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HypnoticsSeveral classes of hypnotic medication are available: the older barbiturates and their derivatives; benzodiazepines; chemically distinct “z-compounds”; antihistamines and antihistaminic antidepressants; and melatoninergic compounds. The use of hypnotic medications continues at a high rate. However, some switching to the shorter-acting benzodiazepines has occurred. The z-compounds-eszopiclone, zolpidem, and zaleplon-have become popular; they seem to have fewer residual effects than the benzodiazepines. Even so, care is needed in prescribing such hypnotics for the elderly.
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Anxiety in the Medical PatientAnxiety is a ubiquitous, natural affective state that is essential for evolutionary survival. Nearly as common, however, are experiences of anxiety that exceed social, psychological, or physiological needs, leading to functional impairment. Indeed, primary anxiety disorders, including panic disorder, social phobia, and generalized anxiety disorder (GAD), represent the most common category of mental illness in the United States. Secondary, or reactive, anxiety is also widespread and can arise not only from numerous medical causes but also from the psychological process of coping with illness.
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College Students Under StressEmerging adults in the midst of a tremendous emotional growth spurt and a leap of neurocognitive maturation often need guidance articulating what bothers them.
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Gender Differences and Psychiatric DisordersGender is an important variable in medicine and psychiatry. The initial interest in gender issues was stimulated by recognition that women were absent from much medical research. Now, however, the field has expanded to include more specific and sensitive attention to men and the role of gender and gender differences.
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Contraception and MisconceptionsPsychiatrists who treat women and adolescent girls may find it necessary to discuss with their patients reproductive planning and the role of contraception in setting comprehensive treatment goals. Here's why.
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Can You Trust Your Physician?Statutes in 8 states are not designed to assure informed decision-making, say these psychiatrists; instead they represent an unprecedented effort by the government to use physician communications as an instrument for discouraging pregnant women from exercising their constitutional right to make their own reproductive choices.
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The State of the Evidence on Pediatric Bipolar DisorderPediatric bipolar disorder (PBD) is a serious psychiatric illness that impairs children’s emotional, cognitive, and social development. PBD causes severe mood instability that manifests in chronic irritability, episodes of rage, tearfulness, distractibility, grandiosity or inflated self-esteem, hypersexual behavior, a decreased need for sleep, and behavioral activation coupled with poor judgment. While research in this area has accelerated during the past 15 years, there are still significant gaps in knowledge concerning the prevalence, etiology, phenomenology, assessment, and treatment for PBD.
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Biological Markers and the Future of Early Diagnosis and Treatment in SchizophreniaBiological Markers and the Future of Early Diagnosis and Treatment in Schizophrenia
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Dementia, Agitation, and Aggression: The Role of Electroconvulsive TherapyWhat role might electroconvulsive therapy play for short-term treatment of agitation and aggression in patients with dementia?
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New Findings Related to Childhood-Onset PsychopathologyInnovative approaches that advance our understanding of the mechanisms that confer risk for psychiatric illness in youths is the focus.
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Podcast: Brief Dynamic Therapy-5 Tenets to Maximize EffectivenessIn this podcast, Dr Mantosh Dewan, discusses strategies to help you and your patient get the most benefit from this form of therapy.
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Are We Over-Diagnosing ADHD Based on “Hyperactivity"?Here’s why ADHD is a diagnosis of exclusion.
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Lessons Learned From the International Society for Bipolar Disorders Task Force on SuicideWhat is the actual risk of suicide attempts or suicide death in people with bipolar disorder? How does a BD diagnosis affect short-term and long-term suicide risk? How should a BD diagnosis help guide us toward the most effective suicide prevention strategies?
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Early Evaluation and Management of Mild Traumatic Brain Injurymild traumatic brain injury, MTBI, concussion, post-concussive syndrome
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The Case of Factitious Disorder Versus MalingeringPatients who exaggerate, feign, or induce physical illness are a great challenge to their physicians. Trained to trust their patients’ self-reports, even competent and conscientious physicians can fall victim to these deceptions.
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The Age of Cannabis Has Arrived: Issues for Older AdultsCannabis use has prompted symptoms such as dizziness, sleepiness, and fatigue in older patients. Are there any benevolent effects?
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Stroke: While Current Treatment Is Limited, New Options Are on the HorizonCurrent therapy for acute ischemic stroke remains limited to intravenous recombinant tissue plasminogen activator (tPA) administered within 3 hours of symptom onset, but despite strong evidence supporting its effectiveness,1-5 only 2% to 4% of all stroke patients currently receive tPA.
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Co-occurring Substance Use and Eating DisordersWhat does existing research say about the connection between substance use disorders and eating disorders?
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Treating Comorbid Anxiety Disorders in Patients With Schizophrenia: A New PathwayIdentifying comorbid anxiety disorders as potential treatment targets may contribute to more positive outcomes for patients with schizophrenia. Details here.
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New Insights in Premature EjaculationEjaculatio praecox, or premature (rapid, early) ejaculation (PE), is a prevalent male sexual complaint. It may be part of the normal ejaculation variability in men, but it may also be the symptom of an ejaculatory dysfunction.
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Alcohol and Drug Abuse Intervention in the Emergency DepartmentIf done properly, the assessment of alcohol and substance use disorders in the emergency department (ED) or psychiatric emergency service can be the first step toward recovery.
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Headache and Psychiatric ComorbidityMigraine affects approximately 12% of the population, and a high percentage of these patients have comorbid psychiatric disorders. Knowing more about the interaction between headache and psychiatric factors can assist in evaluating and treating these patients.
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Borderline Personality Disorder: Splitting CountertransferenceSplitting, archetypally imbedded in a patient's psychic structure, acts as a powerful unconscious force to protect against the ego's perception of dangerous anxiety and intense affects. Rather than providing real protection, splitting leads to destructive behavior and turmoil in patients' lives.
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Clinical Care of the Suicidal College Student: When and How to Involve ParentsTwenty years ago, it was rare for college students to mention suicidal thoughts, and even more rare to involve parents in their care. Today, students are more likely to describe suicidal ideation, necessitating a more thorough safety assessment with potential outreach to parents.
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Common Augmentation Strategies for Depression: Findings Show Lack of EvidenceIt is estimated that at least half of persons who begin antidepressant treatment will not respond to monotherapy.
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Serving the Underserved: Who Needs Mental Health Care?Experts address specific concerns when treating the immigrant sector and describe supervised mental health services for uninsured, largely undocumented patients.
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Epilepsy and Seizures: Neuropsychiatric ImplicationsPsychiatric comorbidity in epilepsy represents not only a matter of intellectual interest but also an important variable that affects prognosis in terms of morbidity and mortality.
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Atypical Antipsychotics for Treatment of Schizophrenia Spectrum DisordersThe number of prescriptions for antipsychotic treatment of teenagers has increased sharply in office-based medical practice. Adolescents with psychotic symptoms frequently present for clinical evaluation, and early-onset schizophrenia spectrum disorders (onset of psychotic symptoms before the age of 18 years) represent an important consideration in the differential diagnosis in these youths
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Treatment of Insomnia in Anxiety DisordersHow often do insomnia and anxiety disorders coexist? And how best to treat patients with comorbid insomnia and anxiety? Answers here..
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Can Your Older Patient Drive Safely?Medical professionals may be reluctant to initiate a discussion about driving with older patients in anticipation of a negative impact on the physician-patient relationship.
