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Colin T. McDonald, MD, specialized in neuro-critical care at Massachusetts General Hospital (Mass General), Harvard Medical School in Boston in 1998, when the father of an emergency room physician at an affiliated hospital became one of his patients. One morning, the father experienced symptoms of stroke, which the son immediately recognized. Doing something about those symptoms, however, was complicated; the father and son were on Martha's Vineyard, where the local hospital was not equipped for emergency neurology care.

mild traumatic brain injury, MTBI, concussion, post-concussive syndrome

ischemic stroke, statins, lipid-lowering agents, secondary prevention of stroke, stroke prevention

mental notes

Neurotechnologic devices are proving themselves in clinical medicine. Many of these devices offer several distinct advantages over traditional pharmaceutical-based therapies: their effects are reversible, they are often cheaper than pharmaceuticals, and they solve therapy adherence issues. "If a problem occurs, you can turn off the device; or if the disease evolves over time, you can dynamically adjust the device," explained Ali R. Rezai, MD, chairman of the Center for Neurological Restoration at the Cleveland Clinic.

Parkinson disease, hallucinations, thought disorderCognitive decline, role of estrogen in cognitive decline

Parkinson disease, depression, hallucinations, psychosis, suicidality, motor control, psychiatric adverse effects

In last month's editorial, I touched on the pitfalls of the information age: the ironic inability of many patients to effectively absorb and understand information given to them by their physicians and the lack of accuracy in health care reporting by the general media. A look at the recent research on stroke education and outreach magnifies the challenge faced by physicians.

Poetry from the June 2000 issue of Psychiatric Times.

Diagnosing Alzheimer disease at its earliest stage can lead to effective early interventions.

There is hope for patients with schizophrenia who do not respond to first-generation antipsychotic drugs: phase 2 results of the CATIE study show that second-generation antipsychotic drugs may be effective.

Every young woman who reads Pride and Prejudice imagines herself as the heroine, Elizabeth. Can a male director who confesses a lack of literary influences create a faithful adaptation of Jane Austen’s beloved work?

Was Virginia Woolf mad? Thomas Szasz seeks to answer that question in his 30th book

Eating disorders in patients with schizophrenia have been underappreciated and poorly studied. Profiling characteristic phenotypic patterns will help clarify the distinctions among eating behaviors that are part of the spectrum of schizophrenia, those that represent distinct coexistent entities, and those that represent overlapping comorbidity.

A discussion of the current evidence base of psychosomatic medicine in the context of its public health significance and suggestions for the future development of the field.

BasicNeeds is a program in developing countries that works with individuals with mental illness or epilepsy, their families, and their communities to establish accessible treatment programs, satisfy basic needs, and reduce social marginalization and stigma.

Emotional maltreatment is of two major types: emotional abuse and emotional neglect. While emotional abuse is easier to identify, emotional neglect is subtler, possibly more damaging, and poses even more challenging barriers to definition and study.

Clinical practice guidelines, produced by various professional organizations and academic institutions, are usually considered the best practices for clinical care. But how do physicians use guidelines, and what factors influence their use?

An appreciation of melancholia as the principal definable mood disorderoffers a better guide to diagnosis and treatment than does DSM-identified major depression.

The idea that schizophrenia and bipolar disorder might be caused by infection is not new. New research on infectious agents in patients with schizophrenia and bipolar disorder has implications for psychiatric clinicians.

Noise, or unwanted sound, is a pollutant and an environmental stressor. The frequency of noise events seems to have increased in recent years while the amount of the day without noise has lessened.

Half of patients with nonpsychotic major depressive disorder can achieve symptomatic remission with no more than two treatments.

Psychiatrists often believe they are protected from liability when conducting third-party evaluations in civil litigation. However, the nature of the physician-patient relationship and the issue of associated liability is not that straightforward.

Caregivers may face years of continuous exposure to physical and psychosocial demands with burdens that can include physical, psychological, social, and financial problems; embarrassment; overload; and resentment.

The shift toward biologic preeminence has led to psychiatric residency programs de-emphasizing psychotherapy education. How does psychotherapy fit into the “age of the brain”?

Increased demand for accountability is requiring more clinicians to supplement their judgments of patient outcome with standardized and objective protocols. The protocol outlined here is a model or jumping-off point for outcome evaluation.

Childhood adversities associated with suicide risk include childhood maltreatment, problematic family relationships, socioeconomic hardship, and difficult relationships with peers. Acute suicide prevention strategies should focus on the treatment of contributory psychiatric disorders and on the crises that may precipitate suicidal behavior.

Antidepressant treatment extended beyond the recommended 6 to 12 months was recently reported to be more effective than monthly psychotherapy in maintaining remission in elderly patients.

Defining "stress" and how it is expressed and managed in both psychiatrists and patients is a difficult proposition. This Special Report focuses on stress and the middle ground between the impulse to say there is no such thing as “stress” and the tendency to describe many explicit addressable issues under the monolithic term "stress."

A review of nonconvention treatments for dementia and mild cognitive impairment, including dietary modification, Ginkgo Biloba, Huperzine-A, Phosphatidylserine, CDP-choline, Idebenone, and exercise.