Promising avenues of therapeutics for bipolar illness

Basic scientific advances in understanding the neuropsychobioloqy of bipolar disorder have given us a multitude of opportunities to explore and exploit new avenues of therapeutics. Pharmacotherapeutic approaches include: neuropeptides (agonists such as thyrotropin-releasing hormone and antagonists such as corticotropin-releasing hormone), neurotrophic factors (especially brain-derived neurotrophic factor), and glutamatergic mechanisms (such as riluzole, ketamine, and antagonists of the NR-2B subunit of the glutamate receptor). Physiological interventions that would offer alternatives to electroconvulsive therapy include: repeated transcranial magnetic stimulation, especially at more intense stimulation parameters; magnetic stimulation therapy (seizures induced more focally by magnetic rather than electrical stimulation with resulting reduced meaning loss); vagal nerve stimulation, and deep brain stimulation. However, these, as well as the panoply of existing treatments, require further intensive investigation to place each of them in the proper therapeutic seguence and combination for the individual patient, based on development of better clinical and biological predictors of response. Large clinical trial networks and development of systematic research in clinical practice settings, such as that featured by the National Cancer institute for cancer chemotherapy, would greatly accelerate the progress in incorporating new, as well as existing, agents into the best treatment strategies. The bipolar disorders, which are increasingly recognized as complex, highly comorbid conditions with a high morbidity and mortality, of which the majority start in childhood and adolescence, are not likely to respond completely to any single new treatment agent, and new public health initiatives and research strategies are needed as much as any new single treatment advance

Prevention of Recurrent Affective Episodes Using Extinction Training in the Reconsolidation Window: A Testable psychotherapeutic strategy.

Stressors may initially precipitate affective episodes, but with sufficient numbers of recurrences, episodes can occur more autonomously. It is postulated the memory engram for these recurrent depressions moves from the conscious representational memory system to the unconscious habit memory system encoded in the striatum. If this were the case, cognitive behavior therapy targeted toward extinction of habit memories could be an effective maneuver for helping reverse the automaticity of affective episode recurrence. Extinction training in the reconsolidation window (which opens about 5 min to 1 h after active memory recall) can revise, reverse, or eliminate the long term memories associated with PTSD and other anxiety disorders and with drug abuse craving. We hypothesize that similar cognitive behavioral work in the reconsolidation window could inhibit stress-induced and spontaneous affective episodes. Some initial formulations of possible therapeutic strategies are presented and discussed, as well as caveats. It is hoped that preliminary exposition of this theoretical approach to recurrences in the affective disorders based on principles dependent on work in the reconsolidation window will lead to more detailed elaboration of the therapeutic maneuvers most likely to be successful and ones that can be specifically tested for their clinical efficacy

It\u27s What\u27s For Lunch: Nectarines, Mushrooms, and Beef - The First Amendment and Compelled Commercial Speech

JAMES WEINSTEIN: Time for dessert, intellectual dessert. It\u27s my great pleasure to introduce and moderate a discussion between two of the nation\u27s most distinguished law professors: Kathleen Sullivan and Robert Post. Any introduction that would do justice to their accomplishments would take up far too much of the short time allotted. So, by way of a very summary and incomplete introduction, Kathleen Sullivan is the Stanley Morrison Professor of Law at Stanford Law School where she served as dean from 1999 to 2004. She is the author of numerous works on various aspects of constitutional law, including, with the late Gerald Gunther, co-author of the leading constitutional case book. Robert Post is the David Boies Professor of Law at Yale Law School and also the author of numerous works on constitutional law, including Constitutional Domains, an extremely influential book on free speech. Despite their wide-ranging interests and accomplishments in other areas of constitutional law, I think it\u27s fair to say that they both have written most extensively on and have a special interest in free speech. Both have written important articles on commercial speech, including, as it turns out, in The Supreme Court Review. And, Robert Post\u27s recent article in that publication is on the subject of today\u27s presentation, compelled commercial speech