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Comorbidity of Dysthymic Disorders in Children and Adolescents by Atilla Turgay, M.D. Many patients with dysthymic disorders also have associated comorbid disorders. A detailed history will provide insight into the comorbidity profile, cross-sectionally and developmentally. Dysthymic disorder should be addressed clinically, as it may cause long-term chronic unhappiness and poor quality of life for the patient.

Through the Times With Max Fink, M.D. by Arline Kaplan Long viewed as a pre-eminent researcher and advocate for electroconvulsive therapy, Max Fink, M.D., reflects on more than five decades of groundbreaking research.

Evidence-Based Therapies in Child and Adolescent Psychiatry by Jon McClellan, M.D. Given the lack of large, randomized controlled studies of psychiatric medications that involve children and adolescents, it can be difficult to establish evidence-based therapies that are effective for this population. However, there are studies that have shown the effectiveness of various medications, as well as for various psychotherapy techniques.

Poetry by Richard M. Berlin, M.D. - "Fungo"

Updates Show Progress in TMS for Depression and Schizophrenia by Arline Kaplan In research presented at the 2005 APA annual meeting, transcranial magnetic stimulation is showing efficacy in treating depression and schizophrenia in the research setting. The question of how to translate those findings to a real-world setting still remains.

Childhood Reactions to Terrorism-Induced Trauma by Wanda P. Fremont, M.D. The unpredictable, indefinite threat of terrorist events, the profound effect on adults and communities, and the effect of extensive terrorist-related media coverage can contribute to a continuous state of stress and anxiety in children. Current treatment strategies are discussed as well as direction for further research.

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A team of neuroscientists from Purdue University and Nagoya University in Nagoya, Japan, has identified acrolein as a key neurotoxin in the neurodegenerative process that follows traumatic spinal cord injury. Acrolein, a toxic industrial by-product, naturally occurs in the body in negligible quantities as free radical molecules. However, it can quickly accrue to toxic levels in response to trauma, stress, or exposure to environmental carcinogens. Carriage

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Celebrity Triggers Tumult Over Psychiatric Care: Did the News Media Make Things Worse? by Michael Jonathan Grinfeld When Tom Cruise accused Brooke Shields of being irresponsible by taking antidepressants after the birth of her baby, psychiatry was momentarily thrust into the spotlight. How did journalists and scientists handle the situation, and how can they do better in the future?

The Emerging Role of GABAergic Mechanisms in Mood Disorders by Po W. Wang, M.D., and Terence A. Ketter, M.D. Gamma-aminobutyric acid is a major inhibitory neurotransmitter widely distributed in the mammalian central nervous system. Animal models of depression have pointed toward the importance of the GABA system in the pathophysiology of mood disorders. Thus, elucidating the GABAergic effects of benzodiazepines, mood stabilizers, antidepressants, and new anticonvulsants and antipsychotics may expand our understanding of mood disorder pathophysiology and potentially generate new targets for treatment.

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Antiepilepsy drug use in children presents special challenges because, unlike adults, treatment-emergent neuropsychological deficits occur against the backdrop of cognitive and psychosocial development, with treatment decisions having lifelong implications.

This article will provide an overview of treatment modalities, with emphasis on the future direction of interventions targeting aggression in children with autism.

Treating bipolar disorder in young patients can often result in aggravation, irritability or even reactivation depending on the type of medication used. What are typical examples of medication-induced rebound and what are the implications of these types of responses in children?

A discussion about new depression treatments with the chairperson of Stanford University’s department of psychiatry, Alan Schatzberg, M.D.

Individuals with schizophrenia are at greater risk for weight gain than the general population. From recent research, it appears that some of the second-generation antipsychotics may be more likely to cause weight gain than others. Recommendations for treatment strategies are provided.

Posttraumatic stress disorder is one of the most devastating psychiatric disorders. Research has shown that a combination of multiple genes can lead to conditions for PTSD. Environmental factors, as well as comorbidities, must also be considered when looking for genetic conditions of PTSD.

Although lithium is still a first-line treatment for bipolar disorder, many psychiatrists are reluctant to use it due to blood monitoring requirements. The FDA has approved an in-office blood test that allows lithium blood levels to be obtained in minutes. The test is similar to glucose monitoring devices used for diabetes, and experts on BD are hoping it will increase the use of lithium, which has also been shown to lower the suicide rate among patients with this disorder.

Richard Berlin's Poetry Column

While the utilization of clinical genotyping to determine drug response and dosage has been anticipated for many years, the actual utilization of screening for atypical drug metabolizers has only recently become a reality. What is the promise of this technology, as well as the limitations?

New research into the genetic basis and possible genetic markers for attention-deficit/hyperactivity disorder may open the door for new treatments. There is a clear concordance between twins who have ADHD, as well as siblings. What can genetic mapping tell us about treating ADHD?

Kapur S, Arenovich T, Agid O, et al. Evidence for onset of antipsychotic effects within the first 24 hours of treatment. Am J Psychiatry. 2005;162:939-946.

"The use of restraints . . . may have catastrophic impact on outpatient treatment compliance, leading to a vicious cycle of noncompliance followed by admission to a PES, with the possibility of repeated use of restraints."

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