News

An array of military-related presentations were given at this year’s American Psychiatric Association (APA) conference, addressing the rise of psychiatric issues in returning veterans and their families.

A new study recently posted online by researchers at Kaiser Permanente in Oakland, Calif, offers prospective parents one more reason to worry. The study showed that pregnant women who have symptoms of depression are at increased risk for giving birth prematurely.1

Attention-deficit/hyperactivity disorder (ADHD) is one of the most widely diagnosed disorders: an estimated 8% to 12% of children are affected worldwide. Although many studies about treatment options have been published, the genetic components that underlie the disorder are still being discovered. A special issue of the American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics, highlights recent research and includes results from the first genome-wide study of patients with ADHD. Genome-wide studies have successfully identified variants associated with obesity and such diseases as age-related macular degeneration, diabetes, and prostate cancer.

In response to the resolution made in 2008 by the US Congress that proclaimed May to be borderline personality disorder (BPD) awareness month, the American Psychiatric Association (APA) decided to make BPD a key track of this year’s meeting. Among the several excellent presentations on BPD was Dr John G. Gunderson’s lecture on the ontogeny of the disorder. Having spent the past 30+ years studying BPD, both as a researcher and a clinician, Dr Gunderson of McLean Hospital of Harvard Medical School is an expert on the history of BPD.

Der Spiegel has anointed Fatih Akin the new face of the German film industry. Of Turkish descent, Akin has no interest in the ghosts of Germany’s past or in facing history through films such as The Reader-which still attract large audiences and Oscar nominations in America. Akin finds his inspiration in the new Europe and in the lives of people like himself who are the rising generation of Europe’s immigrants.

who remarked that the problem with most new books he reads these days is that there is “too much space between the covers.” After all, he queried rhetorically, “Do I really need more than 250 pages or so on any one subject?” Days before this conversation, I had accepted an invitation to write a review of Psychotherapy Supervision and had received the 632-page tome by mail.

In “Changes in Psychiatric Diagnosis” (Psychiatric Times, November 2008, page 14) Michael First relates the sad fact that the reorganization of DSM is still without formal guidelines and continues to be subject to the vicissitudes of groupthink and vocal constituencies. He relates that he and Allen Frances envisioned the application of biologically based diagnostic criteria when summarizing the work of DSM-IV, but complains that no criteria are forthcoming as yet.

I first met 22-year-old “Linda” when she was brought to the emergency department (ED) after a drug overdose. Although the drug Linda had ingested-clonazepam-was a CNS depressant, she did not appear groggy or sedated. In fact, her speech was rapid and pressured; she showed marked psychomotor agitation, which was demonstrated by her twitching feet and the incessant twisting of her hair. This presentation suggested a paradoxical response to her medication. Her chief concern was, “I feel as if I am going to come out of my skin.” I was puzzled.

Every August, during my lakefront vacation, I kayak to the middle of Otter Pond, lay the paddle across my knees, and drink in the tranquil scene around me. Sunshine glints hypnotically off the rippling water. Every muscle relaxes, my cares recede. But this past summer, my annual reverie was interrupted by the shriek of a young child. “Let me out, let me out!” he cried, teetering halfway out of a passing paddleboat. “I want to swim back to the house!”

From time to time, health conditions emerge that are relative “orphans” when it comes to having the resources of a health care discipline or subspecialty to take ownership or accept responsibility for developing the body of knowledge that underlies their systematic evaluation and treatment. Female sexual dysfunction (FSD) is such a class of conditions.

The study and treatment of human sexual problems should fall under the purview of clinical psychiatry. Sexual behavior is an important factor in most of our patients’ lives and may help define their sense of competence and serve as a force leading to interpersonal bonding

Because of recent scandals, pedophilia is one of the few psychiatric disorders widely known to the general public.

The foreword to the Textbook of Vio­lence Assessment and Management promptly reminds readers that the mental health system has been invested in the prediction and prevention of violence since its inception. In a field dedicated to promoting wellness via the management of cognition, emotion, and behavior, violent thoughts, feelings, and actions are of primary concern. When psychiatric illness or psychological distress manifests as violence, the costs in terms of human suffering are extreme, wreaking havoc in the lives of patients, clinicians, and society at large-often with irrevers­ible consequences.

Psychiatry is eminently corruptible. Soviet psychiatrists of the 1950s disgracefully organized themselves into the medical arm of the Gulag state. Political dissidence became prima facie evidence of impaired reality testing, of “sluggish schizophrenia.” We like to believe in the benefits of scientific progress, but for Soviet inmates, progress was prefixed with a minus sign; every apparent advance in psychiatric technology left them more tightly controlled and worse off.

Whether you credit the idea to Niels Bohr or Yogi Berra, it is true that predictions are very difficult to make, especially about the future. It is a daunting task, yet obviously an intriguing one, to try to imagine what our field will be like in 10 years or more.

From this book’s title, iBrain, I expected to learn about the positive impact of the computer world on the ever-evolving brain. I was in for a surprise. iBrain is a nuanced account of brain anatomy and function, brain plasticity, the impact-good and bad-of the Internet and Web access on the brain, and how to have a healthy brain and life in the face of our technological world. The book is written by psychiatrist-neuroscientist Gary Small, MD, director of the Memory and Aging Research Center at UCLA, and his wife, Gigi Vorgan, a film and television actor and writer. Small and Vorgan have a linear, easy-to-understand writing style that includes entertaining and educational case vignettes.

New treatments for patients with schizophrenia may be on the horizon, according to research presented at the annual meeting of the American Psychiatric Association in San Francisco. While some of these therapies may help treat the negative and cognitive symptoms of schizophrenia, a few are associated with QTc interval prolongation.

Eastern philosophy and religion have always had what the philosopher Hajime Nakamura2 called “a preference for the negative.” This stands in stark contrast to our Western penchant for the positive, and our proclivity for defining and intervening is most pronounced in the overactivist mode of modern American medicine."

Psychiatrists failed to get privacy protection for an expanded version of their psychotherapy notes in the stimulus bill Congress passed last February. But the American Recovery and Reinvestment Act (ARRA) did authorize a study on the issue and made other pro-privacy improvements to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The FDA’s Psychopharmacologic Drugs Advisory Committee (PDAC) flashed partial green lights to 2 manufacturers of atypical antipsychotics. The committee recommended approval for 2 new uses for Seroquel XR (quetiapine fumarate) extended-release tablets and also gave first-time approval in this country for Serdolect (sertindole).

Patients who have had a myo­cardial infarction (MI) should be screened and appropriately treated for depression, according to a guideline recently issued by the American Academy of Family Physicians (AAFP).1 The group recommends use of a standardized depression symptom checklist during hospitalization and “at regular intervals” thereafter.

Cardiovascular disease kills more people worldwide than everything else combined, said Dean Ornish, MD, cardiologist and clinical professor of medicine at the University of California in San Francisco. Dr Ornish is well known for his lifestyle-driven approach to the control of cardiovascular disease. Depending on the extent of personalized lifestyle changes, disease progression can be stopped and even reversed.

I have been practicing psychodynamic psychotherapy for more than 30 years. During this time, there has been an accepted taboo against coupling psychotherapy with spirituality-despite a number of articles that have been written on this subject.

Then he fell silent and moments passed. I knew, of course, about his father’s recent death and their stormy relationship. I was moved by his sadness-could feel it within. I found myself thinking about my own father’s death. The silence between us continued, and finally I said, “It is so sad.” His crying intensified; he did not look at me. I felt a teary mist in my eyes and thought, “Now what?” Should I try to stay inside where he was and reflect again on his sadness, or should I back away by offering him a more cognitive level of dialogue? This question-whether to move in or out or, perhaps more accurately, to offer him the choice of where he feels most safe-is at the heart of some forms of psychotherapy. However, as we shall see, this is not the case in all forms.

“Is it wise to stay on my pill?I know the question may seem inane.”I’ll answer since you’ve paid your bill.

Make no mistake: Dr Torrey is on the side of the patient. He is enraged by the plight of the seriously mentally ill in the postinstitutional era, and he takes aim at a troika of villains-deinstitutionalization, the civil liberties bar, and the antipsychiatry movement. These 20th-century forces have conspired to relegate citizens with mental illness to a deplorable state of neglect that puts us all at risk. The Insanity Offense threads a needle of making us fear the violent mentally ill without stigmatizing them as a group.

We at Psychiatric Times wish to note, with great sadness, the passing of our colleague and editorial board member, Dr Gene Usdin, at the age of 87.

A collaborative effort of prominent medical leaders seeking to wean professional medical associations (PMAs) from pharmaceutical and device industry funding serves as a major step toward building best practice models for managing conflicts of interest (COI), said the president of the Institute on Medicine as a Profession (IMAP).

Depression is an insidious, ugly beast, creeping into the mind over time until one is engulfed and powerless, feeling only a sense of futility and heaviness. In my case it came some months after I had had to retire from a fruitful and enjoyable academic neurodevelopmental pediatrics practice, because of onset of a degenerative neuromuscular disease. My depression was manifested mainly by weight loss, poor affect, anger and irritability, fitful sleep, and thoughts of suicide. Luckily, my primary physician recognized the signs immediately and recommended both pharmacotherapy and psychotherapy. For both therapies and for this physician, I am extremely grateful. However, in this essay, I will speak of the ways I experienced psychodynamic psychotherapy and its ramifications into many parts of my life.

Anger is an emotion that is familiar to everyone. An episode of anger may dissipate quickly and harmlessly or evolve into a murderous rage. Between the benign and malignant end points in this spectrum, a seething, chronic anger may come to dominate a person’s thinking, feeling, and behavior.