Myra Partridge

Results of a large study funded by the National Institute of Mental Health showed that electroconvulsive therapy (ECT) might be equally effective in both patients with unipolar depression and those with bipolar depression. The study, led by Samuel H. Bailine, MD, assistant professor in the department of psychiatry and behavioral sciences at Zucker Hillside Hospital, Glen Oaks, NY, showed that the remission rate in both patient groups was higher than 60%.

Low levels of 3-methoxy-4-hydroxyphenylglycol (MHPG) in patients with major depressive disorder (MDD) or bipolar depression were shown to be associated with increased risk of suicide attempts. Hanga Galfalvy, PhD, assistant professor of clinical neurobiology at Columbia University and the New York State Psychiatric Institute, New York, and her colleagues found that patients with the lowest levels of MHPG at baseline were more likely to commit highly lethal suicidal acts.

All pregnant women should be screened for bipolar disorder, according to a recent article by Verinder Sharma, MB, BS, professor of psychiatry and obstetrics and gynecology at the University of Western Ontario, London, Ontario, and colleagues. This is because bipolar depression may be misdiagnosed as major depressive disorder in the postpartum period, resulting in delays in appropriate treatment.

Because an increasing number of patients pay for care out-of-pocket, marketing has become an essential part of any practice, said David Sprague, chief operating officer at Physicians’ Ally, Inc, Denver. In a presentation at the US Psychiatric and Mental Health Congress in Las Vegas, he provided tips to help physicians market their practice and avoid common pitfalls.

Four simple steps can help you reduce missed patient appointments and boost profitability. So said Mark Rosenberg, MD, PhD, president of Behavioral Health Management, PC, in St Louis, who spoke at the US Psychiatric and Mental Health Congress in Las Vegas. Not only do missed appointments result in lost revenue, said Rosenberg, but also they “interrupt the flow of patient care and impede clinic productivity.”

Many patients with HIV/AIDS experience numerous challenges beyond those posed by the physical effects of their disease-including poverty, mental illness, drug addiction, social alienation, racism, and homophobia. Counseling patients who face these issues can be difficult, but a careful risk assessment along with patient education can improve a patient’s ability to cope and lead to better outcomes, said Marshall Forstein, MD, associate professor of psychiatry, Harvard Medical School, Cambridge, Mass, in a presentation at the US Psychiatric Congress in Las Vegas. On the basis of his extensive experience in treating patients with HIV/AIDS, he said it is also important to provide hope and to encourage treatment adherence.

It is usually traumatic when parents learn that their child has an autism spectrum disorder (ASD). Be clear about the diagnosis and let families know that treatment will begin as soon as possible, said Doris Greenberg, MD, associate clinical professor of pediatrics at Mercer University School of Medicine, Savannah, Ga. In her presentation at the US Psychiatric and Mental Health Congress in Las Vegas, Dr Greenberg discussed strategies for talking to the families of children with ASDs. “Don’t talk around the diagnosis-identify the elephant in the room and get on with it,” she said.

Of the screening tools available to help identify early symptoms of Alzheimer’s disease, which is best?

Current guidelines for the management of bipolar depression are outdated because they are based on the definition and treatment of unipolar depression, according to Eduard Vieta, MD, PhD, director of the bipolar disorders program at the University Clinic Hospital of Barcelona, Spain. Dr Vieta led a study to create new definitions and algorithms for the management of treatment-resistant bipolar I and bipolar II depression.

Although rapid-cycling bipolar disorder has been linked to the use of antidepressants, these treatments may still have a role in the management of patients with bipolar depression, said Stephen V. Sobel, MD, clinical instructor at the University of California, San Diego School of Medicine, in a presentation at the U.S. Psychiatric and Mental Health Congress in Las Vegas.

Repetitive transcranial magnetic stimulation (rTMS) may be an effective therapy for treatment-resistant bipolar depression, according to the results of a recent pilot study led by Guohua Xia, MD, PhD, assistant clinical professor of psychiatry at the University of California, Davis.

A few simple steps can enhance your assessment of a patient’s suicide risk-and thereby reduce your own risk for liability if the patient does commit suicide. Phillip J. Resnick, MD, professor of psychiatry and director of forensic psychiatry at Case Western Reserve University in Cleveland, described those measures in a lecture today at the US Psychiatric Congress in Las Vegas.

The fear of death has been hardwired into all of us, but therapists can help patients with death anxiety by providing powerful ideas along with a powerful human connection, said Irvin D. Yalom, MD,1 professor emeritus of psychiatry at the Stanford University School of Medicine, California. He is the author of a number of books on existentialism and psychotherapy, and most recently has written Staring at the Sun: Overcoming the Terror of Death.

New treatments for patients with schizophrenia may be on the horizon, according to research presented at the annual meeting of the American Psychiatric Association in San Francisco. While some of these therapies may help treat the negative and cognitive symptoms of schizophrenia, a few are associated with QTc interval prolongation.

For almost 10 years, studies have shown that advanced paternal age may be a risk factor for schizophrenia in offspring. However, the risk of schizophrenia may also be higher in male offspring of fathers who are younger than 25 years, according to the results of a study presented at the 2009 American Psychiatric Association annual meeting.

Is neuromyelitis optica (nmo) igg autoantibody unique to NMO or is it expressed in multiple sclerosis (MS) as well? Recent studies have confirmed the autoantibody’s specificity and are shedding more light on how NMO IgG's autoantigen, the water channel aquaporin-4 (AQP4), uniquely behaves in NMO and MS.

In 2005, the aim of the National Multiple Sclerosis (MS) Society Promise 2010 Initiative was to raise $30 million and distribute it to research teams. "Our goal has been to foster collaboration across various disciplines," said Patricia O'Looney, MD, director of biomedical research programs at the National MS Society.

An imbalance in blood levels of oxytocin may be associated with certain forms of autism spectrum disorders (ASDs).

Patients who experience seizure 24 hours after stroke onset may be at increased risk for death, according to Angela Rackley, MD, a clinical neurophysiology fellow in epilepsy, and coresearchers at the University of Cincinnati. Rackley presented an abstract on the incidence of seizures within 24 hours after acute stroke at the annual meeting of the American Epilepsy Society in San Diego this past December. She and colleagues found a higher 30- day mortality rate among patients who had a seizure within hours of stroke compared with patients who did not experience poststroke seizure.

Corticospinal tract (CST) integrity may predict the potential for clinical improvement in chronic stroke patients, according to a recent study. Winston Byblow, MSc, PhD, associate professor and director of the Movement Neuroscience Laboratory in the Department of Sport & Exercise Science at the University of Auckland, Australia, and colleagues used transcranial magnetic stimulation (TMS) and MRI to determine factors that predict functional improvement in a patient's upper limbs.1 In patients with motor-evoked responses (MEPs) to TMS, researchers found that meaningful gains were still possible 3 years after stroke, although the capacity for improvement declined with time. The researchers also created an algorithm to predict functional potential for upper limb recovery in this patient population.

Novel approaches for the evaluation and symptomatic treatment of Huntington disease (HD) were presented at the 59th Annual Meeting of the American Academy of Neurology held April 29 to May 5 in Boston. Interventions included use of tetrabenazine (TBZ) (as yet unapproved for the symptomatic treatment of hyperkinetic movement disorders in the United States but granted orphan drug status in 2004) and deep brain stimulation (DBS) of the globus pallidus externus (GPe).

Migraine has been shown to cause absenteeism and lower productivity at work as well as reduced quality of life.1 According to the US Headache Consortium Guidelines, migraineurs with severe or moderate attacks should be treated with specific antimigraine medications, and prevention is recommended in those with frequent headaches as well as attacks that remain disabling despite optimal acute treatment.

Antiepileptic drugs (AEDs) were first demonstrated to cause bone density loss (BDL) more than 40 years ago-since then, researchers have been determining which therapies cause BDL, why BDL occurs, and how BDL should be prevented and treated. Methods to monitor, prevent, and treat BDL in these patients differ greatly, and some physicians are calling for better guidance in this area.

Fragile X-associated tremor/ataxia syndrome (FXTAS), a late-onset progressive neurological disorder, is found in carriers of a fragile X mental retardation 1 (FMR1) premutation (55 to 200 CGG repeats). Studies are showing that the disorder affects up to 1 in 3000 adult men older than 50 years and is less common in women.

To improve the prediction of stroke risk after atransient ischemic attack (TIA), researchers havecombined the California and ABCD risk scores tocreate a new unified score, ABCD2.

Recent imaging studies have shown that patients with autism spectrum disorders (ASDs) who were presented with images of human faces had lower responses in amygdala activity than controls. These studies strengthen the connection between the amygdala and the abnormal social-emotional behavior seen in patients with ASDs, said Chris Ashwin, PhD, senior research associate at the Autism Research Centre in the Department of Psychiatry at the University of Cambridge, UK.

The connection between Parkinson disease (PD) and melanoma is becoming increasingly apparent, leading some researchers to call for increased melanoma screening in the PD population. In addition, researchers are disproving previous theories that levodopa may be implicated in the link between melanoma and PD.

Intravenous recombinant tissue plasminogen activator (alteplase [Activase]; rt-PA) for the treatment of acute stroke has been shown to increase the likelihood of recovery. A number of studies are examining whether combination therapy with other agents, such as the direct thrombin inhibitor argatroban; the glycoprotein IIb/IIIa inhibitors abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat); and activated protein C (APC), may be safer and more effective.

Rehabilitative therapy may be effective in patients many months after stroke. Patients who underwent constraint-induced movement therapy (CIMT) within 3 to 9 months after stroke showed significant rehabilitation of the affected limb in a study led by Steven Wolf, PhD, professor of rehabilitation medicine at Emory University in Atlanta

Human herpesviruses 6B and 7 (HHV-6B, HHV-7) may be implicated in some forms of epilepsy. Steven Jacobson, PhD, a senior investigator at the National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, led a team of researchers who identified HHV-6B in the hippocampus of a substantial proportion of resections from patients with mesial temporal lobe epilepsy (MTLE) but not in tissue from neocortical resections. He reported his findings at the 2006 annual meeting of the American Epilepsy Society (AES), which met in San Diego from December 1 to 5.