Atypical Antipsychotics Increase Cardiometabolic Risk in Children
December 29th 2009A study of the adverse effects of 4 second-generation antipsychotics in children and adolescents documented substantial weight gain during 11 weeks of treatment with each agent, with the increased abdominal fat that has been associated with development of metabolic syndrome in adults. Metabolic abnormalities emerged with 3 of the 4 agents, differing in type and severity with the agent and, in some cases, with the dose.
Patients With Bipolar and Unipolar Depression Show Similar Response to Electroconvulsive Therapy
December 15th 2009Results of a large study funded by the National Institute of Mental Health showed that electroconvulsive therapy (ECT) might be equally effective in both patients with unipolar depression and those with bipolar depression. The study, led by Samuel H. Bailine, MD, assistant professor in the department of psychiatry and behavioral sciences at Zucker Hillside Hospital, Glen Oaks, NY, showed that the remission rate in both patient groups was higher than 60%.
Violence Risk Assessment in Everyday Psychiatric Practice
December 14th 2009Hy Bloom provided an expert psychiatric report in a multiple murder case in which the accused, who had schizophrenia and depression, had killed his wife and 2 children. Before the murders, the accused had been seeing a psychiatrist and family physician for treatment of the mental disorders.
Medical Decision-Making Capacity of Patients With Dementia
December 14th 2009The United States Census Bureau projects that by 2010 nearly 13% of the US population will be over the age of 65. The elderly are one of the most rapidly growing segments of the US population and are expected to account for more than 20% of the total population by 2050.1 In 2001, the prevalence of dementia in North America was 6.4%. A 49% increase in the number of people with dementia is expected by 2020, and a 172% increase by 2040.2 Patients with dementia may lack the capacity to consent to treatment. The need to evaluate capacity to consent to treatment will therefore increase as the aging population grows.
Critical Information for the Practice of Psychiatry
December 11th 2009It is my privilege and pleasure to highlight this Special Report on forensic psychiatry. (The first articles in this series appeared in the November issue and are posted on www.psychiatrictimes.com.) The respected authors provide us with the most recent thought on subjects that should be of interest to every practicing psychiatrist.
Antonio Damasio’s Descartes’ Error: Emotion, Reason, and the Human Brain
December 9th 2009Descartes’ Error1 can be read in 2 ways. To start, it works as an engagingly written, accurate piece of science journalism (which is something that we need more of; it’s hard to imagine running a democracy without it).
A Call to DSM-V to Focus on the Designation of Borderline Intellectual Functioning
December 9th 2009Borderline Intellectual Functioning is rarely included in clinical reports and case/treatment team reviews except indirectly when, as part of the mental status examination, mention is sometimes made that the patient’s intellect appears to fall below average limits.
Cognitive Impairment in Patients With Bipolar Disorder
December 7th 2009It is widely accepted that patients with schizophrenia have some degree of cognitive deficiency and that cognitive deficits are an inherent part of the disorder. Historically, there has been less focus on cognitive deficits in patients with bipolar disorder; however, numerous studies of cognition in patients with bipolar disorder, including several comprehensive meta-analyses of bipolar patients who were euthymic at the time of testing, have recently been undertaken.1-4 Each of these analyses found that cognitive impairment persists during periods of remission, mainly in domains that include attention and processing speed, memory, and executive functioning.4
The Cellular and Molecular Substrates of Anorexia Nervosa, Part 2
December 7th 2009I think I am going to talk about the neurobiology of happiness in my next column. The reason has to do with the nature of our 2-month journey into the biology of eating disorders-a subject that, considering the dearth of explanatory data, is tough to write about. It’s also a bit depressing, considering how difficult it can be to treat. This is the second installment in a 2-part series that focuses on the neurobiology of restricting-type anorexia nervosa (AN).
Obesity and Psychiatric Disorders
December 5th 2009Obesity has emerged as a significant threat to public health throughout the developed world. The World Health Organization defines overweight as a body mass index of 25.0 to 29.9 kg/m2 and obesity as a BMI of 30.0 kg/m2 or greater.1 Nearly two-thirds of Americans are overweight or obese according to these criteria.2 Numerous health problems, including diabetes, cardiovascular disease, arthritis, and cancer, are associated with obesity. In addition, overweight and obese persons are more likely than their normal-weight peers to have a variety of psychiatric disorders.
Alert to the Research Community-Be Prepared to Weigh in on DSM-V
December 3rd 2009This commentary will suggest how the research community can be instrumental in improving DSM-V and helping it avoid unintended consequences. According to several converging, anonymous (but I think quite reliable) sources to which I have had access, the draft options for DSM-V will finally be posted between mid-January and mid-February of 2010.
Can It Be Done Alone? Solitude and Personality Maturation
December 3rd 2009At 47 she was happily married with an 11-year-old daughter and expressed much satisfaction with her work as a masters-level psychotherapist. Her adolescence and young adulthood, however, were different stories, filled with chaos. She described impulsive, promiscuous behaviors beginning at age 13. Heavy drug use began in her late teens, and her parents kicked her out of the house. She fended for herself as a waitress and had a series of relationships with abusive men. As age 30 approached, she began to get herself under control, stopped using drugs, and married a musician she described as “very straight.” With his encouragement, she attended a community college, majored in psychology, and ultimately obtained a masters degree in counseling. Currently she is employed at a public agency for abused women.
NARSAD Awards for Psychiatric Research
December 2nd 2009Award ceremonies abound, from the Oscars for film to the Clio awards for advertising, but none are as important to mental health and psychiatry as the NARSAD annual awards. NARSAD is a unique organization that is dedicated to mental health research, and the NARSAD awards are considered to be the most prestigious prizes in psychiatric research. On October 30, NARSAD presented its 22nd annual awards for outstanding achievement in mental health research. This year the prizes went to 8 distinguished scientists whose work is making a huge impact on the way psychiatric disorders will be diagnosed and treated.
Suicide Risk and Lethality of Attempts Linked to Low Levels of MHPG
December 2nd 2009Low levels of 3-methoxy-4-hydroxyphenylglycol (MHPG) in patients with major depressive disorder (MDD) or bipolar depression were shown to be associated with increased risk of suicide attempts. Hanga Galfalvy, PhD, assistant professor of clinical neurobiology at Columbia University and the New York State Psychiatric Institute, New York, and her colleagues found that patients with the lowest levels of MHPG at baseline were more likely to commit highly lethal suicidal acts.
Differentiating Bipolar Depression from Postpartum Depression
December 2nd 2009All pregnant women should be screened for bipolar disorder, according to a recent article by Verinder Sharma, MB, BS, professor of psychiatry and obstetrics and gynecology at the University of Western Ontario, London, Ontario, and colleagues. This is because bipolar depression may be misdiagnosed as major depressive disorder in the postpartum period, resulting in delays in appropriate treatment.
Why Psychiatry May Sometimes Need “Fuzzy” Diagnoses
December 1st 2009As a general proposition, most scientists and physicians prefer sharpness to fuzziness, at least when it comes to defining terms. I generally share this view, as regards psychiatric diagnosis, but only up to a point. That point is defined by the well-being of my patient - and sometimes, this may call for a “fuzzy” diagnosis.
Practical Implications of a Study on Treating Chronic Insomnia
December 1st 2009More than a thousand articles on mental disorders are published in medical journals each month! Also, clinicians have limited training, time, and inclination to keep up with reading research articles critically on a regular basis. Thus, a disturbing disconnect (for which there are no easy solutions) exists between clinical research and usual clinical practice.
When a Psychiatrist Kills: The Ultimate Violation of Do-No-Harm at Fort Hood
December 1st 2009The details may, by now, be familiar but they are no less shocking: Army psychiatrist, MAJ Nidal Malik Hasan, MD, accused of killing 13 people and wounding 33 others-including fellow behavioral health providers- is recovering from gunshot wounds and meeting with his attorneys.