Serotonin reuptake inhibitors and benzodiazepines are evidence-based pharmacological treatments for Anxiety Disorders targeting serotonin and GABAergic systems, respectively. Although clearly effective, these medications fail to improve anxiety symptoms in a significant proportion of patients. New insights into the glutamate system have directed attention toward drugs that modulate glutamate as potential alternative treatments for anxiety disorders. Here we summarize the current understanding of the potential role of glutamate neurotransmission in anxiety disorders and highlight specific glutamate receptors that are potential targets for novel anxiety disorder treatments. We also review clinical trials of medications targeting the glutamate system in DSM-5 anxiety disorders. Understanding the role of the glutamate system in the pathophysiology of anxiety disorder may aid in developing novel pharmacological agents that are effective in treating anxiety disorders.
Larrabee (2008) applied chained likelihood ratios to selected performance validity measures (PVMs) to identify non-valid performances on neuropsychological tests. He presented a method of combining different PVMs with different sensitivities and specificities into an overall probability of non-validity. We applied his methodology to a set of 11 PVMs using a sample of 255 subjects. The results of the study show that in various combinations of two or three PVMs, a high reliability of invalidity can be determined using the chained likelihood ratio method. This study advances the ability of clinicians to chain various PVMs together and calculate the probability that a set of data is invalid.
Background: Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk.Methods: A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fiftyseven studies were included from 2940 reviewed citations.Results: In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), nonclozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant.There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. Conclusion:Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.
In this study, we compared objective neuropsychological data using the Meyers Neuropsychological Battery (MNB; Meyers & Rohling, 2004 ) and self-report measures of emotional distress using the Symptom Checklist 90-Revised (SCL-90-R; Derogatis, 1994 ) with self-ratings of functional difficulties as measured by the Patient Competency Rating Scale (PCRS; Prigatano, 1986 ). The results showed a high correlation between the PCRS and scales on the SCL-90-R (r = .65), whereas correlation with the overall test battery mean of the MNB was quite small (r = .18). Our results indicate that self-report of cognitive difficulties is more related to current emotional distress than to objective measures. Therefore, any diagnostic considerations that rely on self-report need to be tempered by considerations of current emotional status. This has implications for diagnoses such as posttraumatic stress disorder and other diagnoses that rely on self-report as a source of diagnostic information.
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