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Depressive disorders are among the most common psychiatric disorders currently affecting individuals. Yet, available data indicate that fewer than one third of adults with depression obtain appropriate professional treatment. Depression and anxiety disorders frequently co-occur. This type of co-morbidity is associated with higher severity, suicidality, chronicity and treatment resistance. However, available treatment guidelines mainly focus on treatment for singular disorders. The current paper describes diagnostic and treatment issues relevant for adequately addressing patients with depression and an anxiety disorder, using information from both guidelines and a search of recent literature. [ABSTRACT FROM AUTHOR]

Adaptation is a continuous process between the genes of a particular species and its environment. Although a couple of weeks are long enough to adapt to some environmental changes. sometimes several generations are needed to adapt. Rapid and sustained environmental changes, however, exceed the adaptation capacity of species and cause gene-environment discordance. Genomes of individuals, who live at the beginning of such discordance, are adapted to the previous environment and therefore physiological mechanisms of the organism are influenced by this novel circumstance. The disrupted interaction between individual and environment appears as diseases, increased morbidity, and mortality in the phenotype. Diseases of civilizations which are the reflections of gene-environment discordance tend to accumulate into several main groups such as metabolic (e.g., cardiovascular, diabetes, hypertension, obesity and metabolic syndrome), reproductive (male and female infertility), neurodegenerative (e.g., Alzheimer, dementia) and some psychiatric disorders (e.g., major depression, bipolar disorders). In spite of the fact that the pathophysiology of many neuropsychiatric disorders are not well known, since symptoms including sleep and appetite problems, fatigue, loss of libido and concentration as well as metabolic disorders may coexist, it is considered that neuropsychiatric disorders may have a complex neurobiological basis. Some scientists have referred to this situation as a "neuropsychiatric syndrome" or "type II metabolic syndrome". Data obtained from metabolic syndrome studies may be adapted to type II metabolic syndrome to clarify the biological basis of the disease. As seen in metabolic syndrome, the neuropsychiatric syndrome may also develop in a broken physiological infrastructure. Some of the disrupted physiological mechanisms shown in metabolic syndrome may be summarized as the mismanaged autonomic nervous system (ANS), reduced central and peripheral GABA production, and epigenetic perturbations which have recently become very popular. ANS dysregulation is closely related to recent treatment modalities such as vagal nerve stimulation (VNS) and light therapy (LT). Both modalities are based on the re-regulation of an already dysregulated autonomic rhythm. Secretion of melatonin from the pineal gland is one of the effective mechanisms in the regulation of ANS. Since melatonin is only used for the treatment of jet-lag and sleep problems, the range of treatment indications with melatonin has remained limited for years. Nevertheless, central effects of melatonin play an important role in the treatment of depression and similar disorders. Therefore, melatonin has been recently used to treat neuropsychiatric syndrome. Moreover, a severe familial tendency in neuropsychiatric disorders has long been recognised. Even so, no genetic defects (e.g., mutation, deletion and insertion) have been found to explain the familial tendency. Therefore, it was hypothesized that epigenetic inheritance rather than genetic mechanisms may have a role in the pathogenesis of disease and it was proved that epigenetic disruptions play crucial roles in the pathogenesis of neuropsychiatric syndrome. Melatonin, as an impressive epigenetic regulator may have potential in the treatment of some neuropsychiatric disorders. Articles used for current review were published between 1977 and 2008 and obtained from Pubmed database by using keywords including melatonin, agomelatine, autonomic nervous system, and depression. The purpose of this paper is to find out whether there it a gene-environment discordance in the pathogenesis of neuropsychiatric disorders and to discuss the role of ANS and melatonin in these circumstances. [ABSTRACT FROM AUTHOR]

From the earliest description of schizophrenia, amotivational syndrome associated with severe functional impairment is recognised. These symptoms are found to be independent from other symptoms in longitudinal and cross-sectional assesments. The negative symptoms are named as primary or idiopathic if they are present at beginning of the disease or if it is specific to the disease. If they are due to positive symptoms, drug adverse effects or depression they are named as secondary negative symptoms. Treatment approach depends on whether negative symptoms are primary or secondary. Deficit syndrome is described by primary negative symptoms presenting at the beginning of disease, emerging spontaneously and staying stable during the disease course. Recent reports showed that deficit syndrome differ on disease course based on neurocognitive measures, functioning, and structural imaging. The role of negative symptoms in clinical diversity of schizophrenia was aimed to be evaluated in this paper by elobarating negative symptoms in various dimensions such as clinical features, biological measures, quality of life, and response to treatment. [ABSTRACT FROM AUTHOR]

Second generation antipsychotics are widely used in bipolar disorders both for the treatment of acute mood episodes and for maintenance treatment. Aripiprazole has been proposed as a "third generation antipsychotic". Its unique pharmacological properties are different from other second generation antipsychotic agents. Its efficacy in the treatment of schizophrenia has been established. Efficacy of aripiprazole in manic or mixed episodes and maintenance treatment of bipolar disorder have been studied in several doubleblind, randomized, controlled clinical trials in recent years. Few openlabel studies of aripiprazole in the treatment of bipolar depression have been published. In the present paper clinical trials assessing the efficacy of aripiprazole in the treatment of acute mood episodes and maintenance treatment of bipolar disorder are examined and advantages and disadvantages of aripiprazole are reviewed. Clinical trials of aripiprazole for acute mania or mixed episodes reveal that it is effective in remitting manic symptoms and does not trigger a depressive episode. One double-blind, randomized, placebo controlled clinical trial of 100-week aripiprazole monotherapy which is the longest clinical trial among the trials conducted in bipolar disorder with second generation antipsychotics showed that aripiprazole was effective for relapse prevention in bipolar patients. Aripiprazole for bipolar depression needs double-blind, randomized, controlled clinical trials. It is well known that some second generation antipsychotics are associated with metabolic disturbances. Aripiprazole's effect on metabolic parameters is more favorable compared with other second generation antipsychotics. Akathisia and tremor are the most common extrapyramidal side effects of aripiprazole. Patients with bipolar disorder are more vulnerable to aripiprazole induced akathisia than patients with schizophrenia. In conclusion, aripiprazole is effective for acute mania or mixed episode and maintenance treatment in bipolar disorder. Its different side effect profile from other second generation antipsychotics provides an advantageous position in the treatment of bipolar disorder. [ABSTRACT FROM AUTHOR]

Obsessive-compulsive disorder (OCD) is on illness that usually manifests itself in the second or third decade of the life. Onset of OCD after age 70 has been rarely reported in the literature. Late-onset OCD is generally associated with an underlying cerebrovascular disease. The current consensus regarding choice of treatment(s) for idiopathic OCD includes cognitive behavioral therapy and serotonin reuptake inhibitors. However, the effectiveness of cognitive behavioral therapy or medications in cases with obsessive-compulsive symptoms due to general medical conditions has remained unclear. In this paper, an elderly patient who had late-onset obsessions and compulsions following chronic cerebral ischemia is presented with special emphasize made on specific issues about rate-onset OCD cases and the application of standard therapeutic methods to these patients. [ABSTRACT FROM AUTHOR]