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Psychotic disorders are a group of syndromes characterized by positive symptoms, including hallucinations, delusions, and thought disorder; and negative symptoms, including mood symptoms, social withdrawal, and reduced motivation. Cognitive deficits also appear with psychotic disorders. Psychotic disorders rank 22nd in the World Health Organization's list of worldwide causes of disability. This ranking is adjusted for the relatively low lifetime prevalence rate for psychosis; the perceived burden of the disease on those affected with psychotic disorders, as well as their relatives and caregivers, is much higher.

Intermittent explosive disorder (IED) is not yet on the radar screens of many psychiatrists, but it is more prevalent than panic disorder and warrants extensive research and attention, 2 experts on IED said recently.

Once reflected on, the concept of acceptance has multifarious implications for modern mental health care. My own work with patients and trainees has convinced me of the significance of acceptance, and I want to illustrate a few examples that may move readers to recognize similar echoes in their own practice

Medications used in the treatment of bipolar disorder are commonly associated with weight gain. Antipsychotic drugs have been implicated in new-onset diabetes.

Beyond demographic characteristics, risk and protective factors for suicide in older adults have been much more clearly defined in recent years by a series of methodologically rigorous, case-controlled psychological autopsy studies.

Substance use disorder (SUD) plays a prominent role in the epidemiology, cause, and course of mental illness. Of the more than 5 million Americans with comorbid mental illness and SUD, fewer than half received treatment at either a specialty mental health or substance abuse treatment facility.

The prevalence of substance use disorders in patients with schizophrenia is greater than the rate observed in the general population, with a dramatic increase since the 1970s. Several theories exist to explain the high rate of comorbidity. The "self-medication" hypothesis suggests that persons may abuse substances to treat underlying psychotic symptoms or adverse effects of medications commonly used to treat schizophrenia.

Weight gain is a major concern in patients with schizophrenia, especially in those taking atypical antipsychotics. Although the exact mechanism of weight gain associated with atypical antipsychotics is unknown, we often hear patients complain about an increase in appetite and a decrease in satiety.

Once his colleagues began to recover from the shock, the death of Dr Wayne S. Fenton triggered a discussion in the professional and lay press about the risks of violence to mental health professionals posed by mentally ill patients. Fenton was found unconscious and bleeding in his office in Bethesda, Md, on Sunday, September 3, 2006. He had been beaten severely around the head and died at the scene.

Psychiatrists certainly do not know all the answers when it comes to the recent spate of school shootings, but we do know some of the most pressing questions. For example, is there a difference in the psychological makeup of adult shooters versus student, or juvenile, shooters? To what degree does untreated psychosis or depression play a part in the shooter's seemingly inexplicable behavior? How important is bullying in motivating some students to seek revenge on their peers? What are the earliest warning signs of an impending attack by an assailant of any age?

The topic of life's meaning is, of course, a primary issue in existential theory.

Borderline personality disorder (BPD) and substance use disorder (SUD) often co-occur. Comorbid BPD and SUD is related to a variety of severe adverse outcomes.

A sharp decrease in visual acuity affecting both eyes developed in a 35-year-old man 3 days after elective abdominal surgery. Six months earlier, acute B cell-type lymphoblastic leukemia was diagnosed in the patient for which he received bone marrow transplantation (BMT). Following BMT, graft-versus-host disease developed in the patient. It was treated with cyclosporine, mycophenolate mofetil (CellCept), sirolimus (Rapamune), and prednisone.

Poetry of the Times by Richard M. Berlin, MD.

How do we help patients manage pain without exacerbating or reactivating an addictive disorder?

There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.

The National Institutes of Health has awarded the Alzheimer's Disease Cooperative Study (ADCS) $52 million to test the effectiveness of therapies to slow the progression and treat symptoms of Alzheimer disease (AD). New initiatives will include 3 studies to explore the effects of therapies on amyloid-β peptide and the tau protein, as well as an initiative to identify new methods for conducting dementia research.

Undertreatment of migraine, while not limited to any particular racial or ethnic group, may be especially pervasive among black persons, according to researchers from Saint Louis University.

Antipsychotic medications for the treatment of agitation, aggression, psychosis, and other symptoms of Alzheimer disease (AD) are no better than placebo and may even be harmful, according to a highly publicized study by a team from the University of Southern California Keck School of Medicine. In a statement to the press, the lead author of the study Lon Schneider, MD, professor of psychiatry, neurology, and gerontology at Keck, commented that after 12 weeks participation in a double-blind placebo-controlled trial, no significant differences were seen in symptom improvement in patients taking an antipsychotic drug compared with patients taking placebo

Upcoming recommendations from a bipartisan presidential commission on possible long-term changes in the Medicaid program have mental health advocates sitting on the edge of their seats.

A new study comparing the benefits of second-generation antipsychotics (SGAs) with their older counterparts in patients with schizophrenia has yielded a surprising result. The study, funded by the UK National Health Service, found that the overall differences between first- and second-generation antipsychotics did not reach statistical significance.

Bipolar disorder is often seen as a perplexing illness by patients and clinicians alike. In recent years, there has been a growing appreciation in psychiatric circles of the disorder's prevalence. This increased attention has filtered its way down to the general public, which, in turn, has produced sometimes sensationalistic media portrayals of manic depression, a number of speculative books about historic figures and noted artists who purportedly had the illness, and an array of self-help books marketed to individuals (and their families) afflicted with the disorder.

Patients with a serious mental illness (SMI), such as schizophrenia or bipolar disorder, may underreport co-occurring medical conditions. Dr Amy Kilbourne and colleagues performed a cross-sectional analysis of 35,857 patients from the Department of Veterans Affairs (VA) National Registry to determine whether SMI patients were less likely to report a co-occurring medical condition. Results were published in the August 2006 issue of The Journal of Nervous and Mental Disease.

The Centers for Medicare and Medicaid Services (CMS) wants to again cut its payment to hospitals and community mental health centers (CMHCs) for outpatient psychiatric care in 2007. The benefit on which the CMS is focusing is called partial hospitalization; it is paid to a facility for treatment of a patient recovering from an acute psychiatric episode. Physicians must certify that in the absence of treatment in the partial hospitalization program (PHP), a patient would require inpatient psychiatric care. Typically, patients in a PHP spend 4 to 8 hours a day, 4 days a week, receiving intensive outpatient psychiatric care.

A 50% improvement in function was seen in patients treated with botulinum toxin type A (BTX-A, Botox) for the reduction of spasticity in the wrist, finger, or arm after stroke.

Predicting extent of neurologic recovery is crucial. The most accurate and standardized method is clinical neurologic examination using the International Standards for Neurological Classification of Spinal Cord Injury.

On March 13 at this year's meeting of the American College of Cardiology (ACC) in Atlanta, investigators from the United Kingdom unveiled the results of the Migraine Intervention with STARflex Technology (MIST) trial. The MIST trial is the first controlled study to examine the effect of patent foramen ovale (PFO) closure on migraine headache.

Characterized by a triad of symptoms including inflammation, demyelination, and gliosis, multiple sclerosis (MS) affects approximately 1.1 million persons worldwide.1 The disorder is accompanied by neurologic symptoms that include disturbances of sensation, coordination, and vision along with changes in sexual function, bladder and bowel function, gait, and endurance.

To evaluate the degree to which newer antipsychotic agents are implicated in parkinsonism and whether drug-induced parkinsonism (DIP) is being adequately recognized, Christine D. Esper, MD, clinical instructor in neurology, and Stewart A. Factor, DO, professor of neurology at Emory University in Atlanta, performed a retrospective review of 354 consecutive patients in whom parkinsonian symptoms were newly diagnosed at a movement disorders clinic in 2004-2005

Because we are an open-access journal, anyone performing a Web search can stumble upon articles that have appeared in Applied Neurology. Thus, we've begun to receive provocative letters from persons who have sought treatment for Lyme disease.