NSAIDs and Cardiovascular Disease
June 1st 2007NSAIDs have long been considered first-line treatments for a variety of pain conditions--most notably, musculoskeletal pain. Many NSAIDs are available in over-the-counter preparations, so they are inexpensive and, for better or worse, can be obtained without consulting physicians or health care professionals. For most patients, these drugs were considered safe, except in those who are at risk for GI bleeding or who have renal dysfunction. The most common adverse effect associated with NSAID use is GI distress.
School Shootings: A Word of Caution
June 1st 2007After wading through the initial shock and horror of the murder of 32 students and faculty at Virginia Tech on April 16 by student Seung-Hui Cho, there is a natural impulse to rush to enact laws to prevent this type of tragic event from ever happening again in our schools. As professionals, as parents, as concerned members of a community, we have a felt need for an immediate response to ensure that schools are safe and secure places to learn and grow. Action is demanded. Not only must this opportunity/obligation not be squandered, but we must make sure that by our actions we do not make things worse.
Troubleshooting Delirium in Elderly Inpatients
June 1st 2007Delirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. Approximately 15% of elderly patients admitted to the hospital have delirium as a presenting or associated symptom. Delirium will develop in another 15% of elderly patients during hospitalization.
Reader Responses to the Virginia Tech Killings
June 1st 2007In the aftermath of the tragic events at Virginia Tech, we would like to suggest some ways in which psychiatrists, psychologists, and college personnel can help identify and treat students who have severe psychiatric disorders--and perhaps prevent another mass murder.
Group Therapy and Cancer Survival-- Where Does the Evidence Lie in 2007?
June 1st 2007One of the most hotly debated questions within oncology over the past decade has been whether the promotion of psychological wellness can extend survival for patients with advanced cancer. The converse--that psychiatric disorder shortens survival--seems true, with mechanisms of poor self-care and reduced adherence to anticancer treatments resultant from depressive or psychotic disorders explaining this outcome.
Treatment of Comorbid Sleep Disorders Improves Seizure Control
June 1st 2007It is a widely known fact that Fyodor Dostoevsky, the famous 19th-century Russian novelist, suffered from epilepsy for most of his life. However, not too many persons are aware that Dostoevsky also had a sleep disorder called delayed sleep phase syndrome, which may have contributed to his seizures.1 Although no one knows for certain, it is quite conceivable that Dostoevsky's sleep disorder worsened his epilepsy, according to Carl Bazil, MD, PhD, director of Clinical Anticonvulsant Drug Trials and director of the Neurology Division, Columbia Comprehensive Sleep Center, Columbia University, New York.
Diabetic Polyneuropathy: Definitive Diagnosis
June 1st 2007Diabetic polyneuropathy (DPN) has a major impact on quality of life and can contribute to significant morbidity and mortality. In the United Kingdom, the prevalence of distal symmetrical polyneuropathy, as seen in specialty care, is about 28.5%, and prevalence increases with age.
Lhermitte-Duclos Disease or Neoplasm?
June 1st 2007A 5-month-old girl was brought to her local emergency department because she displayed increasing fussiness and back arching for 3 days. She vomited once and was febrile on the day of presentation. Meningitis was suspected. A lumbar puncture was performed. It revealed a cerebrospinal fluid (CSF) protein level of 120 mg/dL and a CSF white blood cell count of 10/µL, with 50% polymorphonuclear cells. Antibiotics were empirically administered, and the infant was transferred to a tertiary care facility for further treatment.
Insight Into ICH and Warfarin Dynamics May Lead to Safer Anticoagulation Protocols
June 1st 2007To kick-start his presentation on reversal of coagulopathy during a symposium at the International Stroke Conference (ISC) that took place in San Francisco in early February, J. Claude Hemphill III, MD, professor of neurology at the University of California, San Francisco, displayed a CT scan illustrating a modest intracerebral bleed in the brain of a 64-year-old woman who had been taking warfarin for the treatment of atrial fibrillation. Hemphill noted that standard care, including administration of vitamin K and fresh frozen plasma (FFP), was given.
New Approaches to Neuroblastoma
June 1st 2007Neuroblastoma (NB) is the most common pediatric, intra-abdominal, extracranial, solid tumor derived from nervous tissue. This malignant neoplasm occurs at an annual rate of 9.1 cases per 1 million American children younger than 15 years and is found more frequently in boys. The median age at diagnosis is 2 years for both sexes, with most cases being diagnosed by the age of 5 years. Metastatic disease is often found at presentation and represents about 70% of all newly diagnosed cases.
Combo Therapies for MS: In Trials, Some Pairings Fare Better Than Others
June 1st 2007For years experts in multiple sclerosis (MS) have been touting the potential benefits of combination therapies for controlling disease progression. The difficulty in finding just the right combination, however, was evident in the mixed nature of findings presented at the Annual Meeting of the American Academy of Neurology (AAN) in Boston, April 28 to May 5.
Treatment Advances for Glioblastoma: Tumor Markers and Targeted Treatments
June 1st 2007Although malignant brain tumors affect thousands of persons each year, treatment has not significantly advanced. For 3 decades, the standard of care was palliative surgery, radiation, and chemotherapy. Of these, radiotherapy was the only proven way to lengthen survival time. However, since 2005 the standard of treatment has changed thanks to studies showing posi- tive results from daily temozolo- mide (Temodar) combined with radiotherapy.
Hope for Glioblastoma: Resection and New Treatments
June 1st 2007Glioblastoma multiforme (GBM) is one of the most common brain tumors and is a significant cause of morbidity and mortality.1 Primary tumors of the brain occur in about 16,000 persons and account for around 13,000 deaths annually (a mortality rate of 6 per 100,000) in the United States.
Mass Killings Are Not Incomprehensible
June 1st 2007On Monday, April 16, Seung-Hui Cho, a 22-year-old English major at Virginia Tech, shot and killed 27 students and 5 teachers before taking his own life. The reaction to this latest mass shooting included the opinion that what this young man did was beyond comprehension.
Understanding the Mind of Your Bipolar Child
May 1st 2007Childhood bipolar disorder is a devastating illness that affects emotional, social, and cognitive development. In recent years, increased attention devoted to the study of bipolar disorder in childhood has resulted in greater information regarding the cause, phenomenology, and treatment of the disorder.
The Therapeutic Potential of Neural Stem Cells
May 1st 2007The following must be one of the strangest comments I have ever heard on television. An Iraqi businessman uttered it shortly after a wave of missile strikes during the Gulf War. "The rocket flew down my street and took a left," he said in English. It had smashed into its target, a nearby building--leaving his adjacent shop completely undisturbed.
Intermittent Explosive Disorder and the Like: Overappreciated?
May 1st 2007In "Intermittent Explosive Disorder: Common but Underappreciated"(Psychiatric Times,January 2007, page 1), Arline Kaplan wrote that intermittent explosive disorder (IED) "is not just another name for bad behavior." She quoted Dr Coccaro from the University of Chicago as asserting that patients with IED who react with rage to minor irritants have been shown to have reduced down-regulation of certain cortical nuclei that should be reined in by inhibitory stimuli from the frontal cortex.
Informed Consent and Civil Commitment in Emergency Psychiatry
May 1st 2007Medical school graduation usually involves taking the Hippocratic oath, in which physicians vow not to intentionally harm their patients. Keeping patients safe is another basic principle of patient care. Physicians are charged with ensuring that their patients are in a safe environment and minimizing risks to their patients by carefully selecting treatment options.
Biopsychosocial Model: Helpful or Hindering?
May 1st 2007The points made by Dr G. Scott Waterman in his article, "Does the Biopsychosocial Model Help or Hinder Our Efforts to Understand and Teach Psychiatry?" are right on target. Unfortunately, the biopsychosocial model of psychiatry is not merely conceptual; it is woven into the delivery of care at every level. Institutions of government, insurance, and hospital and outpatient services separate "behavioral" medicine from all other medicine and further separate substance abuse disorders from those deemed "psychiatric."