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Sanil Rege
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Consultant Psychiatrist, Mornington Peninsula and Director at Psych Scene
Consultant Psychiatrist, Mornington Peninsula and Director at Psych Scene

221 followers
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The neurobiology of PTSD is complex and involves neuroendocrine, neurochemical and neuroanatomical changes in neural networks.
The dynamic interaction between the medial prefrontal cortex and the amygdala creates two distinct phenotypes in PTSD patients.
Treatment modalities aim to address the various psychological and biological components.
PTSD is co-morbid unless proven otherwise. Diagnostic overshadowing, whereby symptoms are attributed only to trauma, may result in mis-diagnosis and inadequate treatment.

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Psychotherapy is generally considered benign without side effects, however, research shows that its risks may be underappreciated. This article summarises the risks of psychotherapy. Psychotherapy is an efficacious cornerstone of current practice. the very potency of such therapy gives rise to risks that may not have been adequately appreciated, and thus there has been a tacit assumption by practitioners and patients that psychotherapy is largely devoid of risks. This may be a double blind. We suggest that there is a need for greater awareness and appropriate monitoring of risks, and that pursuit of this proposition will advance the risk benefit ratio of pscyhological treatments. (Berk & Parker)

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Within the gut, there are approximately 1014 microorganisms, which is around 10 fold more cells than there are human cells in the human body. Collectively, the genetic material of the microbiome is approximately 150 times greater than the human genome, which has led some scientists to label the microbiome as a ‘superorganism’. Disruptions to the microbiome are increasingly becoming associated with the prevalence of allergies, autoimmune diseases, metabolic disorders and neuropsychiatric disorders that affect today’s society.The past 5 years have seen an amazing increase in our knowledge of how bacteria signal to the brain and the implications this has for psychiatry. We summarise the mechanisms in this article for the cross talk between the gut and the brain.

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The gut-brain axis (GBA) is a bidirectional link between the central nervous system (CNS) and the enteric nervous system (ENS) of the body. It involves direct and indirect pathways between cognitive and emotional centres in the brain with peripheral intestinal functions. The GBA involves complex crosstalk between the endocrine (hypothalamic-pituitary-adrenal axis), immune (cytokine and chemokines) and the autonomic nervous system (ANS). The mutualistic synergy between microbes and humans is a relationship that is essential for growth, development, health and the prevention of disease.

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This study supports the use of lithium as a neuroprotective agent in the treatment bipolar disorder. This study also showed the benefits of Lithium treatment early in the course of treatment. Lithium exerts it's neuroprotective mechanism through a range of mechanisms outlined in the article.

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"Digital technologies are able to collect and analyse large amounts of information including population and patient data which can then provide a greater predictive potential of an individual’s suicide risk"

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In MS, there is a loss of myelin in defined areas (lesion sites) in the brain and spinal cord. The disease is characterized by a large array of invading immune cells that attack and degrade the myelin sheath, the myelin-producing oligodendrocytes and the nerve itself. With most research into new treatments focusing on the neurological symptoms of MS, the presence of neuropsychiatric symptoms are often overlooked. There is however substantial evidence that a MS diagnosis can affect the mental health of these patients. Depression, cognitive impairment, fatigue, mania and psychosis can all occur in varying frequencies.

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APS can often go hand in hand with Lupus. FRom the head of the Lupus unit; Prof Graham Hughes.

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"There is strong evidence that WMH's are clinically important markers of increased risk of stroke, dementia, death, depression, impaired gait, and mobility, in cross-sectional and in longitudinal studies. They associate with brain damage such as global atrophy and other features of small vessel brain damage, with focal progressive visible brain damage, are markers of underlying subvisible diffuse brain damage, and predict infarct growth and worse outcome after large artery stroke. They could be considered as the neuroimaging marker of brain frailty." (Wardlaw et al., 2015)

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Differentiating Bipolar Disorder from Depression poses a clinical challenge. Evidence suggests that misdiagnosis in bipolar disorder is a frequent occurrence. The absence of biologically-relevant diagnostic markers of BD results in misdiagnosis of the illness as major depressive disorder, or recurrent unipolar disorder (UD) depression, in 60% of bipolar individuals seeking treatment for depression. Solving such a conundrum in clinical practice requires going back to a basic problem-solving approach. Listen, gather information, understand the brain, build a hypothesis based on a bio-psychosocial approach and implement a tailored patient focused plan.
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