Comorbidity

In a presentation given at the midyear meeting of the American Epilepsy Society, Andres Kanner, MD cited studies from the literature showing that the rates of depression, anxiety, psychosis, and attention-deficit/hyperactivity disorder (ADHD) are significantly higher among persons with epilepsy than among the general population

Alcohol is the drug of choice for adolescents, with cigarettes and marijuana being second and third. Contrary to widespread belief, alcohol dependence is most common in 18- to 20-year-olds, with progressively decreasing rates of alcohol dependence in older age groups.

The longitudinal course of bipolar disorder (BD) is characterized by a low rate of recovery, a high rate of recurrence, and poor interepisodic functioning. There is a need to invoke a chronic disease management model (CDMM) when treating individuals with BD.

The continuation of the epidemic of childhood obesity and overweight has major implications and consequences for future research in psychopathology.

New findings in epidemiology, developmental psychiatry, and neuroscience offer the opportunity for a new perspective on the problems of juvenile delinquency and bring to bear the insights of modern psychiatry in the treatment and successful rehabilitation of juvenile offenders.

DSM-IV-TR emphasizes that patients with borderline personality disorder (BPD) show a "instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts," and any five out of nine listed criteria must be present for the diagnosis to be made.

Paraphilias as defined by DSM-IV, are sexual impulse disorders characterized by intensely arousing, recurrent sexual fantasies, urges and behaviors (of at least six months' duration) that are considered deviant with respect to cultural norms and that produce clinically significant distress or impairment in social, occupational or other important areas of psychosocial functioning. The common paraphilias described include exhibitionism (exposure of genitals to a stranger), pedophilia (sexual activity with a prepubescent child, generally 13 years of age or younger), voyeurism (observing others' sexual activities), fetishism (use of inert objects, such as female undergarments), transvestic fetishism (cross-dressing), sexual sadism (inflicting suffering or humiliation), sexual masochism (being humiliated, beaten, bound or made to suffer) and frotteurism (touching, rubbing against a nonconsenting person).

Although psychosis is rare in adolescent patients with anorexia nervosa restricting type, the possibility should be explored because it may be the underlying cause of the eating disorder.

The past few years have seen substantial progress in recognizing and treating several of the subtypes of bipolar disorder. This Special Report addresses the diagnostic challenges and the different strategies for managing these subtypes.

Three issues of current concern in bipolar II disorder include: diagnostic criteria for hypomania, diagnosis of mixed depression, and management of mixed depression.

Bipolar disorder I and II have the highest association with substance use disorder, compared with any other major psychiatric disorder. Treatment requires an integrated approach that includes specific psychotherapy as well as the use of medication.

The presentation of patients to the emergency department following trauma is often complicated by the behavioral reaction to the accident that brought them there. In some cases, the mental reaction to psychological trauma is the primary presenting phenomenon. ED physicians and staff often use medication to treat the acute effects of psychological trauma. However, there is little empiric evidence to support this practice.

The prevalence and debilitating nature of some of the personality disorders has impeded the study of psychopharmacology in these conditions. However, important advances have been made in the last several years.

The evidence showing a relationship between mental disorders in childhood and adulthood has increased in the last several decades.

Mentalization-based treatment (MBT) and transference-focused psychotherapy (TFP) are relatively complex and specialized treatments for the treatment of borderline personality disorder.

With expansion of the concept of bipolar disorder (BD), there has been concern about the potential for overdiagnosis. However, diagnostic errors in bipolar disorder are currently skewed towards underdiagnosis.

The psychiatric community has a need for diagnostic and predictive tests. Some recent techniques have just become available for clinical care.

Eating disorders in patients with schizophrenia have been underappreciated and poorly studied. Profiling characteristic phenotypic patterns will help clarify the distinctions among eating behaviors that are part of the spectrum of schizophrenia, those that represent distinct coexistent entities, and those that represent overlapping comorbidity.

A discussion of the current evidence base of psychosomatic medicine in the context of its public health significance and suggestions for the future development of the field.

Increased demand for accountability is requiring more clinicians to supplement their judgments of patient outcome with standardized and objective protocols. The protocol outlined here is a model or jumping-off point for outcome evaluation.

Antidepressant treatment extended beyond the recommended 6 to 12 months was recently reported to be more effective than monthly psychotherapy in maintaining remission in elderly patients.

Damage can take biologic, syndromic, social, and personal form, with correlations among the various levels of damage.

Evidence showing the effectiveness of psychopharmacologic and psychotherapeutic management of functional gastrointestinal disorders over standard medical treatment is increasing.

Trichotillomania (hair-pulling) was once thought to be rare, but recent estimates indicate that it affects 2% of people.

What does the new set of U.S. Public Health Service guidelines for treating tobacco dependence say? Should everyone, regardless of mental health status, receive treatment?

The fiscal 2007 budget that PresidentBush proposed in early February keepsa tight lid on most domestic spendingprograms, including those at the Centersfor Mental Health Services (CMHS)and the National Institute of MentalHealth (NIMH). Budgets for both willactually decrease for the second yearin a row unless Congress steps in.

The renaming of consultation-liaison psychiatry as psychosomaticmedicine, a new formal subspecialtyof psychiatry, may require someadjustment in our understanding ofthese terms. Both consultation-liaisonpsychiatry and psychosomatic medicinehave focused on treatment and researchof illnesses with mind-body interactions.Despite considerable overlap,consultation-liaison psychiatry hastraditionally been associated with treatmentand clinical research of comorbidmental disorders of the medicallyill, while psychosomatic medicine hasbeen associated with research into thephysiologic mechanisms underlyingmind-body interactions and classicalpsychosomatic diseases such as hypertension,asthma, and ulcerative colitis.

While an antipsychotic medication is the first step of treatment for schizophrenia, it is increasingly recognized that comprehensive care requires the integration of adjunctive therapies and attention to long-term treatment goals.

About 25% of patients seen in epilepsy clinics and monitoring units who do not respond to antiepileptic drugs (AEDs) have received a misdiagnosis.1-3 The eventual diagnosis for most of these patients will be psychogenic nonepileptic seizure (PNES)1,4-a somatoform conversion disorder. It is treatable, but diagnosis, delivery of the diagnosis, and management present significant challenges. A major barrier to care has been the stigma associated with the label "psychogenic."

When a stroke occurs, transportation to the emergency department (ED) by ambulance will get a patient care faster-a factor that so often makes a difference about whether tissue plasminogen activator will be administered-according to poster studies presented at the International Stroke Conference in February in Kissimmee, FL.