Background and Objective: Transcranial direct current stimulation (tDCS) has shown therapeutic efficacy in different psychiatric disorders including depression, attention deficit hyperactivity disorder (ADHD), cognitive functions in healthy subjects have made this technique an interesting research option for developing non-medication techniques for a variety of psychiatric disorders. This paper aimed to comprehensively review the therapeutic applications of tDCS in psychiatric disorders. Method: The databases of PubMed (1985-2018), EMBASE (1985-2018), Web of Sciences (1985- 2018), PsycINFO (1980-2018) and Google Scholar (1980-2018) were searched using the search terms "transcranial direct current stimulation" OR "tDCS" AND "psychiatric disorders" OR “neuropsychiatric disorders” AND "treatment" AND “efficacy”. The retrieved records were screened for the title and abstract by two authors and the relevant papers were reviewed for further details. The applications of tDCS in the disorders with promising outcomes are discussed. Results: TDCS has shown therapeutic effects in different neuropsychiatric disorders such as major depression, attention deficit hyperactivity disorder (ADHD), schizophrenia, Alzheimer disease (AD), tinnitus, obsessive compulsive disorder, hallucinations, and substance abuse. The clinical efficacy for major depression, ADHD, schizophrenia, and tinnitus is more promising. This may be partly because more studies have been conducted on these disorders than the other disorders. For depression tDCS shows treatment efficacy comparable with the first generation antidepressive pharmacological drugs. Anodal tDCS over prefrontal cortex (PFC) was the most used protocol for major depression. The anodal tDCS over frontal cortex and right inferior frontal gyrus show promising therapeutic effects in ADHD. For tinnitus the most frequent used protocols are bifrontal and bilateral tDCS applied over dorsolateral PFC and auditory cortex. Anodal tDCS over frontal cortex particularly LDLPFC and temporal cortex showed therapeutic efficacy in AD. For schizophrenia, tDCS has shown effectiveness in reducing the disease’s symptoms ranging from auditory hallucinations which the effects were the most marked to working memory, learning, negative and cognitive symptoms. The frequently used sites of stimulation were PFC and temporal cortex. Conclusion: The current evidence showed the therapeutic efficacies of tDCS as adjunctive or alternative treatment option for different neuropsychiatric disorders. TDCS due to its safe and cost-effective profile could be developed for symptoms amelioration or at least cognitive enhancement in these disorders. However, further studies with big sample size should be conducted to develop effective protocol for each disorder as well as understanding the mechanisms of action of tDCS in neuropsychiatric disorders. Keywords: Transcranial direct current stimulation, neuropsychiatric disorders, treatment, depression, schizophrenia, ADHD, Alzheimer disease, tinnitus.
Background: Short-term dynamic psychotherapy is a well-established treatment modality. Habib Davanloo, MD was a pioneer in bringing it to the forefront of psychotherapy. Objective: The aim of this paper is to highlight Habib Davanloo’s unique contribution to the field of dynamic psychiatry and psychotherapy by tracing the development of his metapsychological theory of the unconscious, placing it in historical perspective. Method: The origin and development of dynamic psychiatry, from the early work of Mesmer through classical psychoanalysis and contemporary theories will be reviewed. Next, the movement aimed at shortening the course of psychotherapy while maintaining a psychodynamic perspective will be explored. Davanloo’s unique contributions to the field will be elaborated. The development of Davanloo’s metapsychology of the unconscious from his earliest work beginning in the 1960’s and further developed in his technique of “Unlocking the Unconscious” in the 1980’s will be examined. I will then turn to Davanloo’s work in the 1990’s and early 2000’s, which focused on widening the range of patients who could be successfully treated with his technique, and on expanding his training programs. Davanloo’s most recent work in the 2000’s and 2010’s involving Audiovisual Closed Circuit Training Workshops on the Mobilization of the Unconscious, Total Removal of Resistance and Multidimensional Unconscious Structural Change will be reviewed. Conclusion: Davanloo was indeed a pioneer in short-term psychotherapy. He remains at the cutting edge, continuing to shorten the course, increasing the depth and the range of this powerful treatment modality, and developing innovative teaching methods. Keywords: H. Davanloo, short-term dynamic psychotherapy, ISTDP, unlocking the unconscious, mobilization of the unconscious, unconscious structural change.
Background: Davanloo’s ISTDP has been the subject of much focus and attention. He has published extensively on his earlier work. But many of his newer theories and techniques, developed during the last decade in the Montreal Closed Circuit Training Program, have not been disseminated as widely as his original publications. These include his opinions and theories on transference neurosis (and its various presentations), intergenerational transference neurosis, and impairment in the unconscious defensive organization. Objective: This paper is the second of a two-article series on these newer concepts. The first paper focused on definitions and discussions of these concepts. This second paper will now focus on the application of these principles in a case seen in the private practice of one of the authors. Method: The authors have translated (from German into English) several vignettes from a therapeutic interview. The patient is a 17-year-old girl with anorexia nervosa and a complex unconscious. The psychotherapeutic techniques used in each vignette will be underscored and explained in subsequent analyses. Results: Davanloo’s newer principles and techniques will be illustrated and made easy to understand in the case of an adolescent with a complex unconscious. Conclusion: This case was reviewed at the 38th Annual Metapsychology Meeting in Montreal, Canada in October, 2017 and highlights the new discoveries and techniques of this psychotherapeutic modality. Keywords: Unconscious, anorexia nervosa, transference neurosis, intergenerational, ISTDP, Davanloo.
Background: Developing group of recent findings demonstrate that serotonin receptors play a significant pathophysiological role in major depressive disorder (MDD). Objective: This article will briefly review the literature concerning mechanisms of action, brain distribution and localization of 5HT receptor subtypes and their changes in patients with MDD, as reported via neuroimaging, postmortem and genetic studies. Method: Postmortem brain researches, neuroimaging PET studies and genetic polymorphism studies in suicide and depression were examined in order to explore the role of 5-HT receptor subtypes in the neurobiology of major depression as possibly beneficial biomarkers for diagnosis and treatment response in MDD. Results: Reported significant association between Gene polymorphisms of 5-HT receptors including 5-HT1A, 5-HT1B, 5-HT3, 5HT4 and 5HT6 and diagnosis and treatment response in depression suggests these serotonin receptor subtypes as important therapeutic and diagnostic markers for depression. Neuroimaging studies by PET revealed a higher rostrally and lower caudally binding potential of 5-HT1A receptor in the dorsal raphe nucleus in patients with suicidal depression, decreased potential binding of 5-HT1B receptor and elevated binding potential of cortical 5-HT2A receptors. Postmortem studies reported an elevated abundance of 5-HT2A receptors in the prefrontal cortex, altered mRNA encoding editing of 5-HT2C receptors in the prefrontal cortex and higher levels of 5HT4 receptor binding in frontal cortex and caudate nucleus of depressed suicide victims. Conclusion: 5-HT receptors including 5-HT1A, 5-HT1B, 5-HT2A, 5-HT2C, 5-HT3, 5-HT4 and 5-HT6 are involved in the neurobiology of major depression and might be beneficial biomarkers for diagnosis and treatment response in MDD and will help the development of future treatments.
Background: Schizophrenia is a severe and debilitating mental disorder whose cause is still unclear. It is accompanied by cognitive deficits that are commonly attributed to a dysfunction of the frontal and temporal lobes. Recently, compelling experimental evidence has been collected suggesting a role also for the parietal lobe. Parietal lobe integrates sensory information among various modalities and is engaged in a number of cognitive operations. Objective: To review the existent literature on cognitive deficits present in schizophrenia that show suggestive analogies with deficits that follow lesions of the parietal lobe. Results: Analogies between cognitive disorders related to lesions of the parietal region and those related to schizophrenia were found for visuospatial attention, space representation, motor imagery, sense of agency, praxis abilities, and language. Conclusion: Some specific cognitive deficits present in schizophrenia can be attributed to parietal lobe impairment. This view is also supported by neuroimaging studies showing both structural and functional disorders of the parietal lobe in schizophrenia. Furthermore, being parietal areas functionally interconnected with other brain regions, parietal impairment may also contribute to deficits usually attributed to the dysfunction of other brain regions.
Background: Medications can have a wide range of symbolically mediated effects on patients and these effects can be positive or negative. When medications serve conflicting counter-therapeutic goals, action, including deprescribing, may be needed to ameliorate them. Method: Drawing on work with complex, treatment-refractory patients, we have identified strategies to inform and guide practitioners encountering meaning-based counter-therapeutic medication effects. Conclusion: These include the development of an overall diagnosis, a focus on the therapeutic alliance, addressing pathogenic meanings of medications and approaching deprescribing as an interpersonal process.
The term "deprescribing," initially coined in geriatric medicine, describes a process of pharmacologic regimen optimization through reduction or cessation of medications for which benefits no longer outweigh risks. Burgeoning rates of polypharmacy, growing appreciation of long-term adverse effects, and a focus on patient-centered practice present specific indications for deprescribing in psychiatry. A strong therapeutic alliance, appropriate timing, and consideration of the meaning of medication for the patient must accompany the following established elements: review of all medications, identification of medications that could be ceased or reduced, collaborative planning of the deprescribing regimen, and provision of review and support to the patient and caregivers. The authors discuss how deprescribing might be adapted for and implemented in psychiatry, identify potential barriers, and make recommendations for future directions.
Background: Standard guidelines for the management of chronic psychoses recommend the rapid initiation of treatment with antipsychotic medications (APs) and often, indefinite continuation. Ongoing treatment with APs is based primarily on evidence from AP discontinuation studies, which have several crucial flaws. Due to this equivocal evidence for continued treatment with APs and owing to their serious side effects, there is a critical need for considering controlled reduction and/or discontinuation of APs in persons with chronic psychoses. Discussion and Conclusion: Deprescribing has been defined as the systematic process of medication reduction and or discontinuation when current or potential harms outweigh current or potential benefits, taking into account a patient's medical condition, functional status and their values and preferences. In this paper, we utilize the framework of deprescribing to answer the questions of why and how to reduce and/or discontinue treatment with APs. We first approach the complex issue of assessing the risk-benefit ratio of APs by examining the evidence for their continued benefit and their side effects. We emphasize deprescribing as a patient-centered process, using shared-decision making, psychosocial interventions and a flexible approach while prescribing. Finally, we present some of the limitations and challenges of using this approach in AP reduction and discontinuation.
Background: Deprescribing, or the active reduction or elimination of psychiatric medications, requires close collaboration between physician and patient. Purpose: This article outlines the use of shared decision making, peer support, and relapse prevention strategies as key elements of successful deprescribing in people with psychiatric disorders who are interested in decreasing or stopping psychiatric medications. Drawing from existing literature and a recovery oriented care perspective, specific recommendations to create appropriate contexts for deprescribing including collaborative relationships, social support and rehabilitation for example. Conclusion: Deprescribing as an intervention requires care coordination and preplanning to provide the best supports for the person in recovery.
With the growth of polypharmacy across medicine, the concept of deprescribing—reducing or eliminating the use of medication—is gaining traction among prescribers in a range of specialties. Applying this concept to psychiatry is more complex than in other fields of medicine and requires expanding the intervention to include consideration of psychological, social, environmental, and cultural factors. Taking a recovery-oriented and strengths-based approach, this book outlines the need for deprescribing in psychiatry and expands on the intervention to look at barriers and strategies for addressing them, as well as specific considerations for classes of psychotropic medications. The book is explicitly not against the use of medications but instead promotes a rational approach to considering the reduction of medications when indicated and when agreed upon by both prescriber and patient by promoting the use of shared decision-making and working to minimize risk while maximizing quality of life. The book includes learning objectives, self-assessment quizzes, and case examples to support the reader and provide concrete illustrations of implementation. It is geared toward all prescribers of psychiatric medications and is useful as well for patients, family members, and other mental health practitioners interested in learning more about approaches to making the best, most judicious use of psychiatric medications in mental health.
Background and Objective: Transcranial direct current stimulation (tDCS) has shown therapeutic efficacy in different psychiatric disorders including depression, attention deficit hyperactivity disorder (ADHD), cognitive functions in healthy subjects have made this technique an interesting research option for developing non-medication techniques for a variety of psychiatric disorders. This paper aimed to comprehensively review the therapeutic applications of tDCS in psychiatric disorders.Method: The databases of PubMed (1985-2018), EMBASE (1985-2018), Web of Sciences (19852018), PsycINFO (1980-2018) and Google Scholar (1980-2018) were searched using the search terms "transcranial direct current stimulation" OR "tDCS" AND "psychiatric disorders" OR "neuropsychiatric disorders" AND "treatment" AND "efficacy". The retrieved records were screened for the title and abstract by two authors and the relevant papers were reviewed for further details. The applications of tDCS in the disorders with promising outcomes are discussed.Results: TDCS has shown therapeutic effects in different neuropsychiatric disorders such as major depression, attention deficit hyperactivity disorder (ADHD), schizophrenia, Alzheimer disease (AD), tinnitus, obsessive compulsive disorder, hallucinations, and substance abuse. The clinical efficacy for major depression, ADHD, schizophrenia, and tinnitus is more promising. This may be partly because more studies have been conducted on these disorders than the other disorders. For depression tDCS shows treatment efficacy comparable with the first generation antidepressive pharmacological drugs. Anodal tDCS over prefrontal cortex (PFC) was the most used protocol for major depression. The anodal tDCS over frontal cortex and right inferior frontal gyms show promising therapeutic effects in ADHD. For tinnitus the most frequent used protocols are bifrontal and bilateral tDCS applied over dorsolateral PFC and auditory cortex. Anodal tDCS over frontal cortex particularly LDLPFC and temporal cortex showed therapeutic efficacy in AD. For schizophrenia, tDCS has shown effectiveness in reducing the disease's symptoms ranging from auditory hallucinations which the effects were the most marked to working memory, learning, negative and cognitive symptoms. The frequently used sites of stimulation were PFC and temporal cortex.Conclusion: The current evidence showed the therapeutic efficacies of tDCS as adjunctive or alternative treatment option for different neuropsychiatric disorders. TDCS due to its safe and cost-effective profile could be developed for symptoms amelioration or at least cognitive enhancement in these disorders. However, further studies with big sample size should be conducted to develop effective protocol for each disorder as well as understanding the mechanisms of action of tDCS in neuropsychiatric disorders.
Background: Drug abuse is one of the major concerns of human societies. The relapse of abusing drugs is one of the main targets of addiction therapies. Studies in this regard have introduced four basic mechanisms: 1) drug-induced reinforcement 2) cue-induced reinforcement 3) stress-induced reinforcement and 4) negative reinforcement. Objective: In recent studies, cognition has got great interest in addiction research. It has been proposed that prefrontal cortex can reduce the risk of relapse, by influencing cognition. In this review, we are going to discuss the benefit of better cognition in the context of the above four basic mechanisms, not specifically prefrontal cortex. Method: A literature search was conducted in all major indexing databases including Pubmed, Em base and Google Scholar. The included articles were not limited to the time of publication and all relevant articles were used. Results: Our findings suggest that cognition is necessary for controlling drug abuse. Also, it was found that cognition may control relapse to drug abuse by influencing the four basic mechanisms that are responsible for relapse to drugs. Conclusion: Cognition is a necessary factor for controlling drug abuse. It suggested paying special attention to cognition before implementing a plan for treatment of relapse to drug abuse.
Background: Crisis as a topic in mental health is more relevant than ever. There are rapid changes happening in the world, involving politics, education, migration and so on. All these new events have consequences over mental health, at the short and long terms. Objective: Accomplish the need to understand the neuronal mechanisms underlying an illness after a crisis event, as well as a better guidance of the therapeutic intervention. Method: This article is a review of crisis and the consequent illness that it can originate. It consists of a brief presentation of the main contributions of several authors in their theoretical and practical components, from their starting point in the development of Crisis Theory. The review continues in a presentation of the correlations between the perpetuation of crisis and consequent mental illness, describing the known neurocircuitry underlying the anxious and depressive outcomes. The neurobiological connection between crisis and mental illness with psychotherapeutic intervention is discussed. Results: The present neuroscientific data allow the understanding of how the brain can work defining behavior, judgement or decision making. The knowledge of the neurobiology involved is increasingly relevant in this area, as it is in others that involve mental illness. Conclusion: As neuroscience progresses, neurobiology and neurocircuitry can provide the unifying language and the explanation to the processes involved in mental health and disease, permitting the use of psychotherapeutic techniques with more benefits to the patient.
Background and Objective: Preclinical and clinical studies have demonstrated promising therapeutic effects of transcranial direct current stimulation (tDCS) for depressive disorders (DDs). Although food and drug administration has not approved tDCS as a clinical treatment option for DDs, clinical outcomes of the initial studies indicate significant therapeutic efficacy of tDCS which has encouraged further studies to develop this technique as a treatment option for some types of DDs. The present study aims to comprehensively review the therapeutic applications of tDCS in DDs and clinical efficacies of the technique. Method: The databases of PubMed (1980-2018), Web of Sciences (1980-2018), Scopus (1980-2018), CINAIIL (1990-2018), PsycINFO (1990-2018), and Google Scholar (1980-2018) were searched. The searching keywords were "transcranial direct current stimulation" OR "tDCS" AND "depressive disorder" OR "DD" OR "depression" AND "treatment". The clinical trials that assessed the tDCS effects through a cognitive or neurophysiological measure were included in the study. Results: The current evidence shows tDCS, particularly in bifrontal anodal design to be effective in reducing depressive symptoms. In addition to the potential clinical utility and minimal adverse effects of tDCS, it could improve different behavioral and cognitive functions in DDs patients. Furthermore, the interesting clinical importance of tDCS is its therapeutic efficacy for both treatment resistant and non-treatment-resistant patients with mild to moderate depression. Conclusion: The clinical trials and metal analyses showed that tDCS is effective as first-line antidepressants. Further studies are needed to reach the exact dose-response profile of tDCS for DDs as well as to identify the mechanisms of actions of antidepressant effects of tDCS.
Background: Short-term dynamic psychotherapy is a well-established treatment modality. Habib Davanloo, MD was a pioneer in bringing it to the forefront of psychotherapy.Objective: The aim of this paper is to highlight Habib Davanloo's unique contribution to the field of dynamic psychiatry and psychotherapy by tracing the development of his metapsychological theory of the unconscious, placing it in historical perspective.Method: The origin and development of dynamic psychiatry, from the early work of Mesmer through classical psychoanalysis and contemporary theories will be reviewed. Next, the movement aimed at shortening the course of psychotherapy while maintaining a psychodynamic perspective will be explored. Davanloo's unique contributions to the field will be elaborated. The development of Davanloo's metapsychology of the unconscious from his earliest work beginning in the 1960's and further developed in his technique of "Unlocking the Unconscious" in the 1980's will be examined. I will then turn to Davanloo's work in the 1990's and early 2000's, which focused on widening the range of patients who could be successfully treated with his technique, and on expanding his training programs. Davanloo's most recent work in the 2000's and 2010's involving Audiovisual Closed Circuit Training Workshops on the Mobilization of the Unconscious, Total Removal of Resistance and Multidimensional Unconscious Structural Change will be reviewed.Conclusion: Davanloo was indeed a pioneer in short-term psychotherapy. He remains at the cutting edge, continuing to shorten the course, increasing the depth and the range of this powerful treatment modality, and developing innovative teaching methods.
