Meet our New Field Editor

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Reflections on psychological and psychiatric consequences of COVID-19 pandemic

Although far from reaching a clear conclusion, some evidence increasingly highlights the possible connections among climate change, environmental pollution and the current COVID-19 pandemic, as well as their intertwined detrimental effects on both physical and mental health. Such a catastrophic event calls for a novel awareness of the interdependence of all biotic and nonbiotic factors in our environment and planet

Only the human brain has the cognitive capacity for jealousy

Jealousy is exclusively a human phenomenon because nonhuman animals lack the brain structures regulating the higher processes underlying jealousy

Topiramate plus citalopram in the treatment of Compulsive-Impulsive Sexual Behaviors

Compulsive-Impulsive Sexual Behaviors (C-ISBs) include repetitive sexual acts and compulsive sexual thoughts which occur so frequently and with such intensity that they interfere with sexual intimacy and interpersonal and occupational functioning and whose categorization and effective treatments are still unclear. We report the case of a patient affected by C-ISBs and bipolar disorder of type II who improved dramatically after three months' addition of topiramate to citalopram. Topiramate is a powerful anticonvulsant which has recently been proposed also for the treatment of migraine, bipolar disorder and binge eating disorder. This case-report suggests that topiramate might be beneficial in augmentation with citalopram in patients suffering from C-ISBs, although controlled studies to confirm our findings are needed

Novel challenges to psychiatry from a changing world

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O que a farmacologia ensina sobre a fisiopatologia dos transtornos obsessivo-compulsivos

Once considered rare and resistant to treatments, obsessive-compulsive disorders (OCD) has now emerged as one the most common psychiatric conditions, with a lifetime prevalence of about 2.5 %, and as a major cause of long-term disability to patients and their families. The treatment of OCD has changed dramatically over the last decade following the introduction of selective serotonin (5-HT) reuptake inhibitors (SSRIs), such as fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, which provide symptom remission in about 60% of the patients. OCD is unique in the response to serotonergic agents and it has been clearly demonstrated that non-serotonergic antidepressants such as desipramine have no effect. The specific response of OCD patients to SSRIs has emphasized the possible role of the main target of these drugs, namely the 5-HT system, in the pathophysiology of the disorder. If the role of 5-HT in OCD is not questionable, future studies should be directed towards the elucidation of the 5-HT receptor subtypes involved, of the second messengers transducing the signal, as well as of the interactions between 5-HT and the other neurotransmitters

Response to the Letter to the Editor "Psychiatry's undeclared identity crisis in a changing world" by Richard Skaff

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Sponsorship and conflict of interest inexistent. What pharmacology teaches us about the pathophysiology of obsessive-compulsive disorder O que a farmacologia ensina sobre a fisiopatologia dos transtornos obsessivo-compulsivos

Once considered rare and resistant to treatments, obsessive-compulsive disorders (OCD) has now emerged as one the most common psychiatric conditions, with a lifetime prevalence of about 2.5 %, and as a major cause of long-term disability to patients and their families. The treatment of OCD has changed dramatically over the last decade following the introduction of selective serotonin (5-HT) reuptake inhibitors (SSRIs), such as fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, which provide symptom remission in about 60% of the patients. OCD is unique in the response to serotonergic agents and it has been clearly demonstrated that non-serotonergic antidepressants such as desipramine have no effect. The specific response of OCD patients to SSRIs has emphasized the possible role of the main target of these drugs, namely the 5-HT system, in the pathophysiology of the disorder. If the role of 5-HT in OCD is not questionable, future studies should be directed towards the elucidation of the 5-HT receptor subtypes involved, of the second messengers transducing the signal, as well as of the interactions between 5-HT and the other neurotransmitters. Obsessive-compulsive disorder. Serotonergic drugs. Serotonin reuptake inhibitors. Psychopharmacology. Serotonin receptors. Signal transduction. Antes considerado de ocorrência rara e resistente ao tratamento, o transtorno obsessivo-compulsivo (TOC) é atualmente um dos problemas mais comuns em psiquiatria, com uma prevalência de cerca de 2,5%, e uma das principais causas de incapacidade a longo prazo tanto para pacientes como para suas famílias. Na última década, o tratamento do TOC conheceu mudanças drásticas com a introdução dos inibidores seletivos de captação de serotonina (ISCS), tais como fluoxetina, fluvoxamina, paroxetina, sertralina e citalopram, que proporcionam remissão dos sintomas em cerca de 60% dos pacientes. O TOC responde de forma singular aos agentes serotoninérgicos, mas tal efeito não ocorre quando são usados antidepressivos não-serotoninérgicos, como a desipramina, como foi bem demonstrado. A resposta específica dos pacientes com TOC aos ISCS reforça o possível papel do principal alvo destas drogas, o sistema serotoninérgico, na fisiopatologia deste transtorno. Se o papel da serotonina no TOC é inquestionável, então os futuros estudos devem ser direcionados para o esclarecimento dos subtipos de receptores de serotonina e de mensageiros secundários na transdução do sinal, assim como das interações entre a serotonina e outros neurotransmissores. Transtorno obsessivo-compulsivo. Agentes serotoninérgicos. Inibidores da captação de serotonina. Psicofarmacologia. Receptores de serotonina. Transdução de sinal. Abstract Keywords Resumo Descritore

Pain and psychiatry: a critical analysis and pharmacological review

Pain is one of the most difficult medical problems to diagnose and treat and can be a common symptom of several psychiatric disorders. Pain-related issues are heterogeneous and often underestimated or misinterpreted, with the result that psychiatric interventions, which might have been beneficial from the outset, are often delayed or requested only as a last measure. Several problems arise from the definition, classification and assessment of pain, when documented according to the different scales which are commonly used, since these attempt to cover a multitude of analytical requirements, without really succeeding. An area of constant debate regards the connection between pain and various psychiatric disorders, and the difficulty in the classification of pain disorders within the currently existing framework. The pharmacological treatment of pain is complex and implies a variety of different compounds, from opioids to psychotropic medications like antidepressants and anticonvulsivants. This paper explores the mutual and reciprocal influence between pain and psychiatric disorders reviewing the latest developments in the definition, assessment and treatment of pain, with special emphasis on the impact of pain on psychiatric disorders (and vice versa), and on the use of psychotropic drugs in the treatment of pain syndromes

Type 2 Diabetes Mellitus, Platelet Activation and Alzheimer's Disease: A Possible Connection

: Type 2 diabetes mellitus DM (T2DM) is associated with a 70% increased risk for dementia, including Alzheimer's disease (AD). Insulin resistance has been proposed to play a pivotal role in both T2DM and AD and the concept of "brain insulin resistance" has been suggested as an interpretation to the growing literature regarding cognitive impairment and T2DM. Subjects with T2DM present an abnormal platelet reactivity that together with insulin resistance, hyperglycaemia and dyslipidaemia effect the vascular wall by a series of events including endothelial dysfunction, oxidative stress and low-grade inflammation. Activated platelets directly contribute to cerebral amyloid angiopathy (CAA) by promoting the formation of β-amyloid (Aβ) aggregates and that Aβ, in turn, activates platelets, creating a feed-forward loop suggesting the involvement of platelets in the AD pathogenesis. Moreover, islet amyloid polypeptide deposition, co-localized with Aβ deposits, is a common finding in the brain of patients with T2DM. These observations raise the intriguing prospect that traditional or novel antiplatelet therapeutic strategies may alleviate fibril formation and could be used in the prevention or treatment of AD subjects with diabetes