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In an attempt to reframe the either-or debate over the impact of genetics versus environment on emotional makeup, a panel convened at the American Psychoanalytic Association’s Winter 2005 Meeting in New York City. This article highlights studies presented at the meeting.

Irritable Bowel Syndrome: Psychiatric Factors and Therapies

Obsessive-compulsive disorder is a prevalent, disabling and chronic illness. Serotonin reuptake inhibitors are the first-line of treatment; however a large proportion of patients will have either a partial or nonresponse. This review outlines the strategies for treatment-resistant OCD, including augmentation agents, alternative monotherapies, intravenous strategies and newer nonpharmacologic somatic treatments under development.

After the apparent failures of the U.S. Food and Drug Administration to discern cardiovascular effects of COX-2 inhibitors and suicidality in children receiving antidepressants, critics of the FDA say that the agency has failed to protect public health. Read what advocacy groups are saying and Congress is doing to change the FDA.

Impulsive behaviors play an important role in both bipolar and substance abuse disorders. However, results of studies investigating this link are often ambiguous, in part, due to the multidimensional nature of the impulsivity construct and the fact that many studies use a single measurement technique. We describe a model of impulsivity characterized by three components: response initiation, response inhibition and consequence sensitivity. How these components differ from one another in terms of their use, behavioral theory and biological function is discussed, along with measurement techniques.

Proposed changes in the conceptualization of compulsivity and impulsivity in the DSM-V will have important implications in the way clinicians recognize and treat these disabling conditions.

One of this year’s recipients of the National Medal of Science sits down to talk with Psychiatric Times about his research, accomplishments and music.

If I Were a Painter

Marijuana is the number one illegal drug of abuse in the United States; in second place is the nonmedical use of prescription medications such as pain relievers, tranquilizers, stimulants and sedatives. The National Institute on Drug Abuse is intensifying its research in understanding mechanisms that underlie the reinforcing, addictive and toxic properties of prescription medications, and developing medications with less abuse potential.

Comparative data are emerging on the metabolic effects of the second-generation antipsychotics on adolescents and children. Data presented at national meetings is discussed. When using these medications, the risks and benefits need to be carefully weighed until more definitive information is available.

Subspecialization within the practice of neurology is now reality with the recent approvals of subspecialty designations for neuromuscular pathology, headache medicine, and neuro-oncology. The American Academy of Neurology (AAN) Committee on Neuromuscular Pathology sponsored the neuromuscular pathology membership application. Two associations--the AAN Headache and Facial Pain Section and the American Headache Society--sponsored the headache medicine application.

The Workforce Task Force of the American Academy of Neurology projects that the number of pediatric neurologists will be 20% below demand, at least through the year 2020

Animal models enable researchers to track amyotrophic lateral sclerosis (ALS) pathogenesis. Erik Storkebaum, MSc, and colleagues at the Center for Transgene Technology and Gene Therapy at Flanders Interuniversity, Leuven, Belgium, took several approaches to increase supply of the neuroprotective protein vascular endothelial growth factor (VEGF) in an animal model. "When administered to rats at 60 days, which is 1 month before symptoms, it delayed onset and prolonged survival by 22 days. When we gave VEGF at the age of disease onset, which more closely mimics the human situation, the treatment still prolonged life by an average of 10 days," Storkebaum reported at the Society for Neuroscience annual meeting in October 2004

All clinical trial sponsors will be required to register all publicly and privately sponsored clinical trials with the existing government clinical trials registry, www.clinicaltrials.gov, before the first patient is enrolled in the trial.

Until recently, physicians assumed that any recovery from spinal cord injury (SCI) was limited to the first few months to a year after the injury occurred. In children, this window of opportunity for recovery could last about 2 years. Certainly, no one expected any significant recovery in any person with a chronic SCI or other condition that causes SCIs, such as a stroke, blood clots, or arteriovenous malformation affecting the spinal cord.

An estimated 18,500 cases of primary cancer of the brain and CNS will be diagnosed this year, according to the American Cancer Society (Cancer Facts and Figures 2005;

Clinical trials--and how they are conducted--have been getting a lot of attention lately, as discussed in our article, "Clinical Trials Appear Headed for More Openness," beginning on page 13. We had already finished editing the article, however, when I got a notice on June 22 about a survey commissioned by the Michael J. Fox Foundation for Parkinson's Research. According to the results, of the surveyed US physicians who treat people with Parkinson disease (PD), 96% agreed that clinical trials are necessary to develop better treatments.

On physical examination, the patient appeared well, except for the obvious diffuse rash. Erythematous macules, papules, and patches covered his extremities, face, trunk, palms, and soles. His conjunctivae, mucous membranes, and joints were normal, as were the results of cardiac, pulmonary, abdominal, and neurologic examinations. Several anterior and posterior cervical lymph nodes (0.5 to 1 cm) were present bilaterally.

The FDA approved on June 21 the prescribing of levetiracetam (Keppra, UCB Pharma) as an add-on treatment for partial-onset seizures in children 4 years or older who have epilepsy. The approval follows a randomized, double-blind, placebo-controlled trial conducted at 60 sites and involving 198 children aged 4 to 16 years

Reporter Breaking the Frontier: Update on Etiology and Treatment of Alcohol Abuse and Dependence

CMEducator: Insomnia and Its Risks: Causes, Consequences and Treatment - application for credit only; article not available online

Poetry of the Times Our Medical Marriage

Music as a creative expression can rouse emotions. Sometimes, music can be used as a means of exploring those emotions and making a connection between musician and listener. Two examples, the Beatles' White Album and the Talking Heads' Remain in Light, show how music can do more than soothe the savage beast--it can also tell us something about ourselves.

In a variety of creative fields, psychiatrists have been portrayed in many ways. This Special Report is psychiatry's turn to address creativity with offerings as diverse as the creative arts themselves. From Shakespeare to rock 'n' roll, there's something for everyone.

Dr. Schwartz, founder and editor in chief of Psychiatric Times, discusses his career as a clinician and entrepreneur.

The case of dentist Charles Sell, who suffers from delusional disorder, still awaits resolution. In the meantime, Sell remains incarcerated while his competency to stand trial is debated. Does this serve justice?

New tests approved by the FDA can allow clinicians to genetically test for patients who may be low- or high-responders to certain drugs. How effective are these tests and what might the ethical implications be?

Psychiatrists have often turned to literature for theory building, clinical understanding and teaching. Hamlet is a common example, beginning with Freud. Most psychiatrists, like Freud, look at content (character and motivation) when using literature. However, the process (interaction between characters) can also teach us much about the psychiatrist-patient encounter.

In most patients who seek treatment for headache, the cause is benign (primary headache). More worrisome, however, both to the patient and the physician, is the secondary or organic headache, which may be associated with significant morbidity or even mortality.

The common conclusion from 2 studies that were conducted in different countries and used different assessment tools is more notable than their differences: preoperative mental health scores are predictive of functional outcomes in patients undergoing total knee replacement (TKR).