Psychiatric Times Vol 24 No 12

Of the many bits of wisdom my parents shared with me as a teenager, one stands out as particularly useful: "John, 90% of the things you worry about will never happen to you!" I still think about this comforting observation from time to time, especially now that I have my own children, and I furrow my brow because I wonder how they--or anybody else--could come up with such an optimistic statistic.

A new strategy that normalizes neurotransmitter deficits common in withdrawal from long-term cocaine use may reduce cocaine-seeking behaviors.

Book review

Poetry of the Times

The articles in this Special Report, although far from comprehensive, address an intriguing sample of the many key topics in child and adolescent psychiatry today.

The FDA is considering changes to the Patient Medication Guides (MedGuides), which must now accompany about 65 drugs, including those in 2 major classes, one of which is antidepressants. MedGuides provide information about potential adverse reactions and are considered a warning of sorts.

How time flies! It has been more than a year since my last column, when I staked my claim in psychiatry. I planned to eschew the medical rat race and find my own little piece of medicine as it used to be, when doctors were doctors, nurses were nurses, and insurance salespeople were . . . salespeople. Should one read anything into the long delay between that column and this one? Absolutely! But I'll get to that.

There are moments in therapy that seem to have a special, illuminative quality; something important is suddenly revealed. Such moments may come as the result of deliberate observational and interventional processes or may emerge from the therapist's unconscious.

According to the National Institute on Drug Abuse, of all the illicit substances, marijuana is the most commonly abused among adolescents and young adults, and abuse during adolescence increases the likelihood of dependency in adulthood.

I was Dr George Engel's assistant and associate for 14 years. His biopsychosocial model was a conceptual effort designed to get beyond the reductionistic biomedical model that still prevails. In his letter, Dr Victor Schwartz reads Dr Engel much more closely and to the point than does Dr Waterman "Biopsychosocial Model: Helpful or Hindering?" Psychiatric Times, May 2007).

Although the Washington Report used the term "postabortion depression," this is a term to which the APA objected. There is no credible scientific evidence for such a diagnostic category or for a causal relationship between abortion and mental illness.

All of us have heard the phrase "between a rock and a hard place," and many of us have been in the situation that the idiom describes. However, few of us (other than English professors) likely know the origin of the saying and even fewer of us know how it applies to clinical psychiatry. Delving into these seemingly unrelated queries will be the subject of this month's column.

Early relapse is a limiting defect in electroconvulsive therapy (ECT). Although more than 80% of patients with a severe depressive illness who complete an acute course of ECT are relieved within three weeks, up to 60% relapse within six months, despite continuation treatments with antidepressant medications.1,2 In a large, government-supported, collaborative study led by the Columbia University Consortium (CUC), patients with unipolar major depression that had failed to respond to multiple trials of medications were treated with ECT to clinical remission and then randomly assigned to one of three continuation treatments--placebo, nortriptyline (Aventyl, Pamelor) alone, or the combination of nortriptyline and lithium (Eskalith, Lithobid). The patients were monitored for adequacy of blood levels.1 Within the six-month follow-up period, 84% of patients treated with placebo, 60% of patients treated with nortriptyline, and 39% of patients treated with the combination medications had relapsed.

It is not known what makes children vulnerable to the development of psychogenic nonepileptic seizures. To date, there are no research studies available on the epidemiological, medical, or genetic risk factors for childhood PNES.

Since its introduction in DSM-III in 1980, attention-deficit/ hyperactivity disorder (ADHD) has proved to be a developmental disorder with many causes and complex behavioral, cognitive, and emotional manifestations that can impair academic functioning, occupational achievement, social relationships, and self-esteem.

Bone mineral density (BMD) was reduced at a greater rate in older women when they had symptoms of depression, according to one recent report from the Study of Osteoporotic Fractures Research Group, while another report implicated treatment with SSRI antidepressants.

Suicide is the third leading cause of death in younger (10- to 14-year-old) adolescents in the United States and the leading cause of death in this age group in other countries, including China, Sweden, Ireland, Australia, and New Zealand.

Portable pulse oximeters are inexpensive ($150 to $600), are noninvasive, and can measure a patient's oxygen saturation in 5 to 10 seconds.

In 20 years of dealing with severe schizophrenia in her sister and daughter, it occurred to psychologist Joyce Burland, PhD, that she "had never been given any instruction on how to be helpful to them," so in 1991, she wrote up a highly structured course with a standardized curriculum and training guide.

The Treatment for Adolescents With Depression Study (TADS) represents the single largest and potentially most informative clinical trial of adolescents with depressive illness. The overall aim of the study was to investigate the effectiveness of standard interventions for adolescent outpatients with moderate to severe depression.

Child and adolescent psychosomatic medicine, usually in the realm of the pediatric psychiatric consultation-liaison service, seeks to address the complex relationship between a child's physical illness and affective state with the goal of improving the child's emotional well-being.

In part 1 of this essay, I argued that individual freedom is not only compatible with determinism but dependent on it. I also argued that freedom is not an "either/or" condition. Rather, actions may be more or less free, and therefore, more or less "responsible," depending on a number of contingent factors, yielding various degrees of freedom. Psychiatrists, I suggested, can be most helpful in so far as we can describe, study, and categorize these degrees of freedom and the psychopathological conditions that undermine them. In part 2, I elaborate on the "naturalistic" model of freedom and autonomy and suggest how it may be applied to psychiatric disorders and medico-legal determinations of culpability.

The American Academy of Child and Adolescent Psychiatry recently published a practice parameter with evidence-based guidelines for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Recommendations for the best treatment practices were made based on empirical evidence and clinical consensus, and the strength of these recommendations was based on the extent and degree of these variables. This column will provide a summary of the parameter.

There is no shortage of hyperbole when politicians of all stripes describe the nature and effects of video games. Republican presidential candidate Mitt Romney proclaimed, "Pornography and violence poison our music and movies and TV and video games.

Attachment may be defined as a composite of behaviors in an infant, toddler, or young child that is designed to achieve physical and emotional closeness to a mother or preferred caregiver when the child seeks comfort, support, nurturance, or protection.

Research Review: Update on Child and Adolescent ADHD