News

In my last column I used the ancient metaphor from Homer's Odyssey of being caught between the two monsters of Scylla and Charybdis to describe the predicament of contemporary physicians treating chronic pain.

Most estimates suggest that there are just over a million persons living with HIV/AIDS in the United States. According to CDC data, between 2001 and 2005, an average of 37,127 new cases of HIV infection, HIV infection and later AIDS, and concurrent HIV infection and AIDS were diagnosed each year.

Paraphilias and paraphilia-related disorders (nonparaphilic sexual compulsivity or sexual addiction) are sexual disorders that predominantly afflict men.

Here is the conundrum: You have completed treatment with a fascinating and complex patient. Mr A has bipolar depression, Marfan syndrome, and hypothyroidism. You not only managed to navigate around the rocks of his medical problems, but you also managed to stabilize Mr A's bipolar disorder using a combination of lithium (Eskalith, Lithobid), thyroxine, and interpersonal therapy. You would now like to share your experience with colleagues, so you write up the case history; then suddenly, you are seized with misgivings.

Although methadone (Dolophine, Methadose) is primarily thought of as treatment for opioid addiction, it is also an excellent and underused analgesic. This column discusses the issues to consider when deciding whether to prescribe methadone for pain relief.

Since the revision of DSM-III, high rates of co-occurring psychiatric disorders have been observed, particularly in cases of moderate and severe psychiatric illness. The reason lies in the design of the diagnostic system itself: DSM-IV is a descriptive, categorical system that splits psychiatric behaviors and symptoms into numerous distinct disorders, and uses few exclusionary hierarchies to eliminate multiple diagnoses.

A recent analysis that found a 40-fold increase in the diagnosis of bipolar disorder in youth has highlighted diagnostic dilemmas and prompted calls for more research studies.

Among clinicians and researchers in geriatric psychiatry, interest in late-life bipolar disorder is growing, fueled not only by the increasing size of this clinical population but also by the recent discovery that mood stabilizers such as lithium may influence the pathogenesis of Alzheimer disease.

Bipolar disorder (BD) in later life is a complex and confounding neuropsychiatric syndrome with diagnostic and therapeutic challenges.

Many recall the phrase "To know syphilis is to know medicine." Now Lyme disease (Lyme borreliosis), the new "great imitator," is the ultimate challenge to the breadth and depth of our knowledge. In psychiatry, we generally treat mental symptoms or syndromes rather than the underlying cause of a disorder.

The use of psychedelic plants and drugs in psychiatric medicine has been a promise for more than half a century, suppressed by a draconian legal response to the epidemic of drug abuse in the 1960s. This 2-volume work seeks to reverse the suppression of scientific inquiry in this field by bringing together a comprehensive airing of the topic.

School-based drug abuse prevention programs do more than just effectively decrease drug use and misuse among children and adolescents, according to a study by Gilbert J. Botvin, PhD and associates, they may also reduce adolescent delinquency, verbal and physical aggression, and fighting.

Poetry of the Times

In September, Gov Rod Blagojevich (D, Ill) signed Senate Bill 234 into law, allowing early state intervention for persons with severe mental illnesses. Before this enactment, the state required that persons must be a danger to themselves or others before court-ordered treatment could take place.

The role of the forensic psychiatrist frequently requires straddling a fence. On the one side lie the standard function and commensurate ethics of a physician; on the other are the needs of the legal system calling for objectivity, truth, and justice.

Adolescence is a time of great importance during which children make extraordinary developmental strides. According to Erik Erikson, adolescents consolidate a self-concept by struggling with essential questions such as Who am I? and What is my role in life?

Ataxia is a relatively rare, genetic neuromuscular disorder, affecting about 150,000 persons in the United States. It is one of those disorders for which knowledge is growing but is slow to get to the practicing clinician. Hence, many persons with ataxia go for years with no diagnosis or a misdiagnosis. Alternately, because ataxia is a progressive disorder without a cure, many patients are given a stark diagnosis and sent home to cope with the disorder on their own.

Widespread media reports and billboard campaigns decrying a methamphetamine epidemic are drawing attention away from the greater and more entrenched use of cocaine, according to a National Institute of Drug Abuse (NIDA) scientist speaking at the American Society of Addiction Medicine's (ASAM) 38th Annual Medical-Scientific Conference, held in Miami, April 26 to 29.

Of the many bits of wisdom my parents shared with me as a teenager, one stands out as particularly useful: "John, 90% of the things you worry about will never happen to you!" I still think about this comforting observation from time to time, especially now that I have my own children, and I furrow my brow because I wonder how they--or anybody else--could come up with such an optimistic statistic.

When offered a gift by a patient or a patient's family, a psychiatrist faces a significant practical challenge to negotiate "the poles of rule-bound rigor and individually tailored flexibility," the McLean Hospital Ethics Committee wrote in a recent article.

Virtual games, such as World of Warcraft, The Sims, and Second Life, are played by thousands every day, allowing people, worldwide, to connect and share information. In fact, the virtual "worlds" that can be created in these games are now being used to make money (through buying and selling virtual objects), to form partnerships and friendships, and even to conduct business; it is easy to see how many become engrossed in this alternative life.

Many psychiatrists feel intimidated by or frightened about courtroom testimony. However, with the proper preparation, the psychiatrist need not have a difficult experience. It is the role of an expert witness to educate the court on matters that are beyond a layperson's understanding.

Part 1 of this article, discussed a general approach to treating psychiatric emergencies in patients with bipolar and related disorders, as well as the assessment and management of agitation and impulsive aggression. Part 2 focuses on psychosis, suicidality, and specific treatments relevant to patients in emergency settings who are agitated or have bipolar disorder.

Many of the things that we busy ourselves with have no apparent utility. Blogging, playing games, and collecting come to mind. To declare that we are compelled to do these things may be too strong, but we do pursue these activities with little deliberation and without concern as to their usefulness. The ubiquity of these pursuits suggests that these activities or their variants helped humans survive at some point and that they now rest on innate brain programs.

Marijuana is the most commonly used illicit drug in the United States and worldwide. Initiation of use typically occurs during adolescence. The most recent epidemiological data indicate that in the United States, 42% of high school seniors have tried marijuana, 18% have used it in the past 30 days, and 5% use it daily.

There are hundreds of studies that show that pharmacotherapy is used to treat depression in adult and geriatric populations. There are far fewer studies that test the efficacy of psychotherapies and even fewer studies that focus on combined treatment for older patients.

Almost one third of US mental health care costs (approximately $50 billion) go toward the treatment of anxiety disorders. Conventional pharmacological treatments for anxiety are often beneficial but have limited efficacy.

One consequence of the "graying" of the world's population is that psychiatrists, along with all health care professionals, will increasingly be providing services to older adults. In the United States, the first set of people belonging to the baby boom generation turned 60 in 2005, and the number of people older than 60 will soonoutnumber children for the first time in recorded history.

Parkinson disease (PD) is a progressive neurodegenerative disorder affecting 1% of people 65 years and older. The core symptoms include the motor manifestations of tremor, bradykinesia, and rigidity.

Contributing to the problem is the relative unreliability of EEG tracings recorded from patients during the interictal period. Although these tracings can reveal certain abnormalities that are characteristic of epilepsy, such as spikes, they tend to be relatively nonspecific. Interictal spikes, for instance, occur inconsistently; they are present in some persons who do not have epilepsy and absent in others who do.