Glutathione : a novel treatment target in psychiatry

There is accumulating evidence for oxidative stress mechanisms as common pathophysiological pathways in diverse psychiatric disorders, which offers novel treatment targets in oxidation biology systems. Of these the glutathione system has the most favourable theoretical foundation, given its dominance as the most generic of cellular antioxidants. Clinically, this hypothesis has been supported by several recently published studies that have reported on the efficacy of N-acetylcysteine, a glutathione precursor, in the treatment of various psychiatric disorders. This article outlines the multidimensional evidence that currently exists for oxidative stress mechanisms in psychiatric disorders and specifically discusses glutathione as a promising novel therapeutic target.

N-acetylcysteine in psychiatry - current therapeutic evidence and potential mechanisms of action

There is an expanding field of research investigating the benefits of alternatives to current pharmacological therapies in psychiatry. N-acetylcysteine (NAC) is emerging as a useful agent in the treatment of psychiatric disorders. Like many therapies, the clinical origins of NAC are far removed from its current use in psychiatry. Whereas the mechanisms of NAC are only beginning to be understood, it is likely that NAC is exerting benefits beyond being a precursor to the antioxidant, glutathione, modulating glutamatergic, neurotropic and inflammatory pathways. This review outlines the current literature regarding the use of NAC in disorders including addiction, compulsive and grooming disorders, schizophrenia and bipolar disorder. N-acetylcysteine has shown promising results in populations with these disorders, including those in whom treatment efficacy has previously been limited. The therapeutic potential of this acetylated amino acid is beginning to emerge in the field of psychiatric research.

The role of psychotherapy in bipolar disorder

• Adjunctive psychosocial interventions for bipolar disorder target many of the issues that are not addressed by medication alone, including non-adherence, efficacy–effectiveness gap and functionality.

• Psychosocial interventions have been found to reduce relapse, particularly for the depressive pole, and improve functionality.

• Approaches such as psychoeducation, cognitive behaviour therapy, interpersonal and social rhythm therapy, and family therapy have shown benefits as adjunctive treatments.

• Each of the various psychosocial interventions has a unique emphasis, but they share common elements. These include: providing information and education; developing a personal understanding of the illness, such as triggers and early warning signs; having prepared strategies in place for early intervention, should symptoms of illness develop; and promoting a collaborative approach.

• Evidence to date supports the use of adjunctive psychosocial interventions in the management of bipolar disorder.

Is psychotherapy a vector for isolation and anomie?

A key traditional question the client learns in the conventional psychotherapies is ‘Am I getting what I want?’. But can this question incite a mindset that does not align with the ‘give and take’ essence of sustainable everyday relations? Is it possible that the psychotherapies—if these practices can be bundled together—might teach clients to become more self-centred and relationally illiterate? MARK FURLONG suggests that well-intentioned practitioners can inadvertently de-empathise, ignore or even disrupt their clients’ intimate networks. Findings from his research support the proposition that the action of the mainstream therapies tends to undermine the service users’ prospects for sustainable personal relationships. Exceptions were found in the specialist settings of paediatric and aged care, and in narrative and family therapy practice.

Adaptive, eclectic and democratic : an alternative year 2020 vision of the place of psychiatry

It was the end of the academic year in 2020. On the third floor of the Southern Health University's administrative building, the five Vice-Chancellors of the Health Universities were gathering. Outside it was raining, but the patter of drops on the window only served to enhance the coziness of the meeting room. This annual event would take three days. The Vice-Chancellors enjoyed this meeting. They seldom saw each other during the busy academic year and under Professor Hope Brightview's 6 years of chairmanship they had been able to work well together to formulate a rational and profitable distribution of teaching, research and consultation services.

Competing ethical paradigms in forensic psychiatry and forensic psychology: commentary for a special section of legal and criminological psychology

In her paper Gwen Adshead (2013) identifies the principle of respect for justice as the foundation for ethical practice in forensic psychiatry. This commentary discusses how forensic psychologists have approached a key aspect of the justice principle, the ethical imperative to promote the welfare of the individual client. The approaches of the psychiatric and psychological professions are compared and the role of psychologists as allied health professionals working in the forensic setting considered.