{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzp8hd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzp8hd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/8\\\/23\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/8\\\/23\u0022}],\u0022ac\u0022:{\u0022spmdc;14\\\/8\\\/23\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;14\\\/8\\\/23\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses drug therapy in mood disorders, recent developments in anxiety, updates in obsessive-compulsive disorder therapy, as well as neural mechanisms of fear in posttraumatic stress disorder (PTSD).\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychopharmacology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMood Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAnxiety Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychopharmacology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMood Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAnxiety Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EA cadre of researchers from Columbia University Medical Center, New York City, New York, USA, provided a clinical and research update on anxiety, eating, and mood disorders.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDRUG THERAPY OF MOOD DISORDERS\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EPatrick J. McGrath, MD, discussed recent advances in drugs used in the treatment of mood disorder. Selected diagnostic revisions from the recently updated \u003Cem\u003EDiagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)\u003C\/em\u003E has absorbed dysthymia as part of persistent depressive disorder (PDD), which features the absence of mania, hypomania, and cyclothymia. Individuals diagnosed with PDD experience depression more days than not and have two or more of poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, and poor concentration or indecisiveness.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EAn anxious distress modifier has been added to all mood disorders to recognize that this predicts a somewhat poorer response to selective serotonin reuptake inhibitor (SSRI) antidepressants. The \u201cwith anxious distress\u201d modifier features the presence of some or all of five symptoms (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) during the majority of days: mild, two symptoms; moderate, three symptoms; moderate-severe, four or five symptoms; severe, four or five symptoms along with motor agitation.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15856\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15856\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15856\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003ESymptoms of Anxious Distress\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ELevomilnacipran is a new serotonin norepinephrine reuptake inhibitor (SNRI). An enantiomer of milnacipran, it is more pharmacologically active and is a relatively potent inhibitor of the norepinephrine transporter. The interest of this potency is that it may be more effective for some dimensions of depression like attention, working memory, concentration, alertness, energy, and social activity than are medications more selective for serotonin reuptake blockade. The drug is administered for treatment of major depressive disorder at a dose of 20 mg\/day, increased to 40 mg\/day at first and ultimately (if tolerated) to 120 mg\/day in 40-mg increments. Food has no effect on drug absorption.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EVortioxetine is an SSRI with agonist, partial agonist, or antagonist action, depending on the serotonin receptor binding site. Vortioxetine appears to have beneficial effects on cognition according to animal models, which could be advantageous for some patients. The most common adverse effect is nausea (about one-quarter to one-third of users), which is typically mild and occurs in the first week of treatment. The drug is initially given at a dose of 10 mg\/day with subsequent increase to 20 mg\/day if tolerated. Dose-related benefits have been documented. Food has no effect on drug absorption.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ELurasidone is a newly FDA-approved treatment for bipolar depression. Although clearly effective, its tolerability with long-term use is a concern, as are the sedative effect and weight gain. A recent 6-week, randomized, double-blind, placebo-controlled study of lurasidone monotherapy in the treatment of bipolar I depression demonstrated the drug\u0027s efficacy compared with placebo (n= 162), with no dose response evident when using 20 to 60 mg\/day (n=161) and 80 to 120 mg\/day (n=162) [Loebel A et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EInterest is building in the use of ketamine in the relief of depression. Recent results of a two-site, randomized control trial that compared Montgomery-Asberg Depression Rating Scale (MADRS) scores after 24 hours (primary outcome) and for up to 7 days for 47 subjects receiving ketamine and 25 subjects receiving placebo reported that ketamine use met the primary outcome, with the significant improvement persisting to 7 days [Murrough JW et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 2013]. The ketamine-treated subjects also displayed a significantly higher response rate, measured using the MADRS, on Days 1, 2, 3, and 7. Ketamine studies have raised the possibility of developing faster acting, and more effective antidepressant treatments using modulation of glutamate neurotransmission.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EThe Establishing Moderators and Biosignatures of Antidepressant Response for Critical Care study [EMBARC; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01407094\u0026amp;atom=%2Fspmdc%2F14%2F8%2F23.atom\u0022\u003ENCT01407094\u003C\/a\u003E] is now underway, aimed at clarifying the optimal treatment for depression based on individual biology. Its goal is to develop biosignatures of specific antidepressant responses using brain imaging, electrophysiology, and behavioral testing, ultimately to be able to select antidepressant medication treatment rationally rather than through a process of trial and error.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EANXIETY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EFranklin Schneier, MD, reviewed recent developments in anxiety. Fear is an emotion related to an immediate response to an actual threat, and mobilizes the \u201cfight or flight\u201d response. Anxiety is an emotion related to an anticipation of threat, and drives preparative or avoidance strategies. Anxiety is an evolutionary trait that is valuable for survival. But anxiety that is disproportionate or inappropriate to the particular circumstance is the hallmark of anxiety disorder. It is the most common class of psychiatric disorders, with \u0026gt;20% of all individuals being affected in their lifetime. Aside from the human cost, the economic costs are enormous, with estimates of $42 to $47 billion in health care system expenditures, representing 30% and 53% of total and drug expenditures for mental illness, respectively [Ohayon MM. \u003Cem\u003EJ Psychiatr Res\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EThe \u003Cem\u003EDSM-5\u003C\/em\u003E includes the two new anxiety disorders that were previously recognized as disorders occurring only in children: separation anxiety disorder (distress concerning separation from attachment individuals, such as parents, or spouse or child) and selective mutism (failure to speak in certain situations while speaking normally in others).\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EPanic disorder, phobias, and generalized anxiety disorder are anxiety disorders that share a chronologically early onset and often become chronic. These disorders are more prevalent in women by a 2:1 margin. All exact appreciable social and occupation disabilities and can be risk factors for depression, alcohol abuse, and suicide. The good news is that efficacious treatments are available. The bad news is that these treatment options continue to be underutilized.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003ECognitive behavioral therapy (CBT) is an evidence-based psychotherapy that has been adapted to treat specific anxiety disorders. The benefits of CBT can sometimes surpass those attained using medications. Medications used as first-line drugs include selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. There is no evidence of superiority of any particular SSRI or SNRI. Alternatives to SSRIs, based on evidence from randomized controlled trials, are benzodiazepines, buspirone, pregabalin\/gabapentin, tricyclics, \u03b2-blockers, and monoamine oxidase inhibitors although only a subset has specific FDA indications for anxiety disorders.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EOBSESSIVE-COMPULSIVE DISORDER\u003C\/h2\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EAccording to Helen Blair Simpson, MD, PhD, obsessive-compulsive disorder (OCD) is a disabling disorder with a lifetime prevalence of approximately 2% following its onset\u2014half of cases start by age 19, with a quarter starting by the age of 14 [Kessler RC et al. \u003Cem\u003EArch Gen Psychiatry\u003C\/em\u003E 2005]. The onset age is considerably younger than for major depression, for which 50% of cases start by 32 years of age [Kessler RC et al. \u003Cem\u003EArch Gen Psychiatry\u003C\/em\u003E 2005]. OCD is chronic, often with a \u201cwaxing and waning\u201d pattern of occurrence. OCD and obsessive-compulsive personality disorder (OCPD) are both impairing disorders marked by ritualized behaviors but are differentiated by the presence of obsessions in OCD and by excessive capacity to delayreward in OCPD [Pinto A et al. \u003Cem\u003EBiol Psych\u003C\/em\u003E 2014]. Treatments for OCD include the tricyclic antidepressant clomipramine, various SSRIs (including fluoxetine, fluvoxamine, sertraline, paroxetine, Citalopram and escitalopram, all of which are FDA approved for OCD, and Citalopram and escitalopram, which are not FDA approved for OCD), and CBT consisting of exposure and ritual (or response) prevention (EX\/RP). In one study, EX\/RP combined with clomipramine (n=31) and EX\/RP alone (n=29) significantly reduced OCD severity compared with clomipramine alone (n=36) group and the placebo (n=26) group after 12 weeks of treatment [Foa EB et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 2005]. EX\/RP can augment SRIs (ie, clomipramine and the SSRIs), with response rate and rate of symptom remission for EX\/RP augmentation to be 74% (40\/54) and 33% (18\/54), respectively, as compared to augmentation with stress management therapy of 33% (18\/54) and 4% (2\/54), respectively. [Simpson HB et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 2008]. EX\/RP augmentation of SSRIs was also superior to antipsychotic augmentation with risperidone (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Simpson HB et al. \u003Cem\u003EJAMA Psychiatry\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/8\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Augmenting SRIs: EX\/RP and Antipsychotics\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-578899313\u0022 data-figure-caption=\u0022Augmenting SRIs: EX\/RP and Antipsychotics\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/8\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/8\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/8\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15854\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EAugmenting SRIs: EX\/RP and Antipsychotics\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EEX\/RP=exposure and ritual prevention; OCD=obsessive-compulsive disorder; SRI=serotonin reuptake inhibitor; Y-BOCS=Yale-Brown Obsessive Compulsive Scale.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Simpson HB et al. Cognitive-Behavioral Therapy vs Risperidone for Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder: A Randomized Clinical Trial. \u003Cem\u003EJAMA\u003C\/em\u003E Psychiatry 2013;70(11):1190\u20131199. With permission from the American Medical Society.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EFor the patients of tomorrow, development of novel treatments, such as ketamine [Rodriguez CI et al. \u003Cem\u003ENeuropsychopharmacology\u003C\/em\u003E 2013], based on a better understanding of the underlying brain mechanisms, should lead to identification of new treatment targets.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPOSTTRAUMATIC STRESS DISORDER\u003C\/h2\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EYuval Neria, PhD, discussed neural mechanisms of fear in posttraumatic stress disorder (PTSD). Traumatic events are common, with more than half of American men and women experiencing at least one such event in their lives. Yet, only a minority develops persistent PTSD, which has prompted the hypothesis that PTSD involves a failure of neural mechanisms of recovery [Yehuda R, LeDoux JE. \u003Cem\u003ENeuron\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EEfforts to clarify these neural mechanisms are utilizing functional magnetic resonance imaging, skin conductance response, and clinical assessments. The ultimate goal is to identify neural predictors of treatment response. PTSD research is focusing on the early neural events in fear conditioning, late extinction, and extinction recall [Amstadter AB et al. \u003Cem\u003EPsychiatr Ann\u003C\/em\u003E 2009]. Emerging data suggest that deficits in the ability to recall extinction memory are associated with PTSD and fear circuitry, including the hippocampus and ventromedial cortex [Milad MR et al. \u003Cem\u003EBiol Psychiatry\u003C\/em\u003E 2009; Shvil E et al. \u003Cem\u003ENeurobiol Learn Mem\u003C\/em\u003E 2014]. Whether deficits in extinction recall can be reversed and relevant psychotherapy is appropriate to induce changes in brain functioning are open questions.\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EIn prolonged exposure (PE) therapy, a patient\u0027s recollection of the traumatic event provides the springboard for assembling a list of activities that are better avoided or that provoke stress. Such an extinction-based approach may help a patient overcome the trauma of past events, which, in the brain, could involve reversal of dysfunctional circuitry in locations that perhaps include the prefrontal context and hippocampus that elicits the fear. Preliminary findings from a National Institute of Mental Health study (Yuval Neria, primary investigator) suggest that patients who clinically responded to PE therapy exhibited substantial improvement in their capacity to recall fear extinction, demonstrating enhanced activation of circuits involved in top-down control of fear processing including the hippocampus and the venro medial prefrontal cortex.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/8\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp8hd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp8hd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp8hd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}