News

When Gordon R. Kelley, MD, was called to the ICU in Kansas City, Mo, to evaluate a deteriorating patient who had apparently overdosed on methadone, he was puzzled. CT and MRI scans revealed an obstructive hydrocephalus associated with abnormal signals throughout the cerebellum, basal ganglia, and hippocampi. He knew that these findings were not consistent with a typical cerebrovascular injury, but he and other treating physicians were unsure of the cause of the findings. Reaching for his handheld computer, he entered several key words into his favorite program, NERVLINE: cerebellum . . . heroin . . . leukoencephalopathy

During a trip to Beijing on behalf of the World Psychiatric Association, Dr. Stone witnessed up close how the psychiatry is practiced in today's China. What he found may surprise you--it certainly surprised him.

Are juveniles mature enough to receive the death penalty? No, according to a ruling by the U.S. Supreme Court. Medical, psychiatric, psychological and brain-imaging data all supported the decision to ban execution of juvenile death-row inmates.

Diagnosis of the two main major eating disorders, anorexia nervosa and bulimia nervosa, can be difficult because of denial of symptomatology by the patients and problems with some of the diagnostic criteria. Although CBT has been the most effective, there are no treatments available that can guarantee a cure for either disorder. Medication is only a helpful adjunct to the treatment of anorexia, while many controlled studies that show antidepressant medications are effective in reducing binge/purge behavior in bulimia.

The FDA has issued a "black box" warning about the use of all antidepressants in the pediatric population due to a 1.8-fold increase in suicidality on drug compared to placebo. Yet these medications can be an effective tool in treating depression. How should parents and patients be educated, considering this information?

Autism is a highly prevalent, highly heterogeneous disorder of unknown etiology. Studies to clearly establish the efficacy of various classes of psychoactive drugs are scarce. Nonetheless, available findings do support the efficacy of atypical antipsychotics and antidepressants in treating the core symptoms of repetitive behavior.

Bipolar disorder in children is particularly difficult to treat. A treatment algorithm combining pharmacology with psychotherapy in order to get optimal results is presented.

Heavy smoking and caffeine intake are highly prevalent in patients with psychiatric disorders, both of which significantly impact the metabolism of a number of psychotropic medications. Hence, these factors should be routinely considered in making prescribing decisions.

The discipline of psychopharmacology has expanded enormously during the last several decades. As this Special Report illustrates, while the treatment of mental illness with medication has definitely advanced, it is neither quick nor easy. Instead, it has become more complex and complicated.

Psychiatric evaluation of juveniles who commit murder is perhaps one of the most difficult tasks in forensic psychiatry. A study has shown that these inmates are more likely to have been abused, be addicted to drugs or alcohol, or have a serious psychiatric disorder. Additionally, they are more likely to engage in risky behavior without thinking about the consequences.

Drug Company Dinner

Psychiatric Reporter:Insomnia and Its Risks: Causes, Consequences and Treatment

Locomotor training is an emerging rehabilitation intervention to help patients who have spinal cord injuries or who are recovering from stroke walk again. The basis for the intervention lies in understanding the neurobiology of walking and the nervous system's capacity for activity-dependent plasticity.

Alzheimer disease (AD) affects between 6% and 8% of Americans older than 65 years. As the population of older adults increases, the number of persons with AD is expected to rise from 4.5 million in 2000 to 13.2 million by 2050.1 This disease is important not only because of the number of patients affected but also because it leads to significant physical and emotional burdens on families and caregivers.

Recent medical meetings provided platforms for researchers to present their latest findings and for practicing physicians to catch up on the latest developments in their fields. Following are summaries of some of those presentations, and more will follow in the next issue.

Of the 2300 research papers submitted for presentation at the American Academy of Neurology (AAN) annual meeting in Miami Beach last month, 1400 were accepted. John H. Noseworthy, MD, chair of neurology at the Mayo Clinic College of Medicine in Rochester, Minn, and chair of the AAN's science committee for the meeting, had the difficult task of boiling down all that research into what the committee considered the top 10% of papers to discuss at the scientific highlights session. The presentations covered the full scale of basic science to clinical practice, and Noseworthy summed up the results in a nutshell: "We've enjoyed a superb week."

On March 31, Johnson & Johnson's Ortho-McNeil Neurologics unit added a warning to its prescribing label for galantamine hydrobromide, known commercially as Reminyl, a treatment approved for individuals who have mild to moderate Alzheimer disease (AD). On April 11, the company changed the commercial name of the drug to Razadyne.

Often, a clinical diagnosis of AD comes too late for an individual to benefit from treatment. Clinicians can assign the diagnosis of mild cognitive impairment (MCI) to patients with memory complaints, but they cannot state emphatically which of these individuals will progress to AD. Typically, about 10% to 15% of persons diagnosed with MCI convert to AD within a year, while 30% to 40% do not convert--at least not for another 6 to 8 years.

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

Joseph I. Sirven, MD, and Joseph F. Drazkowski, MD, neurologists at the Mayo Clinic in Phoenix, led a recent study in partnership with the Walter Cronkite School of Journalism and Mass Communication at Arizona State University (ASU) to determine how well medical risks and treatment advances for neurologic conditions are conveyed in US newspaper articles.1 Their findings reveal that coverage of neurologic disorders does not always correlate with the prevalence of the disorders and that more collaboration is needed between journalists and neurologists to better educate the public.

Sometimes, medically and scientifically backing up what otherwise would appear to be obvious can take a long time. This is no more evident than in our cover story for this issue, "Heart and Brain: A Clearer Connection." Recently published research is offering evidence

Sildenafil (Viagra, Pfizer) may help patients recover from stroke by aiding regeneration of brain cells. After successfully proving that the drug stimulates cortical neurogenesis in experimental models of stroke, researchers from the Henry Ford Hospital in Detroit have now embarked on a clinical trial of sildenafil and plan to recruit 84 patients who have suffered a moderate stroke within 72 hours of entering the study.

Congress and the Bush Administration are wrangling over how to strengthen the drug safety oversight activities at the FDA in the wake of the recent controversies over cyclooxygenase-2 inhibitors and pediatric antidepressants. The White House intends to create an independent Drug Safety Oversight Board (DSB) within the FDA. Several key senators like the idea but insist that the DSB be separate from the FDA to keep it from being "under the thumb" of that agency.

"Pseudodementia" needs a third look. Always a "soft" diagnosis, it has never had objective, explicit diagnostic criteria or a spot in an official nomenclature.

Research presented in late February at the annual meeting of the American Academy of Orthopaedic Surgeons underscores the increasing importance of functional assessment tools to quantify outcomes after spinal intervention, whether in measuring the effectiveness of a specific procedure or in better understanding the risks faced by patients who undergo spinal surgery in general.

Osteoporosis is a disorder characterized by low bone mass and microarchitectural deterioration with resulting compromised bone strength and increased risk of fracture.1 The World Health Organization defines osteoporosis based on T-scores, which reflect bone mineral density (BMD) relative to mean BMD for healthy 25-year-old same-sex populations. A T-score between 0 and 21 is considered normal density, a score between 21 and 22.5 indicates osteopenia, and a score of less than 22.5 signifies osteoporosis.2 Severe osteoporosis is defined as a T-score of less than 22.5 combined with a fragility fracture.2

More than 100 neurologic diseases, injuries, and intoxications are known to prominently or exclusively involve the white matter of the brain.

Since its 1999 appearance in New York, West Nile virus (WNV) has spread relentlessly westward each year, opening up new fronts in the Midwest and the mountain states until pummeling California in the summer of 2004. The flavivirus, which is spread primarily by mosquitos, affects a variety of animals, including humans, horses, and nearly 300 bird species. As of October 15, 2004, about 940,000 Americans had been infected, of whom 190,000 became ill and 6790 developed WNV's most feared complications: neuroinvasive disease, including meningitis, encephalitis, and acute flaccid paralysis.1

When Hillel Panitch, MD, decided last summer to accept an invitation to make a presentation on the status of multiple sclerosis (MS) clinical trials at the annual meeting of the American Society for NeuroTherapeutics (ASENT), he did not realize just how timely his presentation would be. "This turned out to be a little more topical than I thought it would be, because of the news over the last few days," he told attendees of the session on March 4 in Washington, DC. "The news," of course, was the withdrawal from the market of natalizumab (Tysabri, Elan Corporation/Biogen Idec), a newly approved drug for MS, and the discontinuation of clinical trials after 1 fatality and an occurrence of another serious disorder in one of the trials.

Levodopa (l-dopa) and dopamine agonists are the main treatment for Parkinson disease (PD), but these therapies are of limited value in the long course of the illness because they counter a neurotransmitter deficit but do not halt neurodegeneration. In this main article and in an accompanying story, we offer an update on the status of Parkinson treatments today.