Addiction & Substance Use

This article emphasizes core philosophies and components of effective dual disorder programs.

Over the past century, the syndrome currently referred to as ADHD has been conceptualized in relation to varying cognitive problems including attention, reward response, executive functioning, and other cognitive processes.

Brief psychotherapy is not the name of a specific model or theory of treatment. Rather, it describes an approach that attempts to make psychotherapy as efficient and practically helpful as possible within a limited time frame. The aim of brief therapy is to speed up the process of change, amplify patient involvement, and foster more focused psychotherapy sessions. Over the years, several approaches to brief psychotherapy have evolved. Some advocate a handful of sessions; others involve more than 20 sessions (eg, psychodynamic therapy).

Traumatic experiences are common in childhood and adolescence and can have significant psychological effects on the child’s emotional well-being and overall development. Outcomes can be affected positively or negatively depending on responses and interventions.

In my January column (“Fishing Expeditions and Autism: A Big Catch for Genetic Research?” Psychiatric Times, January 2009, page 12), I described the great difficulties research­ers face characterizing the genetic basis of the disease. Complexities range from trying to establish a stable diagnostic profile to making sense of the few isolated mutations that show clear associations (either with disease or syndrome variants).

Book Review: What one thing could we do to improve our relationships, our work, and the way we learn? According to Dr Medina, we should make friends with our brains and learn to work with them, not against them. In Brain Rules, Medina outlines 12 practical ideas to help acquaint us with the ways our brains function and the ways we can engage positively as individuals and as a society.

The rationale for the use of anticonvulsants in anxiety disorders is supported by neurobiological underpinnings that make these compounds a likely alternative for short-term treatment.

My first job after residency involved working at a large Veterans Affairs hospital in an outpatient dual diagnosis treatment program that focused on the comorbidity of schizophrenia and cocaine dependence. Having recently completed a chief resident position at the same hospital’s inpatient unit that focused on schizophrenia without substance abuse, I was struck by how “unschizophrenic” my new patients were. They were organized and social. Their psychotic symptoms were usually limited to claims of “hearing voices,” for which insight was intact and pharmacotherapy was readily requested.

The number of persons in the United States who take prescription opioids for pain is growing. Sullivan and colleagues2 found that from 2000 to 2005 there was a 19% increase in the number of patients who received prescriptions for opioids to manage chronic noncancer pain conditions. Based on a survey conducted from 1998 to 2006 with more than 19,000 subjects, Parsells Kelly and associates3 reported that 2% of the US population 18 years and older legally used opioids as analgesics at least 5 days per week for 4 or more weeks-and that another 2.9% used these drugs less frequently.

The words attributed to Socrates resonate with the perspectives of many contemporary parents and clinicians.1 The endurance of the concern suggests something fundamental about the psychopathology of deviant, disruptive behavior of youth. Yet clinicians struggle to understand its origins, to help parents control their children, and to help the children control themselves. Clinically, this manifests in failed pharmacological treatments, incompleted courses of individual therapy, problems in engaging families in treatment, and controversies over which therapy is most effective.

Women with bulimia nervosa (BN) respond more impulsively during psychological testing than do women without eating disorders, according to a recent article in Archives of General Psychiatry.1 Functional MRI showed differences in brain areas responsible for regulating behavior in women with and without BN.

The FDA is forcing manufacturers of all antiepileptic drugs to include new warnings of possible suicide ideation in the prescribing information and also to prepare a new Medication Guide to be distributed by pharmacies to consumers. In addition, the companies will have to produce a Risk Evaluation and Mitigation Strategy for each drug, which the FDA only requires for drugs with possible adverse effects it considers especially dangerous.

Fibromyalgia syndrome is a chronic condition that consists of a pervasive set of unexplained physical symptoms with widespread pain (involving at least 3 of 4 body quadrants and axials) of at least 3 months duration and point tenderness at 9 bilateral locations (Figure) as the cardinal features.1 Patients with FM report a set of symptoms, functional limitations, and psychological dysfunctions, including persistent fatigue (78.2%), sleep disturbance (75.6%), feelings of stiffness (76.2%), headaches (54.3%), depression and anxiety (44.9%), and irritable bowel disorders (35.7%).1 Patients also report cognitive impairment and general malaise, “fibro fog.” This pattern of symptoms has been reported under various names (such as tension myalgia, psychogenic rheumatism, and fibro­myositis) since the early 19th century.

The 2 most common anxiety disorders are generalized anxiety disorder (GAD) and panic disorder. Approximately 5.7% of people in community samples will meet diagnostic criteria for GAD in their lifetime; the rate is about 4.7% for panic disorder (with or without agoraphobia).1 GAD-which is characterized by excessive and uncontrollable worry about a variety of topics (along with associated features such as trouble sleeping and impaired concentration)-is often chronic and is associated with significant costs to the individual and to society.

Suicide risk assessment is a core competency that all psychiatrists must have.1 A competent suicide assessment identifies modifiable and treatable protective factors that inform patient treatment and safety management.2 Psychiatrists, unlike other medical specialists, do not often experience patient deaths, except by suicide. Patient suicide is an occupational hazard. A clinical axiom holds that there are 2 kinds of psychiatrists: those who have had patients commit suicide-and those who will.

I am a fan of the television show Deadliest Catch-a documentary series that follows the travails of deep-sea fishermen in the Bering Sea. (Actually, it is mostly about deep crab fishing.) Living in Seattle, I have actually seen some of the boats filmed on the show.

A new study is raising important questions about the brain’s ability to remain active and regenerate in later life and whether Web searching can stimulate brain activity in middle-aged and older adults.

Identifying and Reducing Professional Liability When Treating Older Adults, by Jacqueline M. Melonas, RN, MS, JD and Charles D. Cash, JD, LLM, ARM

A large percentage of youths use and abuse psychoactive substances. According to the 2007 Monitoring the Future (MTF) survey, the percentage of US adolescents who used illicit drugs or drank alcohol continued a decade-long drop, revealing that 19% of 8th grad­ers, more than 36% of 10th graders, and 47% of all 12th graders have taken an illicit drug (other than alcohol) during their lifetime.1 According to the National Survey on Drug Use and Health, the rate was 3.3% for misuse or nonmedical use of prescription drugs.2 The misuse of prescription drugs among adolescents was second only to marijuana use. In fact, prescription drugs increasingly have become a part of the repertoire of drug-using adolescents.

Identifying and Reducing Professional Liability When Treating Older Adults, by Jacqueline M. Melonas, RN, MS, JD and Charles D. Cash, JD, LLM, ARM

After some members and mental health writers criticized the American Psychiatric Association (APA) for “secrecy” surrounding the development of DSM-V, the Board of Trustees of the APA voted to make public regular DSM-V reports as well as summaries from work group chairs on the Web site at www.dsm5.org.

It is an ancient practice to state instructions for distributing one’s property after death. In Genesis 48, Jacob verbally bequeaths his property to Joseph, Joseph’s siblings, and Joseph’s 2 sons. Wills existed in ancient Greece and Rome, with restrictions.

For some couples, the transition to parenthood is not filled with this rich mixture of great perplexity and great joy.

The substantial and often recurrent distress and impairment associated with major depressive disorder (MDD) in youth has prompted increased interest in the identification and dissemination of effective treatment models. Evidence supports the use of several antidepressant medications, specific psychotherapies, and, in the largest treatment study of depressed teenagers, the combination of fluoxetine and cognitive-behavioral therapy (CBT) as effective treatments.1-3 CBT is the most extensively tested psychosocial treatment for MDD in youth, with evidence from reviews and meta-analyses that supports its effectiveness in that population.3-5

Even though there was no name attached to the message, I knew instantly who had sent the vague text that left my heart racing. This was the last communication I had with Mr R, a 36-year-old neuroscience researcher with no past psychiatric history.

The prospect of using computers to deliver psychotherapy has been intriguing a number of investigators who have been studying innovative methods of bringing technology into clinical practice.

The term “paranoia,” derived from the Greek &lduo;para” (beside) and “nous” (mind), was coined as a descriptor of psychopathology by Heinroth in 1818.1 By the end of the 19th century, 50% to 80% of patients in asylums in German-speaking coun­tries had received a diagnosis of paranoia.1 Beginning in 1899, Kraepelin’s efforts to define paranoia more precisely resulted in a decrease in diagnoses of paranoia in favor of dementia praecox and, later, schizophrenia.1,2 This narrowing of the definition of paranoia is reflected in current nosology and practice. In DSM-IV-TR, the prevalence of delusional disorder is estimated at 0.03% of the general population and accounts for 1% to 2% of psychiatric admissions. The prevalence of paranoid personality disorder is 0.5% to 2.5%; this condition accounts for 10% to 30% of psychiatric admissions.3

Every life ends with death. For the elderly, death is the end of a long life that has been shaped by personal history and world events, various relationships, well-set personality characteristics and, of course, happenstance. Each of these, in addition to the specific circumstances that herald death, shapes the experience of dying in old age.

An increasing youth suicide rate may point toward an emerging public health crisis, necessitating national efforts to develop effective interventions, experts recently warned.

Racial/ethnic and sexual orientation minorities and women historically have been relegated to social, legal, and economic disadvantage in the United States.