Strong, silent and stigmatized

The global lifetime prevalence rate of all image and performance enhancing drugs (IPED) is unknown, however it is 6.4% in men an 1.6% in women for anabolic androgenic steroids [1]. IPED are widely used in the bodybuilding scene and have found a bigger audience through social media platforms. Risk groups for IPED use are young men, leisure athletes, general gym goers, elite athletes and bodybuilders. The main drivers for IPED use are increased muscularity and performance. Abuse of performance enhancing drugs in elite sports (doping) is well recognized, however IPED abuse is a public health problem that is often overlooked and should be addressed by the medical community.

Who Are the Stalking Victims? Exploring the Victimization Experiences and Psychosocial Characteristics of Young Male and Female Adults in Hong Kong

Most stalking studies are conducted in the West. Limited information is available on victims of stalking from the Asian continent. This study specifically explored the victimization experiences of young male and female adults in Hong Kong. Using a large sample of university students ( N = 2,496) aged between 18 and 40 years, the gender distribution of stalking incident characteristics was examined, along with prevalence of various stalking behaviors, and victim–offender relationships by types of stalking behaviors. The differential role of demographic and psychosocial characteristics in stalking victimization experience was also explored. The lifetime prevalence rate of stalking victimization was 8.2%, with a higher estimate in females than males (11.6% vs. 3.8%). The sample analyzed in this study was 196 stalking victims. Although surveillance-oriented behaviors were most frequently reported by both males and females, significant gender differences in types of stalking behaviors were noted. Multivariate analyses indicated that increases in age and levels of self-esteem were correlated with an increased probability of experiencing stalking victimization, while being a male and higher levels of life satisfaction were related to a lower likelihood of falling prey to stalking victimization. This study concludes with a call for anti-stalking legislation in Hong Kong given the devastating nature and consequences of stalking victimization.

Neuromodulation Strategies in Post-Traumatic Stress Disorder: From Preclinical Models to Clinical Applications

Post-traumatic stress disorder (PTSD) is an often debilitating disease with a lifetime prevalence rate between 5–8%. In war veterans, these numbers are even higher, reaching approximately 10% to 25%. Although most patients benefit from the use of medications and psychotherapy, approximately 20% to 30% do not have an adequate response to conventional treatments. Neuromodulation strategies have been investigated for various psychiatric disorders with promising results, and may represent an important treatment option for individuals with difficult-to-treat forms of PTSD. We review the relevant neurocircuitry and preclinical stimulation studies in models of fear and anxiety, as well as clinical data on the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS) for the treatment of PTSD.

The prevalence, correlates, and help-seeking of eating disorders in Switzerland

BackgroundEating disorders (EDs) have long-term physical and mental impacts on those affected. However, few population-based studies have estimated the prevalence of EDs. We aimed to estimate the lifetime and 12-month prevalence rates of EDs using DSM-IV criteria, and to examine differences against the DSM-5 criteria for anorexia.MethodA nationally representative sample of 10 038 residents in Switzerland was interviewed, and prevalence rates for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) were assessed using WHO Composite International Diagnostic Interviews (WHO-CIDI).ResultsThe lifetime prevalence rate for any ED was found to be 3.5%. Lifetime prevalence estimates for AN, BN, and/or BED were 1.2%, 2.4%, and 2.4%, respectively, among women and 0.2%, 0.9%, and 0.7%, respectively, among men. Utilizing the DSM-5 criteria, the prevalence of AN in women increased by more than 50%, from 1.2% to 1.9%. Among those meeting the criteria for any ED, only 49.4% of men and 67.9% of women had ever sought professional help about their problems with eating or weight.ConclusionsThe higher prevalence of BN we detected relative to other studies should prompt further monitoring for a possible increasing trend. The female v. male ratios, especially for bulimia and BED, are decreasing. Given that more than half of those affected have never consulted any professional about their problems with eating or weight, routine inquiries about eating and weight by clinicians, school teachers/psychologists, and family members may help those who are at risk, especially among men.

Clozapine Can Be the Good Option in Resistant Mania

Bipolar mood disorder is a mental disorder with a lifetime prevalence rate of about 1% in the general population and there are still a proportion of individuals who suffer from bipolar mood disorders that are resistant to standard treatment. Reporting clozapine responsive mania that was not responding to two previous consecutive atypical antipsychotics and one typical antipsychotic was aimed at. A 17-year-old male manic patient was admitted into the psychiatry inpatient department and was nonresponsive to Risperidone 12 mg daily for 4 weeks, Olanzapine 30 mg daily for 3 weeks, and Haloperidol 30 mg daily for 3 weeks, along with valproate preparation 1500 mg daily. He was started on clozapine as he was nonresponsive to Lithium in previous episodes and did not consent to starting Electroconvulsive Therapy (ECT). He responded adequately to 100 mg clozapine and 1500 mg valproate preparation and remission happened within 2 weeks of starting clozapine. Clozapine can be a good option for resistant mania and further RCT based evidences will strengthen the options in treating resistant mania.

Pharmacological Treatments for Schizophrenia

Schizophrenia, a chronic mental disorder, has a lifetime prevalence rate of approximately 1%. The first antipsychotic drug, chlorpromazine, was introduced in 1954, followed by several similar drugs. With the introduction of clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and more recently paliperidone, iloperidone, asenapine, and lurasidone, antipsychotic drugs are often classified as first generation or typical (chlorpromazine-like) versus second generation or atypical (clozapine-like), although the distinction between the two classes, particularly with respect to efficacy, is not as meaningful as initially believed. Both classes have been demonstrated to safely improve psychotic symptoms in the acute phase of the illness and to reduce the risk of relapse in the maintenance phase of treatment. Because of the limited efficacy of antipsychotics in resolving the full range of schizophrenic psychopathology, adjunctive treatments are often used to reduce morbidity. This chapter reviews controlled trials of the pharmacological agents used to treat schizophrenia.

Differential Diagnosis of Bipolar Disorder

Before reviewing the differential diagnosis of bipolar disorder, it is important to understand the epidemiology, incident, and prevalence of the disorder as well as to divide it by type: type I, type II, or the phenomenon of not otherwise specified, which is defined as subthreshold mania or hypomania. Subthreshold mania or hypomania entails fewer than the requisite number of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptoms of mania or hypomania, or an insufficient duration of time with which to make a diagnosis of a syndrome of mania or hypomania. Currently, the most reliable epidemiology of prevalence rates were reported in a replication study of 9,282 respondents to the National Comorbidity Survey conducted by Merikangas and colleagues.Those data show there is a lifetime prevalence rate of bipolar I disorder of 1 % and bipolar II disorder of 1.1%. In this study, not otherwise specified was labeled subthreshold bipolar disorder as the illness duration was not long enough or the number of symptoms was not extensive enough to constitute syndromal mania or hypomania. This type had a prevalence rate of 2.4%, for a total lifetime prevalence of ~4.4%. This rate is somewhat higher than has been described in the past, but included the subdivision that researchers believe comprises the bipolar spectrum.There has been much underdiagnosis or lack of diagnostic accuracy of bipolar disorder, with relative overdiagnosis of major depressive disorder, which historically has been well documented. However, in the last 10 years, there has been a substantial increase in the making of diagnoses of bipolar disorder in various clinical settings. One dataset examined ambulatory medical care survey data and found that among adults over an ~10-year period, there was approximately a doubling in the incidence of diagnosing bipolar disorder of any type (Slide 1).

Cardiovascular and Respiratory Comorbidities in Patients with Bipolar Disorder: A Systematic Review

Objective:To synthesize the available knowledge on cardiovascular and respiratory comorbidities in patients with bipolar disorder (BD).Methods:Relevant studies were identified by a MEDLINE search from 1966 to January 2008, and supplemented by a manual review of reference lists of the articles identified and previous review articles. When available, priority was given to comparative studies.Results:We identified 21 studies, 15 (71%) comparative. As compared to the general population, two studies reported higher point-prevalence rates of hypertension (28-60.8% vs 11.9-43%), two studies lower point-prevalence rates (10.4-34.8% vs 14.9-36.8%), one study a higher lifetime-prevalence rate (28.7% vs 14.8%), and one study a significantly increased incidence rate ratio (1.24 females and 1.34 for males). In addition, two studies reported higher point-prevalence rates of hypertension than in medical samples (4.6-18.1% vs 2.2-9.2%) and one study reported a higher risk than in patients with schizophrenia (OR 1.13, 95%CI 1.01-1.26). Point-prevalence rate of stroke was not different than in the general population (n=1, 1.7 vs 2.1, p=0.063); four studies evaluating the risk of stroke as compared to clinical samples provide contradictory results. Point-prevalence rates (n=2, 15.9-17% vs 8.3-10%) and lifetime-prevalence rate (n=1, 16.7% vs 9.7%) of asthma were higher than in the general population. Point-prevalence rates of COPD were also higher than in the general population (n=1, 10.6% vs 9.4%) and in clinical samples (n=3, 1-12.9% vs 0.6-3.6%).Conclusion:BD seems to be associated with increased rates of hypertension, asthma and COPD. Available data do not support the association between BD and stroke.

Pharmacological Treatment of Schizophrenia

Schizophrenia is a chronic mental disorder with a lifetime prevalence rate of approximately 1%. The first antipsychotic drug, chlorpromazine, was introduced in 1954, followed by several similar drugs. With the later introduction of clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, antipsychotic drugs have come to be classified as conventional (chlorpromazine-like) or atypical (clozapine-like). Both of these broad classes of medications have been demonstrated to safely improve psychotic symptoms in the acute phase of the illness and reduce risk of relapse in the maintenance phase of treatment. The atypical antipsychotics offer hope for enhanced efficacy in the treatment of schizophrenic psychopathology with a reduced burden of extrapyramidal motor dysfunction. Because of the limited efficacy of antipsychotic medication in resolving the full range of schizophrenic psychopathology, adjunctive treatments are often used to reduce morbidity. Concomitant medications such as benzodiazepines, lithium, carbamazepine, valproic acid, antidepressants, glutamate agonists, and dopamine agonists have been used alone and in combination with antipsychotic drugs in order to improve treatment response. In this chapter, we review controlled trials of the pharmacological agents used to treat schizophrenia.

OCD in Women: Diagnosis and Magnitude

Key Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for obsessive-compulsive disorder (OCD) include the presence of either obsessions or compulsions, some recognition by the individual that their symptoms are excessive or irrational (except in children), duration of at least 1 hour/day, and association with marked distress or functional impairment. OCD patients report that somatic, religious, and sexual obsessions as well as those concerning contamination, aggression, symmetry, and hoarding are most common. The most frequent compulsions reported in OCD patients involve checking, cleaning, counting, repeating, and hoarding behaviors. Factor analyses of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) symptom checklist have also identified five primary symptom dimensions: aggression/checking; contamination/cleaning; symmetry/repeating, counting, or ordering rituals; hoarding; and a sexual/religious symptom dimension.Results from a large, 2-year prospective study suggest that symptoms of adult OCD are much more stable than previously thought, with any changes more likely to occur within, rather than between the symptom dimensions. Prevalence estimates based on the Epidemiologic Catchment Area survey and the Cross-National OCD Collaborative Group study indicate a worldwide lifetime prevalence rate for OCD of 2% to 3%. Females have a slightly higher risk (1.5 times) for OCD (Slide I). OCD onset is relatively early, generally during adolescence or young adulthood. The clinical course of OCD is generally chronic and complicated by comorbidities.