July 11th 2024
What is new in research on alcohol use disorder?
Substance Abuse in Women: Does Gender Matter?
January 1st 2007There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.
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NIH Provides $52 Million Grant for the Study of AD
December 2nd 2006The National Institutes of Health has awarded the Alzheimer's Disease Cooperative Study (ADCS) $52 million to test the effectiveness of therapies to slow the progression and treat symptoms of Alzheimer disease (AD). New initiatives will include 3 studies to explore the effects of therapies on amyloid-β peptide and the tau protein, as well as an initiative to identify new methods for conducting dementia research.
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Antipsychotic Drugs Not "All That" for Patients With AD
December 2nd 2006Antipsychotic medications for the treatment of agitation, aggression, psychosis, and other symptoms of Alzheimer disease (AD) are no better than placebo and may even be harmful, according to a highly publicized study by a team from the University of Southern California Keck School of Medicine. In a statement to the press, the lead author of the study Lon Schneider, MD, professor of psychiatry, neurology, and gerontology at Keck, commented that after 12 weeks participation in a double-blind placebo-controlled trial, no significant differences were seen in symptom improvement in patients taking an antipsychotic drug compared with patients taking placebo
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Issues and Challenges in the Diagnosis and Treatment of Mentally Ill Hispanic Patients
December 1st 2006Despite the accepted validity of Hispanic as a distinct demographic and cultural category, we have only fragmentary evidence and scarce guidelines regarding the treatment of mentally ill Hispanic Americans. This article provides a brief review of the topics with the most clinical relevance to diagnosis and treatment of mental disorders in Hispanic Americans.
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Health and Psychiatric Issues in Children of Rural Methamphetamine Abusers and Manufacturers
December 1st 2006Many abusers of methamphetamine in rural areas manufacture the drug for their personal use. These "mom-and-pop cooks" produce methamphetamine in and around homes where children are also living. This article provides an overview of the mental health of children whose parents abuse methamphetamine.
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Is the DSM the Bible of Psychiatry?
December 1st 2006A discussion of the intellectual, social, and historical similarities and differences between sacred texts and the DSM would require a full-length book, but we will concentrate here on 5 main aspects: controversy, communication, interpretation, change, and power.
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Effects of Culture on Recovery From Transient Psychosis
December 1st 2006Analyzing data gathered in a 10-nation study of psychoses by the World Health Organization (WHO), Susser and Wanderling1 found that the incidence of nonaffective psychoses with acute onset and full recovery was about 10 times higher in premodern cultures than in modern cultures. Transient psychoses with full recovery were comparatively rare in modern cultures. Such a dramatic difference begs for explanation.
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Genetic Counseling in Psychiatry: Preparing for Anticipated Demand
December 1st 2006In a recent article on genetic counseling in psychiatry, Christine Finn, MD, and Jordan W. Smoller, MD, ScD, noted that family and twin studies have documented the familiality and heritability of schizophrenia, bipolar disorder, major depression, anxiety disorders, autism, attention-deficit/hyper- activity disorder (ADHD), and Tourette syndrome, among others, and that molecular genetic studies have begun to identify possible susceptibility loci for several of these disorders, most notably schizophrenia.
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Does the Biopsychosocial Model Help or Hinder Our Efforts to Understand and Teach Psychiatry?
December 1st 2006In this essay, I approach the question about the BPSM from the perspective of a teacher of psychiatry, medical school dean responsible for (among other matters) student career advising, and clinician. In those capacities, my duties include fostering an understanding of psychiatric disorders among medical students and residents, instilling confidence in and respect for the discipline of psychiatry among students as well as nonpsychiatric colleagues, and explaining psychiatric diagnosis and treatment to patients and their families.
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Racial, Ethnic Variables Shape the Experience of Chronic Pain
November 1st 2006That depression, anxiety, sleep disorders, and other neuropsychological conditions are often associated with chronic pain isn't news to most neurologists. But physicians who do not specialize in pain management are largely unaware of a growing body of research suggesting that the race (a genetic classification) or ethnicity (a cultural classification) of a patient with chronic pain may determine the patient's risk of neuropsychological symptoms.
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Depression in Parkinson Disease
November 1st 2006Prevalence of depression in PD is estimated to range from 7% to 76%. The variation is largely attributed to the diversity of the populations under study, differences in the definition of depression, and the fact that some studies used point prevalence and other studies used monthly prevalence. Also, the prevalence of depression varies with fluctuations of cognitive status and other comorbidities that are an integral part of PD.
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Clinical Challenges in Co-occurring Borderline Personality and Substance Use Disorders
November 1st 2006Borderline 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.
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Pinpointing the Cause of Non-Alzheimer Dementia
November 1st 2006Many 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.
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Keys to Successful Cotreatment
November 1st 2006For 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.
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Cultural Issues in the Emergency Setting
November 1st 2006The setting of a fast-paced emergency department (ED) or psychiatric emergency service makes it especially difficult to sensitively elicit and address an individual patient's needs and concerns. When considering the myriad differences in culture that come into play between a patient and a psychiatrist or other mental health care clinician, optimal diagnosis and treatment can be even more challenging, as the cases described here illustrate. The important influence of culture cannot be stressed enough. Taking the time to understand "where the patient is coming from" can prevent an already stressful, highly emotionally charged situation from becoming even more convoluted.
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Improving Care Through Cultural Awareness
November 1st 2006All clinicians know that culture influences virtually every aspect of a person's life. Sometimes the influence of culture is obvious; other times it is subtle. In either case, culture as a clinical variable is often overlooked. Being cognizant of the influence of culture is especially important for clinicians who manage psychiatric emergencies, because failing to do so can lead to misdiagnosis and delays in treatment.
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Treatment-Resistant Anxiety Disorders: Neurotrophic Perspectives
October 31st 2006Anxiety 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.
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Enlisting Family Members to Address Treatment Refusal in Substance Abusers
October 31st 2006Anyone 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.
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Pathology and Management of Treatment Resistance in Bipolar Disorder
October 30th 2006The 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.
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Treatment Resistance in Schizophrenia: The Role of Alternative Therapies
October 30th 2006In 1931, Gananath Sen and Kartick Chandra Bose reported on the use of an alkaloid extract from the Rauwolfia serpentina plant in the treatment of hypertension and "insanity with violent maniacal symptoms." They noted that dosages "of 20 to 30 grains of the powder twice daily produce not only a hypnotic effect but also a reduction of blood pressure and violent symptoms
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Troubleshooting Delirium in Elderly Inpatients
October 1st 2006Delirium 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.
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ChEIs Beneficially Affect REM Sleep in AD. Cholinesterase inhibitors (ChEIs) do not modify disturbances of sleep-wake rhythm or sleep continuity in patients with either Alzheimer disease (AD) or frontotemporal dementia (FTD), but they may have a beneficial effect on REM sleep, according to investigators from the University of Marburg in Germany.
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Costs of Ischemic Stroke Projected to Rise
October 1st 2006The direct and indirect costs of ischemic stroke may exceed $2.2 trillion from 2005 to 2050 in the United States, according to research by Devin L. Brown, MD, assistant professor in the Department of Neurology at the University of Michigan, Ann Arbor, and colleagues.
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IOM Report Takes on Medication Errors . . . Again
October 1st 2006In its latest report on medication errors, a committee assembled by the Institute of Medicine (IOM) included some sidebars on psychiatric drugs. The report, issued in July, said that there is too little data on misadministration of psychiatric drugs and that clinical trials with psychiatric drugs have been small and incapable of providing pragmatic, comparative information.
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