Psychiatric Times Vol 25 No 1

New research is examining the link between schizophrenia/psychosis and select infections affecting the CNS. Two reports investigated this link in children and military personnel in the January 2008 issue of the American Journal of Psychiatry.

Although valiant efforts have been made to reduce access to the chemical precursors of methamphetamine, it is likely that methamphetamine will remain accessible and inexpensive, and costs associated with increased use will continue to rise.

Momentum is picking up in Congress to expand the frontline federal grant program that provides money to local prisons and jails for handling of nonviolent offenders who have mental health problems.

Although the percentage of US adolescents who use illicit drugs or drink alcohol continued a decade-long reduction in 2006, according to the Monitoring the Future (MTF) survey,1 the use of prescription drugs, such as narcotics, tranquilizers, sedatives, and stimulants remains at relatively high levels. Concerns about marijuana and alcohol, which are easily the most prevalent substances misused by adolescents, have obscured the increasing problem of prescription drug misuse in youth. This article presents information on prescription drug misuse and diversion based on surveys of high school and college students.

Many veterans face mental illnesses on return from duty, but for how long and to what extent? Psychiatrist Charles S. Milliken and colleagues are on a mission to measure the mental health needs of returning soldiers from Iraq, including soldier assessment and use of mental health care, using 2 surveys--the Post-Deployment Health Assessment (PDHA) and the Post-Deployment Health Reassessment (PDHRA). The results of their analyses were reported in the November 2007 issue of JAMA.

A Public Health Approach to Intervening With Youth in Schools

Evidence for Use of Neurostimulating Techniques

Intensive psychosocial intervention was found to improve overall functioning in patients with bipolar depression, concluded researchers of the Systemic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial. Results were reported in the September 2007 issue of the American Journal of Psychiatry.

Recent years have witnessed exciting developments in understanding and treating addictions. For example, it seems that almost weekly we get new insights into the neurobiology underlying vulnerability to addiction. Similarly, there have never been more medications available to treat the spectrum of addictive disorders, especially alcohol, nicotine, and opioid dependence. In addition, studies continue to underscore the crucial role of psychosocial treatments in recovery from addiction.

Almost 3 years after the FDA warned of increased mortality in elderly patients who received atypical antipsychotics off-label for neuropsychiatric syndromes of dementia, no medication has been approved as safe and effective for this increasingly challenging problem. Recent publications, however, including a white paper from the American College of Neuropsychopharmacology (ACNP), indicate that clinical investigators are wrestling with the dilemma and considering potential alternatives to antipsychotics.

The goal of this well-intentioned and mostly well-written, small book is to present an "integrated pharmacopsychosocial approach to treatment" of substance addictions and behavioral addictions, such as pathological gambling, eating disorders, and compulsive sexuality. A unified framework for the treatment of addictive disorders has great clinical appeal, given that most people seeking treatment will have multiple addictions as well as co-occurring psychiatric symptoms and disorders. The authors offer valuable advice on principles that increase the likelihood of successful treatment, such as "Less is more--simplification of pharmacotherapy" and "Importance of accurate diagnosis as the basis for treatment." They also correctly emphasize that addiction is a chronic disorder requiring a long-term approach to treatment.

The November death of an Israeli fashion model whose weight had dropped below 60 lb was chilling even in a world that prizes rail-thin models as an ideal of feminine chic. Social critics have long blamed the fashion industry's use of such models for inspiring teenagers and young women to engage in extreme dieting. But at the recent Annual Meeting of the California Psychiatric Association, in Huntington Beach, eating disorders expert Walter Kaye, MD, reminded attendees that the causes of anorexia nervosa (AN) relate more to genetics and neurobiology than to size-zero models on catwalks.1

Having grown up as a "military brat," I have been familiar for decades with how my family's friends coped with war experiences. I did not know the term "PTSD" in those days, but I could see the enduring, horrific marks that posttraumatic stress disorder had left on them. I learned early on that wars could keep killing soldiers long after the peace treaties had been signed and weapons had been rendered silent.

As an educator who still considers textbooks essential tools because of their utility as starting points for learning and exploration, I am pleased that the new edition of Lewis's Child and Adolescent Psychiatry has arrived. The current version lives up to its title; it remains a basic text that provides an overview of child and adolescent psychiatry that is useful and accessible for students and practitioners.

Several new substances and new uses for available products were evaluated in research projects reported at the 47th annual NIMH-sponsored New Clinical Drug Evaluation Unit, held this past June in Boca Raton, Fla. The agonists included a melatonergic compound for depression, 2 new agents for schizophrenia, some g-aminobutyric acid (GABA)-ergic antipsychotics, and several drugs being evaluated for non-approved indications.

This morning my best friend will come with his chain saw and ax, and we'll cut down the ash where a barred owl perched last night and hooted his four-note song. We'll split it and stack it into cords, and I'll be thinking about midnight in January when the air is twenty below zero and the northern lights shimmer purple and blue. My wood stove will be burning today's work at 700 degrees, and I'll be warm enough to open a window wide and listen again for owls and the calls of coyotes yipping at the moon, my monogrammed white coat draped on a peg, washed whiter by the moonlight, hanging around for the next moment of healing, like winter waiting for the earth's heart to thaw.

Public concern about the use of anabolic androgenic steroids by athletes and others has led to enhanced testing for these drugs as well as an improved understanding of their medical and psychiatric effects. This article reviews the pharmacology of these compounds, the prevalence and effects of their use among athletes, and the basics of steroid testing, and it concludes with treatment recommendations. Even though athletes may use other illicit substances, such as stimulants, human growth hormone, and erythropoietin, this article focuses only on anabolic androgenic steroids. Review articles on the psychiatric effects of the other performance-enhancing substances are available elsewhere.1,2

In part 1 of this column, I reviewed research findings of the most substantiated nonpharmacological and integrative treatments for anxiety, such as kava-kava, L-theanine, applied relaxation, yoga, meditation and mindfulness training, virtual reality graded exposure therapy, and biofeedback training.

There have been numerous definitions of culture. Dwight Heath1 offers a simple definition: "It [culture] is a system of patterns of belief and behavior that shape the worldview of the member of a society. As such, it serves as a guide for action, a cognitive map, and a grammar for behavior."

A recent longitudinal study examined the potential relationship between social anxiety disorder during adolescence and young adulthood and the subsequent development of depression.1

From 1826 to 1827, the great philosopher and political scientist John Stuart Mill was stricken with a devastating bout of depression. Although the genesis of his affliction is far from clear, Mill was able to find a fitting description of his mood in Coleridge's poem, "Dejection": A grief without a pang, void, dark, and drear; A stifled, drowsy, unimpassioned grief Which finds no natural outlet, no relief In word, or sigh, or tear.1

The adage has it that the road to hell is paved with good intentions. It is evident from this revealing portrait of neurologist Walter Freeman--the originator of the infamous "ice pick" lobotomy--that good intentions without sober analysis can indeed have hellish consequences.

Although psychotropic medications have revolutionized the treatment of many psychiatric disorders, the benefits sometimes come at a price.

Poetry of the Times

As the new science content editor of Psychiatric Times, long-time contributor and editorial board member Ronald Pies, M.D., will collaborate with editors to expand the depth, breadth and credibility of the publication.

Following reports that psychologists and psychiatrists have been involved in interrogations in Guantanamo Bay, Cuba, and other locations, Dr. Stone calls on the professional organizations for both specialties to make it clear that torture is not condoned by the medical or psychological profession.

With its focus on both behavior modification and mindfulness training, dialectical behavior therapy has proven quite effective in treating patients with borderline personality disorder. This article provides a primer on a modified version of this outpatient treatment for borderline patients with substance use disorders, a comorbid condition that may affect as many as two-thirds of patients with BPD.

The U.S. Departments of Defense and Veterans Affairs have developed protocols for assessing soldiers returning from combat operations in Iraq and Afghanistan. With data showing that many veterans do not show psychiatric symptoms until three to six months after returning home, a new post-deployment assessment was created and is ready to roll out. In the meantime, a jump in PTSD cases led to an internal review at the VA.

Smokers with co-morbid psychiatric and substance use disorders smoke at a much higher rate and seem to have more difficulty quitting than those in the general population. Tobacco treatment that is integrated into mental health settings may lead to greater success than non-integrated treatment. As a result, mental health care providers can play a critical role by careful assessments of smoking, employment of motivational techniques and increasing access to pharmacological and behavioral treatments.

The most common club drugs or party drugs are MDMA, ketamine and GHB. How dangerous is continued use of these substances? Can they cause real damage to the brain?