Psychiatric Times Vol 25 No 2

Poetry of the Times

Congress substituted a 0.5% increase in Medicare fees for the first 6 months of 2008 for the 10% reduction that would otherwise have been enacted. That reduction in what is called the Medicare fee "update" was predetermined by a formula Congress itself put in place.

There are no books written by, or even about, locum tenens psychiatrists. Why is that? Why is their story-the story of psychiatrists who "hold a place," participate a bit, and then move on-not shared? Is there nothing in their experience worth sharing?

It's often said that the word "crisis" is expressed in Chinese by two characters representing "danger" and "opportunity." In truth, the Chinese word for "crisis" (weiji) is better translated as "danger" (wei) and "crucial moment" (ji).

There have been nearly 1.5 million military deployments to the southwest Asian combat zone since the start of the Afghanistan operation and Iraq war in 2001 and 2003, respectively. There have been many casualties, some of which have been highly profiled, such as service members being killed in action, losing limbs, or suffering blast injuries to their brain.

Reading crystal balls has always been difficult. Nevertheless, it may be a worthwhile exercise to stop and make some educated guesses about where the field of psychopharmacology will stand 10 years from now--knowing full well that insights and discoveries we cannot predict or anticipate now may pop up to dramatically change the course and direction of clinical psychopharmacology.

The idea that there may be genetic influences on how we think about God and politics is usually greeted with disbelief, even scorn. "Ludicrous," was the intense response of a distinguished psychologist-friend upon hearing me explore this topic in a brief paper.

Anxiety disorders are the most prevalent disorders among children and adolescents in both community and clinical settings. The high prevalence of anxiety disorders in children and adolescents leads to increased interest in the development and implementation of effective treatments.

The FDA recently approved the use of aripiprazole (Abilify) in combination with antidepressant medication for the treatment of major depression in adults. Although a variety of agents have been used in efforts to augment the effect of antidepressants, this first approved adjunct is likely to increase this use of atypical antipsychotics.

The use of cannabinoids for medical indications is the subject of ongoing debate. Some medical professionals and patients argue that cannabinoids have marked analgesic properties, while other physicians, who cite the still relatively scant literature supporting their use, are skeptical about their efficacy, especially in comparison with other currently available analgesics.

Cortical development in children with attention-deficit/hyperactivity disorder (ADHD) generally lags behind that in other children by several years, NIMH researchers reported recently.

This is the second installment in a 3-part series discussing the behavioral, cellular, and molecular characteristics of posttraumatic stress disorder (PTSD). The first installment described clinical aspects of PTSD and how these characteristics make understanding the underlying biological substrates so challenging. In this installment, I discuss progress addressing these challenges at the tissue and cell level. In the final installment, I will review potential genetic underpinnings of PTSD, with emphasis on potentially heritable risk factors.

For many years, research on mood disorders has focused on neurotransmitters, particularly on the monoamines (serotonin, norepinephrine, and dopamine) and their action at the neuronal junction, or synapse. Although the monoamine theory helps explain the action of tricyclics, monoamine oxidase inhibitors, and SSRIs, it fails to account for many other things.

Panic disorder with or without agoraphobia is a chronic, debilitating psychiatric illness that affects about 4.7% of the general US population.

On a hypothetical morning, you've arrived early at your office to answer e-mails and respond to prescription requests without interruptions. The following voice mail, left for you much earlier that day, awaits your attention: "Doctor, I need to discuss my mother's behavior with you. The medications she's taking might be calming her down during the days, but she's not okay at night."

No other psychiatric diagnosis has more profound negative implications than autism. On the surface, autism impacts social, emotional, behavioral, and academic functioning. However, autism is pervasive in ways less immediately observable, and, as a result, children with autism require developmental and educational interventions that are different in both form and intensity from those required by children with other special needs.

Both cognitive-behavioral and pharmacological treatments for panic disorder have been found to be effective over the short term. Not all patients, however, can tolerate or fully respond to these approaches, and the effectiveness of these interventions over the long term remains unclear.

Anxiety disorders are some of the most common mental health problems that confront clinicians, either as a primary diagnosis or as comorbid conditions.

When a suicidal patient in crisis calls the psychiatrist and hears the recorded message, "If you have a 'true' emergency, go to your nearest emergency room or call 911," the patient's risk of suicide may increase.

Congress agreed in December to drop from its consideration of a budget reconciliation bill a provision that would have allowed family therapists and counselors to bill Medicare for mental health diagnoses. Many psychiatrists viewed the proposed legislation as a scope-of-practice attack by non-MDs.

Research Review: Treating Major Depressive Disorder With MAOIs: Effect of Delivery System on Cardiovascular Events

Insights Into Depression & Anxiety: Living With an Ambiguity in Clinical Practice: Antidepressant Drug-Drug Interactions

Poetry of the Times

CMEducator: Recognizing and Managing Bipolar Disorder

Insights Into Depression and Anxiety: Overview of the Anxiety Disorders

Compliance is a major issue in treatment of schizophrenia. How can compliance be improved, and can newer formulations make that compliance easier?

Funded by the National Institute of Mental Health, the STAR*D project is one of the largest depression treatment studies ever conducted, with more than 4,000 participants. Results from the second phase of the study will be published over the next year. In this issue PT readers will find a preliminary review of data drawn from the first 1,500 enrollees.

Postmortem studies indicate that neural circuit abnormalities in schizophrenia could be reflected in gamma-band synchrony. We review findings of recent studies that demonstrate abnormal synchrony in the gamma band of the EEG in chronic schizophrenia patients, and point to links between gamma oscillations and some of the core symptoms of schizophrenia.

Schizophrenia poses a challenge for diagnosis and treatment at least in part because it remains a syndromal diagnosis without clearly understood neuropathological bases or treatments with clearly understood mechanisms of action. Neuroimaging research promises to advance understanding of the unique pathological processes that contribute to this syndrome, and to foster both better appreciation of how current treatments work, and how future treatments should be developed.

Although several clinical studies suggest that cognitive impairments in schizophrenia are associated with reduced stimulation of dopamine receptors in the prefrontal cortex, mounting evidence suggests that other monoaminergic neurotransmitter systems may also be involved. We provide an overview of neurotransmitters that hold promise as therapeutic interventions for the cognitive deficit in schizophrenia.