Comorbidity

"Pseudodementia" needs a third look. Always a "soft" diagnosis, it has never had objective, explicit diagnostic criteria or a spot in an official nomenclature.

Little attention has been paid to the prevalence of sexual assault and its sequelae among military men. The past-year prevalence of sexual assault among enlisted men ranges from 0.4% to 3.7%, a figure equal to or exceeding the lifetime prevalence among civilian men in some studies. Increased awareness and understanding of male sexual assault as well as routine screening of all patients, regardless of gender, for exposure to sexual victimization will enhance their recovery.

The dozens of journalists killed while covering the current war in Iraq gives currency to the dangers encountered by those who bring us the news from the world's conflict zones. Despite the risks inherent in their profession, it is only recently that the psychological health of war reporters has been captured in a systematic and empirical manner.

Road rage is well known in popular culture and to many people it is a common and dangerous experience. Alcohol problems, illicit drug use and general psychiatric distress are associated with road rage perpetration. Road rage incidents may also result in psychiatric distress. Although treatment for road rage has received little research attention, encouraging results have been reported from specialized programs.

Medical-psychiatric comorbidity predicts poorer outcomes and increased health care utilization and cost. The collection of articles in this Special Edition is clinically informative and an illustrative set of examples of the unique practice of psychosomatic medicine in different medical-surgical settings.

Comorbid substance use disorders may complicate treatment for both the hepatologist and psychiatrist. Comprehensive assessment of psychiatric illness and psychopharmacological management may be critical.

Attempts have been made to integrate psychiatry and medicine as far back as Benjamin Rush, a physician and signer of the Declaration of Independence. Recent advances in research, clinical practice and organizational makeup, however, now make integration seem more plausible than ever. Find out what's happening to bring these two fields closer together.

It’s a classic risk/benefit dilemma: Does preventing suicidality-assuming suicidality can predict suicide-justify scaring some doctors away from prescribing antidepressants for young patients?

Tricyclic antidepressants and antipsychotics are known to prolong cardiac repolarization and induce QTC interval prolongation, possibly putting patients with mental disorders at higher risk of cardiovascular diseases. The mechanism of gender difference in vulnerability for cardiovascular diseases is still unclear, but the role of hormones is one of possible explanatory factors.

Although a lot remains to be learned, much is already known about the early childhood characteristics that predispose children to antisocial behavior and violence in adolescence and early adulthood, an expert in psychopathology said recently at a National Institutes of Health conference.

The relationship between depression and epilepsy is bidirectional as not only are patients with epilepsy at higher risk of developing depression but patients with depression have a three- to sevenfold higher risk of developing epilepsy. Several studies have found that the presence of depression in patients with intractable epilepsy was a stronger predictor of poor quality of life than the frequency and severity of seizures. The principles of managing depression in epilepsy are reviewed in this article.

Migraine affects approximately 12% of the population, and a high percentage of these patients have comorbid psychiatric disorders. Knowing more about the interaction between headache and psychiatric factors can assist in evaluating and treating these patients.

Despite the fact that awareness of HIV and AIDS transmission is pervasive, risky sexual behavior has been increasing in many parts of the world in recent years, with a concomitant rise in new cases of HIV and other sexually transmitted diseases.

A cross-cultural comparison of suicide in old age, including a discussion of recent epidemiological trends in suicide rates. The authors also discuss the impact of social and cultural variables on the detection of depression and the formulation of suicide prevention strategies.

Patients with anorexia nervosa often attempt to deceive health care professionals because they do not want treatment for their disorder. Thus, physicians must maintain a high index of suspicion for signs and symptoms of AN due to its potentially fatal complications.

Assessing and treating patients with suicidal behavior is not an easy task. Acts of suicide cannot be predicted; the best a psychiatrist can hope for is the ability to identify a patient's risk factors and reduce them. With the publication of a new practice guideline, it is hoped that psychiatrists will be better equipped to deal with this particularly vexing challenge.

Borderline personality disorder is a complex, disabling disorder. The chairperson for the American Psychiatric Association workgroup for the evidence-based practice guideline on its treatment gives an overview of this disorder's etiologies, neurobiology, longitudinal course and recommended treatments. Future directions for both treatments and research are also discussed.

Although the term borderline has been in clinical use since the late 1930s, it only became an official Axis II diagnosis in 1980 with the publication of DSM-III.

Three studies over the past three years show that individuals over age 65 who are suffering from depression may still not be receiving the treatment they need. Is integrating treatment into primary care the answer?

Anorexia nervosa, bulimia nervosa and binge-eating disorder remain challenging disorders for the practicing psychiatrist. While psychopharmacological agents play an important role in the overall treatment of eating disorders, current empirical evidence does not support their sole use. A recipe consisting of evidence-based psychopharmacological agents together with evidence-based psychotherapeutic approaches is usually required for a successful outcome.

Headache is a frequent somatic complaint in childhood and adolescence, and its prevalence has increased over the last few decades. The presence of a comorbid psychiatric disorder tends to worsen the course of headache by increasing attack frequency and severity, making the headaches less responsive to treatment, and increasing the risk of chronification. Identification and treatment of comorbid psychiatric conditions is, therefore, important for the proper management of headache, especially in children and adolescents.

While the symptoms of somatoform and dissociative disorders are influenced by the patient's culture, these syndromes are heterogeneous and may have overlapping features. Although more frequently reported in non-Western cultures and thought of as exotic and culture-bound, multiple personality disorder may be a North American example of one such disorder.

How does the role of culture affect disease presentation? The author reviews the impact of religion, ideology and upbringing on the epidemiology of OCD in Egypt.

According to National Comorbidity Survey data, panic disorder is 2.5 times more prevalent in women than in men. Do physiological changes for women during the perimenstrual and perimenopausal phase play a role in this disorder?

Unlike other forms of self-injury, suicidal self-injury has special meaning, particularly in the context of borderline personality disorder. How is suicidal self-injury differentiated from non-suicidal self-injury in these patients, and how can their behavior be properly assessed and treated?

Assessing and treating suicidal behavior in the elderly can be difficult. What are the risk factors and how can this population best be treated?

Results from three statewide studies of the clinical practices for assessing and treating children and adolescents with a primary diagnosis of conduct disorder, ADHD or bipolar I disorder demonstrate gender and ethnic differences only for those diagnosed with conduct disorder. The implications of these findings and their similarities to the literature on adults with psychiatric disorders are discussed.

Cognitive Therapy's Faulty Schema

The American Psychiatric Association has developed a sweeping vision for reforming mental health care in the midst of a fiscal crisis that it says threatens a wholesale collapse of the system. The plan calls for an investment in mental health services equal to the level of disability that mental disorders cause, an end to behavioral health carveouts and better integration between psychiatry and primary care.

An increasing amount of systemic research has galvanized opinions regarding pediatric-onset bipolar disorder (BD). Although originally thought to be a rare condition, the number of pediatric-onset BD diagnoses is rising. This article summarizes current thinking regarding pediatric BD, including work focusing on presentation, psychiatric comorbidity and recent treatment data