News

There are still many questions about how to develop useful guidelines, introduce them into clinical practice, and measure their effectiveness. What does it mean to use a guideline in practice?

The past few years have seen substantial progress in recognizing and treating several of the subtypes of bipolar disorder. This Special Report addresses the diagnostic challenges and the different strategies for managing these subtypes.

A review of the diagnosis and treatment of complex regional pain syndrome (CRPS).

A discussion of the many difficulties in treating patients with the rapid-cycling subtype of bipolar disorder, along with a history of the condition and the author’s treatment approach.

A report from the Government Accountability Office supports an earlier accusation in the New England Journal of Medicine that the FDA is failing to protect the public from unsafe drugs.

New ways to address medication adherence problems in patients with schizophrenia offer the hope of better treatment outcomes. Two new and promising approaches for individuals with schizophrenia are the use of environmental supports and cognitive adaptation training and cognitive-behavioral therapy.

The connection between social policy and the treatment of addiction was the topic of several symposia at the 37th annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM).

Three issues of current concern in bipolar II disorder include: diagnostic criteria for hypomania, diagnosis of mixed depression, and management of mixed depression.

Bipolar disorder I and II have the highest association with substance use disorder, compared with any other major psychiatric disorder. Treatment requires an integrated approach that includes specific psychotherapy as well as the use of medication.

A discussion of the development of the brain and whether neurobiology of the brain can play a role in predicting risk for future bipolar disorders and substance use disorders SUDs.

With an application to certify its use in depression before the FDA, transcranial magnetic stimulation (TMS) has become a hot topic in the expanding field of device-based treatment modalities.

The publication of a major new textbook is an important event in any discipline, but the arrival of Psychosomatic Medicine is a particularly exciting development for clinicians working in the interface between psychiatry and medicine.

Questions concerning the adequacy of mental health care for returning Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans continue to capture congressional attention. The latest reminder was a Government Accounting Office (GAO) report issued in May stating that of the 5 percent of returning veterans between 2001 and 2004 who tested as being at risk for posttraumatic stress disorder (PTSD), only 2 percent were referred by Department of Defense (DOD) health care providers for further mental health or combat/operational stress reaction evaluations.

According to the Substance Abuse and Mental Health Services Administration, emergency department (ED) visits related to medical and psychiatric complications of methamphetamine use increased nearly 75% between 1999 and 2002. Because methamphetamine can be manufactured locally from common household ingredients, users and producers are often one and the same. Users can experience various injuries to multiple body systems as well as psychiatric symptoms, since methamphetamine is a neurotoxin; producers are also at risk for injuries from fires and explosions that result when volatile chemicals are combined.

When I was young, we had a neighbor named Frank. A proud father of 5 and a trusted employee at the local mill, Frank lived an apparently peaceful and happy life together with his wife, Kay. Frank had a secret, however.

Electronic medical records (EMRs) are becoming increasingly common in health care. Many hospitals use computer systems for some aspects of patient care, including gathering demographic and insurance information, posting laboratory results or radiology reports, providing access to transcribed dictations, and listing currently prescribed medications.

Since its initial description by Kahlbaum (1828-1899) over a century ago, catatonia has been associated with psychiatric, neurologic, and medical disorders. Contemporary authors view catatonia as a syndrome of motor signs in association with disorders of mood, behavior, or thought. Some motor features are classic but infrequent (eg, echopraxia, waxy flexibility) while others are common in psychiatric patients (eg, agitation, withdrawal), becoming significant because of their duration and severity.

The incidence of child and adolescent psychiatric emergencies has increased over the past 20 years. This rise in emergency department (ED) mental health visits coincides with an overall increase in ED use from 89.8 million visits in 1992 to 107.5 million visits in 2001. Psychiatric presentations by children and adolescents (often in the absence of medical complaints) account for up to of the total visits to an ED in a given year and, in some reports, such presentations account for as many as 16% of ED visits.

Using Antidepressants During Pregnancy: An Update

There are dozens of books on the market aimed at helping the general public recognize depression; there are far fewer that focus specifically on the more subtle forms of bipolar disorder. This disparity has its clinical parallel in the over-diagnosis of unipolar depression among patients who ultimately prove to have a bipolar disorder. Indeed, survey data suggest that there is typically a 7-year delay in the correct diagnosis of bipolar spectrum disorder.

The following 3 cases illustrate the diagnostic challenges related to differentiating brain injury and posttraumatic stress disorder (PTSD) in patients presenting to the emergency department (ED) in the acute period following a traumatic injury. Such patients pose a dilemma for ED clinicians because of the interplay between head injury and PTSD in the clinical presentation of cognitive impairments in the aftermath of trauma.

Any survivor of a traumatic event is at increased risk for the development of a stress disorder. Considering the number of persons affected by events related to the global war on terrorism and several recent large-scale natural disasters, it seems inevitable that the number of persons who will experience a stress disorder will increase. It is also probable that many of these persons will at some point seek treatment in or be brought to an emergency department (ED).

The presentation of patients to the emergency department following trauma is often complicated by the behavioral reaction to the accident that brought them there. In some cases, the mental reaction to psychological trauma is the primary presenting phenomenon. ED physicians and staff often use medication to treat the acute effects of psychological trauma. However, there is little empiric evidence to support this practice.

DBS Provides a New Lease on Life

It is common for mental health professionals to label a patient as difficult, however, it remains unclear as to what the classification actually means or what it entails.

Deep brain stimulation (DBS) may hold promise for patients with treatment-resistant and severe major depression and obsessive-compulsive disorder (OCD). However, it may not be the best choice for patients with Parkinson (PD) disease who display certain compulsive behaviors, reported researchers from the Cleveland Clinic and from Brown Medical School (Providence, Rhode Island) at the annual meeting of the American Academy of Neurological Surgeons, which took place April 22-27 in San Francisco.

A discussion of the epidemiology, assessment, diagnostic dilemmas, and treatment of avoidant personality disorder.

The prevalence and debilitating nature of some of the personality disorders has impeded the study of psychopharmacology in these conditions. However, important advances have been made in the last several years.

Suicidality in patients with borderline personality disorder is chronic. It is important to distinguish these patients from those with classic mood disorders, who are suicidal only when acutely depressed.