Clinical Depression

In order to address the concerns about the potential for the over-diagnosis of and treatment for bipolar disorder in children, a new diagnosis, disruptive mood dysregulation disorder (DMDD) has been recently added to the depressive disorders for children up to 12 years of age in DSM 5. It refers to the presentation of children with persistent irritability and frequent episodes of extreme behavioral dyscontrol. Such children were found to typically develop unipolar depressive disorders or anxiety disorders rather than bipolar disorders as they mature into adolescence and adulthood. Whether this new diagnosis will also lead to a more judicious use of psychotropic medications and increased utilization of behavioral, psychosocial, and family interventions remains to be seen.

Mood disorders represent a major cause of hospitalization in psychiatric ward. We focused on sex differences, therapies and rehospitalization rates/length of stay in inpatients with mood disorders. Rehospitalization is often observed in patients with mental disorders, with rates up to 80%. Socio-demographic features, clinical features and treatment type influence the length of stay. The objective of this study was to assess how the literature findings match everyday clinical practice in an acute psychiatric ward. We performed a retrospective observational study extracting data from our medical records from 1st July 2012 to 1st July 2014. 85 patients were eligible for the study; the overall number of admittances to the ward was 103. We have not found any difference in the rates of Bipolar Disorder between males and females, we failed to find an higher frequency of Depressive disorders in females. In our sample the rates of early readmission is 17.5%. Patients with an involuntary admission included exclusively those with a manic or hypomanic episode; patients with depressive episodes were more likely to have committed a suicide attempt.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by loss of dopamine in the substantia nigra. It is predominantly a motor disorder but has shown to present with psychosis in few cases. Psychotic symptoms result from chronic treatment with few anti- Parkinson’s medications, ranging from depression, delusions to visual hallucinations, eventually progressing to auditory hallucinations in a few cases. Presence of psychotic symptoms with loss of insight is indicative of late stage of Parkinson’s disease and has poor prognosis. Accurate diagnosis of symptoms can be difficult due to significant overlapping clinical presentations which can be an admixture of underlying disease, exacerbation of pre-existing psychiatric illness or iatrogenic. The article below portrays the complex interplay between Parkinson’s disease psychosis, medications and underlying disease process which heralds early identification of the symptoms using diagnostic tools and imaging techniques to improve the health of individuals and the community by “translating” findings into diagnostic tools and medicines. It also highlights the dire need to develop neuroprotective drugs as a mode of primary prevention of psychosis. We cannot underemphasize the need to educate the patient and caregiver to seek medical attention at earliest for prompt identification and application of disease modifying therapies to reduce disability and morbidity associated with it and limit nursing home placements

Neural derived exosomes can be used as a diagnostic marker to screen various psychiatric conditions. These intravenously injected exosomes carry the potential to cross the blood brain barrier and deliver miRNA specifically to neurons, microglia, and oligodendrocytes in the brain, resulting in a specific gene knockdown. MicroRNAs have been identified as markers in depression where miR-16 has been found to be a negative regulator of the serotonin transporter (SERT) through computer analysis. Futhermore, where miR 134 levels in bipolar disorder have been discovered to be inversely correlated with severity of manic symptoms; manipulating expression or activity of miR-219 can prove as a therapeutic tool for schizophrenia. Despite these studies, the exact nature and extent of dysregulation of microRNAs in psychiatric disorders is yet to be determined. To realize the therapeutic potential of MiRNAs in greater depth; efficient, tissue-specific and nonimmunogenic delivery of exosomes must be developed.

Maternal postpartum depression is well recognized by clinicians as one of the psychiatric complication of delivery, conversely paternal postpartum depression or paternal postnatal depression which affects up to 10% -14% of new fathers 6 to 12 months after a child birth is rarely recognized and treated. Without proper diagnosis and prompt treatment paternal postnatal depression could lead to dire consequences including, deterioration in paternal mental health, loss of paternal bonding with the newborn child, which has been associated with long term later child psychiatric complications such as conduct disorders, hyperactivity, anxiety, depression, posttraumatic stress disorder and delays in language acquisition. It can also lead to marital conflicts, stressful family interactions and psychiatric disability leading to potential loss of income, and increase medical care costs. Like major depressive disorders the treatment of paternal postnatal depression may require psychopharmacological treatment typically with selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors. The purpose of this report is to increase clinicians awareness in recognizing and treating paternal postnatal depression as illustrated in a case of a 30 year-old new father who developed paternal postnatal depression and his progress in response to treatment with the first-of-class serotonin partial agonist reuptake inhibitor antidepressant vilazodone which basic pharmacology is summarized.

Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders in childhood which deficits of inattention, hyperactivity and impulsive behavior. Disruptive mood dysregulation disorder is characterized by severe recurrent temper outbursts that are inconsistent with developmental level and manifest verbally or behaviorally. The disorder can co-exist with ADHD and conduct disorder. In treatment of ADHD most common used pharmacological agent is methylphenidate. Atypical antipsychotics (e.g. risperidone, aripiprazole, olanzapine) can be added to treatment in some cases because of unsatisfactory clinical response and comorbidities such as conduct disorder, pervasive developmental disorders, disruptive mood dysregulation disorder, mental retardation. Olanzapine is one of the Food and Drug Administration approved atypical antipsychotics which antagonizing the dopamine (D1, D2, D4), serotonine (5-HT2A, 5-HT2C, 5-HT6), histamine (H1), alpha1- adrenergic and muscarinic (especially M1) receptors. It is used increasingly for the treatment mood disorders, schizophrenia, conduct disorder and pervasive developmental disorders at child and adolescent psychiatry clinics. Studies pointed that olanzapine causes mostly dry mouth, weith gain, increase apetite, sedation and hyperlipidemia. In this article, we report a 8-year-old male patient treated with olanzapine and OROS methylphenidate who have ADHD, disruptive mood dysregulation disorder and conduct disorder. This issue want to get attention that these two psychopharmacologic agent is usable concominantly ADHD and comorbidities.