On the Differential Diagnosis of Anxious from Nonanxious Major Depression by means of the Hamilton Scales

Objective. Anxious major depressive disorder (A-MDD) is differentially diagnosed from nonanxious MDD (NA-MDD) as MDD with a cut-off score ≥7 on the HAM-D anxiety-somatization factor (ASF). We investigated whether additional HAM-D items discriminate A-MDD from NA-MDD. Moreover, we tested the validity of ASF criterion against HAM-A, gold standard of anxiety severity assessment. Methods. 164 consecutive female middle-aged inpatients, diagnosed as A-MDD () or NA-MDD () by the normative HAM-A score for moderate-to-severe anxiety (≥25), were compared regarding 17-item HAM-D scores. The validity of ASF ≥7 criterion was assessed by receiver-operating characteristics (ROC) analysis. Results. We found medium and large effect size differences between A-MDD and NA-MDD patients in only four out of the six ASF items, as well as in three further HAM-D items, namely, those of agitation, middle insomnia, and delayed insomnia. Furthermore, the ASF cut-off score ≥9 provided the optimal trade-off between sensitivity and specificity for the differential diagnosis between A-MDD and NA-MDD. Conclusion. Additional HAM-D items, beyond those of ASF, discriminate A-MDD from NA-MDD. The ASF ≥7 criterion inflates false positives. A cut-off point ≥9 provides the best trade-off between sensitivity and specificity of the ASF criterion, at least in female middle-aged inpatients

Impact of active distribution networks on transient stability

The increasing penetration of distributed energy resources (DERs) has turned passive distribution networks into active, in turn affecting the dynamic behavior of the system. It is essential to investigate to what extent transmission system dynamics are affected by these changes. This paper aims at identifying the impact of active distribution networks (ADNs) on transient stability. The studies consider two main scenarios. In the first, same initial conditions are considered in an attempt to investigate the effect of ADN dynamics alone. In the second, prefault operating conditions are also varied in a realistic manner through generation of representative daily profiles for load and renewable generation. The impact of fault, ADN, and critical SG location is investigated. In addition, the response of DER control and protection to short and longer faults highlights how different aspects of transient stability are affected

Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report

<p>Abstract</p> <p>Background</p> <p>Type-1 diabetes mellitus (DM) is a lifelong serious condition which often renders the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, risky – especially for acute manic episodes. We present such a case whereby the application of standard anti-manic treatments would have jeopardized a patient whose physical condition was already compromised by DM.</p> <p>Methods</p> <p>We report the case of a 55-year-old female with a history of type-1 DM since the age of 11, and severe ocular and renal vascular complications thereof. While on the waiting list for pancreatic islet cell transplantation, she developed a manic episode that proved recalcitrant to a treatment with gabapentin, lorazepam and quetiapine. Moreover, her mental state affected adversely her already compromised glycemic control, requiring her psychiatric hospitalization. Her psychotropic medication was almost discontinued and replaced by oxcarbazepine (OXC) up to 1800 mg/day for 10 days.</p> <p>Results</p> <p>The patient's mental state improved steadily and on discharge, 3 weeks later, she showed an impressive improvement rate of over 70% on the YMRS. Moreover, she remains normothymic 6 months after discharge, with OXC at 1200 mg/day.</p> <p>Conclusion</p> <p>Standard prescribing guidelines for acute mania recommend a combination of an antipsychotic with lithium or, alternatively, a combination of an antipsychotic with valproate or carbamazepine. However, in our case, administration of lithium was at least relatively contra-indicated because of patient's already compromised renal function. Furthermore, antipsychotics increase glucose levels and thus were also relatively contra-indicated. Moreover, the imminent post-transpantation immunosupressant treatment with immuno-modulating medicines also contra-indicated both valproate and carbamazepine. Despite the severe methodological limitations of case reports in general, the present one suggests that OXC as monotherapy might be both safe and efficacious in the treatment of acute mania in patients with early-onset type-1 DM, whose already compromised physical condition constitutes an absolute or relative contra-indication for the administration of standard treatments, though there are no, as yet, randomized clinical trials attesting to its efficacy unambiguously.</p

On the nature of mental disorder: towards an objectivist account

According to the predominant view within contemporary philosophy of psychiatry, mental disorders involve essentially personal and societal values, and thus, the concept of mental disorder cannot, even in principle, be elucidated in a thoroughly objective manner. Several arguments have been adduced in support of this impossibility thesis. My critical examination of two master arguments advanced to this effect by Derek Bolton and Jerome Wakefield, respectively, raises serious doubts about their soundness. Furthermore, I articulate an alternative, thoroughly objective, though in part normative, framework for the elucidation of the concept of mental disorder. The concepts of mental dysfunction and impairment of basic psychological capacities to satisfy one’s basic needs are the building blocks of this framework. I provide an argument for the objective harmfulness of genuine mental disorders as patterns of mental dysfunctions with objectively negative biotic values, as well as a formally correct definition of the concept of mental disorder. Contrary to the received view, this objective framework allows for the possibility of genuine mental disorders due to adverse social conditions, as well as for quasi-universal mental disorders. I conclude that overall, the project of providing an objective account of the concept of mental disorder is far from impossible, and moreover, that it is, at least in principle, feasible

The epistemological role of empathy in psychopathological diagnosis: a contemporary reassessment of Karl Jaspers’ account

Introduction: In his classic essay &quot; The phenomenological approach to psychopathology&quot;, Karl Jaspers defended the irreducible reality of the &quot; subjective&quot; mental symptoms and stressed the pivotal role of empathy in their diagnostic assessment. However, Jaspers&apos; account of the epistemological role of empathy in psychopathological diagnosis was far from clear: whereas at several places Jaspers claimed that empathy provides a direct access to patients&apos; abnormal mental experiences, at other places he stressed that it did so only indirectly, through a whole battery of their observable clinical indicators. The aim of this paper is to reassess Jaspers&apos; account of the epistemological role of empathy in psychopathological diagnosis .Methods: I examine thoroughly Jaspers&apos; assertions on in the role of empathy in the diagnosis of &quot; subjective&quot; symptoms. Moreover, I explicate briefly the epistemological status of psychopathological diagnostic examination with the aid of the distinction between direct and indirect observation. Results: Diagnostic assessment of &quot; subjective&quot; mental symptoms involves necessarily indirect psychopathological observation. Jaspers&apos; ambiguity is traced to his failure to distinguish clearly between direct and indirect psychopathological observation along with his excessive reliance on empathy. Relatedly, Jaspers&apos; ambiguity is also traced to his conflation of the semantics with the epistemology of psychopathological concepts representing patients&apos; &quot; subjective&quot; mental symptoms. These results apply also to contemporary phenomenological approaches to psychopathological diagnostic examination which maintain that patients&apos; abnormal mental experiences are invariably expressed in their overt behavior. Conclusions: Jaspers was right in stressing that psychopathological concepts of subjective mental symptoms represent patients&apos; genuine abnormal experiences irreducible to concepts representing their associated behavioral manifestations. Moreover, he was right in stressing the importance of the empathic &apos;second person&apos; approach to patients&apos; mental experiences. However, he failed to recognize unambiguously that the epistemological access to patients&apos; mental symptoms, though enormously aided by empathy, remains mainly indirect and thus requires also a &apos;third person&apos; approach to them. Overall then, clinical psychopathological examination requires both a &apos;second&apos; and a &apos;third&apos; person approach, as well as their judicious alternation during the diagnostic interview. Although focused on Jaspers&apos; essay, my critical analysis is also highly relevant to contemporary psychopathological approaches aiming to overcome the serious limitations of currently prevailing systems of diagnostic criteria of mental disorders. © 2014 Oulis; licensee BioMed Central Ltd

Nature and main kinds of psychopathological mechanisms

The paper deals with two central issues in the philosophy of neuroscience and psychiatry, namely those of the nature and the major kinds and types of psychopathological mechanisms. Contrary to a widespread view, I argue that mechanisms are not kinds of systems but kinds of processes unfolding in systems or between systems. More precisely, I argue that psychopathological mechanisms are sets of actions and interactions between brain-systems or circuits as well as between the latter and other systems in one's body and external environment, both physical and social, involved in human psychopathology. According to the kinds of properties of the interacting systems or their component-parts, psychopathological mechanisms may be physical, chemical, biological, psychological, social, or, typically, mixed ones. Furthermore, I focus on two main kinds of psychopathological mechanisms involved in the causation of mental disorders, namely the pathogenetic and pathophysiological ones, stressing the importance of their careful distinction for the integrative understanding of otherwise disparate and apparently incommensurable psychiatric research findings. I illustrate my analysis with an example drawn from contemporary research on the mechanisms of acute psychosis. Finally, I stress the relevance of psychopathological mechanisms to a more scientifi cally-grounded classifi cation of mental disorders

Pregabalin in the Treatment of Alcohol and Benzodiazepines Dependence

We review all available studies on the use of the newer anticonvulsant drug pregabalin (PGB) in the treatment of both alcohol dependence (AD) and benzodiazepine dependence (BD). In AD, the available evidence includes one open-label and one double-blind randomized studies, whereas in BD, only a few case reports and one open-label study are as yet available. In both conditions, PGB was found efficacious with significant improvement in withdrawal symptoms at the dosage ranges of 150-450 mg/day (AD) and 225-900 mg/day (BD). Moreover, its side effects were mild and transient. Despite the limited quality of the studies design, their findings suggest that PGB might constitute a novel efficacious and safe option in the treatment of both AD and BD

Pregabalin augmentation in treatment-resistant obsessive-compulsive disorder

The therapeutic limitations of mainstay psychopharmacological treatments of obsessive-compulsive disorder (OCD) warrant the clinical testing of further add-on agents to improve patients’ clinical symptoms. One such agent might be pregabalin, which has been found efficacious in other anxiety disorders. We report on the findings of a small, 8-week open-label trial of adjunctive pregabalin with a 4-week follow-up in 10 OCD patients resistant or only partial responders to a combination of serotonin reuptake inhibitors with atypical antipsychotics. Adjunctive pregabalin at 225-675 mg/d was well tolerated and led to patients’ substantial improvement in their OCD symptoms, as reflected in their scores on the Yale-Brown Obsessive Compulsive Scale. Despite the several limitations of the study, its results suggest that adjunctive pregabalin might be a safe and efficacious new augmentation agent in the treatment of drug-resistant OCD. We hypothesize that pregabalin’s mechanism of action in OCD might consist in its inhibition of glutamatergic neurotransmission. Int Clin Psychopharmacol 26:221-224 (C) 2011 Wolters Kluwer Health | Lippincott Williams &amp; Wilkins