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Civilian cases of traumatic brain injury (TBI) account for more than 50,000 deaths annually and represent about 50% of deaths attributed to physical injury. These injuries are a significant medical and socioeconomic burden and represent one of the leading public health problems in the United States. However, thanks to injury prevention and changes in hospital admission practices, a decline of almost 50% in civilian hospitalizations for TBI has been observed since 1980, with many patients now treated on an outpatient basis.

Involuntary Emotional Expression Disorder Often Misdiagnosed and Untreated

In this article, we examine the relationship between anxiety disorders and SDs, using DSM-IV-TR categories, although we are conscious of the limits of this approach. In doing so, we will consider not only the dichotomy between normal and pathological functioning but also the issue of sexual satisfaction as part of wellness.

Alejandro Gonzales's Babel is a meditation on the barriers to communication in a world divided by class, culture, and language. Although his vision is dark, he never surrenders to cynicism. His Babel, unlike the Bible story, holds out the promise of a universal language of the human heart. Psychiatrists know this language as empathy--the wordless connection that is the art form of every caring profession.

Mounting evidence shows that patients with bipolar disorder benefit significantly when their families are involved in treatment. Despite the challenges entailed, clinicians can successfully implement a family-focused approach if they’re willing, flexible and patient.

Democratic control of Congress may result in the dislodging of a long-stuck bill authorizing an unspecified amount of additional federal funding for research into postpartum depression. But in hearings in a House subcommittee recently, Republicans voiced an intention to add postabortion depression to the bill's focus.

Twenty years after the initial meeting of the International Congress for Schizophrenia Research (ICSR), this year's biennial ICSR remained true to its mission to serve as a venue for active researchers. ICSR hosted investigators in neuroscience, cognitive neuroscience, basic and clinical psychopharmacology, psychosocial interventions, and genetics.

The Casebook of a Residential Care Psychiatrist is knowledgeable, humorous, compassionate, and historical, with a strong plea that the mental health community become more involved in the rehabilitation of patients in RCFs.

To assist in meeting the daunting challenge of medication management, the Clinical Manual of Geriatric Psychopharmacology is a valuable, up-to-date resource for any clinician who prescribes for elderly patients.

Response to SSRIs, the most frequently used first-line agents for major depression, tends to be slow, and full remission is obtained by fewer than half of treated patients.

From our Readers

Medication adherence is a particular challenge for patients with first-episode schizophrenia. In addition to physician and patient concerns about adverse effects of antipsychotics, many patients at this stage are particularly resistant to continuing medications over the long term.

One of the major challenges in child psychiatry is teaching the essentials of the field to the general physician or medical school student who needs some understanding of developmental issues and psychopathology. Dorothy Stubbe's contribution to this challenge is a small and well-written handbook published as part of the series, Practical Guides in Psychiatry.

Dr. Harvey Roy Greenberg briefly discusses the inaccuracies of psychiatry in today's movies and television shows.

Poetry of the Times

From our Readers

Perceptions

In past discussions on brain-computer interfaces (BCIs), parallels were drawn between emerging applications and the idea of the "bionic man." However, a presentation by John P. Donoghue, PhD, during a "Hot Topics" plenary session on May 2 at the 59th Annual Meeting of American Academy of Neurology in Boston suggests that current neural interface technology is much more about the marvels of the human neuron and will than about machinery.

Two new online resources that neurologists should be aware of include a portal on seizure preparedness at Epilepsy.com and a Web site on migraine care and practice management.

From our Readers

Homelessness rates in both Canada and the United States have increased dramatically over the past 10 years. Among the homeless, there is a high prevalence of mental illness and substance use disorders.

This commentary arises from my concern about the superficiality that characterizes the process of diagnosing attention-deficit/hyperactivity disorder (ADHD) in children--usually followed by the prescription of one of the most powerful drugs on earth, methylphenidate.

More than any other branch of medicine, the profession of psychiatry is unable to coexist with business because the suffering of mentally ill persons is deeper and darker and more pervasive and powerful than any other form of human anguish, whether biological or social.

Psychiatric emergencies usually involve some combination of agitation, aggression, impulsivity, psychosis, and risk of destructive behavior, including suicide and homicide. The psychiatrist must ensure the safety of the patient and others while identi- fying and treating immediate medical and psychiatric problems and developing and initiating a strategy for continuing the management of less immediate problems. In the diagnosis of acute behavioral disturbances, it is necessary to determine the role of the patient's primary psychiatric illnesses and any complications or treatments of those primary psychiatric illnesses, as well as the role of other medical or toxic disturbances that may be interacting with the patient's psychiatric illnesses or treatments.

Improving Medication Adherence: How to Talk with Patients About Their Medications, by Shawn Christopher Shea, is a slim and excellent primer on the verbal strategies and interviewing tips that clinicians can use to improve medication adherence.

Figures from the US Department of Justice indicate that more than half of prison and jail inmates have a mental health problem. Mental health courts (MHCs) were designed to divert mentally ill persons convicted of nonviolent crimes to supervised treatment instead of incarceration, but while the number of MHCs has grown substantially over the past decade, limited information has been available about outcomes and costs.

The results of two recent studies suggest that antidepressant medication may have an expanded role in the management of stroke patients. Prophylactic use of antidepressants following stroke appeared in a meta-analysis to be effective in fending off depression, and a short course of antidepressants in a placebo-controlled study was associated with long-term restoration of executive function, independent of depressive symptoms.

Numerous studies have documented the increasing prevalence of mental health and substance abuse issues in youths nationwide. As many as 1 in 5 children and adolescents in the United States have a behavioral or emotional disorder.

This article examines the risks involved in prescribing psychotropic medication and offers suggestions for managing those risks to ensure the best possibility for a favorable outcome.

Psychiatrists who work in inpatient units are faced with daily decisions about predicting which patients will be violent, both in the hospital and after discharge. These decisions are often made using unstructured clinical judgment based on the clinician's experience and knowledge of the literature. How long such judgment stays the standard of care remains to be seen, because psychiatric researchers have produced a number of assessment and management tools to improve the accuracy and use of violence risk assessment. This article briefly outlines 3 tools: the Brøset Violence Checklist (BVC), the Classification of Violence Risk (COVR), and the Historical Clinical Risk-20 (HCR-20).