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At this time, both patients and professionals seem to have an unprecedented interest in circadian rhythms. We now know that the body's clock is located in the suprachiasmatic nucleus (SCN) of the hypothalamus, and that the SCN regulates the pineal gland's secretion of the hormone melatonin.

For clinicians, the assiduous and sustained resistance to change common in patients with narcissistic personality disorder (NPD) has been especially noticeable and trying. However, until recently the natural course of NPD has not received much attention in the clinical and empirical literature, and there is very little documented knowledge about the factors that might contribute to changes.

Personality disorders are characterized by the presence of inflexible and maladaptive patterns of perceiving oneself and relating to the environment that result in psychosocial impairment or subjective distress. The enduring nature of the behaviors, their impact on social functioning, the lack of clear boundaries between normality and illness, and the patient's perception of the symptoms as not being foreign make this group of conditions more difficult to conceptualize than the more typical, episodic mental disorders.

Psychopathy (renamed antisocial personality disorder) is marked by persistent violations of social norms, including lying, stealing, truancy, inconsistent work behavior and traffic arrests.

Significant research developments in the etiopathogenesis of schizophrenia have occurred during the past several years. One such advance is the "neurodevelopmental" hypothesis that events during early brain development, especially the prenatal and perinatal periods, may play an important causal role in at least some, and perhaps many, cases of schizophrenia.

Temporal lobe epilepsy (TLE), now more commonly called complexpartial seizure disorder so as to include seizures that originatein the frontal foci, straddles the borderland between psychiatryand neurology.

Brain serotonin levels as a predictor of suicide has been the subject of intense research scrutiny over the past several years, with scientists trying to find easily accessible markers so that the neurotransmitter's levels might someday be readily measured in clinical settings.

Late last year, Oregon voters approved a law that would permit doctors to prescribe lethal drugs to patients judged to be in the last six months of life. Oregonians are setting out on a path that the Dutch have traveled for the past 20 years.

Venlafaxine (Effexor) is a novel antidepressant recently released to the American market. Its entry into the antidepressant market has been much heralded. The lay press has described the drug as "Prozac with a punch," and many patients were asking for it long before it was available. As the hoopla settles down, we are learning that venlafaxine is a potentially important drug with both advantages and disadvantages over other available antidepressants, including the selective serotonin reuptake inhibitors (SSRIs).

Sleep disorders and substance abuse disorders are widespread acrossthe United States, researchers have found. According to the NationalCommission on Sleep Disorders Research, more than 80 million Americanscomplain of sleep difficulties, while Schuckit and Irwin reportedthe lifetime prevalence of alcohol abuse or dependence to be 13percent and nonalcohol drug abuse, 5.9 percent.

Insomnia, the subjective sense of having inadequate quantity orquality of sleep, may result from a variety of causes. In itschronic form, such etiologies may include psychiatric disorderssuch as depression or anxiety, medical illnesses, medications,substance abuse, circadian dysrhythmias and pathophysiologiesintrinsic to sleep such as sleep apnea or periodic movement disorder.When these conditions have been ruled out, however, there remaintwo very interesting groups that at this time are best understoodin psychophysiological terms.

Sleep apnea, a medical disorder with significant health and behavioraleffects, is of particular interest to psychiatrists for its capacityto mimic or exacerbate symptoms of psychiatric disturbances suchas depression, anxiety and panic disorder.

Dopamine plays an important role in controlling movement, emotion and cognition. Dopaminergic dysfunction has been implicated in the pathophysiology of schizophrenia, mood disorders, attention-deficit disorder, Tourette's syndrome, substance dependency, tardive dyskinesia, Parkinson's disease and other disorders.

The gloom of winter, more often a literary theme than a medical topic, is a biological reality for an estimated 10 million Americans who suffer from seasonal affective disorder (SAD). For some, however, the depression ushered in by the dark days of winter can be treated simply and with rapid results with 30 minutes to two hours of bright-light therapy per day for a few weeks.