News

Generalized anxiety disorder (GAD) is a chronic, impairing and highly comorbid psychiatric condition. A small but sufficient group of empirically supported instruments to assess the severity of GAD are now available.

Anxiety disorders are the most common mental conditions in the general population, including in children and adolescents. Young people can present with a pattern of anxiety symptoms somewhat different from that typically seen in adults. One of the most common aspects of this difference is that children (especially younger ones) may not report overt worries or fears, but instead manifest pronounced physical symptoms.

Panic disorder is a common psychiatric illness that can have a chronic, relapsing course. The question of whether pregnancy represents a time of increased risk for recurrence of panic symptoms has been a matter of debate.

Despite high prevalence and negative consequences of anxiety disorders in later life, this area has received little research attention. A relatively small number of outcome investigations on late-life anxiety have focused on the impact of pharmacological and psychotherapeutic treatments.

Is AD Type 3 Diabetes?

intracerebral hemorrhage, hemicraniectomy, stroke, neurosurgery, traumatic brain injury

Nonconvulsive status epilepticus (NCSE), like convulsive status epilepticus, is a state of continuous or almost continuous intermittent seizure activity lasting more than 30 minutes without a return to baseline function.

In the late 1890s, Joseph Francois Felix Babinski (1857-1932), a French neurologist of Polish descent, discovered that if noxious stimulation of the sole of a patient's foot caused the big toe to rise and the other toes to splay, the reflex was indicative of corticospinal tract damage. "

Well into the 1970s, we psychiatrists believed that depression came from anger turned inward-and we acted on this notion. Psychiatrists spent countless hours trying to get depressed patients to talk about their anger. Enterprising psychologists and psychiatrists devised schemes to make such patients angry.

Alzheimer disease, cognitive impairment, neurologic imaging

Prescriptions for psychotropic drugs for adolescents aged 14 to 18 years increased by 250% between 1994 and 2001. The bulk of the momentum occurred from 1999 onward, according to a study by a team from Brandeis University in Waltham, MA.

I haven't conducted a scientific poll on this, but it seems as if more studies are being published lately on how stress takes a toll on our health. One study concluded that chronic stress at work is a risk factor for metabolic syndrome.1 Another showed how stressful effects of marital conflicts at home can slow wound healing and suggested that hospitals find ways to minimize stress in patients before surgery.2 And another study described how multiple negative life events can even be a risk factor for death, especially in people with low levels of income and education.3

Congress agreed in December to drop from its consideration of a budget reconciliation bill a provision that would have allowed family therapists and counselors to bill Medicare for mental health diagnoses. Many psychiatrists viewed the proposed legislation as a scope-of-practice attack by non-MDs.

Research Review: Treating Major Depressive Disorder With MAOIs: Effect of Delivery System on Cardiovascular Events

Insights Into Depression & Anxiety: Living With an Ambiguity in Clinical Practice: Antidepressant Drug-Drug Interactions

Poetry of the Times

CMEducator: Recognizing and Managing Bipolar Disorder

Insights Into Depression and Anxiety: Overview of the Anxiety Disorders

A limited number of back issues of Psychiatric Issues in Emergency Care Settings are available. Each issue is focused on a specific topic of interest to clinicians working in emergency department and psychiatric emergency service settings. Please use the coupon below to order the issues. Cost is $10 per copy, including shipping within the United States.

Anabolic steroids have gone from an appropriate treatment for men with hypogonadism to an agent abused by athletes, bodybuilders, adolescents, and young adults. Use of steroids at levels 10 to 100 times those of therapeutic dosages can cause psychiatric symptoms, such as aggression, mania, depression, and psychosis. Steroid abusers often "stack" several steroids or "pyramid" agents through a 4- to 12-week cycle. Presenting complaints of steroid abusers include muscle spasms, dizziness, frequent urination, and menstrual abnormalities. Signs may include high blood pressure, needle marks, icteric eyes, muscle hypertrophy, and edema; testicular atrophy and gynecomastia in men; and hirsutism and atrophied breasts in women. Mood changes can occur within a week of first use, and body changes may occur after acute behavioral disturbances.

Wang PS, Schneeweiss S, Avorn J, et al. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005;353:2335-2441.

Psychiatric symptoms are not uncommon in patients with autoimmune disorders, such as multiple sclerosis (MS), systemic lupus erythematosus (SLE), Sjögren syndrome, temporal arteritis, sarcoidosis, scleroderma, Hashimoto thyroiditis, and myasthenia gravis. The CNS is frequently involved with many of these disorders. The lifetime risk of depression in patients with MS is 50.3%, with demyelination, inflammation, and neuroendocrine response implicated. In patients with MS of 10 years' duration, 56% may show cognitive decline. Included in the diagnostic criteria for SLE are seizures and psychosis, including visual hallucinations and paranoia. Cognitive impairment can occur in 79% of patients with SLE. Cognitive dysfunction is also seen in patients with Sjögren syndrome.

Pavuluri MN, Birmaher B, Naylor MW. Pediatric bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 2005; 44:846-871.

Compliance is a major issue in treatment of schizophrenia. How can compliance be improved, and can newer formulations make that compliance easier?

Funded by the National Institute of Mental Health, the STAR*D project is one of the largest depression treatment studies ever conducted, with more than 4,000 participants. Results from the second phase of the study will be published over the next year. In this issue PT readers will find a preliminary review of data drawn from the first 1,500 enrollees.

Postmortem studies indicate that neural circuit abnormalities in schizophrenia could be reflected in gamma-band synchrony. We review findings of recent studies that demonstrate abnormal synchrony in the gamma band of the EEG in chronic schizophrenia patients, and point to links between gamma oscillations and some of the core symptoms of schizophrenia.

Schizophrenia poses a challenge for diagnosis and treatment at least in part because it remains a syndromal diagnosis without clearly understood neuropathological bases or treatments with clearly understood mechanisms of action. Neuroimaging research promises to advance understanding of the unique pathological processes that contribute to this syndrome, and to foster both better appreciation of how current treatments work, and how future treatments should be developed.

Although several clinical studies suggest that cognitive impairments in schizophrenia are associated with reduced stimulation of dopamine receptors in the prefrontal cortex, mounting evidence suggests that other monoaminergic neurotransmitter systems may also be involved. We provide an overview of neurotransmitters that hold promise as therapeutic interventions for the cognitive deficit in schizophrenia.

It was not too long ago that the management of schizophrenia focused primarily on symptom relief in inpatient and outpatient settings. Over the past two decades, there has been a paradigm shift in our approach in the overall management of schizophrenia, toward preventive and early interventions. What are some of these management techniques, and how well do they work?