Alcohol Abuse

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.

Carpenter LL, Schecter JM, Underwood JA, et al. Service expectations and clinical characteristics of patients receiving psychiatric emergency services. Psychiatr Serv. 2005;56:743-745.

A number of highly publicized cases in the lay press have underscored the significance of, and dangers associated with, perinatal psychiatric illness. Unfortunately, the field of psychiatry has failed to use these tragic cases to disseminate accurate information and educate the public about the high frequency of perinatal depression and anxiety, as well as the relative rarity of postpartum psychosis and infanticide. Moreover, psychiatrists continue to have difficulty in educating their medical colleagues about the need to screen for these illnesses, so most obstetricians and pediatricians still do not screen for perinatal depression and anxiety, much less manage it effectively. Decisions about appropriate treatment are further complicated by a lack of empiric outcome data.

Over the past decade, there has been increasing attention to the identification and management of mood and anxiety disorders related to childbearing. Emergen- cy physicians, including psychiatrists, primary care providers, obstetricians, gynecologists, and pediatricians, encounter women who are struggling with mental health issues in the context of reproductive events, such as pregnancy, pregnancy loss, and the postpartum adjustment period. In some cases, the reproductive event may precipitate a mental health crisis. In others, it may exacerbate an underlying mental health condition that, in turn, may need to be managed differently because of issues related to pregnancy or breast-feeding.

New mothers may present to the emergency department (ED) with symptoms ranging from mild anxiety to severe psychosis. Postpartum psychosis has abrupt onset and severe symptoms and usually occurs in the immediate postpartum period. Patients who have had a previous episode of postpartum psychosis or have first-degree relatives with postpartum psychosis or bipolar disorder are at higher risk.

Women with postpartum depression frequently experience intrusive, obsessive ruminations that are part of a depressive episode. Many women with postpartum depression have significant anxiety, and many reach the level of meeting criteria for full-blown anxiety disorders. An anxiety disorder may also precede and contribute to the development of a depressive episode.

A pioneer in alcohol addiction studies reviews his past accomplishments and looks toward the future.

Selective serotonin reuptake inhibitors have been shown effective in the treatment of depression with psychosis. This efficacy appears to correlate with the SSRIs’ level of affinity at the sigma-1 receptors in the brain. What role does the sigma-1 receptor play in psychotic depression? Based on this role, are there implications for other treatments?

Through the Times With Max Fink, M.D. by Arline Kaplan Long viewed as a pre-eminent researcher and advocate for electroconvulsive therapy, Max Fink, M.D., reflects on more than five decades of groundbreaking research.

Updates Show Progress in TMS for Depression and Schizophrenia by Arline Kaplan In research presented at the 2005 APA annual meeting, transcranial magnetic stimulation is showing efficacy in treating depression and schizophrenia in the research setting. The question of how to translate those findings to a real-world setting still remains.

Childhood Reactions to Terrorism-Induced Trauma by Wanda P. Fremont, M.D. The unpredictable, indefinite threat of terrorist events, the profound effect on adults and communities, and the effect of extensive terrorist-related media coverage can contribute to a continuous state of stress and anxiety in children. Current treatment strategies are discussed as well as direction for further research.

diabetic neuropathy

restless legs syndrome, Parkinson disease, ADHD

The Emerging Role of GABAergic Mechanisms in Mood Disorders by Po W. Wang, M.D., and Terence A. Ketter, M.D. Gamma-aminobutyric acid is a major inhibitory neurotransmitter widely distributed in the mammalian central nervous system. Animal models of depression have pointed toward the importance of the GABA system in the pathophysiology of mood disorders. Thus, elucidating the GABAergic effects of benzodiazepines, mood stabilizers, antidepressants, and new anticonvulsants and antipsychotics may expand our understanding of mood disorder pathophysiology and potentially generate new targets for treatment.

Posttraumatic stress disorder is one of the most devastating psychiatric disorders. Research has shown that a combination of multiple genes can lead to conditions for PTSD. Environmental factors, as well as comorbidities, must also be considered when looking for genetic conditions of PTSD.

Kapur S, Arenovich T, Agid O, et al. Evidence for onset of antipsychotic effects within the first 24 hours of treatment. Am J Psychiatry. 2005;162:939-946.

Delirium,Dementia

traumaticbraininjury,behavioralneurology,generalneurology,neuropsychiatry

Suicidal behavior is a complex and multi-factorial phenomenon for which epidemiological genetics suggests a genetic basis that may be specific and independent from those implicated in the vulnerability to the psychiatric disorders associated with SB. Recently, new molecular biology tools have been designed to identify predisposition factors to complex disorders. One of the main goals of current studies is to specify the suicidal phenotype, as well as the intermediate phenotypes associated with these genes.