Psychiatric Times Vol 24 No 1

Psychiatric Times Archives 2002

The effects of antidepressants and other medications on a person's driving ability have been debated for some time. A recent German study by Dr Alexander Brunnauer and associates adds to the evidence that antidepressants impair driving.

I met Wally for the first time when he was in the ICU. He was 14 years old and fighting a losing battle against rhabdomyosarcoma. Wally greeted me with a look of silent despair. His right arm had been amputated just above his elbow and he was on a ventilator. This was my first experience with a dying child and, seeing Wally in his shocking state, I felt totally overwhelmed.

In many jurisdictions, children and adolescents are currently being treated with cocktails of various psychotropic medications, the vast majority of which have never been empirically tested or validated in the age group in which they are being prescribed. Stating otherwise is being disingenuous. Medications are prescribed so often that one frequently cannot discern which symptoms are clinically derived and which are iatrogenic.

Persons who have anxiety disorders commonly self-medicate with alcohol and other drugs, a recent survey confirmed. The results were published in the November 2006 issue of The Journal of Nervous and Mental Disease.

Freud

Just before it left Washington at the tail end of the December lame-duck session, Congress gave physicians a last-minute reprieve from the 5% Medicare pay cut that would have gone into effect on January 1, 2007. Moreover, the House and Senate approved a 1.5% bonus to be added to Medicare reimbursement in the second half of 2007 for physicians who voluntarily report quality-of-care measures.

Is there something to the adage, laughter is the best medicine? Dr Marc Gelkopf and associates in Israel studied a different treatment approach for patients with schizophrenia using funny movies.

Psychotic disorders are a group of syndromes characterized by positive symptoms, including hallucinations, delusions, and thought disorder; and negative symptoms, including mood symptoms, social withdrawal, and reduced motivation. Cognitive deficits also appear with psychotic disorders. Psychotic disorders rank 22nd in the World Health Organization's list of worldwide causes of disability. This ranking is adjusted for the relatively low lifetime prevalence rate for psychosis; the perceived burden of the disease on those affected with psychotic disorders, as well as their relatives and caregivers, is much higher.

Intermittent explosive disorder (IED) is not yet on the radar screens of many psychiatrists, but it is more prevalent than panic disorder and warrants extensive research and attention, 2 experts on IED said recently.

Once reflected on, the concept of acceptance has multifarious implications for modern mental health care. My own work with patients and trainees has convinced me of the significance of acceptance, and I want to illustrate a few examples that may move readers to recognize similar echoes in their own practice

Medications used in the treatment of bipolar disorder are commonly associated with weight gain. Antipsychotic drugs have been implicated in new-onset diabetes.

Beyond demographic characteristics, risk and protective factors for suicide in older adults have been much more clearly defined in recent years by a series of methodologically rigorous, case-controlled psychological autopsy studies.

Substance use disorder (SUD) plays a prominent role in the epidemiology, cause, and course of mental illness. Of the more than 5 million Americans with comorbid mental illness and SUD, fewer than half received treatment at either a specialty mental health or substance abuse treatment facility.

Weight gain is a major concern in patients with schizophrenia, especially in those taking atypical antipsychotics. Although the exact mechanism of weight gain associated with atypical antipsychotics is unknown, we often hear patients complain about an increase in appetite and a decrease in satiety.

The topic of life's meaning is, of course, a primary issue in existential theory.

Borderline personality disorder (BPD) and substance use disorder (SUD) often co-occur. Comorbid BPD and SUD is related to a variety of severe adverse outcomes.

Poetry of the Times by Richard M. Berlin, MD.

How do we help patients manage pain without exacerbating or reactivating an addictive disorder?

There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.