What is the best approach for management of depression in a pregnant woman after a suicide attempt?
March 1st 2007Although suicidal ideation occurs in roughly 5% to 14% of pregnancies,1 suicide attempts are relatively rare (0.04%) and are associated with substance abuse and poor pregnancy outcome.2 After a suicide attempt, the clinician must first consider the possibility of recurrence of self-destructive behavior by assessing the woman's motivation, her attitude toward the pregnancy, and the severity of her depressive symptoms.
The Role of Population and ED Trends in Delirium Management
March 1st 2007In this issue, Drs Heinrich and Sponagle present a thorough overview of the challenges of detecting and treating delirium in the emergency care setting. They also address the high risks involved when the diagnosis is missed. The difficulties of identifying and appropriately managing delirium are not new. However, the importance of doing so is taking on a greater significance because of certain current and forecasted realities that will affect the nation's emergency departments (EDs).
Bipolar II: Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression
March 1st 2007Ronald Fieve and his colleagues were among the first to document milder versions of manic symptoms-hypomania-in the 1970s, observations that did not make it into DSM until 1994.This book appears mainly to be intended for families and patients; clinicians might find some parts simplistic and other parts informative.
Clinical Assessment and Management of Pathological Gambling
March 1st 2007Pathological gambling (PG) is characterized by persistent and recurrent maladaptive patterns of gambling behavior (eg, a preoccupation with gambling, the inability to control gambling behavior, lying to loved ones, illegal acts, and impaired social and occupational functioning).1 With past-year prevalence rates similar to those of schizophrenia and bipolar disorder,2 it is apparent that PG has become a significant public health issue. The aim of this article, therefore, is to introduce clinicians to the assessment and treatment of PG with the hope that early interventions will reduce the considerable personal and social costs associated with the disorder.
Mental Illness in US Latinos Addressed in Survey, Outreach Efforts
March 1st 2007Early findings from a national study are shedding light on differences in the type and prevalence of mental disorders in US-born and immigrant Latinos, as well as differences among Latinos from various countries of origin.
Optimizing Individual Outcomes in Schizophrenia: Challenges and Opportunities
February 1st 2007Despite significant advances in our understanding of the nature of the disease and development of more effective treatments, schizophrenia remains one of the most challenging medical conditions of our time.
Multidisciplinary Rehab in Acute Stroke: Canadian Model Sign of Things to Come?
February 1st 2007Organized and early acute stroke treatment has been shown to improve functional deficits, reduce the need for institutionalization after stroke, and reduce patient mortality. Today, stroke research has evolved to incorporate an integrated, multidisciplinary treatment approach. Data from a study done in 2005 in Ontario, Canada, demonstrate the utility of providing rapid and integrated acute stroke treatment in a real-world setting. The study evaluated functional outcomes associated with rehabilitation services that are part of a flagship stroke treatment program initiated by the Ontario government. The hope for the future is that this approach to patient management will reduce associated health care costs, which are anticipated to increase dramatically in the coming decades.
SIDS Traced to Aberrant Brain Chemistry
February 1st 2007Sudden infant death syndrome (SIDS) is the leading cause of postneonatal death in the United States.1 This unfortunate disorder is characterized by the sudden, unexpected death of an of infant between ages 1 and 12 months whose cause of death remains a mystery in the aftermath of a thorough postmortem examination that includes an autopsy, an investigation of the death scene, and a careful review of the infant's medical history. New research, published in the November 2006 issue of The Journal of the American Medical Association,2 that made recent headlines confirmed earlier research by the same investigative team3,4 showing that serotonergic brain stem abnormalities may be the at the root of SIDS.
Ketamine and NMDA Receptor Antagonists for Depression
February 1st 2007In recent months, it's been the rare week that doesn't come with a report about the dangers of antidepressants. These drugs do have their drawbacks, but the dangers they pose are not their main problem. Their biggest shortcoming is that they don't work very well; fewer than half of the patients treated with them get complete relief, and that relief takes an unacceptably long time 2 o 3 weeks t kick in.