This review speculates on the changes currently taking place in psychopharmacology that will alter the course of psychotropic drug discovery and application in the coming millennium. The importance of endocoids as causative agents in central nervous system diseases; the role of neuropeptides and “trace” amine transmitters; the impact of imaging methods in elucidating the mechanism of action of psychotropic drugs; gene therapy; and the new role of psychoneuroimmunology in drug discovery are predicted to have a major impact in both the research and development of new psychotropic drugs in the twenty-first century.

In the past decade, clozapine, risperidone, and olanzapine were marketed for the first time in the United States, and other new antipsychotic drugs are expected to follow soon. Also within the past decade, the efficacy of serotonin-reuptake inhibitors (SRIs) has been demonstrated in patients with obsessive-compulsive disorder (OCD) and the serotonin hypothesis of OCD has been articulated clearly.

The study presented was conducted to analyze the effects of obsessive-compulsive symptoms on patients' quality of life and the costs incurred by patients and society for the treatment of obsessive-compulsive disorder (OCD). To accomplish this, a detailed 410-item questionnaire of psychosocial function and economic cost was sent to every fourth member of the Obsessive Compulsive Foundation. Of the 2,670 members who received the survey, 701 (26.9%) returned it.

Outcome measures included symptomatology, course of illness, impact of illness on psychosocial and other functioning, effects of diagnosis and treatment, and economic consequences. The demographics of this group were similar to those in smaller treatment-seeking clinical samples, but not necessarily to OCD sufferers within the US population as a whole. More than half of the patients reported moderate to severe interference in family relationships, socializing, and ability to study or work, secondary to OCD symptoms. A 10.2-year gap was observed between the onset of symptoms and the first attempt to seek professional help, and a 17.2-year gap was observed between the onset of symptoms and receipt of effective treatment. Specific treatments, such as serotonin reuptake inhibitors and behavior therapy showed greater symptom improvement, and significantly reduced the total annual fees incurred by OCD patients when compared with nonspecific treatments.

Our study results indicate that OCD has a profound effect on psychosocial functioning and quality of life. Large direct costs for OCD, and even larger indirect costs due to lost wages and underemployment were found. Greater awareness of OCD among practitioners may result in earlier diagnosis and more appropriate and cost-effective treatments.

Functional brain-imaging studies have suggested an opposite pattern of brain activity in obsessive-compulsive disorder (OCD) and schizophrenia. Patients with OCD have higher than normal activity in the frontal lobe and caudate nucleus while patients with schizophrenia have lower than normal activity in these areas. Changes in the nature of the connections between the executive and impulse control regions of the frontal lobe and the basal ganglia might be involved in both illnesses. These findings are statistical in nature and involve structures of complex three-dimensional shapes. New technology for studying the function of these structures may be useful in exploring the relation of each structure to symptoms of specific disorders. This technology may also enable identification of anatomical and functional causes of individual differences in medication response.

While the etiologies of pervasive developmental disorders (PDDs) appear complicated, multifactorial, and relatively poorly understood research over the last 30 to 40 years has implicated certain neurochemicals in the pathophysiology of these diseases. From these studies, a great deal of evidence has emerged supporting a role for serotonergic dysfunction in individuals with autism and related disorders. Recent clinical trials of drugs influencing serotonergic systems have demonstrated promising effects in children, adolescents, and adults with PDDs.

Various neuroimaging modalities are available for evaluating patients with temporal lobe epilepsy (TLE). All patients considering surgery should undergo magnetic resonance imaging, which is valuable in the detection and characterization of lesions, particularly mesial temporal sclerosis, the most common abnormality in TLE. A localized seizure focus is predictive of successful surgical outcome. Complimentary neuroimaging studies include positron emission tomography, single-photon emission tomography, and proton magnetic resonance spectroscopy.

In this article, we present data on the analysis of maze-solving behavior as a tool for the investigation of cognitive disturbance in schizophrenic patients. Solving maze tasks efficiently requires both an interaction between and an integration of perceptive and action-oriented processes. Starting from the hypothesis that these domains are preferentially disturbed in schizophrenia, we propose that the maze-solving behavior of schizophrenic patients permits insight into specific impairments in disease-related cognitive processing. We present the results of a maze task study comparing medication-free schizophrenic patients and matched healthy controls. This analysis forms the basis for an investigation of the influence of psychopharmacological treatment strategies on the observed behavior in the maze-solving paradigm. Finally, a third study concerned with improvement over time associated with medication is presented, and possible influences of extrapyramidal motor disturbances on schizophrenic patients' maze performance are discussed.

Epilepsy is common, but conditions that imitate epilepsy are even more common. In order to make a correct diagnosis of epilepsy, the clinician must carefully elicit a detailed history of the seizure episode. Realizing the overlap that exists between seizures that define epilepsy and those of other psychiatric conditions can also help in differentiating between epilepsy and an imitator of epilepsy. Deciphering the features of a seizure episode is also key to correct diagnosis.

In this article, the physiological and psychological imitators of epilepsy are described, as well as the features of a seizure episode that should be considered in making a diagnosis. Seizure presentations are also explained followed by a description of common diagnostic pitfalls to avoid.

In the past 10 to 15 years, advances in psychopharmacology and research on the neurobiological basis of obsessive-compulsive disorder (OCD) have led to the currently predominant biological model of OCD. Nevertheless, the centrality of complex ideation in OCD supports the usefulness of a psychological approach.

In this article, we propose an integrated psychobiological model that presumes a biological etiology without assuming biological reductionism. We hypothesize that the relationship between biological and psychological organization is best explained in the context of emergent systems theory, and that the psychological meaning of OCD reflects development across phylogeny as opposed to ontogeny. Finally, we propose that OCD reflects disruption of a behavioral inhibition/harm assessment system that incorporates brain structures from different points across human phylogeny. Hence, complex psychological symptoms of a biological etiology are generated.

The literature on neuropsychiatric, neuropsychological, and neuroimaging findings in autism and Asperger's disorder is briefly reviewed. Neurological soft sign, neuropsychological, and positron-emission tomography findings in one patient with Asperger's disorder and one patient with autism are highlighted, discussed as examples of heterogeneity, and integrated with the relevant literature.

Molecular biology techniques are used widely in the study of central nervous system structures and functions. The possibilities offered by such methodologies are attracting an increasing number of researchers for their versatility and for their promise to permit the investigation of different proteins, step by step, from gene transcription to posttranscriptional processes. Of particular interest is the study of the enzymes responsible for the synthesis and catabolism of neurotransmitters, as well as neuroreceptors.

Today, a general knowledge of such methods and of how they can be used in CNS studies is fundamental for psychiatrists, even if not directly involved in basic research, since it can be easily predicted that the next century will be characterized by an increasing application of these approaches to biological psychiatry. In this article, we describe gene expression methods and the aim of gene expression studies. We also present some general information on the various steps and techniques used for different purposes in biological psychiatry.