Alcohol Abuse

For over 50 years we clinicians have administered electroconvulsive therapy with little to guide us in deciding whether or not a particular induced seizure is an effective treatment. At first we thought that piloerection or pupillary dilatation predicted the efficacy of a seizure, but these signs were difficult to assess and were never subjected to controlled experiments.

The explosion of neuroscience developments in this "Decade of the Brain" now provides people with schizophrenia a new generation of antipsychotic therapies. For many, these medications (e.g., clozapine [Clozaril], olanzapine [Zyprexa], risperidone [Risperdal], and quetiapine [Seroquel]) produce an improvement over their "old" antipsychotics in terms of side effects and, for some, clinical response. For a select few, however, these medications can produce dramatic improvement, akin to what Sacks (1990) termed an "awakening." These medications create exciting opportunities to use psychotherapy, group work and rehabilitation with a population historically relegated to back wards or triaged to "case management."

While The Medical Letter relates several neuropsychiatric side effects with most drugs on the list, it emphasizes the association of depression with calcium channel blockers by indicating only this condition with this drug category. This, despite a single report of hallucinations with verapamil (Isoptin) as the only neuropsychiatric symptom of a calcium channel blocker included on the 1993 list.

The increasing complexity and specificity of clinical trials, widely publicized research scandals and major advances in psychopharmacology have created a dilemma for academic institutions and private research organizations alike--how to find appropriate volunteers to participate in clinical drug trials. A major obstacle to patient recruitment is finding patients who are protocol-appropriate, said Nancy Hashim, affiliated with the Feighner Research Institute in San Diego.

Urging psychiatrists and other physicians to stay abreast of "what's going on in the youth culture," social psychologist Lloyd Johnston, Ph.D., explained that one of every 16 students entering high school has tried the potentially neurotoxic MDMA (Ecstasy) and among high school seniors, one-quarter are daily cigarette smokers and nearly one-third are frequent binge drinkers.

After a teenager's suicide attempt, her desperate and bewildered parents dragged her to a mental health clinic. The 16-year-old admitted to drinking nearly every day and using an assortment of other illicit drugs. Only after a month in treatment did the clinician learn that the teenager had been molested when she was 8 years old by an uncle and threatened with death if she ever told her parents.

The findings are disturbing. The Substance Abuse and Mental Health Services Administration (SAMHSA), in an effort to measure substance use and abuse among women, compiled data from its National Household Survey on Drug Abuse into a new report, Substance Use Among Women in the United States, which was released in September 1997. What they found is a worrisome indicator that substance use in this country is a significant problem for women, particularly among young girls ages 10 to 14.

Addicts are people who have learned how to give themselves a quick chemical fix or achieve an emotional high when they either want to or have to change how they feel, and when they want to ignore real-life problems. Most people do that, but the next morning, they feel sick or foolish. They don't do it again because it didn't work for them. What makes addicts different is that they are willing-or feel compelled-to do it again and again even though they "know" that doing so will get them into trouble.

In May 1997, a young Rwandan girl came to a clinic in Kigali reporting nausea and the feeling of insects crawling on her face. She complained of the strong smell of feces and grew increasingly agitated and fearful, describing vivid images of people trying to kill her at that moment. For months she had vomited at the sight of avocados, and for three years she had been unable to tolerate the sight of rice.

Nothing is sacred in America's pop culture. So when it embraces any topic, we've grown used to the relentless distortion that occurs, one that transforms reality into an odd combination of fact and fantasy.

In the two years since receiving a $1.5 million private grant from William and Joy Ruane to study the effects of psychiatric medications in children and adolescents, the division of child psychiatry at New York State Psychiatric Institute (NYSPI)-the nation's oldest psychiatric research facility-has opened a pediatric psychopharmacology research unit and established a federally supported research unit in pediatric psychopharmacology (RUPP), one of the first in the United States.

Today, average young adults report sleeping about seven to seven and one-half hours each night. Compare this to sleep patterns in 1910, before the electric lightbulb, the average person slept nine hours each night. This means that today's population sleeps one to two hours less than people did early in the century.

For elders confronted with the necessity of living in a nursing home, the choice of facility is a decision with profound consequences-for their health, their quality of life and their family finances. Nursing home care may cost $50,000 a year or even more, and more than half of all elders begin their nursing home stays by paying the costs out of pocket. That imposing sum can purchase excellent care, or can pay the rent for a place that is literally "worse than death" for the unfortunates who live there.

"Hwa-byung" and "ataque de nervios," listed in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) as culture-bound syndromes, can serve as gateways to understanding anger's role in psychiatric morbidity, according to a panel of experts.

It was a bad combination, I'll allow that. The call from the emergency room reached me the Saturday morning after I had finished reading Ayn Rand's Atlas Shrugged. I hadn't gotten a lot of sleep, partly because I finally reached page 1,168 around midnight, partly because I couldn't get my mind off John Galt, Hank Rearden, Francisco d'Anconia, Dagny Taggart and the rest of Rand's characters. Before I drifted off, I was already drawing parallels between the current state of psychiatry and Rand's fictional world in which the mind is denigrated, and autonomy and free will nearly stamped out.

The goals of National Coalition for Mental Health Professionals and Consumers are to educate the public about the problems of managed mental health care and to develop alternative health delivery models. I think greater media coverage has spawned greater awareness of the difficulties with managed care and has provided legislators with vital information. Certainly sharing their stories has made many people feel less alone and isolated within a system they find frustrating and depriving. I think media advocacy has helped doctors find support for their right to stand up to these abuses and band together in greater numbers to fight for integrity and quality in mental health care delivery.

All of the forces affecting and influencing my professional life thunder through my day like these footsteps on the bridge. So many times we hear that private practitioners are "dinosaurs" in today's managed health care environment. At times, I admit, I do feel like a hanger-on in some evolutionary cul-de-sac. Yet, as referrals keep coming in, I find myself feeling more and more fit to survive the Darwinian challenges facing psychiatry. Sharing daily life with colleagues I trust and respect better enables me to live with or ignore the "footsteps on the bridge," which in my more optimistic moments I imagine to be the sound of the real "dinosaurs" rumbling off into the mist.

I find expertise is best defined by the attending psychiatrist. I usually ask them whose opinion they respect in the community, whether that person is acceptable to them to do the evaluation and if their conclusions about disability would be acceptable. If the attendings have no one in mind, I have developed a network of excellent forensic psychiatrists around the country from which I can draw. In this case, I make a suggestion, and ask the attending if the particular provider is acceptable.

Detoxification from alcohol and drugs can be safely accomplished in outpatient settings. Careful selection of appropriate patients and frequent monitoring are key elements of successful detoxification. The success of outpatients withdrawing from alcohol without serious medical complications and continuing in recovery programs is comparable to success rates of inpatients when there is careful selection of patients, a good triage process and good nursing and medical assessments.

In 1962, fewer than 4 million Americans had ever tried illegal drugs. By 1983, that number had risen to 80 million. Drug use peaked in 1985 and dropped until 1992. Since then, use has been increasing steadily, particularly among teenagers. This increase is partially a result of a trend back toward glorification of drug experimentation and legalization, and also because there's a general resurgence of smoking. Whether it's marijuana, tobacco, opiates or cocaine, it's still smoking.

Because alcohol- and drug-dependent patients tend to develop high rates of symptoms usually associated with common psychiatric syndromes, practitioners often fail to diagnose substance dependence and instead jump to treat more familiar disorders. The risk that such circumstances will occur is understandable given statistics that two of every three alcohol- or drug-dependent individuals meet the criteria for psychiatric disorders and one of every three such individuals meets the criteria for anxiety or depressive disorders.

To understand our fascination with drugs in the first place, we need to ask some basic questions, such as "Why do we like to take poison in small quantities?" The truthful answer is always some variation of "To feel better." How does this come about, and why do we have so much trouble with it?

Despite the public's growing acceptance of addiction as a biopsychosocial disease from which recovery is possible, an ideological chasm persists between psychiatry AA.

What Z has done is momentarily lift the veil that conceals...another veil. Thrilling because he is doing in public what I do in private. Stripping the professional illusion that psychiatrists are invisible machers, not just real friends and enemies, creditors and debtors, parents and partners, but detached angels. An illusion fostered by a xenophobic profession carefully cultivating the illusion of transcendental social levitation.

Project for Psychiatric Outreach to the Homeless Inc. (PPOH) is an award-winning program through which volunteer psychiatrists help agencies treat the homeless mentally ill started by psychiatrist Katherine Falk, M.D. "Up to this point I could walk by people living in cardboard or over gratings, shrug my shoulders and say 'at least they get taken to Bellevue,'" Falk recalled. "But what I found out is... they weren't taken to Bellevue or anywhere else."

During this first century of Western psychotherapy, arguments among and between the schools of psychotherapy have dominated discourse. The psychotherapy of the next century is likely to place theory and associated techniques in their appropriate, practical places in the psychotherapy outcome puzzle.

Adolescents are among the most difficult populations with whom to work therapeutically. Giovacchini (1985) wrote that they possess a "propensity for creating problems within the treatment setting [including]...their reticence about becoming engaged or their inclination to express themselves through action rather than words and feelings."

The state of North Carolina has relatively liberal policies regarding petitions for involuntary commitment. If such documents bear words like "dangerous" or "mentally ill," even in the most nebulous sense imaginable, the police will surely locate the relevant individuals and dutifully bring them to the emergency department. This generosity of interpretation produces some sticky situations for the lucky ED resident of the day.

Mood disorders and their impact on women and their families was the topic of a half-day conference held at New York City's Algonquin Hotel;, former haunt of the famous-and depressed- writer Dorothy Parker, who made at least one suicide attempt there in the early 1900s.

Attention-deficit/hyperactivity disorder (ADHD) in adults is a common-and, frequently undiagnosed-psychiatric disorder. This article will focus on the symptoms, associated features, diagnosis, differential diagnosis, prevalence, etiology and treatment of this illness.