Self-Management of Depression: Beyond the Medical Model

Self-management is increasingly becoming the standard of care among people with chronic medical conditions. Its application to depression is mostly extrapolated from the paradigms used for nonpsychiatric medical illnesses. Such an approach falls short in addressing strength-based interventions that foster recovery in individuals with depression. This article describes a new paradigm of self-management, which is in line with the recovery model, is patient-centered, and goes beyond amelioration of clinical symptoms.

Cocaine use as a risk factor for ziprasidone-induced acute dystonia

Cocaine use is an under-recognized risk factor of antipsychotic-induced acute dystonia. A case of a patient with psychotic illness and concurrent cocaine use developing acute dystonia with ziprasidone is described.

Insular volumes in first-episode schizophrenia: gender effect

Insula is a multimodal sensory integration region that acts as a gateway between somatosensory areas and limbic structures such as amygdala. Only a handful of region of interest (ROI) studies have suggested insular volume reduction in patients with schizophrenia but none have documented a gender effect on the volume of this structure. The authors used magnetic resonance images to measure insular volumes in previously untreated patients with first-episode schizophrenia (N=30) relative to those of healthy comparison subjects (N=30). Correlations with symptom severity were carried out. Intracranial volume was used as a covariate in the analysis. Female patients (N=15) had significantly reduced right insular volume relative to healthy female comparison subjects (p<0.05). On preliminary analysis, the right and left insular volumes in female patients had significant negative correlations with the positive symptoms scores (p<0.05), but not on correcting for multiple comparisons. Insula is developmentally and phylogenetically a watershed region where the more primitive allocortex transitions into the more developed isocortex. Thus its role as a substrate of neurodevelopmental hypothesis in schizophrenia and the interplay with gender deserves more attention.

Psychotropic drug-induced neutropenia

Psychotropic medications have been known to cause blood dyscrasias, including neutropenia, and since the advent of clozapine, this side effect is now increasingly being recognized. Almost all the major classes of psychotropic medications have been associated with neutropenia. Operational definitions for blood dyscrasias have allowed us to create an epidemiological database on this rare side effect of psychotropic medications. With increased awareness of drug-induced neutropenia among physicians, methods of early detection and treatment of this side effect have also been the focus of recent literature. Another area of active research has been identifying the risk factors and mechanism of drug-induced neutropenia. This article attempts to synthesize our current understanding of psychotropic drug-induced neutropenia and also provide insights into future research in this realm.

Drug-induced catatonia

Catatonia is a heterogeneous syndrome that varies in etiology, presentation, course and sequelae. Initially conceptualized as a subtype of schizophrenia, catatonia is now recognized to occur not only with other psychiatric conditions but also with medical conditions and drug-induced and toxic states. While drug-induced catatonia is now a recognized entity, most studies club it with catatonia due to general medical conditions or organic catatonia, thus precluding any meaningful interpretation of such cases. The literature on drug-induced catatonia mostly draws from scattered case reports. This article attempts to review the available literature in this realm and integrate the information in an attempt to explore the epidemiology, etiology, mechanism and treatment of drug-induced catatonia.

Personality dimensions in first-episode psychoses

OBJECTIVE

The authors compared the patterns and specificity of premorbid personality dimensions in first-episode schizophrenia patients with those in patients with first-episode nonschizophrenia psychoses and healthy comparison subjects.

METHOD

A series of 63 patients with first-episode schizophrenia and related psychotic disorders, 34 patients with first-episode nonschizophrenia psychoses, and 77 healthy comparison subjects were assessed with the Personality Disorder Evaluation, a semistructured interview schedule that measures personality dimensions.

RESULTS

Cluster A as well as cluster C dimensional scores-in particular, the avoidant personality score-were higher for the schizophrenia patients, and cluster B dimensional scores were higher for the patients with nonschizophrenia psychoses. Cluster C dimensional scores, particularly the avoidant personality score, were highly intercorrelated with all cluster A dimensional scores.

CONCLUSIONS

The observed association between avoidant personality and schizophrenia supports the recent literature on the comorbidity of nonspectrum personality disorders in schizophrenia. This association may be related to shared neurodevelopmentally mediated impairments in social cognition in schizophrenia and some cluster C personality dimensions.

Neurobiological basis of ganser syndrome

Ganser syndrome continues to be a rare and widely misunderstood condition. While DSM-IV classifies Ganser syndrome as a dissociative disorder, its etiology continues to be debated. There are episodic reports in the literature of Ganser syndrome in patients with head trauma or strokes. However, the mechanisms by which these cerebral insults lead to Ganser syndrome or other dissociative states are largely unknown.A case of a patient with Ganser syndrome with a prior history of stroke and bifrontal infarcts is described. This case demonstrates how organic pathology may predispose a patient to dissociative states, such as Ganser syndrome. We review the relationship between hyperglutamatergic states, caused by stroke and stress, and dissociative symptoms.Ganser syndrome continues to be a rare and widely misunderstood condition. While DSM-IV classifies Ganser syndrome as a dissociative disorder, its etiology continues to be debated. There are episodic reports in the literature of Ganser syndrome in patients with head trauma or strokes. However, the mechanisms by which these cerebral insults lead to Ganser syndrome or other dissociative states are largely unknown.A case of a patient with Ganser syndrome with a prior history of stroke and bifrontal infarcts is described. This case demonstrates how organic pathology may predispose a patient to dissociative states, such as Ganser syndrome. We review the relationship between hyperglutamatergic states, caused by stroke and stress, and dissociative symptoms.