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Harvard Review of Psychiatry

Christie Sylvester, Marie Menke, Priya Gopalan
BACKGROUND: Depression and anxiety are prevalent disorders and are often treated with selective serotonin reuptake inhibitors (SSRIs). Infertility is also common among couples, and rates of depression and anxiety are elevated in this population, but the impact of SSRIs on fertility has received modest attention. This review explores the literature available on SSRIs, fertility, and infertility-treatment outcomes to assist clinicians in better counseling their patients. METHODS: A literature search was performed using the search terms infertility, fertility, antidepressants, and SSRIs to identify studies that investigated the relationship between SSRI use and fertility or infertility-treatment outcomes...
January 22, 2019: Harvard Review of Psychiatry
Sarah K Fineberg, Swapnil Gupta, Jacob Leavitt
Psychopharmacology in borderline personality disorder (BPD) is complicated by comorbid disorders, substance use, sensitivity to side effects, risk of self-harm through medication misuse, and intense but transient symptoms. Patients' relationships with medications may range from tenuous to highly enmeshed, and may profoundly influence the response to treatment. For these reasons, awareness of current evidence and flexible approaches are particularly relevant to prescribing in BPD. In this narrative review, we illustrate the current status of medication management in BPD by focusing on polypharmacy...
January 22, 2019: Harvard Review of Psychiatry
Robert K McNamara, Daniel M Almeida
Meta-analytic evidence indicates that mood and psychotic disorders are associated with both omega-3 polyunsaturated fatty acid (omega-3 PUFA) deficits and progressive regional gray and white matter pathology. Although the association between omega-3 PUFA insufficiency and progressive neuropathological processes remains speculative, evidence from translational research suggests that omega-3 PUFA insufficiency may represent a plausible and modifiable risk factor not only for enduring neurodevelopmental abnormalities in brain structure and function, but also for increased vulnerability to neurodegenerative processes...
January 9, 2019: Harvard Review of Psychiatry
Margaret Spottswood, John Fortney, Jessica A Chen, Dimitry Davydow, Hsiang Huang
Posttraumatic stress disorder (PTSD) occurs following acute threatening events in approximately 12.5% of the primary care population. OBJECTIVE: The aim of this article is to advance evidence-based clinical practice and collaborative care approaches to PTSD by summarizing targeted-care guidelines. METHOD: This narrative literature review addresses important aspects of PTSD and management options, in conjunction with expert opinion when indicated. Guidelines were included if they targeted treatment of PTSD in the primary care setting or if the treatments described could be provided in the primary care setting...
January 4, 2019: Harvard Review of Psychiatry
Larkin Elderon Kao, Sejal B Shah, Kenneth I Pargament, James L Griffith, John R Peteet
No abstract text is available yet for this article.
January 2019: Harvard Review of Psychiatry
Eric T Ward, Kristin M Kostick, Gabriel Lázaro-Muñoz
Psychiatric genomics is a rapidly growing field that holds much promise for improving risk prediction, prevention, diagnosis, treatment selection, and understanding of the pathogenesis of patients' symptoms. The field of psychiatry (i.e., professional organizations, mental health clinicians, educational institutions), however, needs to address numerous challenges to promote the responsible translation of genomic technologies and knowledge into psychiatric practice. The goal of this article is to review how clinicians currently encounter and use genomics in the clinic, to summarize the existing literature on how clinicians feel about the use of genomics in psychiatry, and to analyze foreseeable ethical and legal challenges for the responsible integration of genomics into psychiatric care at the structural and clinic levels...
January 2019: Harvard Review of Psychiatry
Christoforos Iraklis Giakoumatos, David Osser
BACKGROUND: The Psychopharmacology Algorithm Project at the Harvard South Shore Program presents evidence-based recommendations considering efficacy, tolerability, safety, and cost. Two previous algorithms for unipolar nonpsychotic depression were published in 1993 and 1998. New studies over the last 20 years suggest that another update is needed. METHODS: The references reviewed for the previous algorithms were reevaluated, and a new literature search was conducted to identify studies that would either support or alter the previous recommendations...
January 2019: Harvard Review of Psychiatry
Joshua L Roffman
No abstract text is available yet for this article.
January 2019: Harvard Review of Psychiatry
Aaron J Hauptman, Diler Acar, Paul Hammerness, Jason M Fogler, Diane Stafford
No abstract text is available yet for this article.
November 2018: Harvard Review of Psychiatry
Charlie Rioux, Jean R Séguin, Joel Paris
Evolutionary models of psychopathology can shed light on gene-environment interactions. Differential susceptibility to the environment means that heritable traits can have positive or negative effects, depending on environmental context. Thus, traits that increase risk for mental disorders when the environment is negative can be adaptive when the environment is positive. This model can be applied to borderline personality disorder, with predictors such as emotional dysregulation and impulsivity seen as temperamental variations leading to negative effects in an unfavorable environment but to positive effects in a favorable environment...
November 2018: Harvard Review of Psychiatry
Torsten Klengel
Understanding the complexity and regular function of the human brain is an unresolved challenge that hampers the identification of disease-contributing components and mechanisms of psychiatric disorders. It is accepted that the majority of psychiatric disorders result from a complex interaction of environmental and heritable factors, and efforts to determine, for example, genetic variants contributing to the pathophysiology of these diseases are becoming increasingly successful. We also continue to discover new molecules with unknown functions that might play a role in brain physiology...
November 2018: Harvard Review of Psychiatry
Waguih William IsHak, Raymond Y Wen, Lancer Naghdechi, Brigitte Vanle, Jonathan Dang, Michelle Knosp, Julieta Dascal, Lobsang Marcia, Yasmine Gohar, Lidia Eskander, Justin Yadegar, Sophia Hanna, Antonious Sadek, Leslie Aguilar-Hernandez, Itai Danovitch, Charles Louy
BACKGROUND: Pain comorbid with depression is frequently encountered in clinical settings and often leads to significant impaired functioning. Given the complexity of comorbidities, it is important to address both pain and depressive symptoms when evaluating treatment options. AIM: To review studies addressing pain comorbid with depression, and to report the impact of current treatments. METHOD: A systematic search of the literature databases was conducted according to predefined criteria...
November 2018: Harvard Review of Psychiatry
Farah Ahmad, Catherine Maule, Jamie Wang, Wai Lun Alan Fung
Despite the increasing presence of Chinese communities in the West, their experiences of depression and the variations in symptoms or presentation are not well understood. Using Arksey and O'Malley's methodical framework, we conducted a scoping review of the published literature, using electronic databases MEDLINE and PsycINFO, and searched for articles published since 1999. Out of 1177 articles identified, 21 met the inclusion criteria. Thematic synthesis revealed valuable scholarly work on (1) depression rates, migration, and contextual determinants, (2) causation beliefs and help seeking, (3) acculturation and symptoms, (4) presenting symptoms and somatization, and (5) culturally sensitive assessment and care...
November 2018: Harvard Review of Psychiatry
Shelly F Greenfield
No abstract text is available yet for this article.
November 2018: Harvard Review of Psychiatry
Dawn F Ionescu, Julia M Felicione, Aishwarya Gosai, Cristina Cusin, Philip Shin, Benjamin G Shapero, Thilo Deckersbach
Major depressive disorder (MDD) is one of the most prevalent conditions in psychiatry. Patients who do not respond to traditional monoaminergic antidepressant treatments have an especially difficult-to-treat type of MDD termed treatment-resistant depression. Subanesthetic doses of ketamine-a glutamatergic modulator-have shown great promise for rapidly treating patients with the most severe forms of depression. As such, ketamine represents a promising probe for understanding the pathophysiology of depression and treatment response...
November 2018: Harvard Review of Psychiatry
Ioline D Henter, Rafael Teixeira de Sousa, Carlos A Zarate
After participating in this activity, learners should be better able to evaluate the evidence supporting the antidepressant effects of glutamatergic modulators.Both preclinical and clinical studies have implicated glutamatergic system dysfunction in the pathophysiology of mood disorders such as bipolar depression and major depressive disorder. In particular, rapid reductions in depressive symptoms have been noted in response to subanesthetic doses of the glutamatergic modulator ketamine in subjects with major depressive disorder or bipolar depression...
November 2018: Harvard Review of Psychiatry
Fanny B Cegla-Schvartzman, Santiago Ovejero, Jorge López-Castroman, Enrique Baca-García
OBJECTIVE: Diagnostic stability is the degree to which a diagnosis remains unchanged during follow-up. It is an important measure of predictive validity in bipolar disorder (BD). In this study, we review the literature concerning diagnostic stability in BD, analyze the factors contributing to diagnostic stability, and describe the implications of diagnostic boundaries and diagnostic delay. METHODS: A comprehensive literature search of MEDLINE and EMBASE databases was conducted, including all studies published from 1980 to 2016, to evaluate the diagnostic stability of BD...
October 24, 2018: Harvard Review of Psychiatry
Geneviève Sauvé, Mathieu B Brodeur, Jai L Shah, Martin Lepage
BACKGROUND: Patients in every stage of the psychosis continuum can present with negative symptoms. While no treatment is currently available to address these symptoms, a more refined characterization of their course over the lifetime could help in elaborating interventions. Previous reports have separately investigated the prevalence of negative symptoms within each stage of the psychosis continuum. Our aim in this review is to compare those prevalences across stages, thereby disclosing the course of negative symptoms...
October 24, 2018: Harvard Review of Psychiatry
Brian Theyel
No abstract text is available yet for this article.
September 2018: Harvard Review of Psychiatry
Abigail M Judge
In recent years, heightened attention has been paid to commercial sexual exploitation, including domestic human sex trafficking (HST), with mental health concerns named the most dominant health concern among survivors. Human sex trafficking is associated with significant and long-term mental health consequences. Research to date has emphasized ways to identify survivors in health care settings. Once identified, however, few specialized services are available to help survivors exit and recover. The current services infrastructure for HST has been compared to the disjointed social response to intimate partner violence before the women's movement helped develop a system of battered women's shelters...
September 2018: Harvard Review of Psychiatry
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