News

"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.

Nerve root injections can help patients with lumbar radicular pain avoid surgery for at least 5 years, according to research from Washington University in St Louis that was presented in late February at the annual meeting of the American Academy of Orthopaedic Surgeons.

As a neurosurgeon with more than 30 years' experience in the field, and as medical director of a local hospital, I must take serious issue with the published and highlighted remarks of Dr Jung Ahn that "pressure sores in spinal cord injury are, as far as I'm concerned, preventable" (Watanabe ME. Spinal cord injury: dealing with more than inability to move. Appl Neurol. 2005;1[1]:32-34).

Are older adults highly susceptible to epilepsy and not getting the right diagnosis when a seizure occurs? R. Eugene Ramsay, MD, thinks so. Ramsay, a professor of neurology and psychiatry and director of the International Center for Epilepsy at the University of Miami, is working hard to get that word out to neurologists and primary care physicians. He's written articles,1,2 conducted clinical trials, and made presentations, one of which I attended in Philadelphia in March during the joint conference of the National Council on the Aging and the American Society on Aging.

With one in six Iraqi War veterans exhibiting mental health problems, psychiatrists are faced with the challenge of reducing or averting the psychological wounds of war and preventing long-term, service-connected disabilities. At the 13th Annual Medicine Meets Virtual Reality Conference, new therapies using virtual reality were put to the test.

Poetry of the Times

Little attention has been paid to the prevalence of sexual assault and its sequelae among military men. The past-year prevalence of sexual assault among enlisted men ranges from 0.4% to 3.7%, a figure equal to or exceeding the lifetime prevalence among civilian men in some studies. Increased awareness and understanding of male sexual assault as well as routine screening of all patients, regardless of gender, for exposure to sexual victimization will enhance their recovery.

The dozens of journalists killed while covering the current war in Iraq gives currency to the dangers encountered by those who bring us the news from the world's conflict zones. Despite the risks inherent in their profession, it is only recently that the psychological health of war reporters has been captured in a systematic and empirical manner.

Road rage is well known in popular culture and to many people it is a common and dangerous experience. Alcohol problems, illicit drug use and general psychiatric distress are associated with road rage perpetration. Road rage incidents may also result in psychiatric distress. Although treatment for road rage has received little research attention, encouraging results have been reported from specialized programs.

Youth gangs are a recognized risk factor for adolescent violence and delinquency. This article reviews recent research on these topics, including the prevalence, characteristics and influence of youth gangs, and discusses the implications of those findings for clinical practice.

Traumatic events affect individuals as well as entire communities. In this Special Report on trauma and violence, a number of often forgotten traumatic experiences are described. The individuals exposed to these events are at increased risk of several psychiatric disorders, as well as behavioral changes such as increased alcohol use or cigarette smoking.

Dr. Gabbard discusses using psychotherapy and psychiatry combined, how media portray psychiatrists and why Tony Soprano does the things he does.

Is the HAM-D still viable? What are its flaws and is it possible to compensate for them?

Mental illness occurs more frequently among people infected with HIV. In addition, individuals with mental illnesses are at greater risk for contracting HIV. Therefore, psychiatry has a great deal to offer in the management of patients with HIV--whether through proper patient education or safe and effective psychopharmacology.

Prostate cancer, the second leading cause of cancer death in men, is the most common cancer in males in the United States. Out of an estimated 230,000 new cases in 2004, more than 70% will occur in men over age 65. Close liaison between urologists, prostate oncologists, radiation oncologists and psychiatrists allows for improved information transfer and proper referrals, as well as improved identification of the symptoms as being either physical, psychological or both.

Multiple studies show that diabetes approximately doubles the risk of comorbid depression. Furthermore, major depressive disorder is a risk factor for the subsequent development of type 2 diabetes mellitus. Treatments for depression in the setting of diabetes must be evaluated for their effects on blood glucose levels, propensity for weight gain, possible concomitant use for diabetic neuropathy and potential drug interactions.

Medical-psychiatric comorbidity predicts poorer outcomes and increased health care utilization and cost. The collection of articles in this Special Edition is clinically informative and an illustrative set of examples of the unique practice of psychosomatic medicine in different medical-surgical settings.

Comorbid substance use disorders may complicate treatment for both the hepatologist and psychiatrist. Comprehensive assessment of psychiatric illness and psychopharmacological management may be critical.

Attempts have been made to integrate psychiatry and medicine as far back as Benjamin Rush, a physician and signer of the Declaration of Independence. Recent advances in research, clinical practice and organizational makeup, however, now make integration seem more plausible than ever. Find out what's happening to bring these two fields closer together.

Research on amyloid-beta immunotherapy for use as a therapeutic modality for Alzheimer disease (AD) is back on track, and new study results are promising.

Management of diabetic peripheral neuropathy (DPN) centers on proper footcare, offloading, and various orthotic devices to prevent the development of ulcers. Management trends, however, show that off-label use of some pharmaceutical agents is common and that these agents are proving beneficial in relieving the pain that can accompany DPN in up to 35% of patients. In addition, innovations in orthotic devices and new technologies for patient monitoring are being rolled out.

MRI has provided important insights into the pathophysiology of multiple sclerosis (MS).1 However, conventional MRI scans furnish only gross estimates of the nature and extent of tissue damage associated with MS,2 and the data correlate poorly with measures of concurrent disability in patients.

Published research is now backing up what would appear to many to be a clear heart and brain connection. As more of this research is circulated, it could have a direct impact on how neurologists practice medicine and on how neurologists and primary care physicians treat patients and interact with each other.

How high is your knowledge quotient on special considerations in the treatment of women with epilepsy? In a presentation on managing epilepsy in special populations, Trevor J. Resnick, MD, director of the Division of Pediatric Neurology at the University of Miami, cited survey results published back in November 2000 in The Journal of Women's Health and Gender-Based Medicine,1 which illustrated that only 5% of the 3535 practitioners surveyed answered two thirds of the questions correctly. "Almost a quarter didn't know that there was a relationship between seizures and hormonal cycles. Over 80% didn't know that women with epilepsy have lower fertility rates. Two thirds didn't know that women are at a higher risk for osteoporosis and osteopenia. Three quarters didn't know which antiepileptic drugs-and this is very important-interacted and which did not interact with oral contraceptives," stated Resnick in his presentation at a symposium on advances in neurology held recently in New York City.