical illness limits the use of antidepressants. Despite this, older people are rarely offered psychological interventions, and only 3 randomized controlled trials of individual cognitive behavioral therapy (CBT) in a primary care setting have been published. ⋯ Cognitive behavioral therapy is an effective treatment for older people with depressive disorder and appears to be associated with its specific effects.
-
Arch. Gen. Psychiatry · Dec 2009
Comparative StudyDisrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder.
Little is known about the neural abnormalities underlying generalized anxiety disorder (GAD). Studies in other anxiety disorders have implicated the amygdala, but work in GAD has yielded conflicting results. The amygdala is composed of distinct subregions that interact with dissociable brain networks, which have been studied only in experimental animals. A functional connectivity approach at the subregional level may therefore yield novel insights into GAD. ⋯ Our findings provide new insights into the functional neuroanatomy of the human amygdala and converge with connectivity studies in experimental animals. In GAD, we find evidence of an intra-amygdalar abnormality and engagement of a compensatory frontoparietal executive control network, consistent with cognitive theories of GAD.
-
Arch. Gen. Psychiatry · Nov 2009
Comparative StudyBrain structural abnormalities and mental health sequelae in South Vietnamese ex-political detainees who survived traumatic head injury and torture.
A pilot study of South Vietnamese ex-political detainees who had been incarcerated in Vietnamese reeducation camps and resettled in the United States disclosed significant mental health problems associated with torture and traumatic head injury (THI). ⋯ Structural deficits in prefrontotemporal brain regions are linked to THI exposures. These brain lesions are associated with the symptom severity of depression in Vietnamese ex-political detainees.
-
Arch. Gen. Psychiatry · Nov 2009
Comparative StudyAltered corticostriatal functional connectivity in obsessive-compulsive disorder.
Neurobiological models of obsessive-compulsive disorder (OCD) emphasize disturbances in the function and connectivity of brain corticostriatal networks, or "loops." Although neuroimaging studies of patients have supported this network model of OCD, very few have applied measurements that are sensitive to brain connectivity features. ⋯ This study directly supports the hypothesis that OCD is associated with functional alterations of brain corticostriatal networks. Specifically, our findings emphasize abnormal and heightened functional connectivity of ventrolimbic corticostriatal regions in patients with OCD.