Alcohol Abuse

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.

In 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

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.

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.

The 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.

In 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.

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.

In a presentation given at the midyear meeting of the American Epilepsy Society, Andres Kanner, MD cited studies from the literature showing that the rates of depression, anxiety, psychosis, and attention-deficit/hyperactivity disorder (ADHD) are significantly higher among persons with epilepsy than among the general population

Most physicians make at least some use of the placebo effect to enhance treatments, whether they realize it or not. This article examines the extent of the placebo effect in patients with psychiatric illness, and reviews what is known about how placebos work.

Alcohol is the drug of choice for adolescents, with cigarettes and marijuana being second and third. Contrary to widespread belief, alcohol dependence is most common in 18- to 20-year-olds, with progressively decreasing rates of alcohol dependence in older age groups.

Emergency department (ED) visits have increased from 89 million in 1992 to more than 110 million in 2002, while the number of EDs decreased by about 15% during the same period. One suspected consequence of ED overcrowding is an increased tendency to disregard a psychiatric problem, especially if it is not the chief complaint.

Sleep disorders are very common and are often underrecognized and underreported in children. If left untreated, these disorders can cause serious developmental and physiologic problems.

It was just over a generation ago that the routine combination of psychotherapy and drug therapy seemed impossible. Then, one meta-analysis found that combined treatment with psychotherapy and medication was found to be notably superior to either treatment alone.

Depression has long been recognized as a primary concern for health care providers. Many approaches to treating depression have been developed, ranging from medications, to long-term psychotherapy, to shorter, more structured cognitive-behavioral treatments--all of which help some of the patients, some of the time, to some extent.

Psychotropic Drug Handbook, 8th Edition

Your patient has pain and numbness that extends from the shoulder to the hand. You suspect a herniated cervical disk, but the MRI scan comes back normal. What else could the culprit be?

A review of the book, "Principles and Practice of Geriatric Psychiatry."

While many parents fear that strangers might kill their children, a parent is actually more likely to be the perpetrator. This column focuses on preventing the tragedy of maternal filicide.

While some mental health services for adolescents allow self-referral, many require parental involvement. There is increasing evidence that working with the family and the child is important if only to increase compliance with medication and to tackle any comorbid difficulties.

Current treatments for autistic spectrum disorders (ASD) are useful in some cases, but have little enduring impact. This had lead to many parents seeking nonconventional treatments that often border on quackery.

Several forums at the May 2006 American Society of Addiction Medicine (ASAM) addressed the issue of the gap between the number of investigational addiction treatment drugs and the few actually available on the market.

The inclusion of parents in their children's treatment for eating disorder is not universally accepted. However, recent studies suggest that families should be included in treatment and that they are often a powerful resource for helping their children recover.

Treating Parkinson disease with dopamine receptor agonists puts patients at risk for a number of symptoms over and above classic motor disturbances.

DSM-IV-TR emphasizes that patients with borderline personality disorder (BPD) show a "instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts," and any five out of nine listed criteria must be present for the diagnosis to be made.

While dementia is marked by such cognitive deficits as disorientation, memory loss and changes in intellectual functioning, these are not the symptoms that cause the most distress to caregivers.

The obvious sometimes bears repeating: Sick people have trouble thinking. They may be suffering from a delirium, a dementia or a more subtle disturbance of cognition caused by fever, drugs, infection, inflammation, trauma, hypoxemia, metabolic derangement, hypotension, tumor, intracranial pathology, pain and so forth.

Many highly regarded clinicians have built careers working with patients they believe to have dissociative identity disorder (DID). Other distinguished practitioners consider DID to be a bogus diagnostic tag.