Addiction & Substance Use

Recently, 3 reports that shed further light on the short- and long-term mental health consequences for children of depressed parents were published.

Traditional physical therapy for neurologic conditions can be boring for the patient and tiring for the physical therapist, making it difficult to put in the required number of training hours. That is why researchers are developing a new generation of physical therapy tools that use video games, robotics, and virtual reality.

Investigational drugs and novel applications of established agents for psychiatric illness were described in a number of reports at the 46th annual NIMH-sponsored New Clinical Drug Evaluation Unit (NCDEU) meeting in Boca Raton, Fla, June 12-15, 2006.

According to the National Institute on Drug Abuse (NIDA), gender differences can influence the causes, effects, consequences, and treatment of substance abuse disorders. A recent NIDA News Scan focused on several investigations supported by the NIDA.

Epilepsy affects about 2% of the US population and is a disability fraught with unique psychosocial and health care challenges. Authors of a study appearing in the journal Epilepsy and Behavior note that the ongoing quest of persons with epilepsy is to find informed physicians, effective therapies, and resources to help them achieve an adequate level of normalcy.

Huntington disease (HD) is a devastating hereditary, degenerative brain disorder for which there is, at present, no effective treatment or cure. More than a quarter of a million Americans have HD or are at risk for the disease because of potential genetic transmission. The disease slowly diminishes the affected person's ability to walk, think, talk, and reason. As it progresses, concentration and short-term memory diminish and involuntary movements of the head, trunk, and limbs increase.

It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with convulsive, clonic movements may, in fact, be experiencing psychogenic events.

Addictive disorders are among the leading causes of disability worldwide; however, misuse of and addiction to alcohol and illicit substances is often not appreciated as relevant to the care of older adults.

Borderline personality disorder (BPD) is a serious illness involving multiple symptoms and mal adaptive behaviors. According to DSM-IV, “the essential feature of borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects” (p. 650). This pervasive pattern of instability also applies to behaviors that are impulsive and potentially damaging, including excessive spending, sexual promiscuity, reckless driving, binge eating, and substance misuse.

Older adults have higher rates of suicide than younger adults in many industrialized nations.

The emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).

Many physicians, including psychiatrists, may shy away from seeing elderly patients with symptoms of dementia because they imagine that there are a large number of alternative diagnoses and that differential diagnosis is complicated. In fact, however, the number of possible diagnoses in most situations is relatively small and the diagnosis of dementia in older patients is certainly feasible in primary care psychiatry.

Office management of attention-deficit/hyperactivity disorder (ADHD) differs in many important ways from ADHD management conducted in a research environment. In clinical trials, treatments and eligible patients are selected in advance by committees, patients are randomized to different management strategies, and both clinicians and pa tients are blinded to the treatments.

For patients with psychiatric illnesses, the treatment team today often consists of a psychotherapist, psychiatrist, and/or primary care physician-all of whom are motivated to achieve the same goals. These include full remission of symptoms; improvement and restoration of function, quality of life, and relationships; and the delay and preferably prevention of recurrence of symptoms.

Anxiety disorders are the most prevalent psychiatric disorders in the United States. Although effective treatments are available, such as the SSRIs and cognitive-behavioral therapy (CBT), it is estimated that in about 40% of patients, anxiety disorders are partially or completely resistant to first-line treatment.

Anyone who is close to someone who abuses alcohol or drugs knows all too well that substance abusers do not typically seek treatment until they have experienced years of substance-related problems. During the first year after onset of a diagnosable substance use disorder, only 1 of 5 alcohol-dependent persons and 1 of 4 drug-dependent persons receive treatment.

The problem of treatment resistance in bipolar disorder begins with its definition. Characterizing the phases of bipolar disorder as manic, mixed, hypomanic, or depressed does not do justice to the reality for many persons with this disorder.

Parkinson gait is characterized by shuffling, including a decreased stride length and gait speed. The diminished stride and gait speed coupled with increased cadence puts the patient at risk for postural instability resulting in falls.

Delirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. About 15% of elderly patients admitted to the hospital have delirium as a presenting or associated symptom. Delirium will develop in another 15% of elderly patients during hospitalization.

HHD, which affects only a small percentage (4%) of patients with PD, is characterized by adverse psychomotor effects related to dopamine replacement therapy.

Typical smokers need to have brain nicotine receptors almost completely saturated throughout the day. This need creates an almost uncontrollable urge to keep smoking, commented Nora D. Volkow, MD, director of the National Institute on Drug Abuse (NIDA), addressing a study by NIDA researchers on nicotine addiction.

Hundreds of uniquely adapted venomous marine cone snail species inhabit the coral reefs of the Indian and Pacific oceans. Researchers posit that each may be a virtual neurologic pharmacopoeia with potential value for the treatment of everything from diabetic neuropathy to schizophrenia. The venoms, known as conotoxins, selectively inhibit a wide range of ion channels involved in neuromuscular signaling.

A possible link between diabetes and cognitive dysfunction, specifically Alzheimer disease (AD), is becoming increasingly apparent. Indeed, compared with AD risk in healthy persons, the risk of AD development is 65% to 100% greater in persons with diabetes.

First described more than 500 years ago, phantom limb pain (PLP) is a common disorder today; as many as 50% to 80% of patients who undergo amputation report experiencing pain in the missing appendage.

The editors of Pediatric Neuropsychiatry must have drawn on their experiences and the feedback they received on their first book, Textbook of Pediatric Neuropsychiatry (American Psychiatric Press, 1998), for this text.

Effective treatment of drug abuse and addiction in the criminal justice system saves the community money and reduces crime, the NIH's National Institute on Drug Abuse (NIDA) reported in a recently released booklet, Principles of Drug Abuse Treatment for Criminal Justice Populations.

The increase in youth violence and aggression in the past 50 years has been called an "epidemic." This epidemic has had a tremendous impact on society. From an economic and public health perspective, primary prevention of youth violence is obviously desirable.

Typically, delirium worsens at night ("sundowning"), with lucid intervals often present in the morning. It is important to realize that delirium may appear before any abnormal laboratory values are detected and may persist after the resolution of these abnormalities.

If done properly, the assessment of alcohol and substance use disorders in the emergency department (ED) or psychiatric emergency service can be the first step toward recovery.

The degree to which season changes affect mood, energy, sleep, appetite, food preference, or desire to socialize with others has been called "seasonality." Identification of a seasonal pattern can only be made if both the patient and physician actively look for it.