CAN GUT MICROBES PLAY A ROLE IN MENTAL DISORDERS AND THEIR TREATMENT?

The gut microbes, collectively called microbiota, are linked to the brain through a bidirectional system that involves the vagus nerve, the immune system, and various neurotransmitters. Stress response, memory functions, social behavior, and mood are modulated by microbiota. Furthermore, microbiota play a role in the development of the central nervous system. These features, established largely in rodent studies, have informed hypotheses about the role of microbiota in human psychiatric disorders. Microbiota affect phenomena that are known to be parts of the depression phenotype, such as exaggerated response to stress and inflammatory features. Furthermore, the role of microbiota in neurodevelopment and in the modulation of social behavior suggests the possibility of its role in autism spectrum disorder and in schizophrenia. If altered, microbiota play a role in psychiatric disorders, then efforts to normalize the gut microbial population by the ingestion of probiotics (live bacteria) could have antidepresssant or antipsychotic effects. Testing such hypotheses in translational human studies is a matter of future research

SUICIDE IN BIPOLAR DISORDER: A REVIEW

Background: Suicide is a leading cause of death in patients with bipolar disorder. Risk factors and prevention of suicide in this illness are the focus of considerable current research. Methods: MEDLINE data base was searched for the key words “bipolar disorder” with “suicide”, "lithium" with "suicide", "anticonvulsants" with "bipolar disorder", and "anticonvulsants" with "bipolar disorder" and with "suicide". No language or time constraints were applied. The lists of references were searched manually to find additional articles. Results: It is estimated that 25% to 50% of patients with bipolar disorder will attempt suicide at least once over their lifetime, and that 8% to 19% will complete suicide. Mortality rates from cardiovascular diseases are elevated in bipolar disorder. Risk factors for suicide include younger age of onset of the illness, history of past suicidal behavior, family history of suicide acts, comorbid borderline personality disorder and substance use disorders, and hopelessness. The warning signs calling for immediate action include the patients threatening to harm themselves, or looking for ways to kill themselves (seeking access to pills or weapons), or the patient talking or writing about death. Robust evidence supports the effects of lithium treatment in reducing suicidal attempts and completions in bipolar disorder. The evidence for antisuicidal effects of anticonvulsants is weaker. Nevertheless, valproate and other anticonvulsants are frequently prescribed as mood stabilizers. There have been controversial suggestions that this treatment may elevate the risk of suicide, but the data supporting this are not convincing. Psychoeducation can reduce the number of suicide attempts and completions. Conclusions: Suicide in bipolar disorder is a major public health problem. Recent research has expanded our knowledge of risk factors and warning signs. Nevertheless, it appears that the introduction of lithium treatment in the 1970s was the most recent important breakthrough in the prevention of suicide in this illness

Socratic dialogue and guided discovery in cognitive behavioral supervision

Abstract Supervision comprises systematic cooperation between the supervisor and supervisee in the form of a dialogue held in a secure, open and innovative manner. Cognitive behavioural therapy supervision is based on the same principles as therapy. To find associations, the supervisor uses guided discovery in which the supervisee may realize what he or she has not thought of and his or her understanding of the patient becomes deeper or may even change substantially. During the conversation, the supervisor uses questions to help the supervisee understand a wider context of case conceptualization, clarify adequate processes in treatment and realize transference and countertransference phenomena. The article presents several supervisor-supervisee conversations to demonstrate Socratic dialogue in supervision

Problems in Cognitive-Behavioral Supervision : Theoretical Background and Clinical Application

Cognitive-behavioural therapists and trainees are encouraged to undergo supervision when offering therapy to troubled clients and to process personal attitudes and events likely to affect their therapeutic work. We discuss common problems in cognitive behavioural therapy (CBT) supervision, which may arise at the client, supervisee, or supervisor level. These issues include difficulties with case formulation, therapeutic strategies, and the therapeutic relationship. A supervisor can help their supervisee deal with clients with multifaceted or particularly challenging problems, such as difficulties with compliance, complex psychosocial problems, or chronic mental disorders. We also discuss matters related to the supervision process, the supervisor's role, different supervisory styles, and issues affecting a supervisee's feelings of vulnerability and shame. Furthermore, we analyze distinct supervision styles and potential problems arising from the supervision of experienced CBT therapists.Peer reviewe

Chairwork in cognitive behavioral therapy and schema therapy : Options in practice

Chairwork is a creative and emotionally charged technique that enhances therapeutic progress. It is based on the assumption that if individuals become aware and express their inner beliefs or conflicts, it would help them understand and choose solutions more freely than if they act unaware and automatically. When used within the conceptualization of the client's problems, it can liberate clients' intense emotional pain and change their maladaptive cognitions. This article shares the clinical experience using the chair techniques by describing and illustrating typical examples of chairwork in cognitive behavioural and schema therapy. Additional recommendations on how to do chairwork and consider the pace, tone of voice, or location of the chairs are also provided.publishersversionPeer reviewe