Novel Pharmacotherapeutics for Stress-Related Disorders

2019 ◽  
pp. 642-672
Author(s):  
Jamie E. Mondello ◽  
Jenny E. Pak ◽  
Dennis F. Lovelock ◽  
Terrence Deak
Keyword(s):  
Mental Health Problems ◽  
Drug Efficacy ◽  
Careful Consideration ◽  
Pharmacological Intervention ◽  
Pharmacological Interventions ◽  
Diverse Range ◽  
Disease States ◽  
Efficacy Trials ◽  
Participant Selection ◽  
The Relationship

Most mental health problems associated with psychological distress originate with activation of centrally regulated stress pathways, yet a diverse range of central nervous system and somatic disease states can be influenced by exposure to severe or unrelenting stress. The goal of this chapter is to provide a conceptual framework to guide the development of pharmacological intervention strategies. We propose that careful consideration of the relationship between the timing of stressful life experiences, pharmacological intervention, and the ultimate expression of disease symptomatology is critical for the development of pharmacological interventions to treat stress-related disorders. We review a range of physiological systems that are known to be activated by stress, offering potentially new targets for drug development efforts, and argue that participant selection is a key predictor of drug efficacy trials. In doing so, we point toward inflammatory signaling pathways as a potential final common mediator of multiple stress-related disease states.

Delirium

2020 ◽  
pp. 425-436
Author(s):  
David Meagher ◽  
Cara Daly ◽  
Dimitrios Adamis
Keyword(s):  
Antipsychotic Agents ◽  
Careful Consideration ◽  
Cognitive Testing ◽  
Everyday Practice ◽  
Pharmacological Intervention ◽  
Careful Attention ◽  
Healthcare Outcomes ◽  
Underlying Causes ◽  
The Relationship

Delirium is a common, complex neuropsychiatric syndrome that occurs in approximately one in five hospitalized patients. It is associated with a range of adverse healthcare outcomes that are independently predicted by the severity and duration of delirium. Typically 50% or more of cases of delirium are missed, misdiagnosed, or diagnosed late in everyday practice. However, routine systematic cognitive testing aligned to formal screening for delirium in high-risk cases can improve detection in everyday practice. The relationship between delirium and dementia is complex; dementia is a potent risk factor for delirium and 50% of delirium occurs in the context of a pre-existing dementia, but evidence also indicates that the occurrence of delirium can accelerate the course of dementia and that many cases of delirium are followed by long-term cognitive impairment. Delirium is highly preventable, with a third of cases avoidable by addressing a variety of patient, illness, and treatment factors. Treatment of incident delirium requires careful consideration of underlying causes, aggravating environmental factors, and prudent use of pharmacological strategies, with antipsychotic agents the preferred pharmacological intervention. Careful attention to post-delirium care can minimize functional loss, address any psychological sequelae, and reduce the risk of further episodes.

Physicians’ practice and familiarity with treatment for agitation associated with dementia in Israeli nursing homes

2012 ◽  
Vol 25 (2) ◽  
pp. 236-244 ◽  
Author(s):  
Jiska Cohen-Mansfield ◽  
Atarah Juravel-Jaffe ◽  
Aaron Cohen ◽  
Iris Rasooly ◽  
Hava Golander
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Pharmacological Treatment ◽  
Psychotropic Medications ◽  
Actual Practice ◽  
Pharmacological Intervention ◽  
Personal Interview ◽  
Pharmacological Interventions ◽  
The Relationship ◽  
Current Guidelines

ABSTRACTBackground: To clarify physicians’ actual practice in treating agitation in the nursing home and to elucidate the relationship between background factors, familiarity with interventions, and practice.Methods: A survey of actual practice for agitation in persons with dementia was administered to 67 physicians aged 31–70+ working in nursing homes in Israel. Questionnaires were administered by personal interview, self-completed, or a combination of the two.Results: Psychotropic medications are prescribed by 92.5% of physicians for treating agitation, most notably, Haloperidol (39%). Non-pharmacological treatment was also reported to be common, though to a lesser extent, with environmental change being the most prevalent non-pharmacological intervention. Generally, physicians showed low familiarity levels with non-pharmacological interventions, with higher levels noted for physicians with a specialty in geriatrics compared to those who were non-specialized. Physicians who were non-Israeli and younger also reported higher familiarity levels compared to their respective counterparts (i.e. Israeli and older) but this difference did not reach significance.Conclusion: The findings indicate that, despite current guidelines, psychotropic medications are the treatment of choice among nursing home physicians in Israel. While rates of use of non-pharmacological interventions are substantial, their in-practice application may be hindered by lack of familiarity as well as system barriers. The results have implications for system and education changes.

Moderating Role of Gender in the Relationship between Cognitive Errors and Anxiety among Adolescents

2020 ◽  
Vol 4 (1) ◽  
pp. 86-102
Author(s):  
Tasnim Rehna ◽  
Rubina Hanif ◽  
Muhammad Aqeel
Keyword(s):  
Mental Health Problems ◽  
Adolescent Psychopathology ◽  
Future Research ◽  
Cognitive Errors ◽  
Adolescent Anxiety ◽  
Study Results ◽  
The Status ◽  
Manifest Anxiety ◽  
The Relationship

Background: Widespread social paradigms on which the status variances are grounded in any society, gender plays pivotal role in manifestation of mental health problems (Rutter, 2007). A hefty volume of research has addressed the issue in adults nonetheless, little is vividly known about the role of gender in adolescent psychopathology. Sample: A sample of 240 adolescents (125 boys, 115 girls) aging 12-18 years was amassed from various secondary schools of Islamabad with the approval of the Federal Directorate of Education (FDE), relevant authorities of the schools and the adolescents themselves. Instruments: Taylor Manifest Anxiety Scale (Taylor & Spence, 1953) and Children’s Negative Cognitive Errors Questionnaire (CNCEQ) by Leitenberg et al., (1986) were applied in present study. Results: Multiple regression analysis revealed that cognitive errors jointly accounted for 78% of variance in predicting anxiety among adolescents. Findings also exhibited that gender significantly moderated the relationship between cognitive errors and adolescent anxiety. Implications of the findings are discoursed for future research and clinical practice.

Introduction

2018 ◽  
Author(s):  
Gerhard Preyer
Keyword(s):  
Subject Matter ◽  
Diverse Range ◽  
The World ◽  
The Subject ◽  
The Relationship

The study of meaning in language embraces a diverse range of problems and methods. Philosophers think through the relationship between language and the world; linguists document speakers’ knowledge of meaning; psychologists investigate the mechanisms of understanding and production. Up through the early 2000s, these investigations were generally compartmentalized: indeed, researchers often regarded both the subject matter and the methods of other disciplines with skepticism. Since then, however, there has been a sea change in the field, enabling researchers increasingly to synthesize the perspectives of philosophy, linguistics, and psychology and to energize all the fields with rich new intellectual perspectives that facilitate meaningful interchange. One illustration of the trend is the publication of Lepore and Stone’s ...

Attachment to God and Quest as Moderators of the Relationship between Religious Doubt and Mental Health

2021 ◽  
pp. 009164712199240
Author(s):  
Noah S. Love ◽  
Cassidy A. Merlo ◽  
M. Elizabeth Lewis Hall ◽  
Peter C. Hill
Keyword(s):  
Mental Health ◽  
Positive Relationship ◽  
Mental Health Problems ◽  
Negative Relationship ◽  
Health Problems ◽  
Positive Mental Health ◽  
Attachment To God ◽  
Religious Doubt ◽  
Avoidant Attachment ◽  
The Relationship

The present study examined attachment to God and quest as potential moderators of the relationship between religious doubt and mental health. A sample of Christian participants ( N = 235) completed a survey which included measures of attachment to God, quest, religious doubt, and mental health. As hypothesized, attachment to God and quest significantly moderated an individual’s experience of religious doubt. Low avoidant attachment to God (i.e., a more secure attachment) was associated with a more negative relationship between cognitive religious doubt and positive mental health than high avoidant attachment. In contrast, low avoidant attachment to God also ameliorated the positive relationship between affective religious doubt and mental health problems. Low anxious attachment was associated with a stronger negative relationship between both measures of religious doubt (i.e., cognitive and affective) and positive mental health. In addition, high soft quest weakened all four of the relationships between measures of religious doubt and mental health. High hard quest ameliorated the positive relationship between both measures of religious doubt and mental health problems. These results indicate that an individual’s attachment to God and the way an individual is oriented toward religion each play a role in the mental health outcomes associated with religious doubt.

scholarly journals Richness of Rhizosphere Organisms Affects Plant P Nutrition According to P Source and Mobility

Agriculture ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 157
Author(s):  
Jean Trap ◽  
Patricia Mahafaka Ranoarisoa ◽  
Usman Irshad ◽  
Claude Plassard
Keyword(s):  
Careful Consideration ◽  
Soil Conditions ◽  
Organic P ◽  
P Nutrition ◽  
Soil P ◽  
P Acquisition ◽  
Complex Interactions ◽  
Experimental Trials ◽  
The Relationship

Plants evolve complex interactions with diverse soil mutualist organisms to enhance P mobilization from the soil. These strategies are particularly important when P is poorly available. It is still unclear how the soil P source (e.g., mineral P versus recalcitrant organic P) and its mobility in the soil (high or low) affect soil mutualist biological (ectomycorrhizal fungi, bacteria and bacterial-feeding nematodes) richness—plant P acquisition relationships. Using a set of six microcosm experiments conducted in growth chamber across contrasting P situations, we tested the hypothesis that the relationship between the increasing addition of soil mutualist organisms in the rhizosphere of the plant and plant P acquisition depends on P source and mobility. The highest correlation (R2 = 0.70) between plant P acquisition with soil rhizosphere biological richness was found in a high P-sorbing soil amended with an organic P source. In the five other situations, the relationships became significant either in soil conditions, with or without mineral P addition, or when the P source was supplied as organic P in the absence of soil, although with a low correlation coefficient (0.09 < R2 < 0.15). We thus encourage the systematic and careful consideration of the form and mobility of P in the experimental trials that aim to assess the role of biological complexity on plant P nutrition.

scholarly journals Trauma, Sleep and Mental Health Problems in Low-Income Young Adults

2021 ◽  
Vol 18 (3) ◽  
pp. 1145
Author(s):  
Rachel A. Fusco ◽  
Yan Yuan ◽  
Hyunji Lee ◽  
Christina E. Newhill
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Low Income ◽  
Mental Health Problems ◽  
Trauma Exposure ◽  
Health Problems ◽  
Equation Modeling ◽  
Poor Sleep ◽  
Depression And Anxiety ◽  
The Relationship

Low-income young adults are more likely to have exposure to trauma, which increases risk for mental health problems. Although adequate sleep promotes good health, people with histories of trauma are more likely to have sleep problems. The current study explored whether poor sleep mediated the relationship between trauma exposure and mental health. A sample of 143 low-income 18–24-year-old young adults completed depression, anxiety, and trauma exposure measures and wore sleep monitors for four nights. Structural equation modeling (SEM) was used to examine both direct and indirect effects of variables. Results showed that higher trauma exposure was associated with depression and anxiety. Mean sleep hours per night was fewer than six, far below recommended guidelines for optimal health and functioning. Fewer sleep hours partially mediated the relationship between both trauma exposure and depression and anxiety, and the direct effect from trauma remained significant after adjusting for the partial mediation from sleep.

Self-Report Depression Scales in the Elderly: The Relationship between the CES-D and ZUNG

1989 ◽  
Vol 18 (4) ◽  
pp. 325-338 ◽  
Author(s):  
Bruce R. Deforge ◽  
Jeffery Sobal
Keyword(s):  
Mental Health ◽  
Sex Differences ◽  
Mental Health Problems ◽  
Psychological Symptoms ◽  
Somatic Symptoms ◽  
The Elderly ◽  
Self Report ◽  
Common Mental Health Problems ◽  
Depression Scales ◽  
The Relationship

Depression is one of the most common mental health problems in the elderly, but there is little consensus about the best way to assess depression in the aged. The relationship between the CES-D and the ZUNG self-report depression scales was investigated in seventy-eight elderly people with osteoarthritis (mean age 71). The correlation between the scales was r = .69, with the CES-D classifying 15 percent of the participants as depressed, as compared to 6 percent by the ZUNG. Psychological symptoms had the strongest relationship with overall depression scores on both scales. No sex differences were found on psychological items on either scale, but females reported more somatic symptoms on the ZUNG. People over age seventy-four reported more psychological symptoms than their younger counterparts.

scholarly journals Improving the Role and Contribution of Pharmacokinetic Analyses in Antimalarial Drug Clinical Trials

2014 ◽  
Vol 58 (10) ◽  
pp. 5643-5649 ◽  
Author(s):  
Katherine Kay ◽  
Eva Maria Hodel ◽  
Ian M. Hastings
Keyword(s):  
Antimalarial Drug ◽  
Theoretical Data ◽  
Drug Efficacy ◽  
Cost Effective ◽  
Field Studies ◽  
World Health ◽  
Efficacy Trials ◽  
Drug Concentrations ◽  
Health Organization ◽  
Study Designs

ABSTRACTIt is now World Health Organization (WHO) policy that drug concentrations on day 7 be measured as part of routine assessment in antimalarial drug efficacy trials. The rationale is that this single pharmacological measure serves as a simple and practical predictor of treatment outcome for antimalarial drugs with long half-lives. Herein we review theoretical data and field studies and conclude that the day 7 drug concentration (d7c) actually appears to be a poor predictor of therapeutic outcome. This poor predictive capability combined with the fact that many routine antimalarial trials will have few or no failures means that there appears to be little justification for this WHO recommendation. Pharmacological studies have a huge potential to improve antimalarial dosing, and we propose study designs that use more-focused, sophisticated, and cost-effective ways of generating these data than the mass collection of single d7c concentrations.

scholarly journals Quality of care indicators for schizophrenia: determinants of observed variations among Italian Departments of Mental Health. Results from the ETAS DSM study

2016 ◽  
Vol 26 (3) ◽  
pp. 299-313 ◽  
Author(s):  
G. Fantini ◽  
G. Tibaldi ◽  
P. Rucci ◽  
D. Gibertoni ◽  
M. Vezzoli ◽  
...  
Keyword(s):  
Mental Health ◽  
Quality Of Care ◽  
Health Care Professionals ◽  
Treatment Guidelines ◽  
Psychosocial Rehabilitation ◽  
Metabolic Effects ◽  
Administrative Databases ◽  
Pharmacological Intervention ◽  
Pharmacological Interventions

Aims.The primary aim of this study is to analyse the conformance of usual care patterns for persons with schizophrenia to treatment guidelines in three Italian Departments of Mental Health (DMHs). The secondary aim is to examine possible organisational and structural reasons accounting for variations among DMHs.Methods.Within the framework of the Evaluation of Treatment Appropriateness in Schizophrenia (ETAS) project, 20 consensus quality of care indicators were developed. Ten concerned pharmacological treatment and ten encompassed general care and psychosocial rehabilitation interventions. Indicators were calculated using data from a stratified random sample of 458 patients treated at three DMHs located in North-Eastern, North-Western and Southern Italy. Patients’ data were collected by combining information from medical charts and from a survey carried out by the health care professionals in charge of the patients. Data on the structural and organisational characteristics of the DMHs were retrieved from administrative databases. For each indicator, the number and percentage of appropriate interventions with and without moderators were calculated. Appropriateness was defined as the percentage of eligible patients receiving an intervention conformant with guidelines. Moderators, i.e., reasons justifying a discrepancy between the interventions actually provided and that recommended by guidelines were recorded. Indicators based on a sufficient number of eligible patients were further explored in a statistical analysis to compare the performance of the DMHs.Results.In the overall sample, the percentage of inappropriate interventions ranged from 11.1 to 59.3% for non-pharmacological interventions and from 5.9 to 66.8% for pharmacological interventions. Comparisons among DMHs revealed significant variability in appropriateness for the indicators ‘prevention and monitoring of metabolic effects’, ‘psychiatric visits’, ‘psychosocial rehabilitation’, ‘family involvement’ and ‘work’. After adjusting the patient's gender, age and functioning, only the indicators ‘Prevention and monitoring of metabolic effects’, ‘psychiatric visits’ and ‘work’ continued to differ significantly among DMHs. The percentage of patients receiving appropriate integrated care (at least one appropriate non-pharmacological intervention and one pharmacological intervention) was significantly different among the three DMHs and lower than expected.Conclusions.Our results underscore discrepancies among Italian DMHs in indicators that explore key aspects of care of patients with schizophrenia. The use of quality indicators and improved guideline adherence can address suboptimal clinical outcomes, and has the potential to reduce practice variations and narrow the gap between optimal and routine care.

Sign in / Sign up

Export Citation Format

Share Document