Psychosomatics REVIEW ARTICLES

Impact of Bereavement on Progression of AIDS and HIV Infection: A Review [REVIEW ARTICLES]

Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Human immunodeficiency virus (HIV) disease is associated with bereavement and grief reactions brought about by the disease process itself and by the losses of loved ones. OBJECTIVE: The goal of this review is to assess the current literature regarding grief, HIV, and immunity. METHOD: The authors reviewed applicable articles retrieved from a MEDLINE literature search with the search terms "bereavement/HIV," "grief/HIV," and "immunity/grief/HIV." RESULTS: Data continue to emerge that suggest a profound role for bereavement in mediating HIV illness and the need to effectively deal with bereavement issues. CONCLUSIONS: Patients who experience maladaptive grief show more rapid losses of CD4 T-cells over time, even when controlling for age, health status, use of antiretrovirals, and illicit drug abuse. This immune dysfunction may be managed by a variety of psychotherapeutic techniques.

Cancer-Related Fatigue and Its Associations With Depression and Anxiety: A Systematic Review [REVIEW ARTICLES]

Brown, L. F., Kroenke, K. — Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Fatigue is an important symptom in cancer and has been shown to be associated with psychological distress. OBJECTIVE: This review assesses evidence regarding associations of cancer-related fatigue with depression and anxiety. METHOD: Database searches yielded 59 studies reporting correlation coefficients or odds ratios. RESULTS: The combined sample size was 12,103. Almost all studies showed a correlation of fatigue with depression and with anxiety. However, 31 different instruments were used to assess fatigue, suggesting a lack of consensus on measurement. CONCLUSION: This review confirms the association of fatigue with depression and anxiety. Directionality needs to be better delineated in longitudinal studies.

Symptoms of Depression and Anxiety After Delirium [REVIEW ARTICLES]

Davydow, D. S. — Mon, 17 Aug 2009 08:37:44 PDT

BACKGROUND: Delirium is a common problem in hospitalized patients. OBJECTIVE: The author investigated the relationship between in-hospital delirium and subsequent depressive and anxiety symptoms. METHOD: A literature search and review using MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsycINFO was performed. RESULTS: Eight studies were eligible. Five studies found significant associations between delirium episodes and subsequent symptoms of depression and/or anxiety. CONCLUSION: Psychological distress is common after delirium, warranting comprehensive evaluation and treatment.

Evidence for the Partial Dopamine-Receptor Agonist Aripiprazole as a First-Line Treatment of Psychosis in Patients With Iatrogenic or Tumorogenic Hyperprolactinemia [REVIEW ARTICLES]

Hoffer, Z. S., Roth, R. L., Mathews, M. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: Antipsychotic drugs have many side effects, including elevation of prolactin levels through tuberoinfundibular dopamine-receptor blockade. Although a number of studies claim that aripiprazole is a prolactin-sparing antipsychotic drug that may even lower prolactin levels, there has not been an exhaustive evaluation of this claim. OBJECTIVE: The authors analyzed the burgeoning literature suggesting that aripiprazole is efficacious in treating iatrogenic and tumorogenic hyperprolactinemia. METHOD: The authors conducted a literature search for case studies, reports, and placebo-controlled trials that measured prolactin levels in adult patients taking aripiprazole. RESULTS: The search identified 17 studies, in which 3,489 psychotic patients were given aripiprazole alone, as an adjuvant to haloperidol or risperidone, or to treat psychosis with a concomitant prolactinoma. Across all studies, aripiprazole lowered prolactin levels an average of 74.3%, even in psychotic patients with prolactinoma, whereas haloperidol and risperidone increased prolactin levels by as much as 272%. CONCLUSION: These findings suggest that aripiprazole may play an important niche role in treating psychotic patients sensitive to elevated prolactin and patients with prolactin-secreting pituitary tumors.

Distinguishing Among Irrational Suicide and Other Forms of Hastened Death: Implications for Clinical Practice [REVIEW ARTICLES]

Leeman, C. P. — Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: The increasing recognition that not all hastened death is irrational challenges clinical practice. OBJECTIVE: The author distinguishes among the various forms of hastened death. Psychiatrists may be consulted when patients ask to hasten their death in any of the ways described, contrasted, and illustrated in this article. CONCLUSION: The rational desire to hasten death may call for unconventional psychiatric responses. The author discusses the error of failing to provide life-saving medical treatment over the objection of someone who has attempted suicide and the error of trying to prevent rational persons suffering from incurable illness from hastening their death.

On "Distinguishing Among Irrational Suicide, Rational Suicide, and Other Forms of Hastened Death: Implications for Clinical Practice" by Cavin P. Leeman, M.D [REVIEW ARTICLES]

Bostwick, J. M. — Tue, 30 Jun 2009 11:04:36 PDT

On "Distinguishing Among Irrational Suicide, Rational Suicide, and Other Forms of Hastened Death: Implications for Clinical Practice" by Cavin P. Leeman, M.D [REVIEW ARTICLES]

Brendel, R. — Tue, 30 Jun 2009 11:04:36 PDT

On "Distinguishing Among Irrational Suicide, Rational Suicide, and Other Forms of Hastened Death: Implications for Clinical Practice" by Cavin P. Leeman, M.D [REVIEW ARTICLES]

Hicks, D. W. — Tue, 30 Jun 2009 11:04:36 PDT

On "Distinguishing Among Irrational Suicide, Rational Suicide, and Other Forms of Hastened Death: Implications for Clinical Practice" by Cavin P. Leeman, M.D [REVIEW ARTICLES]

Steinberg, M. D. — Tue, 30 Jun 2009 11:04:36 PDT

Neuropsychiatric Problems After Traumatic Brain Injury: Unraveling the Silent Epidemic [REVIEW ARTICLES]

Vaishnavi, S., Rao, V., Fann, J. R. — Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: Traumatic brain injury (TBI) is a significant public health concern. According to the Centers for Disease Control and Prevention, about 1.4 million people in the United States sustain a TBI annually. OBJECTIVE: This review places particular emphasis on the current knowledge of effective treatment of TBI symptoms, and proposes directions for future research. RESULTS: Neuropsychiatric problems are more prevalent and longer-lasting in TBI patients than in the general population. About 40% of TBI victims suffer from two or more psychiatric disorders, and a similar percentage experience at least one unmet need for cognitive, emotional, or job assistance 1 year after injury. The entire spectrum of TBI severity, from mild to severe, is associated with an increase in psychiatric conditions. CONCLUSION: Despite the high incidence of severe consequences of TBI, there are scarce empirical data to guide psychiatric treatment. Some approaches that have been helpful include cognitive and behavioral therapy and pharmacologic treatment. The authors list specific research recommendations that could further identify useful therapeutic interventions.

Paraneoplastic Limbic Encephalitis [REVIEW ARTICLES]

Foster, A. R., Caplan, J. P. — Fri, 17 Apr 2009 11:44:01 PDT

BACKGROUND: Paraneoplastic limbic encephalitis (PLE) is a syndrome characterized by the development of neuropsychiatric symptoms due to a misdirected tumor-activated antibody response that damages host neural tissue. Definitive treatment relies on the identification and ablation of the underlying tumor. Few publications describe the management of psychiatric symptoms associated with PLE. OBJECTIVE: Given the plethora of neuropsychiatric symptoms that may mimic primary psychiatric illness, and the possibility that PLE may herald a life-threatening malignancy, it is important that psychiatrists become familiar with this condition. METHOD: The authors review and discuss the consensus literature on the various aspects of PLE. DISCUSSION: In this review, authors summarize proposed mechanisms and treatments of PLE.

Psychosocial Issues and Mental Health Treatment Recommendations for Patients With Hepatitis C [REVIEW ARTICLES]

Silberbogen, A. K., Ulloa, E. W., Janke, E. A., Mori, D. L. — Fri, 17 Apr 2009 11:44:01 PDT

BACKGROUND: Mental health needs of patients with HCV are increasingly being addressed in medical contexts. OBJECTIVE: The authors review the psychosocial issues relevant to patients with hepatitis C and provide mental health treatment recommendations. Findings: Patients with HCV are faced with a number of challenges, including adjustment to a chronic medical illness, management of symptoms and treatment side effects, and making and maintaining lifestyle changes. Given these issues, mental health clinicians have the opportunity to make a significant contribution to patient care. CONCLUSION: After reviewing the relevant research on these psychosocial issues, the authors have identified areas in which clinicians can intervene; these include adjustment to having a chronic medical illness, coping with stigma and relationship changes, management of side effects, and implementing healthy lifestyle changes.