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Anxiety disorders are the most prevalent psychiatric disorders in the United States. Although effective treatments are available, such as the SSRIs and cognitive-behavioral therapy (CBT), it is estimated that in about 40% of patients, anxiety disorders are partially or completely resistant to first-line treatment.

Anyone who is close to someone who abuses alcohol or drugs knows all too well that substance abusers do not typically seek treatment until they have experienced years of substance-related problems. During the first year after onset of a diagnosable substance use disorder, only 1 of 5 alcohol-dependent persons and 1 of 4 drug-dependent persons receive treatment.

Although studies now suggest that some psychotropic medication regimens have a somewhat higher success rate than the one-third rule would have predicted, psychiatrists are still left with the problem of why it is that only one third to one half of patients who are treated get better, and why fewer still sustain that improvement over time

The treatment of unipolar major depression presents a substantial challenge for the clinician. Major depression is a common disorder with a high propensity for relapse and recurrence.

The problem of treatment resistance in bipolar disorder begins with its definition. Characterizing the phases of bipolar disorder as manic, mixed, hypomanic, or depressed does not do justice to the reality for many persons with this disorder.

In 1931, Gananath Sen and Kartick Chandra Bose reported on the use of an alkaloid extract from the Rauwolfia serpentina plant in the treatment of hypertension and "insanity with violent maniacal symptoms." They noted that dosages "of 20 to 30 grains of the powder twice daily produce not only a hypnotic effect but also a reduction of blood pressure and violent symptoms

Parkinson gait is characterized by shuffling, including a decreased stride length and gait speed. The diminished stride and gait speed coupled with increased cadence puts the patient at risk for postural instability resulting in falls.

The prognosis for patients with intracerebral hemorrhage (ICH) is poor. The 30-day mortality rate is 25% to 50%, and half of these deaths occur within the first 48 hours.

Delirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. About 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.

HHD, which affects only a small percentage (4%) of patients with PD, is characterized by adverse psychomotor effects related to dopamine replacement therapy.

ChEIs Beneficially Affect REM Sleep in AD. Cholinesterase inhibitors (ChEIs) do not modify disturbances of sleep-wake rhythm or sleep continuity in patients with either Alzheimer disease (AD) or frontotemporal dementia (FTD), but they may have a beneficial effect on REM sleep, according to investigators from the University of Marburg in Germany.

A team from the The Scripps Research Institute (TSRI) was able to reactivate a gene, the metabolic silencing of which is responsible for Friedreich ataxia, a rare autosomal recessive neurodegenerative disorder that leaves affected persons crippled and vulnerable to scoliosis, diabetes, and heart disease. The research team, led by Joel Gottesfeld, PhD, a professor in the Department of Molecular Biology at TSRI in La Jolla, California, set about identifying and testing compounds that inhibited histone deacetylases in lymphocytes from persons with Friedreich ataxia. They hit upon one-BML-210-that reactivated the frataxin gene.

Typical smokers need to have brain nicotine receptors almost completely saturated throughout the day. This need creates an almost uncontrollable urge to keep smoking, commented Nora D. Volkow, MD, director of the National Institute on Drug Abuse (NIDA), addressing a study by NIDA researchers on nicotine addiction.

A small group of patients with treatment-resistant major depression achieved symptom relief within hours of receiving a single low-dose intravenous infusion of ketamine. The low-dose anesthetic apparently triumphed in these patients where other treatments including oral antidepressants, which can take 8 weeks or longer to "kick in" failed.

The Reflex Sympathetic Dystrophy Syndrome Association estimates that the CRPS affects between 200,000 and 1.2 million Americans. The underlying causes of the syndrome have yet to be defined, and no definitive diagnostic test exists even though CRPS was first described in the late 19th century by the neurologist Silas Weir Mitchell. Mitchell referred to the cluster of symptoms he noticed in some of the Civil War soldiers who were under his care as "causalgia.

Hundreds of uniquely adapted venomous marine cone snail species inhabit the coral reefs of the Indian and Pacific oceans. Researchers posit that each may be a virtual neurologic pharmacopoeia with potential value for the treatment of everything from diabetic neuropathy to schizophrenia. The venoms, known as conotoxins, selectively inhibit a wide range of ion channels involved in neuromuscular signaling.

A possible link between diabetes and cognitive dysfunction, specifically Alzheimer disease (AD), is becoming increasingly apparent. Indeed, compared with AD risk in healthy persons, the risk of AD development is 65% to 100% greater in persons with diabetes.

Persons who are occupationally or otherwise regularly exposed to pesticides are at a 70% higher risk for Parkinson disease (PD) than is the general population. The findings were drawn from a subpopulation of 7864 persons who reported pesticide exposure in 1982.

When it comes to disease risk, not all of us are created equal. Genetics, culture, diet, education, occupation, income, environment, or a combination of these factors can predispose some persons and ethnic groups to certain illnesses.

First described more than 500 years ago, phantom limb pain (PLP) is a common disorder today; as many as 50% to 80% of patients who undergo amputation report experiencing pain in the missing appendage.

Although the prospect of disability is very real, help is available; the National Multiple Sclerosis Society provides a vast array of information and support services for patients, their families, and for health care professionals.

Intrathecal baclofen therapy (IBT; Lioresal) may be underused in stroke patients with spasticity, according to a new survey by the National Stroke Association. Of patients responding to the survey, 58% experienced spasticity. Of these, only half (51%) received any type of treatment for their condition.

The direct and indirect costs of ischemic stroke may exceed $2.2 trillion from 2005 to 2050 in the United States, according to research by Devin L. Brown, MD, assistant professor in the Department of Neurology at the University of Michigan, Ann Arbor, and colleagues.

The editors of Pediatric Neuropsychiatry must have drawn on their experiences and the feedback they received on their first book, Textbook of Pediatric Neuropsychiatry (American Psychiatric Press, 1998), for this text.

Poetry of the Times.

Wayne S. Fenton, MD, died in Washington, DC, on September 3, 2006.

The need for better tools, as well as better use of existing tools, to measure treatment response in clinical trials was a principle focus of the 46th annual NIMH-sponsored NCDEU (New Clinical Drug Evaluation Unit) meeting, held June 12-15 in Boca Raton, Fla. Improved clinical research techniques are needed to better separate treatment effect from placebo response, to distinguish between active comparators, and to facilitate development of novel treatments, according to several presenters at the conference.

Effective treatment of drug abuse and addiction in the criminal justice system saves the community money and reduces crime, the NIH's National Institute on Drug Abuse (NIDA) reported in a recently released booklet, Principles of Drug Abuse Treatment for Criminal Justice Populations.

In its latest report on medication errors, a committee assembled by the Institute of Medicine (IOM) included some sidebars on psychiatric drugs. The report, issued in July, said that there is too little data on misadministration of psychiatric drugs and that clinical trials with psychiatric drugs have been small and incapable of providing pragmatic, comparative information.

A new edition of an established text is an opportunity for its authors and editors to review new information and prune what is no longer useful. The 4th edition of Principles and Practice of Psychopharmacotherapy is more successful at the former than it is at the latter.