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Eating Disorders Among Older AdultsIn this CME article, learn how to evaluate older adults who present with significant appetite and weight changes for the presence of an eating disorder.
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Gone to Pot: The Association Between Cannabis and PsychosisCannabis, or marijuana, has been consumed by humans for centuriesand remains one of the most widely and commonly used illicitsubstances. The authors review the evidence supporting and refutingthe association between cannabis exposure and psychotic disorders.
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Update on Pediatric Pneumonia: Causes-Treatment OptionsHere we summarize the evaluation of pediatric pneumonia and offer our management recommendations-based on a literature review and on clinical experience-in the outpatient setting.
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In the Eye of the BeholderI have a neuromuscular disorder. This problem presented itself at birth, and I took much longer than other children to crawl, walk, and reach other physical developmental milestones. My sister is also affected, and although we have had extensive workups twice, the diagnosis is unclear. I had physical therapy up until my early teens, at which point I could do everything I needed to do in day-to-day life.
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Psychosocial Treatments for Trauma-Based NightmaresTwo evidence-based psychosocial treatments are available for trauma-based nightmares. The authors provide a case illustration for each method.
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Psychiatrist on the Road: Encounters in Healing and HealthcareAfter 18 years as a senior clinical psychiatrist at a New England inner-city mental health clinic, Dr Lawrence Climo was understandably surprised and saddened when he was given 2 weeks’ notice that his services were no longer needed. Financial constraints meant the clinic was replacing him with a nurse. Although his wife told him it was an opportunity, he remembers thinking that health care reform made him feel that his professional skills were “almost irrelevant or at least unmarketable.”
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A Response to Dr Allen Frances on SVP/ParaphiliasIn this guest blog, Dr Deirdre D'Orazio responds to a recent commentary by Dr Allen Frances on conducting evaluations of potential sexually violent predators.
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Comorbidity: Psychiatric Comorbidity in Persons With DementiaThe assessment and treatment of psychiatric symptoms in persons with cognitive dysfunction are becoming increasingly important. Prevalence estimates of dementia in the United States range from 5% in those aged 71 to 79 years to 25% to 50% in those 90 or older.
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Closing the Research-Practice Gap in Eating DisordersEating disorders (EDs) are associated with high medical and psychiatric comorbidity, poor quality of life, and high mortality, and mortality from anorexia nervosa (AN) is the highest of all mental disorders. Fortunately, there are a number of evidence-based psychological treatment approaches for EDs.
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Emotional Regulation Skills Can Make or Break MDD RelapseResearchers accumulated information on self-reported emotion regulation in patients with current and remitted MDD. Then, they crunched the data.
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Fibromyalgia Syndrome: A Guide for the PerplexedFibromyalgia syndrome is a chronic condition that consists of a pervasive set of unexplained physical symptoms with widespread pain (involving at least 3 of 4 body quadrants and axials) of at least 3 months duration and point tenderness at 9 bilateral locations (Figure) as the cardinal features.1 Patients with FM report a set of symptoms, functional limitations, and psychological dysfunctions, including persistent fatigue (78.2%), sleep disturbance (75.6%), feelings of stiffness (76.2%), headaches (54.3%), depression and anxiety (44.9%), and irritable bowel disorders (35.7%).1 Patients also report cognitive impairment and general malaise, “fibro fog.” This pattern of symptoms has been reported under various names (such as tension myalgia, psychogenic rheumatism, and fibromyositis) since the early 19th century.
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Progress and Promise: Research and Education in Psychosomatic MedicinePractitioners understand the wholeness and unity of their patients. Instead of being considered isolated organ systems or enzyme cycles, patients are understood as coherent entities composed of coordinated and interrelated processes and systems. This fundamental understanding guidesinvestigative and clinical care approaches in psychosomatic medicine.
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Mini Quiz: Addiction on CampusWhat are some of the most commonly abused drugs among college students?
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The Monoaminergic System and Its Putative Role in Alzheimer DiseaseThe SSRIs, although principally targeting serotonin transporter, are complex drugs that might work on other neurotransmitter and receptor systems. It is likely worthwhile to look at the effects of other monoamine and neuropeptide systems on the enzymatic machinery cleaving the amyloid precursor protein.
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Experts Debate Usefulness of Vision Restoration TherapyVision Restoration Therapy (VRT) is an FDA-cleared device for treatment of visual field defects caused by stroke or traumatic brain injury. The therapy works by stimulating the brain to form new connections, according to NovaVision, the device's manufacturer. But critics maintain that VRT is nothing more than a pricey way to promote saccadic eye movement.
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Trauma and Violence in Childhood: A U.S. PerspectiveThis article reviews the Adverse Childhood Experiences (ACE) Study that examined the association between multiple childhood traumas and health outcomes in adults. These findings have significant public health implications for individuals exposed to childhood trauma, and the authors present a vision for a children's mental health care and wellness infrastructure in the United States derived from the Report of the Surgeon General's Conference on Children's Mental Health.
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Cyberbullying: Who Hurts, and WhyThe research on electronic aggression among college students indicates that it is highly prevalent, with over 93% of college students reporting some negative effects due to electronic victimization.
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Frontolobular Cystic Mass and Hydrocephalus in Woman With Headache and LethargyA previously healthy 35-year-old woman was admitted to a New York City hospital after presenting to the emergency department (ED) with a 10- to 14-day history of generalized weakness, progressive frontal headache, and lethargy. She immigrated to Brooklyn, New York, from urban Haiti 9 years previously and had not returned to Haiti since. She denied any recent travel elsewhere and had no pets. An HIV antibody test, performed 4 months before ED presentation, was negative.
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Mini Quiz: Cognitive EnhancersWhich pharmacotherapeutic approach is most effective for cognitive enhancement? Test your knowledge with this quiz.
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The Influence of Diet on ADHDThere is good emerging evidence that aspects of diet can indeed affect ADHD. Clinical recommendations here.
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Culture and Suicide in Late LifeA cross-cultural comparison of suicide in old age, including a discussion of recent epidemiological trends in suicide rates. The authors also discuss the impact of social and cultural variables on the detection of depression and the formulation of suicide prevention strategies.
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The Impact of Antipsychotics on Cognitive Functioning in SchizophreniaCognitive deficits, which play a crucial role in the pathogenesis and prognosis of schizophrenia, can lead to noncompliance and poor outcomes. New treatment options need to be tested that may offer surplus effects on neurocognition.
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The Intersection of Mental Health and Successful AgingOne consequence of the "graying" of the world's population is that psychiatrists, along with all health care professionals, will increasingly be providing services to older adults. In the United States, the first set of people belonging to the baby boom generation turned 60 in 2005, and the number of people older than 60 will soonoutnumber children for the first time in recorded history.
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The Link Between Immune System Dysregulation and SchizophreniaOn the wide range of symptoms in schizophrenia, including alterations of the dopaminergic and/or glutamatergic systems, abnormal neurodevelopment, and the theory of immune system imbalance.
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Suicide in Older Adults: Advances and the Role of Technology in TreatmentRecent updates in suicide prevention interventions for older adults and how a novel tablet application may provide relief to individuals at high risk of suicide.
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Through Hamlet to Narrative Medicine and Neuroscience: Literature as a Basic Science of PsychiatryPsychiatrists have often turned to literature for theory building, clinical understanding and teaching. Hamlet is a common example, beginning with Freud. Most psychiatrists, like Freud, look at content (character and motivation) when using literature. However, the process (interaction between characters) can also teach us much about the psychiatrist-patient encounter.
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Cultural Issues in the Emergency SettingThe setting of a fast-paced emergency department (ED) or psychiatric emergency service makes it especially difficult to sensitively elicit and address an individual patient's needs and concerns. When considering the myriad differences in culture that come into play between a patient and a psychiatrist or other mental health care clinician, optimal diagnosis and treatment can be even more challenging, as the cases described here illustrate. The important influence of culture cannot be stressed enough. Taking the time to understand "where the patient is coming from" can prevent an already stressful, highly emotionally charged situation from becoming even more convoluted.
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Catatonia in Autism or the Blind Men and the ElephantCurrent treatments for autistic spectrum disorders (ASD) are useful in some cases, but have little enduring impact. This had lead to many parents seeking nonconventional treatments that often border on quackery.
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Psychiatric Emergency StrategiesHere we present how to assess safely patients who become oppositional or menacing in a clinic or office.
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Can Dialogue Cure? A Couple's Therapeutic JourneyIndividuals with a past history of chronic psychiatric illness are often given poor prognoses that can limit their therapeutic horizons for further treatment. This pessimism may be misplaced as is demonstrated by the case of Jay, age 71, and Kay, age 65. The couple presented at the Loyola Sexual Dysfunction Clinic in a program consisting of 7 weekly sessions of 5 hours each with 2 trainee therapists.
