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Dialogues in Clinical Neuroscience

Richard J Loewenstein
Controversy about dissociation and the dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence support a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and that DD are artefactual conditions produced by iatrogenesis and/or socio-cultural factors...
September 2018: Dialogues in Clinical Neuroscience
Dieter Naber, Monika Bullinger
Minor/subthreshold depression is associated with functional impairment, reduced quality of life, and the risk of developing into major depression. Therefore, it should be treated. Watchful waiting should be an option only for patients who, despite adequate information, are not interested in any kind of treatment. Psychotherapy has been found to be effective, but due to methodological problems (control group, blinding), efficacy derived from randomized trials might be over-estimated. Studies on the efficacy of antidepressants in the treatment of minor depression have found clinically relevant benefits over placebo, particularly the newer, better-controlled trials...
September 2018: Dialogues in Clinical Neuroscience
Michael Davidson
Several large meta-analyses of maintenance trials have confirmed that patients who suffer from chronic schizophrenia, randomized to placebo, are likely to experience earlier symptomatic worsening than patients randomized to a dopamine (DA)-blocking drug. These findings led expert groups to issue treatment guidelines, which recommend treatment with DA-blocking drugs for periods ranging from several years to indefinitely. The recommendations were accepted by the majority of, but not all, the experts, some of whom proposed a targeted or intermittent therapy approach by which DA-blocking drugs are discontinued upon symptomatic remission, to be renewed in case of symptom re-emergence...
September 2018: Dialogues in Clinical Neuroscience
Pierre Schulz, Vincent Hede
While the legitimacy of medical treatments is more and more questioned, one sees a paradoxical increase in nonconventional approaches, notably so in psychiatry. Over time, approaches that were considered valuable by the scientific community were found to be inefficacious, while other approaches, labelled as alternative or complementary, were finally discovered to be useful in a few indications. From this observation, we propose to classify therapies as orthodox (scientifically validated) or heterodox (scientifically not validated)...
September 2018: Dialogues in Clinical Neuroscience
Matthew Michael Large
It is widely believed that suicide prevention involves the consideration of risk and protective factors and related interventions. Preventative interventions can be classified as "universal" (targeting whole populations), "selective" (targeting higher-risk groups), and "indicated" (protecting individuals). This review explores the range of preventative measures that might be used commensurately with different types of suicide prediction. The author concludes that the best prospects for suicide prevention lie in universal prevention strategies...
September 2018: Dialogues in Clinical Neuroscience
David R Rubinow, Peter J Schmidt
A variety of hormones have been shown to play a role in affective disorders. Reproductive steroids are particularly informative in our efforts to understand the pathophysiology of affective dysregulation for several reasons: i) Reproductive endocrine-related mood disorders (premenstrual dysphoric disorder, perinatal depression, perimenopausal depression) are wonderful clinical models for investigating the mechanisms by which affective state changes occur; ii) Reproductive steroids regulate virtually every system that has been implicated as disturbed in the ontogeny of affective disorders; iii) Despite the absence of a reproductive endocrinopathy a triggering role in the affective disturbance of reproductive mood disorders has been shown clearly for changes in reproductive steroids...
September 2018: Dialogues in Clinical Neuroscience
Falkai Peter, Schmitt Andrea, Andreasen Nancy
Structural brain imaging was introduced into routine clinical practice more than 40 years ago with the hope that it would support the diagnosis and treatment of mental disorders. It is now widely used to exclude organic brain disease (eg, brain tumors, cardiovascular, and inflammatory processes) in mental disorders. However, questions have been raised about whether structural brain imaging is still needed today and whether it could also be clinically useful to apply new biostatistical methods, such as machine learning...
September 2018: Dialogues in Clinical Neuroscience
Margret R Hoehe, Deborah J Morris-Rosendahl
The enormous successes in the genetics and genomics of many diseases have provided the basis for the advancement of precision medicine. Thus, the detection of genetic variants associated with neuropsychiatric disorders, as well as treatment outcome, has raised growing expectations that these findings could soon be translated into the clinic to improve diagnosis, the prediction of disease risk and individual response to drug therapy. In this article, we will provide an introduction to the search for genes involved in psychiatric illness and summarize the present findings in major psychiatric disorders...
September 2018: Dialogues in Clinical Neuroscience
César Carvajal
Throughout history the consequences of psychological trauma and characteristic symptoms have involved clinical presentations that have had different names. Since the inclusion of the category of Posttraumatic Stress Disorder (PTSD) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) with the symptomatic triad of re-experiencing the traumatic event, avoidance behaviors, and hypervigilance, this entity has been a source of controversy. Indeed, some authors have denied its existence, even considering it a diagnostic invention...
September 2018: Dialogues in Clinical Neuroscience
Marc-Antoine Crocq
A crisis of confidence was triggered by the disappointment that diagnostic validity, an important goal, was not achieved with the publication of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) . The Research Domain Criteria (RDoC) project, which provides a framework for neuroscientific research, was initially conceptualized as an alternative to DSM . However, RDoC and DSM are complementary rather than mutually exclusive. From a historical perspective, this article argues that the debate opposing psychology and brain in psychiatric classification is not new and has an air of déjà vu...
September 2018: Dialogues in Clinical Neuroscience
Florence Thibaut
Neuroimaging and recent genetics discoveries have raised many questions regarding the current diagnostic criteria of psychiatric diseases and the current classifications used, which are still based on subjective clinical assessment. Despite high-quality research in brain neuroscience and evidence-based guidelines in many psychiatric diseases, some therapeutic issues are still a matter of debate. These controversial issues will be discussed in this 20th anniversary issue.
September 2018: Dialogues in Clinical Neuroscience
Gregory L Fricchione
Clinical neuroscience struggles with poor scientific validity of neuropsychiatric diagnosis and its negative impact on management. Sydenham's ancient conformity of type approach to nosology with its assumption that the symptom cluster and course of a disorder are due to a common etiology, has proven no match for the complicated comorbidities faced in neuropsychiatry. In the absence of accurate pathological biomarkers there is a challenge in finding a solid foundation for modern neuropsychiatry. We find standard psychiatric nosology to be of limited benefit at the general hospital bedside in evaluating and treating neuropsychiatric disorders...
June 2018: Dialogues in Clinical Neuroscience
Scott Marek, Nico U F Dosenbach
The frontoparietal network is critical for our ability to coordinate behavior in a rapid, accurate, and flexible goal-driven manner. In this review, we outline support for the framing of the frontoparietal network as a distinct control network, in part functioning to flexibly interact with and alter other functional brain networks. This network coordination likely occurs in a 4 Hz to 73 Hz θ/α rhythm, both during resting state and task state. Precision mapping of individual human brains has revealed that the functional topography of the frontoparietal network is variable between individuals, underscoring the notion that group-average studies of the frontoparietal network may be obscuring important typical and atypical features...
June 2018: Dialogues in Clinical Neuroscience
Alessandra Griffa, Martijn P Van den Heuvel
Over the past decades, network neuroscience has played a fundamental role in the understanding of large-scale brain connectivity architecture. Brains, and more generally nervous systems, can be modeled as sets of elements (neurons, assemblies, or cortical chunks) that dynamically interact through a highly structured and adaptive neurocircuitry. An interesting property of neural networks is that elements rich in connections are central to the network organization and tend to interconnect strongly with each other, forming so-called rich clubs...
June 2018: Dialogues in Clinical Neuroscience
Olaf Sporns
Network neuroscience is a thriving and rapidly expanding field. Empirical data on brain networks, from molecular to behavioral scales, are ever increasing in size and complexity. These developments lead to a strong demand for appropriate tools and methods that model and analyze brain network data, such as those provided by graph theory. This brief review surveys some of the most commonly used and neurobiologically insightful graph measures and techniques. Among these, the detection of network communities or modules, and the identification of central network elements that facilitate communication and signal transfer, are particularly salient...
June 2018: Dialogues in Clinical Neuroscience
Guusje Collin, Matcheri S Keshavan
The brain is the ultimate adaptive system, a complex network organized across multiple levels of spatial and temporal resolution that is sculpted over several decades via its interactions with the environment. This review sets out to examine how fundamental biological processes in early and late neurodevelopment, in interaction with environmental inputs, guide the formation of the brain's network and its ongoing reorganization throughout the course of development. Moreover, we explore how disruptions in these processes could lead to abnormal brain network architecture and organization and thereby give rise to schizophrenia...
June 2018: Dialogues in Clinical Neuroscience
Vincent Calhoun
Brain imaging technology provides a powerful tool to visualize the living human brain, provide insights into disease mechanisms, and potentially provide a tool to assist clinical decision-making. The brain has a very specific structural substrate providing a foundation for functional information; however, most studies ignore the very interesting and complex relationships between brain structure and brain function. While a variety of approaches have been used to study how brain structure informs function, the study of such relationships in living humans in most cases is limited to noninvasive approaches at the macroscopic scale...
June 2018: Dialogues in Clinical Neuroscience
Florence Thibaut
Inside the brain, neural regions dynamically interact at multiple spatial and temporal scales through a highly structured and adaptive neurocircuitry. Comprehensive maps of brain connectivity have led to the emerging field of connectomics. Graph theory methods are interesting tools to improve our understanding of the brain as a complex interconnected system.
June 2018: Dialogues in Clinical Neuroscience
Dieter Naber, Monika Bullinger
This manuscript summarizes the literature on mental health outcomes after cardiac arrest. Survivors of cardiac arrest show high rates of mental illness with more than 40% suffering from anxiety, 30% from depression, and 25% from posttraumatic stress disorder (PTSD). Mental health outcomes may differ depending on the setting in which the cardiac arrest occurred. A major problem is reduced neuropsychological functioning. Between 30% and 50% of survivors of cardiac arrest suffer from cognitive deficits. Deficits of attention, declarative memory, executive function, visual-spatial abilities, and verbal fluency have been observed...
March 2018: Dialogues in Clinical Neuroscience
Brenda W J H Penninx, Sjors M M Lange
Psychiatric patients have a greater risk of premature mortality, predominantly due to cardiovascular diseases (CVDs). Convincing evidence shows that psychiatric conditions are characterized by an increased risk of metabolic syndrome (MetS), a clustering of cardiovascular risk factors including dyslipidemia, abdominal obesity, hypertension, and hyperglycemia. This increased risk is present for a range of psychiatric conditions, including major depressive disorder (MDD), bipolar disorder (BD), schizophrenia, anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), and posttraumatic stress disorder (PTSD)...
March 2018: Dialogues in Clinical Neuroscience
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