International Review of Psychiatry (INT REV PSYCHIATR)

Publications in this journal

• Article: The mental health country profile: background, design and use of a systematic method of appraisal.

  Rachel Jenkins, Walter Gulbinat, Ron Manderscheid, Florence Baingana, Harvey Whiteford, Sudhir Khandelwal, Alberto Minoletti, Malik H Mubbashar, R Srinivasa Murthy, M Parameshvara Deva, F Lieh Mak, Aliko Baba, Clare Townsend, Marc Harrison, Ahmed Mohit
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  ABSTRACT: This article describes the construction and use of a systematic structured method of mental health country situation appraisal, in order to help meet the need for conceptual tools to assist planners and policy makers develop and audit policy and implementation strategies. The tool encompasses the key domains of context, needs, resources, provisions and outcomes, and provides a framework for synthesizing key qualitative and quantitative information, flagging up gaps in knowledge, and for reviewing existing policies. It serves as an enabling tool to alert and inform policy makers, professionals and other key stakeholders about important issues which need to be considered in mental health policy development. It provides detailed country specific information in a systematic format, to facilitate global sharing of experiences of mental health reform and strategies between policy makers and other stakeholders. Lastly, it is designed to be a capacity building tool for local stakeholders to enhance situation appraisal, and multisectorial policy development and implementation.
  International Review of Psychiatry 07/2009; 16(1-2):31-47.
• Article: The International Consortium on Mental Health Policy and Services: objectives, design and project implementation.

  Walter Gulbinat, Ron Manderscheid, Florence Baingana, Rachel Jenkins, Sudhir Khandelwal, Itzhak Levav, F Lieh Mak, John Mayeya, Alberto Minoletti, Malik H Mubbashar, R Srinivasa Murthy, M Parameshvara Deva, Klaas Schilder, Toma Tomov, Aliko Baba, Clare Townsend, Harvey Whiteford
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  ABSTRACT: The concept of the burden of disease, introduced and estimated for a broad range of diseases in the World Bank report of 1993 illustrated that mental and neurological disorders not only entail a higher burden than cancer, but are responsible, in developed and developing countries, for more than 15% of the total burden of all diseases. As a consequence, over the past decade, mental disorders have ranked increasingly highly on the international agenda for health. However, the fact that mental health and nervous system disorders are now high on the international health agenda is by no means a guarantee that the fate of patients suffering from these disorders in developing countries will improve. In most developing countries the treatment gap for mental and neurological disorders is still unacceptably high. To address this problem, an international network of collaborating institutions in low-income countries has been set up. The establishment and the achievements of this network--the International Consortium on Mental Health Policy and Services--are reported. Sixteen institutions in developing countries collaborate (supported by a small number of scientific resource centres in industrialized nations) in projects on applied mental health systems research. Over a two-year period, the network produced the key elements of a national mental health policy; provided tools and methods for assessing a country's current mental health status (context, needs and demands, programmes, services and care and outcomes); established a global network of expertise, i.e., institutions and experts, for use by countries wishing to reform their mental health policy, services and care; and generated guidelines and examples for upgrading mental health policy with due regard to the existing mental health delivery system and demographic, cultural and economic factors.
  International Review of Psychiatry 07/2009; 16(1-2):5-17.
• Article: Genomics and the future of pharmacotherapy in psychiatry.

  Anil K Malhotra, Todd Lencz, Christoph U Correll, John M Kane
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  ABSTRACT: Pharmacogenetic studies of psychotropic drug response have focused on determining the relationship between variation in specific candidate genes and the positive and adverse effects of drug treatment. Preliminary evidence exists for a significant relationship between a promoter region polymorphism in the serotonin transporter gene and antidepressant response, as well as for associations between candidate neurotransmitter receptor genes and second generation antipsychotic drug response. More recent work in schizophrenia has focused on the use of first episode, antipsychotic naïve subjects, which may provide greater study power as suggested by studies examining dopamine receptor genetic variation and clinical response measures. An emerging body of literature suggests that pharmacogenetic strategies may be especially useful in the prediction of drug-induced adverse effects, in particular for the important side effect of antipsychotic-induced weight gain. New developments in genomics, including whole genome genotyping approaches and comprehensive information on genomic variation across populations, coupled with large-scale clinical trials in which DNA collection is routine, now provide the impetus for a next generation of pharmacogenetic studies. These increasingly comprehensive approaches should provide informative data on the genes associated with psychotropic drug response, a critical step towards the ultimate goal of 'personalized' medicine.
  International Review of Psychiatry 11/2007; 19(5):523-30.
• Article: Research, empiricism and clinical practice in low-income countries.

  Mohan Isaac, Prabhat Chand, Pratima Murthy
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  ABSTRACT: Mental health problems are relevant for every country. They are particularly important for low-income countries which face a high burden of illness due to infectious disease, greater socio-economic disparities, and have limited resources for mental health care. There is a great mismatch in the areas of mental health research, practice, policy and services in comparison to developed countries. There have been a few studies that have investigated major mental health problems prevailing in these countries but missed out significant health problems. Studies have tended to be more donor driven and conducted in tertiary centres. The low priority accorded to mental health by the policy makers, scarcity of human resources, lack of culture-specific study instruments, lack of support from scientific journals have been some of the impediments to mental health research in these countries. In addition, lack of community participation and absence of sound mental health policies have deprived the vast majority of the benefit of modern psychiatric treatments. Recently, with increase in collaboration in research, availability of treatment including low-priced psychotropics, and a growing emphasis on the need for mental health policy in some low-income countries, the bleak scenario is expected to change.
  International Review of Psychiatry 11/2007; 19(5):559-71.
• Article: Brain imaging research: does the science serve clinical practice?

  Dean F Wong, Gerhard Gründer, James Robert Brasic
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  ABSTRACT: Brain imaging represents a potent tool to characterize biomarkers, biological traits that are pathognomonic for specific neurological and neuropsychiatric disorders. Positron emission tomography (PET) and single photon emission computed tomography (SPECT) are imaging techniques used to identify alterations in the density and distribution of neurotransmitters, neuroreceptors, and transporters in specific regions of the brains of people with these disorders. Brain imaging research currently facilitates the elucidation of dysfunction of dopamine, serotonin, acetylcholine, and other substances in people with Alzheimer's and Parkinson's diseases, schizophrenia, alcoholism and other substance abuse disorders, attention deficit/hyperactivity disorder, and the syndromes of restless legs, Lesch-Nyhan, Rett, and Tourette. Thus, brain imaging research offers great potential for the diagnosis, treatment, prevention, and cure of neurological and neuropsychiatric disorders. Brain imaging research also facilitates new drug development and helps establish therapeutic doses of novel drugs. In particular, studies of specific receptors, such as the dopamine D2 receptor, before and after the administration of doses of drugs that occupy these D2 receptors, provide the means to determine receptor occupancy. For example, an optimal dose of D2 antagonist antipsychotics produces occupancy of 65% to 80% of D2 receptors, while a greater dose carries a risk of extrapyramidal side effects.
  International Review of Psychiatry 11/2007; 19(5):541-58.
• Article: The use of genetic epidemiology to guide classification in child and adult psychopathology.

  Peter Szatmari, Julie White, Kathleen R Merikangas
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  ABSTRACT: The goal of this paper is to illustrate the application of the tools of genetic epidemiology, particularly the family study method, to inform the classification of psychiatric disorders in adults and children. The first section describes family studies of adults designed to investigate the causes of comorbidity of anxiety and depression. The analysis of familial traits provides stronger evidence for the validity of certain sub-types of anxiety and mood disorders that co-occur within the same individual and within families. The second section presents an example of the use of the family study method to examine the validity of the autism spectrum disorders (ASD). A review of these studies suggests that the most consistently familial traits in ASD are language and communication skills, insistence on sameness and non-verbal IQ. These are also the traits most commonly associated with the differentiation of autism from Asperger disorder and PDDNOS using both cross-sectional and longitudinal studies. From these data, a new classification system of the ASDs is proposed based on these familial traits.
  International Review of Psychiatry 11/2007; 19(5):483-96.
• Article: Clinical trials: bridging the gap between efficacy and effectiveness.

  Colin Depp, Barry D Lebowitz
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  ABSTRACT: The need for clinical psychiatry research to provide practical information to clinicians, families, and consumers has led to the development of new approaches to clinical trials. Efficacy trials, the historical backbone of clinical research, have many shortcomings in delivering practical information to stakeholders. The 'effectiveness' or 'public-health' model of intervention research targets a diverse group of patients across multiple settings that are outside of academic medical centres, with study design and outcomes that are selected on the basis of their potential to produce clinically meaningful information. The National Institute of Mental Health has funded three such clinical trials in recent years, respectively targeting schizophrenia and Alzheimer's disease, depression, and bipolar disorder. Each of these studies has made a major impact, and provided new insights into the challenges of public health orientated trials in psychiatry. In this review, we describe the underlying principles and practical considerations in efficacy and effectiveness-orientated trials.
  International Review of Psychiatry 11/2007; 19(5):531-9.
• Article: Making sense of evidence.

  Alex Cohen, Oye Gureje
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  ABSTRACT: There is a constant stream of information emanating from psychiatric research. The challenge for the clinician to keep abreast of the latest research findings is huge. However, even more daunting is the task of making sense of the sometimes conflicting data. In this paper, we provide some examples of evidence that seemed to have been accepted with relatively little critical examination. We discuss how evidence may look plausible on the surface either because contextual factors have not been considered or because they fit into a pre-determined world view. We argue that, in the end, the process of making sense of evidence is not straightforward and that professional biases and social prejudices often influence decisions.
  International Review of Psychiatry 11/2007; 19(5):583-91.
• Article: Psychiatric epidemiology: challenges and opportunities.

  Ronald C Kessler
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  ABSTRACT: This paper discusses challenges and prospects for increasing the clinical relevance of psychiatric epidemiological research. The discussion begins with a review of the structural determinants of the fact that current psychiatric epidemiological research has less clinical relevance than epidemiological research in other areas of medicine. The discussion then turns to ways in which the focus of psychiatric epidemiological research might be changed to increase its clinical relevance. A review is then presented of recent innovations in community psychiatric epidemiological research that were designed to increase clinical relevance. An argument is then made that the full clinical value of psychiatric epidemiology will only be realized when community epidemiology becomes better integrated with clinical epidemiology and the latter takes on a more prominent role than it currently has in psychiatric research. Existing initiatives to realize an integration of community psychiatric epidemiology with clinical epidemiology are then reviewed. Finally, an agenda is proposed for an expansion of clinical psychiatric epidemiology to include a focus on both naturalistic and quasi-experimental studies of illness course and treatment response in diverse clinical samples.
  International Review of Psychiatry 11/2007; 19(5):509-21.
• Article: From research methods to clinical practice in psychiatry: challenges and opportunities in the developing world.

  Dan J Stein, Soraya Seedat
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  ABSTRACT: Psychiatric disorders are amongst the most prevalent, burdensome, and costly of all medical disorders. Several factors make this an exciting time for research on these conditions; these include relevant advances in (1) nosology and epidemiology; (2) neuroscience, including neurogenetics, molecular neurobiology, cognitive-affective neuroscience, and brain imaging; (3) psychopharmacological and psychotherapeutic interventions; (4) systems research in mental health, including evaluation of evidence and of costs; and (5) patient advocacy and mental health literacy. At the same time, there are important challenges facing psychiatry researchers; these include (1) limitations of current diagnostic systems; (2) problems in attracting talented researchers to neuroscience and in obtaining sufficient funding for the vast amount of needed work; (3) a relative lack of controlled pharmacotherapeutic and psychotherapeutic studies undertaken outside the context of tertiary centres in the developed world; (4) ongoing gaps in systems research, including a relative lack of research on the effects of mental health policy; and (5) stigmatization of mental illness and anti-scientific beliefs in the community. These opportunities and challenges exist in both the developed and the developing world, but their scope may differ qualitatively and quantitatively; here we present a perspective from the developing world. We conclude with a wish list for the way forwards.
  International Review of Psychiatry 11/2007; 19(5):573-81.
• Article: Case identification in psychiatric epidemiology: a review.

  William W Eaton, Alyson L F Hall, Ryan Macdonald, Jodi McKibben
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  ABSTRACT: Psychiatric epidemiologic surveys since 1980 have relied heavily on a small number of survey diagnostic instruments for case ascertainment, which encode reports of respondents to highly structured interview questions delivered by interviewers without clinical training. Many validations of these survey diagnostic instruments have been carried out. This paper reviews the success of the survey diagnostic instruments, for eight diagnostic categories, in validations with a psychiatrist examination as the gold standard. Public databases were searched for potentially relevant publications, of which more than 1000 were located. Tables show sensitivity, specificity, Kappa, sample source and size, survey instrument and validation method. The number of validation studies relevant to the eight disorders ranged from 8 for schizophrenia to 29 for major depressive disorder. Reported sensitivities ranged from zero to 100%, and specificities from 22% to 100%. Results for common mental disorders such as major depressive disorder, alcohol disorder, drug disorder, and agoraphobic disorder are better than for panic disorder, obsessive compulsive disorder, bipolar disorder, and schizophrenia. The validity of case ascertainment in psychiatric epidemiology is still in question.
  International Review of Psychiatry 11/2007; 19(5):497-507.
• Article: Classification for clinical practice: how to make ICD and DSM better able to serve clinicians.

  Michael B First, Drew Westen
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  ABSTRACT: With DSM-V and ICD-11 on the horizon, now is an excellent time to consider options for improving their utility in clinical practice. A prerequisite for determining what can be done to improve their clinical utility is to establish a baseline from which to work. Surprisingly, there is virtually no information available that illuminates how clinicians actually use the DSM-IV and ICD-10 in clinical practice settings. Our first recommendation is for studies to be conducted that examine how the DSM-IV and ICD-10 is being used in the field and then to identify areas in need of improvement. We then propose two new diagnostic approaches to be considered that might significantly improve the system's clinical utility: (1) the addition of clinically useful dimensions (i.e., dimensions for indicating disorder severity, dimensions that cut across various disorders that would quantify symptoms of particular treatment-relevance such as psychosis, and dimensions to measure functioning) and (2) the augmentation of the DSM and ICD operationalized diagnostic criteria with the addition of a prototype-matching system that is likely to more closely conform to the way clinicians think about psychiatric diagnoses.
  International Review of Psychiatry 11/2007; 19(5):473-81.
• Article: Research for clinical practice: focusing on the link.

  Oye Gureje
  International Review of Psychiatry 11/2007; 19(5):469-71.
• Article: The neurobiological underpinnings of risk and conversion in relatives of patients with schizophrenia.

  Heather C Whalley, Jonathan C Harris, Stephen M Lawrie
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  ABSTRACT: Schizophrenia is associated with deficits in many domains of cognitive function, along with structural and functional brain abnormalities, most notably in prefrontal and temporal lobes. In recent years, a number of research groups have turned to the study of relatives of affected individuals with the aim of determining if similar cognitive deficits and brain abnormalities are also found in those with increased genetic vulnerability to the disorder. In this article studies on such individuals are discussed. It is concluded that deficits are generally apparent in relatives, which are similar to but less marked than those seen in patients with schizophrenia. The literature on predictors of conversion in people at genetic high risk is much smaller, but suggests a combination of baseline trait severity and further change in key measures.
  International Review of Psychiatry 09/2007; 19(4):383-97.
• Article: The role of dopamine for the pathophysiology of schizophrenia.

  E M Meisenzahl, G J Schmitt, J Scheuerecker, H-J Möller
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  ABSTRACT: Since decades, experimental approaches and clinical experience have suggested a dopaminergic system's dysregulation playing an important role within the pathophysiology of schizophrenia. This paper summarizes the actual standard of knowledge of the physiological fundamentals and hypothesized dysbalances of the dopamine (DA) system with respect to schizophrenia including interaction with other neurotransmitter systems (glutamate, GABA). The assumed functional role of DA with respect to physiological and illness-associated cognitive performance, especially working memory, reward, and motivation, as it was assessed by fMRI studies, is presented. A third focus concentrates on giving a short survey of SPECT and PET studies measuring the amount of the striatal and extrastriatal DA, the striatal and extrastriatal dopamine D2 receptor, and the dopamine transporter (DAT) comparing first-episode, drug-naïve, treated, and relapsing schizophrenic patients and healthy control persons.
  International Review of Psychiatry 09/2007; 19(4):337-45.
• Article: Neuropsychological functioning and brain structure in schizophrenia.

  Benedicto Crespo-Facorro, Laura Barbadillo, José Maria Pelayo-Terán, José Manuel Rodríguez-Sánchez
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  ABSTRACT: Cognitive deficits are core features of schizophrenia that are already evident at early phases of the illness. The study of specific relationships between cognition and brain structure might provide valuable clues about neural basis of schizophrenia and its phenomenology. The aim of this article was to review the most consistent findings of the studies exploring the relationships between cognitive deficits and brain anomalies in schizophrenia. Besides several important methodological shortcomings to bear in mind before drawing any consistent conclusion from the revised literature, we have attempted to systematically summarize these findings. Thus, this review has revealed that whole brain volume tends to positively correlate with a range of cognitive domains in healthy volunteers and female patients. An association between prefrontal morphological characteristics and general inability to control behaviour seems to be present in schizophrenia patients. Parahippocampal volume is related to semantic cognitive functions. Thalamic anomalies have been associated with executive deficits specifically in patients. Available evidence on the relationship between cognitive functions and cerebellar structure is still contradictory. Nonetheless, a larger cerebellum appears to be associated with higher IQ in controls and in female patients. Enlarged ventricles, including lateral and third ventricles, are associated with deficits in attention, executive and premorbid cognitive functioning in patients. Several of these reported findings seem to be counterintuitive according to neural basis of cognitive functioning drawn from animal, lesion, and functional imaging investigations. Therefore, there is still a great need for more methodologically stringent investigations that would help in the advance of our understanding of the cognition/brain structure relationships in schizophrenia.
  International Review of Psychiatry 09/2007; 19(4):325-36.
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  Article: Pathophysiology of early onset schizophrenia.

  Marinos Kyriakopoulos, Sophia Frangou
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  ABSTRACT: Early onset schizophrenia (with onset before adulthood) represents a rarer and possibly more severe form of the disorder which has received particular attention in the last two decades. Current evidence strongly suggest continuity with adult onset schizophrenia, with phenomenological, cognitive, genetic and neuroimaging data pointing towards similar neurobiological correlates and clinical deficits but worse long term outcome. Future research in early onset cases is likely to increase further our insight into the neurodevelopmental origins of schizophrenia and the complex gene-environment interactions affecting its emergence.
  International Review of Psychiatry 09/2007; 19(4):315-24.
• Article: Can neuroimaging studies help us in understanding the biological causes of schizophrenia?

  Paolo Brambilla, Michele Tansella
  International Review of Psychiatry 09/2007; 19(4):313-4.