Treatment-Induced Brain Plasticity in Psychiatric Disorders

In tandem with a better-informed neurobiological model of mental illness, psychiatry has progressively been shaped into its current state of clinical neuroscience. The traditional dichotomy of organic versus endogenous mental disorders has been replaced by the growing recognition that all changes in mental processes are accompanied by changes in structures or functions of the brain. Thus, all psychiatric interventions are deemed to have a biopsychosocial nature, whereby drugs in addition to their effect on the brain have a psychological effect, and psychotherapies beyond their psychological effects may alter the brain. In this view, the ultimate goal of any psychiatric treatment is to induce neural plasticity in a manner that restores the full original function and potential of the injured brain. Herein present chapter gives an insight into how evidence-based treatments achieve their therapeutic effects on the level of cerebral reorganization across a host of psychiatric disorders. The main theme of this work is the posited mechanism of neuroplasticity on neural-systems level for each treatment modality

Paliperidone ER in the Treatment of Borderline Personality Disorder: A Pilot Study of Efficacy and Tolerability

Antipsychotics are recommended for the treatment of impulsive dyscontrol and cognitive perceptual symptoms of borderline personality disorder (BPD). Three reports supported the efficacy of oral risperidone on BPD psychopathology. Paliperidone ER is the metabolite of risperidone with a similar mechanism of action, and its osmotic release reduces plasmatic fluctuations and antidopaminergic effects. The aim of this study is to evaluate efficacy and safety of paliperidone ER in BPD patients. 18 outpatients with a DSM-IV-TR diagnosis of BPD were treated for 12 weeks with paliperidone ER (3–6 mg/day). They were assessed at baseline, week 4, and week 12, using the CGI-Severity item, the BPRS, the HDRS, the HARS, the SOFAS, the BPD Severity Index (BPDSI), and the Barratt Impulsiveness Scale (BIS-11). Adverse events were evaluated with the DOTES. Paliperidone ER was shown to be effective and well tolerated in reducing severity of global symptomatology and specific BPD symptoms, such as impulsive dyscontrol, anger, and cognitive-perceptual disturbances. Results need to be replicated in controlled trials