Current psychiatry reports
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Curr Psychiatry Rep · Oct 2010
ReviewAttention-deficit/Hyperactivity Disorder in the context of Autism spectrum disorders.
Autism spectrum disorders (ASD) are frequently marked by symptoms consistent with attention-deficit/hyperactivity disorder (ADHD), namely inattention, hyperactivity, and impulsivity. Recent work has established that about half of the ASD population also meets diagnostic criteria for ADHD, although the comorbid diagnoses are precluded by the DSM-IV-TR. Individuals with co-occurring ASD and ADHD symptoms are more severely impaired, with significant deficits seen in social processing, adaptive functioning, and executive control. ⋯ Recent work has also demonstrated high rates of ASD symptoms in a subset of children with ADHD. Medication studies have demonstrated the efficacy of methylphenidate, atomoxetine, and guanfacine, among others, in treating ADHD symptoms co-occurring with ASD. However, these effects were not as great as those seen when treating primary ADHD, and they are less well-tolerated in the ASD population.
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Curr Psychiatry Rep · Oct 2010
ReviewUse of naltrexone to treat opioid addiction in a country in which methadone and buprenorphine are not available.
Opioid dependence is one of the most severe drug dependencies. Naltrexone is a medication that completely blocks the subjective and other effects of opioids and, when administered to detoxified opioid addicts and taken as directed, prevents relapse and helps maintain abstinence. The major problem with naltrexone is poor compliance, particularly in countries in which there is a treatment alternative based on substitution of illicit opioids such as heroin with orally administered opioid agonists (methadone) or partial agonist/antagonists (buprenorphine). ⋯ Due to the lack of alternatives to naltrexone and stronger family control of compliance (adherence), naltrexone is more effective for relapse prevention and abstinence stabilization in Russia than in Western countries. Long-acting, sustained-release formulations (injectable and implantable) seem particularly effective compared with oral formulations. This article summarizes the results of studies conducted in Russia during the past 10 years that demonstrate these points.
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Curr Psychiatry Rep · Jun 2010
ReviewPsychiatric aspects of chronic fatigue syndrome and fibromyalgia.
Chronic fatigue syndrome and/or fibromyalgia (CFS/FM) consists of highly overlapping, medically unexplained symptoms, including long-lasting fatigue, effort intolerance, cognitive dysfunction, and widespread pain and tenderness. CFS/FM often seems to be triggered by infections and physical trauma, but depression, sleep disturbances, and personality may also be involved. ⋯ CFS/FM patients can be best helped by a pragmatic and individualized approach aimed at adjusting lifestyle and optimizing self-care, which in the long run may contribute to a restoration of physical and mental adaptability. Future psychiatric research into CFS/FM should focus on the complex interrelationships among pain/fatigue, stress/depression, and personality, as well as on processes of therapeutic change and the advantages of customized treatment.
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Curr Psychiatry Rep · Oct 2009
ReviewManagement of opioid medications in patients with chronic pain and risk of substance misuse.
When prescribed appropriately and used as prescribed, opioid medications can safely and effectively treat pain. Best practices with respect to their use in chronic non-cancer-related pain (CNCP) are evolving. ⋯ Interdisciplinary pain management, the use of universal precautions in all patients, and special attention to the structure of care in those at higher risk for opioid misuse may improve outcomes in opioid treatment of CNCP. This article discusses evolving research and clinical literature related to the care of individuals with CNCP at a higher risk for opioid misuse.
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Curr Psychiatry Rep · Aug 2009
ReviewA systematic review of the quality and impact of anxiety disorder meta-analyses.
Meta-analyses are seen as representing the pinnacle of a hierarchy of evidence used to inform clinical practice. Therefore, the potential importance of differences in the rigor with which they are conducted and reported warrants consideration. In this review, we use standardized instruments to describe the scientific and reporting quality of meta-analyses of randomized controlled trials of the treatment of anxiety disorders. ⋯ Neither the scientific nor reporting quality of the meta-analyses was predicted by any of the impact metrics. The finding that treatment meta-analyses were cited less frequently than quantitative reviews of studies in current "hot spots" of research (ie, genetics, imaging) points to the multifactorial nature of citation patterns. A list of the meta-analyses included in this review is available on an evidence-based website of anxiety and trauma-related disorders.