BMC Psychiatry, an
open-access journal, has an article on Posttraumatic Stress Disorder (PTSD): Altered
oscillatory brain dynamics after repeated traumatic stress.
This is yet another indication that PTSD has an enduring
The insula, as a site of multimodal
convergence, could play a key role in understanding the pathophysiology
of PTSD, possibly accounting for what has been called posttraumatic
alexithymia, i.e., reduced ability to identify, express and regulate
emotional responses to reminders of traumatic events. Differences in
activity in right frontal areas may indicate a dysfunctional PFC, which
may lead to diminished extinction of conditioned fear and reduced
inhibition of the amygdala.
Medscape (open access, free registration required)
has an update on psychotic depression: Current
Issues in the Classification of Psychotic Major Depression.
It is reprinted from the Schizophrenia Bulletin. I
was particularly interested in the updates onthe cognitive features and
the biological correlates of the condition. They also make a
very good point about the classification, with regard to severity.
This is something that has bugged me for a while. I
think it leads to a clinical problem: psychosis in depression
is easy to overlook, especially when the vegetative symptoms are not so
prominent. They mention that about half of depressed persons
who do not respond to treatment have undetected psychosis.
In the current Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition (DSM-IV) classification of
mood disorders, psychotic depression is described by a severity
dimension specifier for major depressive episode, “severe with
psychotic features.” There is no way to designate a mild or moderate
depression with psychotic features. However, research has shown that
the relationship of severity and psychosis is not that strong.
Annals of General Psychiatry (also open access)has a
review of the treatment of bipolar
of bipolar disorder: a complex treatment for a multi-facet disorder.
In some ways it is disappointing, because of what it leaves
out. But you can’t cram everything into an eight-page paper.
The list of references is longer than the text, so there is a
lot of information there for someone who is looking for more.
For those interested in unusual case histories, the Irish Journal
of Psychological Medicine (open access) has a
Beware – case series of clarithromycin and psychosis.
We describe two case reports presenting
approximately one year apart. These indicate a possible association
between clarithromycin and psychosis. Such an association presents new
challenges for clinicians based in non-psychiatric hospital settings
and primary care physicians.
You have to be on your toes in this business. We’ve all seen
things like that, things that come and go, and you never figure out
what it was all about. Or you do, and it turns out to be
alcohol-related. But an antibiotic? Sure, why not?