Bipolar Disorder

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.

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.

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.

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.

CMEducator: Recognizing and Managing Bipolar Disorder

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.

Pavuluri MN, Birmaher B, Naylor MW. Pediatric bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 2005; 44:846-871.

Migraine-Preventive Medications:Guidelines for Success

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.

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.

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.

traumatic brain injury, memory impairment, depression, neurobehavioral disorders

Anesthesia-assisted rapid opioid detoxification has been touted as a painless way to kick an addiction. In a randomized trial comparing it to two other rapid detox methods, it was found to be similar on several methods, but resulted in greater risks for life-threatening adverse events. Opioid dependency is a chronic, remitting disorder and the greatest need is not a fast painless method of getting detoxed, but a reliable method of maintaining abstinence.

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.

The multitalented psychiatrist talks with Psychiatric Times about his research, his literary work and the future of psychiatry itself.

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.

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?

Three psychiatrists give their perspective on helping victims of one of the nation's worst natural disasters.

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.

There is growing epidemiologic and clinical data that confirm progressive hypothalamic-pituitary-gonadal hypofunctioning in aging men. What role does the HPG axis play in the complex psychobiology of male sexual and affective disorders? The treatment rationale, clinical indications and risks in using exogenous testosterone for late-life depression are explored.

Recent evidence suggests that reorganization of neuronal connectivity might play an important role in the pathophysiology of mood disorders and in both pharmacological and psychological treatments of depression. This evidence suggests a new framework for the etiology of mood disorders that focuses more on the problems in neuronal connectivity, plasticity and information processing in the brain than on abnormalities in chemical neurotransmission. Although this framework is still controversial and far from being complete, improved familiarity with the concepts of neuronal development and activity-dependent plasticity among mental health professionals would be useful.

New Clinical Drug Evaluation Unit presented new clinical data at their 45th annual meeting in Boca Raton, Fla. In the first of two articles, suicide studies, the effectiveness of antidepressants and the efficacy of drug combination therapy are explored.

The incidence of polypharmacy is on the rise, and with the increase comes a greater risk of drug-drug reactions. One survey estimated that patients seeing a psychiatrist may be six times more likely to receive multiple psychotropic medicines compared to patients seen by a primary care physician. This article provides an overview of the extent of polypharmacy, the factors driving the phenomenon and issues clinicians should consider when treating patients who are already taking medicines for other illnesses.

Comorbidity of Dysthymic Disorders in Children and Adolescents by Atilla Turgay, M.D. Many patients with dysthymic disorders also have associated comorbid disorders. A detailed history will provide insight into the comorbidity profile, cross-sectionally and developmentally. Dysthymic disorder should be addressed clinically, as it may cause long-term chronic unhappiness and poor quality of life for the patient.

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.

Evidence-Based Therapies in Child and Adolescent Psychiatry by Jon McClellan, M.D. Given the lack of large, randomized controlled studies of psychiatric medications that involve children and adolescents, it can be difficult to establish evidence-based therapies that are effective for this population. However, there are studies that have shown the effectiveness of various medications, as well as for various psychotherapy techniques.

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.