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Clinical trials--and how they are conducted--have been getting a lot of attention lately, as discussed in our article, "Clinical Trials Appear Headed for More Openness," beginning on page 13. We had already finished editing the article, however, when I got a notice on June 22 about a survey commissioned by the Michael J. Fox Foundation for Parkinson's Research. According to the results, of the surveyed US physicians who treat people with Parkinson disease (PD), 96% agreed that clinical trials are necessary to develop better treatments.

On physical examination, the patient appeared well, except for the obvious diffuse rash. Erythematous macules, papules, and patches covered his extremities, face, trunk, palms, and soles. His conjunctivae, mucous membranes, and joints were normal, as were the results of cardiac, pulmonary, abdominal, and neurologic examinations. Several anterior and posterior cervical lymph nodes (0.5 to 1 cm) were present bilaterally.

The FDA approved on June 21 the prescribing of levetiracetam (Keppra, UCB Pharma) as an add-on treatment for partial-onset seizures in children 4 years or older who have epilepsy. The approval follows a randomized, double-blind, placebo-controlled trial conducted at 60 sites and involving 198 children aged 4 to 16 years

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

CMEducator: Insomnia and Its Risks: Causes, Consequences and Treatment - application for credit only; article not available online

Poetry of the Times Our Medical Marriage

Music as a creative expression can rouse emotions. Sometimes, music can be used as a means of exploring those emotions and making a connection between musician and listener. Two examples, the Beatles' White Album and the Talking Heads' Remain in Light, show how music can do more than soothe the savage beast--it can also tell us something about ourselves.

In a variety of creative fields, psychiatrists have been portrayed in many ways. This Special Report is psychiatry's turn to address creativity with offerings as diverse as the creative arts themselves. From Shakespeare to rock 'n' roll, there's something for everyone.

Dr. Schwartz, founder and editor in chief of Psychiatric Times, discusses his career as a clinician and entrepreneur.

The case of dentist Charles Sell, who suffers from delusional disorder, still awaits resolution. In the meantime, Sell remains incarcerated while his competency to stand trial is debated. Does this serve justice?

New tests approved by the FDA can allow clinicians to genetically test for patients who may be low- or high-responders to certain drugs. How effective are these tests and what might the ethical implications be?

Psychiatrists have often turned to literature for theory building, clinical understanding and teaching. Hamlet is a common example, beginning with Freud. Most psychiatrists, like Freud, look at content (character and motivation) when using literature. However, the process (interaction between characters) can also teach us much about the psychiatrist-patient encounter.

In most patients who seek treatment for headache, the cause is benign (primary headache). More worrisome, however, both to the patient and the physician, is the secondary or organic headache, which may be associated with significant morbidity or even mortality.

The common conclusion from 2 studies that were conducted in different countries and used different assessment tools is more notable than their differences: preoperative mental health scores are predictive of functional outcomes in patients undergoing total knee replacement (TKR).

Plenty of data show that a greater share of physicians practice in urban than in rural areas. The Council of Graduate Medical Education called it geographic maldistribution, "one of the most enduring features on the American health landscape," and said that it is likely to continue until universal health care is enacted.

Neurodegeneration associated with glaucoma was prevented in DBA/2J mice as a result of treatment with 1000 rads of radiation plus T-cell-depleted bone marrow.

Most patients who seek treatment for headache have the benign type-usually migraine, tension, or cluster headache. This review looks at what distinguishes benign-type headache from the more worrisome secondary organic-type headache.

Even as data mount in support of rasagiline (Agilect) as an alternative therapy for the motor symptoms of Parkinson disease (PD), additional research on the next generation of dopamine agonists suggests that this class of drugs will not be dispensed with any time soon. Findings presented in April at the annual meeting of the American Academy of Neurology (AAN) linked symptom improvement not only to the monoamine oxidase type B inhibitor but also to several nonergoline agonists, including 2 that target receptors other than D1 and D2 and are delivered transdermally.

Sometimes it pays to look at something in a different way. Growing up in rural Georgia, I hated kudzu. My disdain began as soon as I was old enough to mow the lawn. The creeping vines relentlessly tried to expand from their ceded territory and take over the civilized section of my parents' property.

At first glance, PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection) has little in common with the cuddly bear that roams the bamboo forests of southwest China. But, in fact, they share 2 important features: both are rare and both are threatened with extinction.

The Alzheimer's Disease Neuroimaging Initiative (ADNI) was set to begin recruiting this month for its clinical trial (www.alzheimers.org/clintrials/fullrec.asp?PrimaryKey=208) that will study how brain imaging technology can help measure the progression of mild cognitve impairment (MCI) and early Alzheimer disease (AD).

Patients with chronic pain have always posed big challenges for neurologists, both in diagnosis and in treatment strategies. Why and how neurologists treat pain, however, is dynamically changing.

A progressive, debilitating disorder, multiple sclerosis (MS) is the most common cause of disability in young adults with the exception of traumatic injury. The neurologic symptoms are the result of an autoimmune attack on the myelin enveloping the axons in the brain and spinal cord.

Can a common cough medicine contribute to effective treatment of symptoms in persons with neurologic disorders? The evidence is mounting in its favor. At the recent American Academy of Neurology annual meeting, research results were presented from a phase 3, double-blind, placebo-controlled, multicenter study into the safety and efficacy of a dextromethorphan/quinidine capsule in

An author discusses the similarities he has found between creating believable characters and stories and his work as a psychiatrist.

Of concern is the safety of our roadways as the effects of aging take their toll upon drivers nationwide. Are there accurate ways to test the cognition and response ability of elderly drivers?

Ever since antiquity, thinkers have associated creativity with psychopathology--the classic idea of the "mad genius."

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.

It may be possible to predict whether a patient will have an untoward reaction to a selective serotonin reuptake inhibitor-or potentially another class of antidepressant-by "pretreating" them with a placebo and by monitoring its effect on brain activity.

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