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The 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.

Daydreaming

The call came early one morning. Rich and Christine werevery upset. Their 6-year-old daughter, Mariella, had seena flashing light in her left eye that would not go away. Atrip to the emergency department revealed a smallretinal tear.

The highly readable and informativesecond edition of Substance Use Disorders,by Stuart Gitlow, is a valuablehandbook for treatment providers ofall specialties.

In "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.

Medical 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.

The 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."

In the article by Drs Kunen and Mandry, "Should Emergency Medicine Physicians Screen for Psychiatric Disorders?" (Psychiatric Times, October 2006), no mention was made of formally assessing a patient's mental status to diagnose delirium.

Congressional embarrassment over shoddy care received by veterans at the Army's Walter Reed Medical Center has stimulated passage of 2 House bills addressing veterans' mental health care.

Proper suicide assessment is probably the most important part of a clinician's job; appropriately, heavy emphasis is placed on this in our education. Unfortunately, psychiatrists receive comparatively little practical guidance in documenting the history and physical examination (H&P) of a suicidal patient.

•Methadone can build up to toxic levels in the body if it is taken too often, if the dose is too high, or if it is taken with certain other medications or supplements.

Immigrants in general appear to have lower rates of mental disorders than their US-born counterparts (Table). In the first study of its kind, funded by the National Institute of Mental Health, the affects of immigration and years of residence in the United States on the mental health of Caribbean black, Latino, and Asian populations were examined. Researchers also found differences within population groups that were related to subgroup categories such as ethnicity, gender, English language proficiency, years of US residence, and age at immigration.

In patients with dementia who are physically aggressive and dangerous to themselves or others, the use of intramuscular haloperidol or lorazepam may be appropriate. Because haloperidol causes less drowsiness and cognitive impairment than lorazepam, it is preferred in patients with dementia and delirium. The usual dose of haloperidol for elderly patients with dementia is 0.5 to 1 mg; this dose can be repeated every 25 to 30 minutes until the patient is no longer dangerous to self or others. If benzodiazepine or alcohol withdrawal is suspected, lorazepam is the preferred medication. Physical restraints may be appropriate until the medication takes effect.

Is neuromyelitis optica (nmo) igg autoantibody unique to NMO or is it expressed in multiple sclerosis (MS) as well? Recent studies have confirmed the autoantibody’s specificity and are shedding more light on how NMO IgG's autoantigen, the water channel aquaporin-4 (AQP4), uniquely behaves in NMO and MS.

The Science of Sleep. A quirky Indy motion picture by that title was in theaters last year. The plot concerned an odd but wildly creative and endearing fellow who ran into problems in his interpersonal relationships, in part, because he often couldn't distinguish between being awake and asleep. Wake and dream episodes mirrored each other, creating a penchant for the surreal and a personal narrative for the protagonist that wasn't quite in sync with that of the characters around him.

Personality Traits Early Clue to Distinguishing LBD From AD. Lewy body dementia (LBD) is often difficult to distinguish from Alzheimer disease (AD) but subtleties in symptoms provide clues to the differential diagnosis.

Patients who experience seizure 24 hours after stroke onset may be at increased risk for death, according to Angela Rackley, MD, a clinical neurophysiology fellow in epilepsy, and coresearchers at the University of Cincinnati. Rackley presented an abstract on the incidence of seizures within 24 hours after acute stroke at the annual meeting of the American Epilepsy Society in San Diego this past December. She and colleagues found a higher 30- day mortality rate among patients who had a seizure within hours of stroke compared with patients who did not experience poststroke seizure.

Patients who experience seizure 24 hours after stroke onset may be at increased risk for death, according to Angela Rackley, MD, a clinical neurophysiology fellow in epilepsy, and coresearchers at the University of Cincinnati. Rackley presented an abstract on the incidence of seizures within 24 hours after acute stroke at the annual meeting of the American Epilepsy Society in San Diego this past December. She and colleagues found a higher 30- day mortality rate among patients who had a seizure within hours of stroke compared with patients who did not experience poststroke seizure.

It is not uncommon for combat veterans to exhibit a wide range of psychological conditions, from schizophrenia to depression to posttraumatic stress disorder (PTSD), but how do these disorders affect domestic partners, who often serve as veterans' caregivers?

The introduction of a House mental health parity bill in March has scrambled prospects for congressional passage of a bill that President Bush could sign. The introduction of the Paul Wellstone Mental Health and Addiction Equity Act (HR 1424) by Reps Patrick J. Kennedy (D, RI) and Jim Ramstad (R, Minn) threatens to split both the mental health community and the House and Senate.

FDA Approval of Vagus Nerve Stimulation I am a triple-boarded, long-practicing psychiatrist and have used vagus nerve stimulation (VNS) in several patients so far. I have followed the controversies within the FDA and articles in the national media and was quite impressed by and appreciative of Dr Daniel J. Carlat's article on the sponsorship issues involved in FDA approval of VNS ("Conflict of Interest in Psychiatry: How Much Disclosure Is Necessary?"

Chaput YJA, Lebel MJ. Demographic and clinical profiles of patients who make multiple visits to psychiatric emergency services. Psychiatr Serv. 2007;58:335-341.

The reason that antipsychotic medications cause weight gain is that there is increased activity of the enzyme AMP-kinase in the hypothalamus, the area of the brain that controls hunger. The increase in AMP-kinase levels occurs because antipsychotic medications interfere with the protein histamine. For some time it has been suspected that histamine plays a significant role in weight control, and these findings, from a study conducted in mice by scientists at Johns Hopkins University, confirm this. The researchers hope that these findings will contribute to the development of a new class of effective antipsychotics that do not cause weight gain.

González-Pinto A, Aldama A, González C, et al. Predictors of suicide in first-episode affective and nonaffective psychotic inpatients: five-year follow-up of patients from a catchment area in Vitoria, Spain. J Clin Psychiatry. 2007;68:242-247.

Fliege H, Grimm A, Eckhardt-Henn A, et al. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics. 2007;48:60-64.

HUMAN RECEPTOR ACTIVITY-MODIFYING PROTEIN-1(hRAMP1) may be the switch that turns up the volumeof calcitonin gene-related peptide (CGRP)expression in migraine, according to researchersfrom the University of Iowa in Iowa City.

An analysis of data on nearly 104,000 veterans of the Afghanistan and Iraq wars who sought help from the Department of Veterans Affairs (VA) system confirms that substantial numbers returned from their tour of duty with psychiatric problems.

In the first part of this column (Psychiatric Times, February 2007), I reviewed treatments whose beneficial effects are probably achieved through a discrete biological or pharmacological mechanism of action. These included dietary modifications; supplementation with specific vitamins, minerals, and amino acids; and medicinal herbs. In this part, I will review the evidence for approaches that reduce the risk of relapse, diminish craving, or mitigate withdrawal symptoms but for which there is no evidence for direct biological or pharmacological effect.

Psychiatrists know that it takes longer to interview children and adolescents than adults. Child and adolescent psychiatrists are universally struck by how comparatively easy it is to interview an adult patient, whereas general psychiatrists face the evaluation of a child or adolescent with apprehension.

A complex and heterogeneous condition characterized by a variety of symptoms and marked variability in disease course, bipolar disorder is marked by episodes of depression, hypomania, mania, or psychosis and,patients can experience a mixture of emotional states.