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Available treatments are so robust that nearly one-third of patients with major depression will achieve full clinical remission with monotherapy.

Diagnostic Dilemmas-Effective Treatment Approaches

Epidemiological studies show that, 4% to 5% of the general population have severe ADHD. Of this number, half have a comorbid substance use disorder. The aim of this article is to help physicians understand and manage this challenging combination of comorbidities.

They read sonnets for patients...

Is A Clinician’s Guide to Statistics and Epidemiology in Mental Health what we have been waiting for? Yes and no. It contains solid descriptions of concepts such as the P value and confidence intervals, and it has extensive discussions of the history of modern statistical methods. Perhaps its greatest strength involves critiques of the interpretations of several studies that have mistakenly become cornerstones of clinical lore.

The impact of FDA alerts and label warnings was examined in 2 recently published studies of antipsychotic drug use. In one study, researchers gauged physician response to the 2005 warning of increased mortality with antipsychotic use in elderly patients with dementia, and in the other study, researchers determined whether recommended safeguards were implemented following the 2003 advisories on adverse metabolic effects of second-generation antipsychotics.

My parents lived in 2 different worlds together. One, the outside world, was where they sparkled. Their business was so successful, and they were urbane, sophisticated, and very smooth. At home, the inside world was very different. They were competitive with each other, more critical than affectionate; there was none of the togetherness they presented to the outside world.

Overly sensitive, aversive reactions to stress seem to run in families. The literature abounds with reports of relatives in these populations predisposed to depression, anxiety, and even suicide. Some family members present with glucocorticoid levels notched abnormally high, and in curiously deregulated concentrations. Behaviorally, they seem to exist at a permanent state of high alert.

As a fellow Oregonian, I concur with Dr Jim Phelps that the topic of psychologist prescribing is highly complex, and that even balanced opinions generate “affective discharge” approaching “invective."

Oregon’s legislature has passed the bill: should the governor sign it? Most opinions on this issue are strong, and many have reached the point of invective. Even such a cool mind as Ronald Pies' has weighed in with an emotionally charged editorial.1 To speak in favor when so many are opposed seems only to invite more affective discharge. On the other hand, editorial views thus far may be moving us toward extremes on an issue that is highly complex. Perhaps a dialectic approach -– what value can we find in an opposing view? -- would be wise at this point. In that spirit, here are 4 considerations that I hope will be useful.

You stand blindfolded in a lab. A stranger approaches you but does not speak or make any sounds. This person will touch you in a manner that is intended to convey 8 different emotions. Your role in this experiment is to “decode” the tactile sensations you feel and determine whether they convey anger, fear, happiness, sadness, disgust, love, gratitude, or sympathy.

In January of my third year of medical school while attempting to study for my medical licensing examination, I began a blog. (Any distraction from learning about the Krebs cycle was heartily welcomed!) Within a week, I had posted photos of my family members, criticized an episode of ER, and griped about my studies. A social addict, I was hooked on this self-disclosure.

Domestic violence emerges from a host of causes and motivations, and that each case deserves individual attention and solutions.

A new study sheds some light on the pathogenesis of body dysmorphic disorder (BDD). Feusner and colleagues from UCLA, whose study was recently published in Archives of General Psychiatry, used functional MRI to determine whether patients with BDD have abnormal patterns of brain activation when visually processing their own face. The severity of symptoms of this disorder were found to correlate with activity in frontostriatal systems and the visual cortex. http://archpsyc.ama-assn.org/cgi/content/abstract/67/2/197

My first exposure to electronic medical records (EMRs) was when I saw my own primary care physician about 3 years ago. I didn't like it. Neither did he. For me, it seemed like he had to pay as much attention to the computer as to me. We spent less time talking. He laughed as he typed, joking that once everything was in the computer, it should save time and make for better care. I responded that we heard the same promise with managed care.

In his recent David Letterman–like Top 19 list of DSM5 issues, Allen Frances1 targeted a proposed revision of the DSM-IV diagnosis of Pedophilia, and 2 proposed new diagnoses: Hypersexual Disorder (HD) and Paraphilic Coercive Disorder. He protests the inclusion of pubescent teenagers in the definition of the proposed revision of Pedophilia (including the renaming of it as Pedohebephilic Disorder) and criticizes the quality of writing of these criteria.1 As the chair of the DSM5 Work Group responsible for those draft criteria, I need to address his poorly reasoned claims.

Antidepressants effectively combat depression in people who are physically healthy. But how effective are these agents for depressed patients who are physically ill?

Two events occurred last week that will have significant ramifications for psychiatry. On March 23, The Physician Payments Sunshine Act was signed into law by President Obama. The act was embedded in the larger healthcare reform package, so it didn’t receive a lot of fanfare, but it is huge.

Electroconvulsive therapy (ECT) devices are undergoing FDA scrutiny and could become subject to new requirements and restrictions that affect their use by psychiatrists. The FDA is considering whether to keep ECT devices in their current Class III category or drop them to Class II.

DSM-IV provides separate categories for Substance Abuse and Substance Dependence. The typical substance abuser is someone who gets into recurrent, but intermittent, trouble as a consequence of recreational binges. This is in contrast to the continuous and compulsive pattern of use that is typical of DSM-IV Substance Dependence.

Dateline: Portland, Oregon, April, 2011[From the office notes of Prescribing Psychologist, R.X. Sciolus, PhD]“Ms Malfortuna is a 60-year-old white female with a recent history of significant depressive symptoms, including insomnia, poor appetite, decreased energy, anhedonia, and lack of motivation. . .

Neuroscientists are exploring ways to erase bad memories in patients who have experienced traumatic events. This possibility raises ethical concerns: Is it ethical to erase a memory or flashback and the feelings associated with that moment to alleviate suffering, or should clinicians focus on therapies such as CBT and EMDR (Eye Movement Desensitization and Reprocessing) to help patients cope with a trauma?

Many European-born Israelis who lived through the Holocaust were subject to severe starvation, extreme mental stress, exposure to a variety of infectious agents, and hypothermia. Perhaps it is no coincidence that these Jews now have higher rates of all types of cancers-especially breast and colon cancer-than other Jewish or non-Jewish ethnic groups who currently live in Israel. The authors of a study recently published in the Journal of the National Cancer Institute comment that experiences during WWII appear to have had a direct impact on the long-term health of survivors.

Your Mother Was Right . . .A new study appears to add a new dimension to mothers’ sage advice. Researchers in Austria have found that fish oil with omega-3 polyunsaturated fatty acids reduced the risk of progression to psychotic disorder in young people who had subthreshold psychotic symptoms-with none of the adverse effects associated with drug treatment.

“I just threw him in the lake and expected him to die. . . My only regret is that he lived.”

There are 2 very different methods of describing people with a mental health problem. A typical psychiatrist will give the mental disorder a name. Many psychologists would prefer to give it a number on a rating scale. The first “categorical” approach is the simplest and most natural way people sort things. It is the method used throughout medicine (with just a few exceptions like hypertension). The second “dimensional” approach works best to describe phenomena that are continuous, lacking in clear boundaries, and reducible to numerical measurement.

In a study of 3801 young adults that was just published in the Archives of General Psychiatry, Australian researchers have concluded that early and prolonged use of marijuana is associated with psychosis-related outcomes in young adults. They found a “dose-response” relationship: the longer marijuana was used, the higher the risk was out eventual psychosis.

The proposal for a "Psychosis Risk Syndrome" aims to solve a pressing problem in psychiatry-- the need for early identification and preventive treatment.

I have been closely following the discussions of the proposed DSM5 in Psychiatric Times. Your publication of this discourse is a significant contribution to our field. As a research psychiatrist who has published over 150 peer-reviewed papers, I strongly support Allen Frances’ emphasis on the importance of continuity in diagnostic criteria for DSM5.