Title: Psychiatric Advance Directives: Benefits and Barriers
Volume: 4
Issue: 3
Author(s): Anna Scheyett
Affiliation:
Keywords:
Psychiatric advance directives, serious mental illness, autonomy, crisis, legal, advance statements
Abstract: Evidence is reviewed here which suggests that antiepileptic drugs (AEDs) may be effective for the treatment of impulsivity across a range of psychiatric disorders and for impulse control and cluster B personality disorders in particular. AEDs may be effective for the treatment of the brain circuitry related to impulsivity, by modulating GABA, glutamate, serotonin, and norepinephrine. It is suggested that interventions should be directed at the brain circuitry which modulates core symptoms like impulsivity that may be shared across disorders, rather than the disorder itself. In addition to these core symptom domains, clinicians should identify comorbid conditions and associated symptoms related to brain systems as they can also influence overall treatment response. The increasing experience of psychiatrists in treating impulse control disorders, cluster B personality disorders, and impulsivity across disorders should complement the knowledge obtained from research. This will lead to a better understanding of the brain mechanisms underlying impulsive symptom domains within disorders and to more targeted treatments with improved outcomes.
