Alcohol Abuse

Each year, more than 2 million individuals in the United States sustain a traumatic brain injury. Increased vigilance for previously undiagnosed or incidental TBIs in general mental health populations may lead to more effective clinical management.

While an antipsychotic medication is the first step of treatment for schizophrenia, it is increasingly recognized that comprehensive care requires the integration of adjunctive therapies and attention to long-term treatment goals.

Cannabis, or marijuana, has been consumed by humans for centuriesand remains one of the most widely and commonly used illicitsubstances. The authors review the evidence supporting and refutingthe association between cannabis exposure and psychotic disorders.

The recent evolution of neuropsychiatry/behavioral neurology as a subspecialty represents a paradigmatic shift regarding the responsibility of psychiatrists in diagnosing and managing behavioral disorders with concomitant and demonstrable brain pathology such as dementia or head injury. This authors define the clinical usefulness of electroencephalography in evaluating neuropsychiatric disorders.

Sleep-associated movement disorders are common in the general population. When patients complain of sleep disturbance, psychiatrists should consider,and question for, features of nocturnal movement disorder.

Many of our female patients are more worried about breast cancer than heart disease. Because psychiatrists will almost certainly care for patients who have a history of breast cancer, Dr Riba reviews some of the major issues to consider.

Pilot studies show that preventing PTSD after vulnerable persons are exposed to extreme life-threatening trauma is possible, although we are in the very early stages of knowing exactly what to do.

Psychiatrists specialize in mental phenomena, but this special expertise does not confer license to ignore the additional information that can be gathered from physical signs.

Dementia is characterized as a progressive and chronic decline in cognitive function, not limited to memory impairment, which significantly interferes with baseline daily functioning and frequently involves behavioral disturbances. It is known that behavioral problems in dementia negatively affect patients and caregivers. These disturbances lead to institutionalization, increased costs and caregiver burden, and a poorer prognosis.

Parkinson disease, addictions, pathologic gambling

Guardianship laws--the provisions aimed at ensuring that elderly and incompetent individuals receive the necessities of life (including medical care and financial protection)--are drawing fire around the country amid charges of abuse, fraud and civil rights violations.

Aware that mental illness generally begins early in life and that four teenagers commit suicide every day, several organizations and agencies are stepping up efforts to expand voluntary mental health screening and suicide prevention initiatives for youth--but they are doing so in the face of stigma and vocal opposition.

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.