News

Serotonin, the prefrontal cortex, and the amygdala interact with one another in the emergence of impulsive aggression. Which pharmacological and psychosocial treatments prove most effective?

New imaging techniques have shown a dynamic wave of gray matter loss in early-onset schizophrenia. Can this pattern of destruction provide a window of opportunity to combat this disease?

Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite. In some patients, an organic mental syndrome can be part of a migraine attack (Davidoff, 1995). In other patients, an acute psychotic condition is the dominating clinical feature. This presentation, with paranoid delusions, hallucinations and anxiety, has been described in families with hemiplegic migraine (Spranger et al., 1999). Migraine is, therefore, an important differential diagnosis in relation to episodic phenomena with a mixture of somatic and psychiatric symptoms. In addition, psychosocial stress is the most common precipitating factor for a migraine attack (Davidoff, 1995).

After numerous hospitalizations, electroconvulsive therapy and a battery of drug trials, a college senior remained suicidal. Looking for advice on her patient, a psychiatrist brought the case to a team meeting, only to be told by a senior colleague, "You can't save them all."

Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite.

Psychotic episodes following brain injuries can often be mistaken for schizophrenia. How can the presentation of psychotic episodes reframe our understanding of this complex phenomenon?

The tragedy of Sept. 11, 2001, brought so much public attention to mental health care that the National Institute of Mental Health has awarded several grants for the study of the needs incurred following these attacks. Grants were given to Cynthia Pfeffer, M.D.; David Vlahov, Ph.D., and Gerry Fairbrother, Ph.D.; Rose Zimering, Ph.D.; Charles Marmar, M.D.; Hector Bird, M.D.; Edna Foa Ph.D., and Rachel Yehuda, Ph.D.; Joseph LeDoux, Ph.D.; Daphne Simeon M.D.; and Joann Difede, Ph.D. These researchers from various universities and institutions were given grants to support or continue research on topics such as Sept. 11's effects on mental health symptoms, disorders and care service use; posttraumatic stress disorder (PTSD) and other disorders in children as a result of losing a parent in the attacks; and PTSD in clinicians treating victims of the attacks.

With black bags stuffed below their eyes, all the sad doctors come to me now like mourners in the time of plague. Crying in their office bathrooms, carrying boxes of charts home at night, they are too tired to eat, and sex excites them less than a committee meeting. Without dreams, their eyes watch the clock tick off the wounded hours-thousands of doctors writhing on the scarred suture line of American medicine like a cargo of used syringes washed up with drowned birds on an oil-soaked beach.

The World Health Organization (WHO) has distributed for comments the draft of a Manual on Mental Health Legislation as a guide for all the countries of the world. It is to serve as a model for new legislation and as a guide for countries amending their legislation. Given the different legal systems, the cultural diversity and the vast inequalities in economic resources among the nations of the world, one can certainly question the wisdom of the WHO's top-down approach. In addition, everyone who knows the scarcity of competent mental health care professionals and the limited resources in third world countries will recognize that most of the proposals are quite unrealistic. How can nations who cannot feed their poor or meet the basic necessities of public health measures and primary care be expected to provide "incompetent" mental patients with counsel (lawyers) and independent tribunals (courts) before they begin to treat them?

With the failure of previous federal plans to reform health care, other options must be considered. How might this effect the reimbursements for providing care?

Psychopharmacology can be useful in all stages of couples' therapy. Using a high-functioning couple as a case example, the author illustrates how psychopharmacology, together with psychotherapy, can be used to facilitate treatment success.

Psychiatrists, neurologists, primary care physicians, physician assistants, psychologists, psychiatric nurses, social workers and other mental health care professionals. Continuing education credit is available for most specialties. To determine if this article meets the requirements of your specialty, please contact your state licensing board.

While anorexia nervosa was the first eating disorder to be recognized through the 19th century reports of Gull (1874) and Lassque (1873), bulimia nervosa and the less well-defined eating disorder not otherwise specified (EDNOS) syndromes are more common.

How can psychiatrists and psychotherapists optimize their collaboration and individual skills to facilitate treatment success?

There is no question that psychotherapy and psychopharmacology can be successfully integrated. Indeed, there are still many psychiatrists left in this country who talk to patients and families, provide both psychotherapy and psychopharmacology, and care for patients in a biopsychosocial context.

The use of Personal Digital Assistants (PDAs) by medical professionals has many advantages over traditional paper schedulers. The following is a compilation of additional resources offering information for using and integrating this new technology in your practice. For more information on choosing a PDA to enhance your practice, please see the article How Technology Will Affect Your Practice in the June 2002 issue of Psychiatric Times (p36).

As a psychiatrist working in a state hospital, this author defends the long-term commitment of sexual offenders to institutions and offers insights on factors determining prognosis.

What effects will the verdict from the murder case against Andrea Yates have on the public's view of the insanity defense?

When I raise my rates he folds his fifty dollar co-pay and slides it up my desk like an enlisted man on leave easing a big bill in a stripper's G-string. He tells me I'm like his war-time whore who loved him on payday and left when his money ran dry. Each week I lead him in our dance, excite him with my offer to listen to his dreams. And I tell myself I do it to ease his suffering, because I get paid, because I took an oath. But every month, when we devour another round of sessions, I fill out forms for insurance pimps who won't pay unless I reveal the private parts.

It is amazing how a psychiatric practice changes over the years including the switch to managed care from fee-for-service, larger caseloads, new medications and new treatment options. Despite all the changes, both for better and for worse, one psychiatrist is enjoying his practice as much today as ever before.

Antidepressant use among children and adolescents is on the rise. What prescribing patterns are being formed? Researchers are suggesting that more research into psychiatric pharmacogenetics may produce better treatment outcomes. Will it one day be possible to predict treatment response?

A case history illustrates the need to consider psychosocial approaches to treating postpartum depression.

Advances in basic behavior and neuroscience research have been stunning, but until quite recently, efforts to encourage the clinical application of new knowledge have not kept pace. To aid in applying new knowledge to important public health issues, the National Institutes of Health has placed emphasis on "translational research," which aims to provide a bridge between basic research and clinical care. Particularly promising areas of study are highlighted.

Personal digital assistants have the ability to make your practice more efficient. What are the choices of PDAs on the market, and which one is best for you?

How has the emphasis on economics and mental health care affected the quality of care? Has it improved under managed care? Implementing prevention strategies and improved quality, although initially costly, may save money in the long term.

Ask me about power and I'll tell you cigar smoke, the way it darkens like a thunderhead

The increased money being spent on marketing pharmaceuticals directly to patients is raising questions. Are patients indeed benefiting by becoming more aware of their health, or are they simply being used as a target market for the latest drug?

Patient Drug Information From Mass Media Sources

New medications for the treatment of various addictions are currently under investigation. However, there are still substantial barriers, on the part of health and social policies and the patients themselves, to patients receiving these new treatments. Many of these issues were explored at the 2001 American Society of Addiction Medicine's State of the Art in Addiction Medicine conference.

Several confounding factors need to be taken into account before labeling a patient as treatment-resistant. What options are available for treating a patient with schizophrenia who has been diagnosed as such?