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Delirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. Approximately 15% of elderly patients admitted to the hospital have delirium as a presenting or associated symptom. Delirium will develop in another 15% of elderly patients during hospitalization.

In the aftermath of the tragic events at Virginia Tech, we would like to suggest some ways in which psychiatrists, psychologists, and college personnel can help identify and treat students who have severe psychiatric disorders--and perhaps prevent another mass murder.

One of the most hotly debated questions within oncology over the past decade has been whether the promotion of psychological wellness can extend survival for patients with advanced cancer. The converse--that psychiatric disorder shortens survival--seems true, with mechanisms of poor self-care and reduced adherence to anticancer treatments resultant from depressive or psychotic disorders explaining this outcome.

It is a widely known fact that Fyodor Dostoevsky, the famous 19th-century Russian novelist, suffered from epilepsy for most of his life. However, not too many persons are aware that Dostoevsky also had a sleep disorder called delayed sleep phase syndrome, which may have contributed to his seizures.1 Although no one knows for certain, it is quite conceivable that Dostoevsky's sleep disorder worsened his epilepsy, according to Carl Bazil, MD, PhD, director of Clinical Anticonvulsant Drug Trials and director of the Neurology Division, Columbia Comprehensive Sleep Center, Columbia University, New York.

Diabetic polyneuropathy (DPN) has a major impact on quality of life and can contribute to significant morbidity and mortality. In the United Kingdom, the prevalence of distal symmetrical polyneuropathy, as seen in specialty care, is about 28.5%, and prevalence increases with age.

A 5-month-old girl was brought to her local emergency department because she displayed increasing fussiness and back arching for 3 days. She vomited once and was febrile on the day of presentation. Meningitis was suspected. A lumbar puncture was performed. It revealed a cerebrospinal fluid (CSF) protein level of 120 mg/dL and a CSF white blood cell count of 10/µL, with 50% polymorphonuclear cells. Antibiotics were empirically administered, and the infant was transferred to a tertiary care facility for further treatment.

To kick-start his presentation on reversal of coagulopathy during a symposium at the International Stroke Conference (ISC) that took place in San Francisco in early February, J. Claude Hemphill III, MD, professor of neurology at the University of California, San Francisco, displayed a CT scan illustrating a modest intracerebral bleed in the brain of a 64-year-old woman who had been taking warfarin for the treatment of atrial fibrillation. Hemphill noted that standard care, including administration of vitamin K and fresh frozen plasma (FFP), was given.

Neuroblastoma (NB) is the most common pediatric, intra-abdominal, extracranial, solid tumor derived from nervous tissue. This malignant neoplasm occurs at an annual rate of 9.1 cases per 1 million American children younger than 15 years and is found more frequently in boys. The median age at diagnosis is 2 years for both sexes, with most cases being diagnosed by the age of 5 years. Metastatic disease is often found at presentation and represents about 70% of all newly diagnosed cases.

For years experts in multiple sclerosis (MS) have been touting the potential benefits of combination therapies for controlling disease progression. The difficulty in finding just the right combination, however, was evident in the mixed nature of findings presented at the Annual Meeting of the American Academy of Neurology (AAN) in Boston, April 28 to May 5.

Although malignant brain tumors affect thousands of persons each year, treatment has not significantly advanced. For 3 decades, the standard of care was palliative surgery, radiation, and chemotherapy. Of these, radiotherapy was the only proven way to lengthen survival time. However, since 2005 the standard of treatment has changed thanks to studies showing posi- tive results from daily temozolo- mide (Temodar) combined with radiotherapy.

Glioblastoma multiforme (GBM) is one of the most common brain tumors and is a significant cause of morbidity and mortality.1 Primary tumors of the brain occur in about 16,000 persons and account for around 13,000 deaths annually (a mortality rate of 6 per 100,000) in the United States.

The admission that I am not a sports enthusiast will not come as a surprise to readers. However, I have endured baseball, football, and hockey games on occasion. There even was a time in my life when the rainy Saturday afternoon entertainment was watching championship wrestling on the tube.

Successfully weaving together the long and complex history of melancholic depression as a severe mood disorder with strong biological underpinnings and a distinctive clinical profile.

On Monday, April 16, Seung-Hui Cho, a 22-year-old English major at Virginia Tech, shot and killed 27 students and 5 teachers before taking his own life. The reaction to this latest mass shooting included the opinion that what this young man did was beyond comprehension.

Childhood bipolar disorder is a devastating illness that affects emotional, social, and cognitive development. In recent years, increased attention devoted to the study of bipolar disorder in childhood has resulted in greater information regarding the cause, phenomenology, and treatment of the disorder.

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.