Alcohol Abuse

Other Hormones on Behavior - Poetry of the Times

One day after Eli Lilly and Company researchers reported finding olanzapine (Zyprexa) superior to risperidone (Risperdal) on some measures in a 28-week comparative study presented to the American College of Neuropsychopharmacology (ACNP) meeting in 1996, Janssen Pharmaceutica Inc. issued a press statement critical of the methodology and results of the study. Janssen then announced it would undertake its own comparative trial. The results of this trial's initial eight-week acute treatment phase were presented at the European College of Neuro-psychopharmacology meeting held Oct. 31, 1998, through Nov. 4, 1998, in Paris. They indicate risperidone has an advantage for positive symptoms such as hallucinations and delusions, and for anxiety/depression in patients with schizophrenia and schizo-affective disorder.

Until the last half of this century, there were few if any treatments that seemed consistently effective in responding to the clinical needs of individuals who were abusing or dependent upon alcohol. As a result, support or self-help groups emerged. Alcoholics Anonymous is an extraordinary example of these groups.

Only one month after the American Medical Association unveiled a major reorganization of its science and technology departments-one that included the dismantling of its department of mental health-the former director, psychiatrist Larry Goldman, M.D., was fired after he criticized the changes.

Recent advances in the treatment of mental and addictive disorders, along with research findings in basic neuroscience, molecular genetics and molecular biology that contribute to the understanding of such disorders, were discussed at the American College of Neuropsychopharmacology's 37th annual meeting in Puerto Rico. The following are brief reports from selected presentations.

More than 80 medications are in development to treat mental illnesses, including 18 for depression, 15 for schizophrenia and 16 for anxiety disorders, according to the Pharmaceutical Researchers and Manufacturers of America (1998). Which ones will most likely come to market in the United States?

Marc Schuckit, M.D., professor of psychiatry at the University of California, San Diego, School of Medicine, examined recent developments in the treatments for alcohol and drug dependence, and examined important changes in DSM-IV's classification of substance use disorder at the 11th Annual U.S. Psychiatric & Mental Health Congress.

DeAndra's story: I came into the rooms and realized after a while that I had the attitudes and behaviors of an addict way before I ever picked up a drug. I remember growing up and being at my family's parties, [where] my aunts and uncles would give me and my brothers beer. There are pictures in our photo albums of us, all under 6 or 7, with cans of beer in our hands. At an early age I learned to manipulate to get what I wanted.

Psychiatrists, like the rest of America, continue to have trouble with alcoholic and other addicted patients. We are comfortable when patients want to get better, tell us the truth and come to treatment of their own free will, but alcoholics often don't fit this profile. We respond angrily when patients manipulate us. We are surprised when their sincere desire for help evaporates after we suggest a plan that will bring about real change.

Nearly 25 years ago, the National Institute on Alcohol Abuse and Alcoholism hailed couple and family therapy as "one of the most outstanding current advances in the area of psychotherapy of alcoholism" and called for controlled studies to test these promising methods. Currently behavioral couples therapy (BCT) is the family therapy method with the strongest research support for its effectiveness in substance abuse.

It is now customary psychiatric practice to think of a patient's illness as primarily biological in origin-so much so that, for many illnesses, published practice guidelines almost exclusively describe medication strategies.

This is the first in a series of articles summarizing research presented at the 1998 American College of Neuropsychopharmacology Annual Meeting.

Warning of declining resources for mental health, Nelba Chavez, Ph.D., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), said mental health must become a top priority in public policy, health care services and coverage, training of health care professionals and community education.

The National Household Survey on Drug Abuse (NHSDA), the primary source of statistical information on Americans' use of alcohol, tobacco and illicit drugs, will be expanded in upcoming years to include substantial information on mental illness and state-level data on drug abuse, according to Nelba Chavez, Ph.D., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA).

Consider the following scenario: You are contacted by the major health plan with which you contract and are told that your average length of inpatient stay is longer than their standard. You believe this is because your patients are more severely ill than average. How do you respond?

Insufficient intake of essential fatty acids (EFAs) may contribute to the pathogenesis of mental diseases, while their supplementation may relieve some symptoms, according to researchers who attended the National Institutes of Health (NIH) Workshop on Omega-3 Essential Fatty Acids and Psychiatric Disorders held in Bethesda, Md., in September 1998.

This is the second of two articles regarding herbal medicines as discussed at the American Psychiatric Association's annual meeting in Toronto. Potential benefits and risks of kava, St. John's wort and hoasca were considered at the recent American Psychiatric Association's symposium on herbal medicine.

Organ donation from brain-dead patients has become a psychiatric issue in Japanese transplant medicine. Brain death is recognized as human death only in the context of organ transplantation in Japan. Since many Japanese physicians deny that brain death constitutes the death of an individual, there is no solid, general consensus in Japan about what constitutes brain death.

Only in recent years has the widening scope of domestic violence achieved such national prominence. Highly publicized cases like the Nicole Brown Simpson murder have brought the issue of domestic violence to worldwide attention. Overall rates of violence against women, including both lethal and nonlethal violence, are much higher.

Dissociative identity disorder (DID), known as multiple personality disorder until renamed in the DSM-IV (American Psychiatric Association, 1994), is a controversial diagnosis.

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.

Atypical antipsychotic treatment for borderline personality disorder (BPD) and augmentation therapy with olanzapine (Zyprexa) or estrogen replacement therapy (ERT) for patients with mood disorders were among the research questions addressed at the American Psychiatric Association's annual meeting in Toronto. Following are some brief reports of selected presentations.

The diagnostic criteria for sexual addiction are derived from the behaviorally nonspecific criteria for addictive disorder that were presented in Part 1 (Goodman, 1998b), by replacing "behavior" with "sexual behavior".

Day in and day out, psychiatrists-especially those involved with couples therapy-counsel and treat patients experiencing relationship problems with their spouses or partners. But what about the psychiatrist having a similar problem in his or her own life? Who does a doctor turn to for guidance and insight regarding such intimate matters?

Results of a multicenter, open-label observational trial of DuPont Merck's REVIA (naltrexone) demonstrated that patients were able to decrease their alcohol consumption from 57 to four drinks per week when the medication was part of an overall treatment program.

Women and their special needs regarding addiction was the topic of a recent two-day conference held at New York University (NYU).

Differences between the sexes regarding the prevalence, psychopathology and natural history of psychiatric disorders have become the focus of an increasingly large number of epidemiological, biological and psychological studies. A fundamental understanding of sex differences may lead to a better understanding of the underlying mechanisms of diseases, as well as their expression and risks.

At stake is whether the laws defining sanity can actually distinguish between those individuals who are evil and those who are mentally ill, and what role psychiatrists should play when the legal definitions make the difference between life and death. Also under the microscope is the value of forensic psychiatric testimony itself, and whether the message about mental illness is getting through to juries, judges and appellate justices.

Bestowed in gratitude in recognition of (his) superb, invigorating leadership of the American Psychiatric Association, his dedication to the principle that the highest quality patient care rests firmly on a true integration of the latest advances in psychodynamic and psychobiological thinking, and his strong advocacy for the scientific validation of what we do--all accomplished with his own consummate grace and elegance.

"Can we talk?" asks a recovering patient who chastises psychiatry for too readily dismissing patients with her diagnosis as unable to benefit from talking therapy (A Recovering Patient, 1986). With managed care administrators quick to seize upon a lack of outcome data as a pretext for limiting treatment and a public mental health system pressed to handle caseloads as high as 200 to 300 patients per clinician, psychiatry's regrettable answer has often been: "No, we're too busy." Recent research findings, however, convincingly demonstrate that a flexible form of individual psychotherapy, when combined with appropriate neuroleptic medication, can yield improvements in social and vocational functioning unobtainable with "treatments as usual."