Alcohol Abuse

Nonconvulsive status epilepticus (NCSE), like convulsive status epilepticus, is a state of continuous or almost continuous intermittent seizure activity lasting more than 30 minutes without a return to baseline function.

Anabolic steroids have gone from an appropriate treatment for men with hypogonadism to an agent abused by athletes, bodybuilders, adolescents, and young adults. Use of steroids at levels 10 to 100 times those of therapeutic dosages can cause psychiatric symptoms, such as aggression, mania, depression, and psychosis. Steroid abusers often "stack" several steroids or "pyramid" agents through a 4- to 12-week cycle. Presenting complaints of steroid abusers include muscle spasms, dizziness, frequent urination, and menstrual abnormalities. Signs may include high blood pressure, needle marks, icteric eyes, muscle hypertrophy, and edema; testicular atrophy and gynecomastia in men; and hirsutism and atrophied breasts in women. Mood changes can occur within a week of first use, and body changes may occur after acute behavioral disturbances.

Wang PS, Schneeweiss S, Avorn J, et al. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005;353:2335-2441.

Psychiatric symptoms are not uncommon in patients with autoimmune disorders, such as multiple sclerosis (MS), systemic lupus erythematosus (SLE), Sjögren syndrome, temporal arteritis, sarcoidosis, scleroderma, Hashimoto thyroiditis, and myasthenia gravis. The CNS is frequently involved with many of these disorders. The lifetime risk of depression in patients with MS is 50.3%, with demyelination, inflammation, and neuroendocrine response implicated. In patients with MS of 10 years' duration, 56% may show cognitive decline. Included in the diagnostic criteria for SLE are seizures and psychosis, including visual hallucinations and paranoia. Cognitive impairment can occur in 79% of patients with SLE. Cognitive dysfunction is also seen in patients with Sjögren syndrome.

Funded by the National Institute of Mental Health, the STAR*D project is one of the largest depression treatment studies ever conducted, with more than 4,000 participants. Results from the second phase of the study will be published over the next year. In this issue PT readers will find a preliminary review of data drawn from the first 1,500 enrollees.

Schizophrenia poses a challenge for diagnosis and treatment at least in part because it remains a syndromal diagnosis without clearly understood neuropathological bases or treatments with clearly understood mechanisms of action. Neuroimaging research promises to advance understanding of the unique pathological processes that contribute to this syndrome, and to foster both better appreciation of how current treatments work, and how future treatments should be developed.

Although several clinical studies suggest that cognitive impairments in schizophrenia are associated with reduced stimulation of dopamine receptors in the prefrontal cortex, mounting evidence suggests that other monoaminergic neurotransmitter systems may also be involved. We provide an overview of neurotransmitters that hold promise as therapeutic interventions for the cognitive deficit in schizophrenia.

It was not too long ago that the management of schizophrenia focused primarily on symptom relief in inpatient and outpatient settings. Over the past two decades, there has been a paradigm shift in our approach in the overall management of schizophrenia, toward preventive and early interventions. What are some of these management techniques, and how well do they work?

Long recognized by peers and students alike for his teaching excellence, Henry Nasrallah, MD, was named Teacher of the Year at the 18th annual U.S. Psychiatric & Mental Health Congress. In an interview with PT, Nasrallah talks about his passion for the field of psychiatry and his clinical research in schizophrenia.

Alcohol and substance use disorders take a tremendous toll on society as a whole and also require significant emergency department (ED) resources. Alcohol use and abuse in the United States accounts for over 100,000 deaths each year1 and costs more than $185 billion annually.2 A study of the effects of alcohol-related disease and injuries found that the number of patients who presented with these conditions increased by 18% from 1992 to 2000.3

Psychological debriefing was developed as a way to intervene with large numbers of trauma survivors in circumstances in which individual evaluation and treatment are not possible, such as after mass trauma, terrorist attacks, or disasters. The most commonly used model of debriefing is Critical Incident Stress Debriefing (CISD), a structured protocol developed by Mitchell.1 CISD has been used quite frequently with rescuers, first responders, and law enforcement personnel. After the terrorist attacks in the United States on September 11, 2001, CISD was widely applied to groups of persons who were affected by the attacks.

The use of benzodiazepines in psychiatry and general medicine is fraught with controversy because of the potential for abuse and dependence. In daily practice, clinicians vary widely in their comfort level with prescribing this class of medications, whether for short-term relief of panic or for long-term prophylaxis of generalized anxiety. The use of benzodiazepines in acutely traumatized persons is particularly controversial.

Assessment and management of dual diagnosis--that is, the comorbidity of substance use disorder in persons with mental illness--is a major challenge for clinicians, especially in the emergency department (ED). It is widely accepted, but perhaps less well appreciated in the clinical realm, that substance abuse comorbidity is more the rule than the exception in persons with serious mental illness.

Proper evaluation of patients for alcohol and substance use disorders is usually time-consuming. When done in a busy emergency department (ED), assessment is often rushed, increasing the likelihood of misdiagnosis and, therefore, mismanagement. Because the evaluation is a patient's first step to effective therapy, it should be conducted as efficiently and effectively as possible.

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. A proper assessment, however, can be extremely taxing for both the clinician and the patient. This article offers a paradigm for performing a rapid and comprehensive evaluation in the ED of medically stable adults with alcohol and substance use disorders.

The U.S. Departments of Defense and Veterans Affairs have developed protocols for assessing soldiers returning from combat operations in Iraq and Afghanistan. With data showing that many veterans do not show psychiatric symptoms until three to six months after returning home, a new post-deployment assessment was created and is ready to roll out. In the meantime, a jump in PTSD cases led to an internal review at the VA.

Smokers with co-morbid psychiatric and substance use disorders smoke at a much higher rate and seem to have more difficulty quitting than those in the general population. Tobacco treatment that is integrated into mental health settings may lead to greater success than non-integrated treatment. As a result, mental health care providers can play a critical role by careful assessments of smoking, employment of motivational techniques and increasing access to pharmacological and behavioral treatments.

The most common club drugs or party drugs are MDMA, ketamine and GHB. How dangerous is continued use of these substances? Can they cause real damage to the brain?

Intimate partner violence is a common problem and a significant public health concern. Substance use is involved in 40% to 60% of IPV incidents. Several lines of evidence suggest that when substance use and IPV co-occur, substance use may play a facilitative role in IPV by precipitating or exacerbating violence. This article will review epidemiological, clinical and treatment research relevant to substance-abusing men with co-occurring domestic violence.

Treatment compliance is a crucial determinant of the outcome of any disease. Poor treatment compliance can worsen the prognosis and significantly increase health care costs. Effective methods to improve treatment compliance for individuals with comorbid mental illness and SUDs will translate in better outcome for the patients and significant health care cost savings.

Social anxiety disorder and drug addiction commonly co-occur in the same individual, complicating the presentation, course and treatment of both disorders. Using drugs or alcohol may be a coping mechanism for social anxiety; however, many treatments for addiction are group-based approaches, which would be especially challenging for people with social anxiety disorder. This article provides a brief overview of what is known about the co-occurrence of these disorders, as well as possible treatment interventions for this population.

There has been increasing interest in the overlap between attention-deficit/hyperactivity disorder and substance use disorders. Pharmacotherapeutic treatment of ADHD in children reduces the risk for later SUD in adolescence and adulthood. In contrast, medication treatment of substance-abusing adolescents with ADHD does not reduce the SUD. Diagnostic and treatment strategies for adults with ADHD plus SUDs are discussed.

sleep apnea

traumatic brain injury, memory impairment, depression, neurobehavioral disorders

Are all treatments for schizophrenia created equal? With Phase I of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study completed, five pharmacological options have been compared in an attempt to answer this question. Results from this portion of the trial have been released and are discussed.

Patients with Alzheimer's disease may suffer the same age- and disease-related changes to sleep as their age-matched peers. However, as the dementia progresses, even more severe disturbances develop, with impairments in both nighttime sleep continuity and daytime alertness. This article focuses on long-term, holistic approaches to treatment, including environmental and behavioral interventions to augment sleep medications.

Affecting 70% of patients with Alzheimer's disease and common in patients suffering from other dementing illnesses, apathy is associated with functional impairment and caregiver distress at all levels of disease severity. Assessment and treatment for this under-recognized syndrome are discussed.

Patients with HIV infection are at risk of developing psychiatric symptoms and disorders similar to those seen in the general population. What unique biological, psychological and environmental factors are involved in treating this population?

Published a decade ago, the original National Comorbidity Survey focused largely on anxiety and depression. In an exclusive interview, the survey's designer, Ronald C. Kessler, Ph.D., talks with Psychiatric Times about the just-published replication study, which found that the combined lifetime prevalence of impulse control disorders is higher than that for either mood or substance use disorders.