David Meagher, MD, PhD
Department of Adult Psychiatry, University Hospital Limerick, Ireland

Disclosure: Dr. Meagher reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest. This article includes discussion of off-label treatment with atypical antipsychotics.


PP: You led a study1 reviewing the current evidence on pharmacotherapy for delirium. How did the need for this type of study became apparent to you and your co-authors?

DM: In 2006, during a gathering at Duke University, a group of delirium researchers from Europe decided to start the European Delirium Association. Very soon afterward, the American Delirium Society was started. These two organizations have served as a hub to attract delirium researchers and to encourage them to collaborate in their efforts. We’ve gone from perhaps a dozen active researchers 15 years ago to between 200–300 researchers today, which is still a relatively small number considering how common delirium is. For example, delirium occurs in 11%–42% of general hospital inpatients.2 We did the first point prevalence study of delirium in hospitals, which we published in the British Medical Journal.3 In that study we tested the longstanding assumption that one out of every five people in hospitals have delirium. Even I didn’t really believe that adage until we did this study, in which we found a delirium prevalence of approximately 18% in the general hospital population. Read >

Stephen I. Deutsch, MD, PhD
Anne Armistead Robinson Endowed Chair in Psychiatry; Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School; Attending Psychiatrist, Sentara Norfolk General Hospital, Norfolk, Va.

Disclosure: Dr. Deutsch has received grant support from the Commonwealth Health Research Board (State of Virginia).


INTRODUCTION

Working memory is the ability to retain information on-line for short periods of time—seconds to minutes—in order to use this information to guide goal-directed behavior, eg, retention of a telephone number long enough to actually make the call. Working memory is commonly referred to as the “mental sketchpad” and is itself composed of component processes that are necessary for maintaining relevant information during encoding, inhibiting encoded information that is irrelevant to the desired goal from entering consciousness, and minimizing interference from distractors or irrelevant information at the time of retrieval when a goal-directed response is chosen, among other processes. Working memory is critical to learning, reasoning, verbal comprehension, and academic and vocational success, so it is perhaps unsurprising that a deficit in working memory—a cognitive deficit—would be likely to contribute to the poorer functional outcomes experienced by many schizophrenia patients.1

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Importance Exposure to trauma increases the risk for developing threat (ie, fear) symptoms, such as reexperiencing and hyperarousal symptoms, and loss (ie, dysphoria) symptoms, such as emotional numbing and depressive symptoms. While preclinical data have implicated the activated dynorphin/κ-opioid receptor (KOR) system in relation to these symptoms, the role of the KOR system in mediating these phenotypes in humans is unknown. Elucidation of molecular targets implicated in threat and loss symptoms is important because it can help inform the development of novel, mechanism-based treatments for trauma-related psychopathology.

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Importance Obesity has emerged as a leading health threat but its biological basis remains insufficiently known, hampering the search for novel treatments. Here, we study oleoylethanolamide, a naturally occurring lipid that has been clearly implicated in weight regulation in animals. However, its role for weight regulation and obesity in humans is still unclear

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Importance Posttraumatic stress disorder (PTSD) appears to increase obesity risk but the pathways by which PTSD leads to weight gain are not known. Identification of the links between PTSD and obesogenic eating behaviors is necessary to clarify this pathway and inform development of obesity prevention strategies in PTSD-affected populations. Objective To determine whether women with PTSD symptoms are more likely to report food addiction, a measure of perceived dependence on food, than women without PTSD symptoms

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Importance Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management.

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Importance It has been observed that suicidal behavior is influenced by sunshine and follows a seasonal pattern. However, seasons bring about changes in several other meteorological factors and a seasonal rhythm in social behavior may also contribute to fluctuations in suicide rates. Objective To investigate the effects of sunshine on suicide incidence that are independent of seasonal variation.

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