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The Conundrum of Psychiatric ComorbiditySince the revision of DSM-III, high rates of co-occurring psychiatric disorders have been observed, particularly in cases of moderate and severe psychiatric illness. The reason lies in the design of the diagnostic system itself: DSM-IV is a descriptive, categorical system that splits psychiatric behaviors and symptoms into numerous distinct disorders, and uses few exclusionary hierarchies to eliminate multiple diagnoses.
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Reexperiencing/Hyperaroused and Dissociative States in Posttraumatic Stress DisorderDissociation-a common feature of posttraumatic stress disorder (PTSD)-involves disruptions in the usually integrated functions of consciousness, memory, identity, and perception of the self and the environment.
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Antidepressants: Brand Name or Generic?For many antidepressants, the issue of brand-name versus generic has no practical significance. Elavil was first marketed almost a half century ago, and its patent has long expired. It lives on, however, but as generic amitriptyline. Today, only a few antidepressants are still fully protected by patents, namely, Cymbalta (2010), Lexapro (2012), and Pristiq (2022) for major depressive disorder (MDD); and Seroquel (2011) and Symbyax (2017) for bipolar depression.
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Does Ketamine Hold Promise in Mitigating Suicide Risk?The authors review mechanisms of suicide and the effectiveness of current treatments, and zero in on ketamine--a potential novel, rapidly acting treatment for suicidality.
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The Assessment and Management of Depression in Children With AsthmaAsthma is one of the most impairing diseases of childhood, affecting more than 6% of children. Each year, it is responsible for 14 million lost school days and $3 billion in treatment costs.
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Rock, Paper, Scissors-PicaPica, a condition in which a person is compelled to eat non-food items such as dirt, paper, plaster, cigarette ashes, and other substances, is increasing in prevalence in adults. More in this patient education summary.
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Exploring Gender Difference in DepressionMost studies have found clear gender differences in the prevalence of depressive disorders. Typically, studies report that women have a prevalence rate for depression up to twice that of men (Bebbington, 1996; Nolen-Hoeksema, 1987).
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Managing Treatment-Resistant OCDObsessive-compulsive disorder is a prevalent, disabling and chronic illness. Serotonin reuptake inhibitors are the first-line of treatment; however a large proportion of patients will have either a partial or nonresponse. This review outlines the strategies for treatment-resistant OCD, including augmentation agents, alternative monotherapies, intravenous strategies and newer nonpharmacologic somatic treatments under development.
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Insomnia and Its Risks: Causes, Consequences and TreatmentCMEducator: Insomnia and Its Risks: Causes, Consequences and Treatment - application for credit only; article not available online
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Final Ruling Can Benefit Psychiatrists and Their PatientsThe mental health community was given some much needed relief when the Obama Administration implemented the final rule be put in place from the 2008 Mental Health Parity and Addiction Equity Act. The new mandate will ensure that most health plans cover mental health and addiction services in the same way they treat other medical issues.
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Coming Up for AirAs I lie in my hospital bed, attempting to breathe through my trach tube at a normal rate, waiting for my morning medication, and hoping to hear good, or at least manageable, results from my doctors when they come to me on rounds, my mind wanders. Despite the precariousness of my situation, I can’t help but smile as I think of my now monthly psychotherapy sessions.
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Psychopharmacology of Aggression and Violence in Mental IllnessSeveral studies have been undertaken to test the efficacy of drugs in the management of aggression and hostility in patients with schizophrenia and other mood disorders.
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Is ECT an Ethical Treatment?Although there are many social impediments to the use of ECT, it appears to meet the four ethical principles of health care.
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Sleep Disorders in the ElderlyA variety of conditions may account for the sleep difficulties experienced by many older adults, including specific sleep disorders, circadian rhythm disturbances, and medical and psychiatric comorbidities.
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The Lunch HourHere is a glimpse into the understated yet basic importance of taking a lunch break as a way of recharging during the workday.
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Optimizing Care in a Team Setting: A Program for People With SchizophreniaA look at a multidisciplinary team -- and its focus on meaningful recovery -- for patients with schizophrenia.
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Enlisting Family Members to Address Treatment Refusal in Substance AbusersAnyone who is close to someone who abuses alcohol or drugs knows all too well that substance abusers do not typically seek treatment until they have experienced years of substance-related problems. During the first year after onset of a diagnosable substance use disorder, only 1 of 5 alcohol-dependent persons and 1 of 4 drug-dependent persons receive treatment.
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2021 Sigourney Award Winner: Supporting the MissionThis Sigourney Award winner is glad the recognition can continue supporting the mission of their work.
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Youth-Led Suicide Prevention in an Indigenous Rural CommunitySuicide is a pervasive public health issue for adolescents in Hawaii. In response, a youth leadership model was initiated to empower young leaders in suicide prevention through evidence-based training, relationship building, and community awareness.
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Diagnostic Manual-Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons With Intellectual DisabilityThe editors of Diagnostic Manual-Intellectual Disability (DM-ID) have set out to complete the difficult task of compiling the evidence base on mental disorders in the field of intellectual disability (ID) into one reference book while modifying DSM-IV diagnostic criteria for use in persons with the disorder who present with mental and behavioral disorders.
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Psychosis and Suicidality in AdolescentsInformation from studies on adolescents with psychosis and a review of the evidence about the risk of suicide and suicidal behavior in this patient population.
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Fostering Human Connection in a Sustainable Virtual WorldHow can psychiatry meet its ethical duty to mitigate climate change while also promoting collegiality at conferences?
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Mini Quiz: Perinatal DepressionYour patient is excited to be pregnant. She is currently on sertraline, and has been stable on this for many years. She is very insistent that she would like to stop her medication. What should you do?
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The Clinical and Treatment Implications of Co-Occurring Mania and ADHD in YouthsThe relationship between bipolar disorder and ADHD remains unclear; however, this combined condition may represent an important genetic and clinical subtype with distinct psychopathology, familiality, and treatment response.
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Huntington Disease: Hopes for the FutureInitial symptoms include personality changes and the gradual appearance of small involuntary movements. These move- ments progress to frank chorea, ballism, and dystonia. Later in the disease course, a bradykinetic parkinsonian phenotype manifests. It is characterized by rigidity, severe dystonia, and contractures. Falls are common. Dysphagia is common as well and is progressive, becoming severe and often contributing to death from aspiration pneumonia.
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We Shall Fight Them on the BeachesSettlements by two insurance companies in the RICO lawsuit could have an major impact on psychiatry practices.
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The Differential Diagnosis of Childhood Developmental DisordersReducing complex human experiences into a psychiatric diagnosis can be a daunting task. For children with developmental disorders, this process is even more complicated and requires distilling often incomplete and frequently contradictory scientific evidence.
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Synthetic Cathinones: Signs, Symptoms, and TreatmentSometimes viewed as “legal cocaine,” the over-the-counter status of synthetic cathinones (aka bath salts) gives the illusion that they are safe. In fact, they are highly toxic.
