ADHD

Two recent studies on the treatment of depression in children and adolescents will help guide clinicians’ treatment decisions.

ADHD, the most common diagnosis in child psychiatry, appears to be more challenging to diagnose and treat when there is a comorbid depressive disorder.

Elder abuse is a concern for all practitioners who care for elderly patients or their family members. An elderly person’s fears of aging and dependence may be heightened by stories and news accounts of abuse.

This article focuses on recent innovations in diagnostic issues, tactics, and strategy, and takes a brief look at the future.

Debates over conflicts of interest (COIs) in medical research and practice are intensifying with recent proposals to ban industry funding of medical education, to better “manage” industry-physician relationships, and to mandate public disclosure of industry payments to physicians and medical institutions. Caught in the cross fire are prominent psychiatrists accused of underreporting payments received from pharmaceutical companies.

Two recent studies present clinical evidence that the use of stimulants to treat boys with attention deficit hyperactivity disorder (ADHD) does not increase their risk of later substance use disorders. This evidence provides clinicians and families with much needed reassurance.

In the era of genomics, psychiatry-like all areas of medicine-will likely undergo radical change. As genetic risk factors are uncovered and the dynamic nature of gene expression is elucidated, novel approaches to prevention will diminish or preempt diagnosis and treatment for many psychiatric and neurobehavioral disorders.

In clinical medicine, the term recovery connotes the act of regaining or returning to a normal or usual state of health. However, there is lack of consensus about the use of this term (which may indicate both a process and a state), as well as of the related word remission, which indicates a temporary abatement of symptoms. Such ambiguities also affect the concepts of relapse (the return of a disease after its apparent cessation) and recurrence (the return of symptoms after a remission).

There is substantial comorbidity with oppositional defiant disorder (ODD) and conduct disorder (CD) in children with attention-deficit/hyperactivity disorder (ADHD). It is important to determine the effect of comorbid ODD and CD on the clinical course in youth with ADHD. Biederman and associates1 recently published clinical findings from a 10-year prospective, longitudinal study of boys with ADHD, following them into early adulthood.

In the past several years, there has been an increasing awareness of the syndromal persistence of ADHD into adulthood. Once considered only a childhood disorder, ADHD has become increasingly recognized as a valid psychiatric disorder in adults.

"I've lost my interest in sex." As psychiatrists, we hear this concern (if we ask) from women in a variety of situations: those who are depressed, postpartum, menopausal, traumatized, and those who have been treated with psychotropic medications. Thankfully, we have many interventions, both behavioral and pharmacological, to use in addressing sexual issues.

An international team of experts recently proposed expanding the diagnostic criteria for several subtypes of bipolar disorder, adding a pediatric bipolar disorder category and eliminating the schizoaffective disorder category.

Recently, a number of studies have examined the characteristics of early-onset schizophrenia spectrum disorders and medication treatment for youths with schizophrenia.

Evidence-based medicine (EBM) is rapidly becoming the norm. It is taught in medical schools and is encouraged by both government agencies and insurance plan providers. Yet, there is little proof that this model can be adapted to fit psychiatry.

Although there is evidence in the research literature from as far back as 40 years showing that the symptoms of attention-deficit/hyperactivity disorder (ADHD) often persist into adulthood, it has been only in the past decade or so that integrative treatment models designed specifically for adult ADHD have been developed.

From Our Readers

Cortical development in children with attention-deficit/hyperactivity disorder (ADHD) generally lags behind that in other children by several years, NIMH researchers reported recently.

Although the percentage of US adolescents who use illicit drugs or drink alcohol continued a decade-long reduction in 2006, according to the Monitoring the Future (MTF) survey,1 the use of prescription drugs, such as narcotics, tranquilizers, sedatives, and stimulants remains at relatively high levels. Concerns about marijuana and alcohol, which are easily the most prevalent substances misused by adolescents, have obscured the increasing problem of prescription drug misuse in youth. This article presents information on prescription drug misuse and diversion based on surveys of high school and college students.

The November death of an Israeli fashion model whose weight had dropped below 60 lb was chilling even in a world that prizes rail-thin models as an ideal of feminine chic. Social critics have long blamed the fashion industry's use of such models for inspiring teenagers and young women to engage in extreme dieting. But at the recent Annual Meeting of the California Psychiatric Association, in Huntington Beach, eating disorders expert Walter Kaye, MD, reminded attendees that the causes of anorexia nervosa (AN) relate more to genetics and neurobiology than to size-zero models on catwalks.1

Having grown up as a "military brat," I have been familiar for decades with how my family's friends coped with war experiences. I did not know the term "PTSD" in those days, but I could see the enduring, horrific marks that posttraumatic stress disorder had left on them. I learned early on that wars could keep killing soldiers long after the peace treaties had been signed and weapons had been rendered silent.

Precision of psychiatric drug safety assessments, availability of adequately trained psychiatric researchers, and participation of a diverse research population were prominent among the topics of several panels and workshops on research methodology at the NIMH-sponsored 47th annual New Clinical Drug Evaluation Unit (NCDEU) meeting that took place earlier this year in Boca Raton, Fla.

Paraphilias and paraphilia-related disorders (nonparaphilic sexual compulsivity or sexual addiction) are sexual disorders that predominantly afflict men.

A recent analysis that found a 40-fold increase in the diagnosis of bipolar disorder in youth has highlighted diagnostic dilemmas and prompted calls for more research studies.

A 35-year-old right-handed white man presented with an 8-day history of left leg weakness and difficulty in walking. A day after the onset of symptoms, he self-medicated with oral prednisolone for 1 day and tapered the medication over 6 days. The leg weakness improved over the course of treatment but worsened afterward. His medical history is significant for multiple sclerosis (MS) and restless legs syndrome. He had 1 previous exacerbation of MS 3 years ago.

Book review

Since its introduction in DSM-III in 1980, attention-deficit/ hyperactivity disorder (ADHD) has proved to be a developmental disorder with many causes and complex behavioral, cognitive, and emotional manifestations that can impair academic functioning, occupational achievement, social relationships, and self-esteem.

The American Academy of Child and Adolescent Psychiatry recently published a practice parameter with evidence-based guidelines for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Recommendations for the best treatment practices were made based on empirical evidence and clinical consensus, and the strength of these recommendations was based on the extent and degree of these variables. This column will provide a summary of the parameter.

There is no shortage of hyperbole when politicians of all stripes describe the nature and effects of video games. Republican presidential candidate Mitt Romney proclaimed, "Pornography and violence poison our music and movies and TV and video games.

Attachment may be defined as a composite of behaviors in an infant, toddler, or young child that is designed to achieve physical and emotional closeness to a mother or preferred caregiver when the child seeks comfort, support, nurturance, or protection.

Response to Dr Wagner's Methylphenidate Treatment of ADHD in Preschoolers".