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Savitz J.B.,Laureate Institute for Brain Research | Savitz J.B.,University of Tulsa | Rauch S.L.,McLean Hospital | Rauch S.L.,Harvard University | And 2 more authors.
Molecular Psychiatry | Year: 2013

In response to queries about whether brain imaging technology has reached the point where it is useful for making a clinical diagnosis and for helping to guide treatment selection, the American Psychiatric Association (APA) has recently written a position paper on the Clinical Application of Brain Imaging in Psychiatry. The following perspective piece is based on our contribution to this APA position paper, which specifically emphasized the application of neuroimaging in mood disorders. We present an introductory overview of the challenges faced by researchers in developing valid and reliable biomarkers for psychiatric disorders, followed by a synopsis of the extant neuroimaging findings in mood disorders, and an evidence-based review of the current research on brain imaging biomarkers in adult mood disorders. Although there are a number of promising results, by the standards proposed below, we argue that there are currently no brain imaging biomarkers that are clinically useful for establishing diagnosis or predicting treatment outcome in mood disorders. © 2013 Macmillan Publishers Limited All rights reserved.

Hill K.P.,McLean Hospital | Hill K.P.,Harvard University
Journal of Psychiatric Practice | Year: 2014

With 23 states and the District of Columbia having enacted medical marijuana laws as of August 2014, it is important that psychiatrists be able to address questions about medical marijuana from patients, families, and other health care professionals. The author discusses the medical literature on synthetic cannabinoids and medical marijuana. The synthetic cannabinoids dronabinol and nabilone are approved by the United States Food and Drug Administration for nausea and vomiting associated with cancer chemotherapy and appetite stimulation in patients with wasting diseases such as acquired immunodeficiency syndrome (AIDS). Results of clinical trials of these agents for other conditions have varied widely thus far. In addition, few data are available on the use of the marijuana plant as a medical treatment. The author concludes that there is a clear need for additional research on possible medical uses of cannabinoids. He notes that discussions with prospective medical marijuana patients should emphasize the importance of communication among all parties due to the possible side effects of treatment with marijuana and its potential to interact with other medications the patient may be taking. Facilitating a thorough substance abuse consultation is one of most positive ways that psychiatrists, especially addiction psychiatrists, can make an impact as medical marijuana becomes increasingly common. A careful review of the prospective medical marijuana user's substance use history, co-occurring medical and psychiatric conditions, family history, and psychosocial stressors is essential in evaluating the potential risks of medical marijuana for these patients. The author concludes that psychiatrists can have a significant impact by increasing the likelihood that medical marijuana will be used in a safe and responsible way. Copyright ©2014 Lippincott Williams &Wilkins Inc.

Satterthwaite T.D.,University of Pennsylvania | Baker J.T.,McLean Hospital | Baker J.T.,Massachusetts General Hospital
Current Opinion in Neurobiology | Year: 2015

Psychosis is increasingly being understood as a neurodevelopmental 'dysconnection' syndrome, in which neural connectivity - at both microscopic and macroscopic levels of brain organization - becomes disrupted during late adolescence and early adulthood. Tools to quantify normative brain development and identify individuals at risk are urgently needed to tailor appropriate strategies for prevention and intervention, and could substantially improve clinical outcomes. Resting-state functional connectivity magnetic resonance imaging (rsfc-MRI) provides a rich, functional description of the brain's macroscopic connectivity structure. Over the past several years, rsfc-MRI has evolved to be a powerful tool for studying both normal brain development and abnormalities associated with psychosis. Several recent advances highlight intriguing and potentially significant parallels between these two lines of research. For instance, rsfc-MRI work suggests that psychosis is accompanied by loss of segregation between large-scale brain association networks, a pattern that is normal in early life but typically matures into more segregated systems by young adulthood. Coupled with data sharing across large-scale neuroimaging studies, longitudinal assessments using rsfc-MRI in patients and those at risk will be essential for improving our biological understanding of psychosis and will help inform diagnosis, prognosis, and clinical decision-making. © 2014 Elsevier Ltd.

Gunderson J.G.,McLean Hospital
Personality Disorders: Theory, Research, and Treatment | Year: 2013

This article reviews the process by which the DSM-5 Personality Disorder (PD) proposal for change was developed, challenged, and then ultimately rejected. The DSM-5 workgroup's mandate to introduce radical changes were inherently fraught by the limited time allowed, but their efforts were undermined by dissension within the committee, the lack of a clearly identified scientific rationale, and by the inconsistent dialogue with the existing community of PD experts. Nonetheless, valuable steps were taken to establish a better definition for PD's, introduce dimensions, and identify the steps needed for future revisions. The author only in retrospect has concluded that borderline personality disorder and antisocial personality disorder be treated differently than other PD's because of their clinical significance and empirical support. Specifically, these "major" PD's should remain on Axis I, while other PD's are secondary disorders that are more comfortably dimensionalized and belong on Axis II. (PsycINFO Database Record (c) 2013 APA, all rights reserved. © 2012 American Psychological Association.

Abstract Extensive research implicates disturbed immune function and development in the etiology and pathology of schizophrenia. In addition to reviewing evidence for immunological factors in schizophrenia, this paper discusses how an emerging model of atypical immune function and development helps explain a wide variety of well-established - but puzzling - findings about schizophrenia. A number of theorists have presented hypotheses that early immune system programming, disrupted by pre- and perinatal adversity, often combines with abnormal brain development to produce schizophrenia. The present paper focuses on the hypothesis that disruption of early immune system development produces a latent immune vulnerability that manifests more fully after puberty, when changes in immune function and the thymus leave individuals more susceptible to infections and immune dysfunctions that contribute to schizophrenia. Complementing neurodevelopmental models, this hypothesis integrates findings on many contributing factors to schizophrenia, including prenatal adversity, genes, climate, migration, infections, and stress, among others. It helps explain, for example, why (a) schizophrenia onset is typically delayed until years after prenatal adversity, (b) individual risk factors alone often do not lead to schizophrenia, and (c) schizophrenia prevalence rates actually tend to be higher in economically advantaged countries. Here we discuss how the hypothesis explains 10 key findings, and suggests new, potentially highly cost-effective, strategies for treatment and prevention of schizophrenia. Moreover, while most human research linking immune factors to schizophrenia has been correlational, these strategies provide ethical ways to experimentally test in humans theories about immune function and schizophrenia. This article is part of a Special Issue entitled SI: Neuroimmunology in Health And Disease. © 2015 Elsevier B.V.

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