Anxiety Disorders: Mount Sinai School of Medicine

Pallanti S, Quercioli L. · Mount Sinai School of Medicine, New York, New York, USA. · Prog Neuropsychopharmacol Biol Psychiatry. · Pubmed #16503369 No free full text.

Abstract: While controlled trials with SRIs have demonstrated a selective efficacy in obsessive-compulsive disorder (OCD), up to 40-60% of patients do not have a satisfactory outcome. Non-response to treatment in OCD is associated with serious social disability. There are a large number of non-responsive patients, and they are difficult to cluster due to ambiguities in diagnostic criteria, possibility of subtypes and a high rate of comorbidity. Moreover, the findings of current studies of "so-called" non-responsive cases are currently non-generalizable because of the lack of an operational definition of non-response. The result has been that a cumulative body of data on a reasonably homogeneous sample of non-responders has not been developed. The aims of the research in this area are to clarify some of the obstacles in defining stages of response and levels of non-response and, through a comprehensive analysis, to propose a systematic nosology for this rather common condition. Better characterization of which patients respond and do not respond to various treatments will enable more accurate clustering of patients, and help facilitate multisite data collection for future research trials. The authors reviewed also the more recent therapeutic pharmacological and psychological lines for the treatment of refractoriness in OCD.

Simon AB, Gorman JM. · Mount Sinai School of Medicine, Department of Psychiatry, Laboratory of Clinical Psychobiology, New York, New York 10029, USA. · NeuroRx. · Pubmed #16490413 No free full text.

Abstract: Our current psychopharmacological treatments for anxiety disorders evince a number of shortcomings, including troublesome side effects and lack of primary effects. Whereas many new drugs have been developed in the past few decades, most are based on outmoded theories of the pathogenesis of these disorders (i.e., monoamine hypotheses), thus frustrating our ability to create more specific and effective interventions. Recently, however, the neurobiological literature has shown a convergence of findings focusing on the glutamatergic system in anxiety disorders, and the growth of pharmacological tools targeting these receptors has led to the development of novel treatments having anxiolytic effects in humans and animals alike. Additionally, as this system is showing promise as a final common pathway in the pathogenesis of anxiety disorders, we may be able to employ glutamate-specific neuroimaging techniques (e.g., N-acetyl-aspartate, GLX) to both guide treatment decisions and present reliable objective biomarkers for treatment efficacy.

Bartz JA, Hollander E. · Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA. · Prog Neuropsychopharmacol Biol Psychiatry. · Pubmed #16455175 No free full text.

Abstract: Obsessive-compulsive disorder (OCD) is classified as an anxiety disorder in the DSM-IV-TR [American Psychiatric Association, 2000. Diagnostic and statistical manual of mental disorders, Fourth ed., rev. Washington, DC: Author]; however, the notion of a spectrum of obsessive-compulsive (OC) related disorders that is comprised of such disparate disorders as OCD, body dysmorphic disorder, certain eating disorders, pathological gambling, and autism, is gaining acceptance. The fact that these disorders share obsessive-compulsive features and evidence similarities in patient characteristics, course, comorbidity, neurobiology, and treatment response raises the question of whether OCD is best conceptualized as an anxiety or an OC spectrum disorder. This article reviews evidence from comorbidity and family studies, as well as biological evidence related to neurocircuitry, neurotransmitter function, and pharmacologic treatment response that bear on this question. The implications of removing OCD from the anxiety disorders category and moving it to an OC spectrum disorders category, as is being proposed for the DSM-V, is discussed.

Dell'Osso B, Altamura AC, Allen A, Hollander E. · Department of Psychiatry, Compulsive, Impulsive and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY 10029, USA. · CNS Spectr. · Pubmed #16344833 links to  free full text

Abstract: Recent studies on the epidemiology of obsessive-compulsive disorder (OCD) estimate 50 million patients suffer from OCD worldwide, thus making it a global problem. The treatment of OCD has changed substantially over the last 2 decades following the introduction of selective serotonin reuptake inhibitors, which provide symptom improvement in approximately 60% of patients. However, some patients remain resistant to the standard pharmacologic and behavioral treatments. Although some treatment-resistant patients respond to pharmacologic augmentations, others do not, and there is evidence that some of the most severe cases benefit from treatment with neurosurgical interventions. Besides pharmacologic, behavioral, and neurosurgical approaches, different brain stimulation methods-transcranial magnetic stimulation, deep brain stimulation, and electroconvulsive therapy-have been investigated in treatment-resistant patients with OCD. However, available data about the use of these techniques in OCD treatment are quite limited in terms of sample size and study design, given the difficulty in conducting standard blinded trials for these procedures. In addition, none of the mentioned treatments have received Food and Drug Administration approval for the treatment of OCD. Nevertheless, promising findings regarding efficacy, tolerability, and non-invasiveness and/or reversibility of these techniques have increased interest in investigating their use in treatment-resistant OCD.

Dell'Osso B, Allen A, Hollander E. · Compulsive, Impulsive and Anxiety Disorders Program, Department of Psychiatry, Mount Sinai School of Medicine, Box 1230, New York, NY 10029, USA. · Expert Opin Pharmacother. · Pubmed #16316311 No free full text.

Abstract: Fluvoxamine is the selective serotonin re-uptake inhibitor with the largest database in the treatment of obsessive-compulsive disorder, a severe, and often chronic, anxiety disorder associated with substantial impairment in functioning. The selective serotonin re-uptake inhibitors represent a first-line treatment in patients with obsessive-compulsive disorder. These agents work primarily by blocking the re-uptake of serotonin into the presynaptic nerve terminal, which is believed to be mediated by their effects on the serotonin transport system. In the last two decades, the anti-obsessional effect of fluvoxamine has been tested in several double-blind, placebo-controlled and active-comparison studies, demonstrating its superior efficacy over obsessions and compulsions compared with non-serotonergic antidepressants (i.e., desipramine) and equal efficacy to clomipramine (a tricyclic antidepressant with potent serotonin re-uptake inhibition) and other selective serotonin re-uptake inhibitors (paroxetine and citalopram). However, compared with clomipramine, the selective serotonin re-uptake inhibitor fluvoxamine showed fewer side effects and better tolerability. This reflects the poor affinity of this compound for adrenergic, muscarinic, cholinergic or histaminergic receptors.

Bowie CR, Harvey PD. · Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA. · Psychiatr Clin North Am. · Pubmed #16122570 No free full text.

Abstract: Recent findings support and add to earlier findings of cognitive dysfunction in schizophrenia. Deficits across neurocognitive domains such as attention, working memory, language skills, and executive functioning tend to be moderate, with the most pronounced deficits found in verbal learning and memory. All these neurocognitive domains are related to adaptive and social skills, with executive functions and verbal learning and memory showing more variance across more domains than other neuro-cognitive variables. Negative symptoms and neurocognitive domains, although correlated, are distinct and have differential pathways of change with treatment. General psychopathology symptoms, such as depression and anxiety, may become important treatment targets as strategies are developed for translating cognitive enhancement to real-world functional performance.

Yehuda R, Hyman SE. · Department of Psychiatry, Mt. Sinai School of Medicine, New York, NY, USA. · Neuropsychopharmacology. · Pubmed #16012534 links to  free full text

Abstract: Following the recent US experience with terrorism, including bioterrorism, significant biomedical research resources have been appropriately focused on bioterror weapons. Far less research attention has been focused on the behavioral and psychobiological effects of terrorism. Yet, the psychological responses to terrorism exert significant effects on mental and physical health and on society. We present a research agenda, based on a comprehensive review of the literature, to address the troubling gaps in our knowledge about the long-term effects of terrorism on brain, behavior, and physical health, the risk factors for predicting who will be most affected by terrorism, and interventions that might promote resilience at an individual and population level.

Hollander E, Sood E, Pallanti S, Baldini-Rossi N, Baker B. · Department of Psychiatry, Compulsive, Impulsive and Anxiety Disorders Program, Mount Sinai School of Medicine, Box 1230, One Gustave L. Levy Place, New York, NY, USA. · J Gambl Stud. · Pubmed #15789195 No free full text.

Abstract: Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.

Simon A, Gorman J. · Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA. · Psychiatr Clin North Am. · Pubmed #15325486 No free full text.

Abstract: This article focuses on possible psychopharmacological interventions in the immediate post disaster setting. As there is little evidence for the efficacy or effectiveness of such interventions-given the difficulty in performing randomized, double-blind, placebo controlled studies with these populations-the article will delineate the neurobiological basis for pathological sequelae and theoretical drug interventions targeting putative disease mechanisms.

Taylor TL, Chemtob CM. · Child and Adolescent Trauma Recovery Program, Mount Sinai School of Medicine, New York, NY 10028, USA. · Arch Pediatr Adolesc Med. · Pubmed #15289252 links to  free full text

Abstract: BACKGROUND: Despite the expenditure of large sums of public monies to ameliorate the consequences of childhood trauma, little is known about the efficacy of treatment for traumatized children and their families. OBJECTIVE: To review the efficacy of treatment for child and adolescent traumatic stress. DATA SOURCES: An extensive literature search identified 102 studies addressing child and adolescent trauma treatment. STUDY SELECTION: Only 8 studies met the minimal inclusion criteria of (1) using a comparison group and (2) including symptoms of traumatic stress as a treatment outcome. DATA EXTRACTION: These studies are critically evaluated for adherence to standards of good efficacy research using formal criteria of treatment research quality. DATA SYNTHESIS: Treatment for traumatic stress appears to lead to greater improvement than either no treatment or routine community care. CONCLUSIONS: Child and adolescent posttraumatic stress disorder treatment research lags behind both adult posttraumatic stress disorder treatment research and other child treatment research. There is considerable need to establish a programmatic approach to developing evidence-based child trauma treatment. Barriers to conducting child trauma treatment research include sensitivity to the rights of victims and child service models that perceive research as intruding on vulnerable children at critically sensitive points in their development.

Simeon D. · Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA. · CNS Drugs. · Pubmed #15089102 No free full text.

Abstract: Depersonalisation disorder is characterised by prominent depersonalisation and often derealisation, without clinically notable memory or identity disturbances. The disorder has an approximately 1 : 1 gender ratio with onset at around 16 years of age. The course of the disorder is typically long term and often continuous. Mood, anxiety and personality disorders are often comorbid with depersonalisation disorder but none predict symptom severity.The most common immediate precipitants of the disorder are severe stress, depression and panic, and marijuana and hallucinogen ingestion. Depersonalisation disorder has also been associated with childhood interpersonal trauma, in particular emotional maltreatment.Neurochemical findings have suggested possible involvement of serotonergic, endogenous opioid and glutamatergic NMDA pathways. Brain imaging studies in depersonalisation disorder have revealed widespread alterations in metabolic activity in the sensory association cortex, as well as prefrontal hyperactivation and limbic inhibition in response to aversive stimuli. Depersonalisation disorder has also been associated with autonomic blunting and hypothalamic-pituitary-adrenal axis dysregulation.To date, treatment recommendations and guidelines for depersonalisation disorder have not been established. There are few studies assessing the use of pharmacotherapy in this disorder. Medication options that have been reported include clomipramine, fluoxetine, lamotrigine and opioid antagonists. However, it does not appear that any of these agents have a potent anti-dissociative effect. A variety of psychotherapeutic techniques has been used to treat depersonalisation disorder (including trauma-focused therapy and cognitive-behavioural techniques), although again none of these have established efficacy to date. Overall, novel therapeutic approaches are clearly needed to help individuals experiencing this refractory disorder.

Yehuda R. · Bronx VA Medical Center, Mt. Sinai School of Medicine, Bronx, NY, USA. · J Clin Psychiatry. · Pubmed #14728094 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) is a fairly common psychiatric disorder that is associated with a lifetime prevalence of approximately 9% in the United States. In light of recent war and terrorist activity worldwide, it is likely that increased numbers of individuals will be exposed to severe or life-threatening trauma, and the incidence of PTSD may be even higher than previously indicated in epidemiologic studies. PTSD may develop after exposure to a traumatic event in which the individual experienced, witnessed, or was confronted by either actual or threatened loss of life or serious injury. Patients with PTSD often reexperience intrusive recollections of the event in ways that are highly distressing and may be described as reliving the memory. Not surprisingly, symptoms of avoidance are noted because individuals with PTSD often wish to escape recollections (thoughts, feelings, conversations, places) related to the trauma. Patients also experience symptoms of hyperarousal associated with difficulty concentrating or exaggerated startle response. Notably, individuals who develop PTSD represent only a subset of those exposed to trauma. It is of interest why certain individuals are at risk for development of PTSD after traumatic exposure, whereas others appear to be more resilient to the effects of trauma. Studies suggest that previous exposure to trauma and intensity of the response to acute trauma may affect the development of PTSD. In addition, however, neuroendocrine changes, such as lower cortisol levels, also may influence formation and processing of traumatic memories and may be associated with the underlying pathology of PTSD.

Herman SP. · Department of Psychiatry, Division of Child and Adolescent Psychiatry, Mount Sinai School of Medicine, 1300 York Avenue, New York, NY 10021, USA. · Pediatr Clin North Am. · Pubmed #12964702 No free full text.

Abstract: This article provided many situations in which the pediatrician may cross paths (if not swords) with members of the legal profession. It is extremely rare for the doctor to avoid some aspect of the law for an entire career. The article has provided common examples of the pediatrician's possibilities for involvement in the legal system and suggestions for making the experience less anxiety-provoking, and, instead, gratifying. Our American legal system, imperfect though it is, is probably the best and fairest in the world; attorneys and judges should not be considered the enemy. They may look to pediatricians for guidance in difficult cases in which children must be protected. By comprehensively reviewing all documents provided, preparing well, and, most importantly, remaining scrupulously honest throughout the process, a pediatrician has the opportunity to serve the system well, assist children and their families, and even, perhaps, make the system a bit better.

Kaplan A, Hollander E. · Department of Psychiatry, Mount Sinai Scjhool of Medicine, New York, New York 10029, USA. · Psychiatr Serv. · Pubmed #12883138 links to  free full text

Abstract: OBJECTIVE: Obsessive-compulsive disorder is a chronic and often disabling disorder that affects 2 to 3 percent of the U.S. population. Optimal treatment involves a combination of pharmacologic and cognitive-behavioral therapies. Advances in psychopharmacology have led to safe and effective treatments for obsessive-compulsive disorder that provide clinically significant improvement in symptoms. In this article the authors review studies of pharmacologic treatments. METHODS: A MEDLINE search was conducted to identify relevant articles from 1991 to 2002. Double-blind, placebo-controlled studies as well as open-label studies and case reports were included. RESULTS AND DISCUSSION: The serotonin reuptake inhibitors (SRIs), including clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine, have been approved by the U.S. Food and Drug Administration for the treatment of adults with obsessive-compulsive disorder; three of these (clomipramine, fluvoxamine, and sertraline) have been approved for treatment of children and adolescents. Clomipramine and the selective serotonin reuptake inhibitors (SSRIs) are first-line agents. However, 40 to 60 percent of patients with obsessive-compulsive disorder do not respond to adequate treatment trials with SRIs, and agents that alter serotonin receptors and other neurotransmitter systems, such as dopamine, norepinephrine, and second-messenger systems, may play a role in treatment. Treatment options for patients who do not respond to SRIs include switching, augmentation, or novel-agent strategies. Up to two-thirds of patients with obsessive-compulsive disorder have comorbid psychiatric disorders, which may present a challenge in pharmacologic treatment. Major depressive disorder is the most common comorbid condition. Nonpharmacologic invasive techniques may play a role in refractory cases of obsessive-compulsive disorder, but further research is warranted.

Gorman JM. · Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA. · J Clin Psychiatry. · Pubmed #12662131 No free full text.

Abstract: Recent advances in neuroscience and understanding in the etiology of anxiety have led researchers to new targets for treatments that are proving to be at least as effective as benzodiazepines, which have been the traditional treatment for anxiety for over 40 years. The gamma-aminobutyric acid (GABA) system has long been targeted in anxiety interventions via benzodiazepines, but better understanding of its role in anxiety disorders has led to the development of partial benzodiazepine-GABA receptor antagonists and agents that target specific subunits of the GABA-A receptor and that manipulate GABA levels. The recognition that antidepressants are effective in anxiety even in nondepressed patients has caused researchers to develop antianxiety agents that affect the serotonin and norepinephrine systems. Other neurotransmitter systems such as corticotropin-releasing factor and substance P appear to be abnormally regulated in patients with anxiety disorders, so antagonists of these neurotransmitters may prove to be beneficial anxiolytics. Meanwhile, antistress and antianxiety effects through neurogenesis may be possible with the use of agents that decrease glutamate neurotransmission, such as metabotropic glutamate receptor agonists. Finally, the stimulation of neurotrophic factors, such as brain-derived neurotrophic factor, which appears to enhance neurogenesis, may also prove to have anxiolytic effects.

Gorman JM. · Department of Psychiatry, Mt. Sinai School of Medicine, New York, NY 10029, USA. · J Clin Psychiatry. · Pubmed #12625796 No free full text.

Abstract: Generalized anxiety disorder (GAD) is characterized by chronically persistent worry and therefore requires effective long-term treatment. This article reviews the benefits and risks associated with various pharmacologic and psychological therapies to assess their ability to achieve the elimination of GAD symptomatology and restoration of normal function. Psychotherapeutic approaches such as applied relaxation, cognitive therapy, and cognitive-behavioral therapy have all been shown to be effective when used as monotherapies and may be beneficial when used adjunctively. Current effective pharmacotherapies for patients with GAD include anxiolytic benzodiazepines, buspirone, and antidepressants including venlafaxine and paroxetine. Benzodiazepines have long been used to treat anxiety and are particularly appropriate in short-term treatment situations; however, their adverse side-effect profile and their inability to treat depression commonly comorbid with GAD renders them less than ideal in many situations. Buspirone has demonstrated anxiolytic benefits but, like benzodiazepines, shows negligible antidepressant action. Antidepressants like paroxetine and venlafaxine are not only effective antidepressants but also effective anxiolytics, thus implying their special ability to treat GAD and concurrent depression, even over the long-term.

Yehuda R. · Psychiatry Department and Division of Traumatic Stress Studies, Mount Sinai School of Medicine and Bronx Veterans Affairs, NY, USA. · Brain Behav Immun. · Pubmed #12615190 No free full text.

Abstract: Recent studies of hypothalamic-pituitary-adrenal axis alterations in PTSD have demonstrated a specific type of hyperresponsivity of this stress hormonal system characterized by a greater negative feedback inhibition of cortisol, which may paradoxically serve to lower cortisol levels. The occurrence of cancer has been recently described by many investigators as an event that fulfills the DSM-IV criteria for a "traumatic event" that has been demonstrated in some cases to be linked with the subsequent development of PTSD. This review considers the extent to which neuroendocrine alterations observed in PTSD may be useful in understanding cortisol alterations involved in cancer.

Garakani A, Win T, Virk S, Gupta S, Kaplan D, Masand PS. · Department of Psychiatry, Mt. Sinai School of Medicine, New York, NY, USA. · Am J Ther. · Pubmed #12522523 No free full text.

Abstract: Irritable bowel syndrome (IBS), a functional gastrointestinal disorder, is present in 10% to 20% of the U.S. adult population. The syndrome is best defined as chronic abdominal discomfort with changes in stool frequency, consistency, and passage, with associated symptoms such as abdominal bloating or presence of mucus in stools. Several studies have shown that up to 70% to 90% of patients with IBS who seek treatment have psychiatric comorbidity, most notably mood and anxiety disorders. Recent studies have shown a high prevalence of IBS in psychiatric patients who seek treatment, with a prevalence of 19% in schizophrenia, 29% in major depression, and 46% in panic disorder among other disorders. Our article reviews the comorbidity of IBS in psychiatric patients and discusses implications for treatment.

Evers MM, Marin DB. · Mount Sinai School of Medicine, New York, NY, USA. · Geriatrics. · Pubmed #12391798 No free full text.

Abstract: Major depressive disorder (MDD), commonly called depression, is characterized by a collection of psychologic, somatic, physical, behavioral, and cognitive symptoms that interfere with or prevent the execution of normal daily responsibilities and activities (e.g., work, exercise, hobbies, intellectual pursuits). Older persons with MDD are likely to present with weight loss and suicidal ideation or a preoccupation with death. Also common is irritability, anxiety, a change in functional ability, or some combination of these. Pharmacotherapy is an effective intervention for management of MDD symptoms. It can be used in combination with psychotherapy, or as monotherapy in patients who do not respond to psychotherapy and other nondrug interventions.

Wong CM. · Department of Psychiatry, Mount Sinai School of Medicine, Bronx VAMC, OOMH 130 West Kingsbridge Road, Bronx, NY 10468, USA. · Psychiatr Clin North Am. · Pubmed #12136505 No free full text.

Abstract: Exposure to trauma can result in immune dysregulation, and increasing evidence suggests that there are immune alterations associated with post-traumatic stress disorder (PTSD). However, the exact nature of these immune findings in PTSD has not been defined. The study of psychoneuroimmunology in PTSD is relevant not only for understanding the biological underpinnings of this disorder, but also for establishing the nature of the associations between PTSD and other medical and psychiatric illnesses.

Yehuda R. · Psychiatry Department, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA. · Psychiatr Clin North Am. · Pubmed #12136504 No free full text.

Abstract: This article summarizes findings of hypothalamic-pituitary-adrenal axis alterations in post-traumatic stress disorder (PTSD) and evaluates likely reasons for the lack of agreement among published studies. Sources of variance caused by methodologic and interpretative differences are highlighted, but the disparate findings are explained as illustrating a more complex neuroendocrinology of PTSD than has previously been described.

Grossman R, Buchsbaum MS, Yehuda R. · Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. · Psychiatr Clin North Am. · Pubmed #12136503 No free full text.

Abstract: The authors review some of the advances that have been made in understanding the structural, biochemical, and functional neuroanatomy of post-traumatic stress disorder (PTSD). First, the authors review the primary brain regions that had been hypothesized a priori, from the phenomenology and neurobiology of PTSD, to be implicated in the pathophysiology. Next, they review findings from neuroimaging studies of these brain regions in PTSD, and explain the various experimental methods and imaging technologies used in these studies. A broader perspective, including a discussion of additional brain areas that may be involved in PTSD, is synthesized. The authors conclude with a rationale and approach for studies testing sharply defined hypotheses and those using multidisciplinary strategies that integrate neuroimaging data with other cognitive, biologic, and genetic tools to study this complex disorder.

Pallanti S, Hollander E, Bienstock C, Koran L, Leckman J, Marazziti D, Pato M, Stein D, Zohar J, Anonymous00288. · Mount Sinai School of Medicine, New York, NY, USA. · Int J Neuropsychopharmacol. · Pubmed #12135542 No free full text.

Abstract: While controlled trials with SRIs have demonstrated a selective efficacy in obsessive-compulsive disorder (OCD), up to 40-60% of patients do not have a satisfactory outcome. Non-response to treatment in OCD is associated with serious social disability. There are a large number of non-responsive patients, and they are difficult to cluster due to ambiguities in the diagnostic criteria, possibility of subtypes, and a high rate of comorbidity. Moreover, the findings of current studies of so-called 'non-responsive' cases are currently non-generalizable because of the lack of an operational definition of non-response. The result has been that a cumulative body of data on a reasonably homogeneous sample of non-responders has not been developed. The aims of this paper are to clarify some of the obstacles in defining stages of response and levels of non-response and, through a comprehensive analysis, to propose a systematic nosology for this rather common condition. Better characterization of which patients respond and do not respond to various treatments will enable more accurate clustering of patients, and help facilitate multi-site data collection for future research trials.

Katz CL, Pellegrino L, Pandya A, Ng A, DeLisi LE. · Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574, USA. · Psychiatry Res. · Pubmed #12127471 No free full text.

Abstract: Tragic events such as those of September 11, 2001, underscore the increasingly prominent role that psychiatrists play in aiding survivors, emergency workers, and broader communities to cope with disaster. The present review was undertaken to identify whether there exists a scientific basis for the practice of psychiatry in the aftermath of disasters. Most of the extensive literature over the past 30 years suggests that disasters have psychopathological consequences as well as medical and social ones. Pre-existing mood and anxiety disorders, although surprisingly not psychotic illness, appear to be risk factors for further psychopathology after a disaster. Thus, both acute psychopharmacological and psychotherapeutic interventions at disaster sites may prevent long-term sequelae, although their efficacy remains uncertain. Future controlled treatment trials are needed to determine the optimal treatment strategy.

Hollander E, Bienstock CA, Koran LM, Pallanti S, Marazziti D, Rasmussen SA, Ravizza L, Benkelfat C, Saxena S, Greenberg BD, Sasson Y, Zohar J. · Department of Psychiatry, Compulsive, Impulsive, and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY 10029, USA. · J Clin Psychiatry. · Pubmed #12027116 No free full text.

Abstract: Nonresponse to treatment in obsessive-compulsive disorder is common, associated with substantial impairment, and understudied. Little practical advice is available to clinicians on next-step treatment strategies for patients who have not responded well to 2 trials of selective serotonin reuptake inhibitors (SSRIs). Available options include continuation of SSRI treatment, switching to another SSRI or selective serotonin-norepinephrine reuptake inhibitor, augmenting with atypical neuroleptics or cognitive-behavioral therapy, or utilizing novel treatment approaches. The authors synthesize state-of-the-art treatment and give practical advice for clinicians.