Major Depressive Disorder

In his ongoing critique of the DSM-5 process, Dr Allen Frances started a brushfire recently in challenging the DSM-5 Mood Disorders Work Group proposal to remove the bereavement exclusion from the diagnostic criteria for a major depressive episode. Here’s a summary of the debate.

We can take one further step toward finding common ground in my ongoing debate with Drs Pies and Zisook.

Patients on average spent between 1 and 8 hours per day preoccupied with negative thoughts about their perceived [mal]odor.

There are very real concerns about the miners’ mental well-being. Chile’s Health Minister reported that five of the men were not eating properly and refused to be filmed. In the meantime, a team of nutritionists and psychologists have been assembled to monitor their physical and mental states.

Which antidepressants are associated with the highest rates of sexual dysfunction in patients treated for depression? This and more in this week's quiz.

My colleague Allen Frances is rightly concerned with the risk of over-calling normal grief as major depression - - that is, the risk of "false positives" - - if the DSM-IV "bereavement exclusion" is dropped in the DSM-5 while the 2-week minimum duration criterion is retained.

Before jumping the gun to a premature and potentially harmful diagnosis, why not watchfully wait a few more weeks to determine if the grief is severe and enduring enough to warrant the label of mental disorder.

In the debates around DSM-5, a central figure has been Allen Frances, whose views seem to elicit sympathy from many unhappy with the DSM system (the 4th edition of which Dr. Frances led).

Two recent studies by Harvard psychologists deliver promising data from 2 tests that may help clinicians predict suicidal behavior. The markers in these new tests involve a patient’s attention to suicide-related stimuli and the measure of association with death or suicide.

Screening for Depression in Clinical Practice, which reviews the current body of knowledge on mental health screening in the medical setting, is a reference text written primarily for the consultation-liaison specialist, but it will be of use to the general psychiatrist and the interested primary care physician or medical specialist.

The discipline of evolutionary psychology views modern human behaviors as products of natural selection that acted on the psychological traits of our ancestors. A subdiscipline, evolutionary psychiatry, tries to find evolutionary explanations for mental disorders.

An Overview of Antipsychotic Use in Older Adults

Consider the predicament of Mrs M, a 38-year-old premenopausal mother of two. Mrs M tells her primary care physician, “I just don’t have a strong desire for sex. It’s been about 10 years now, and I hardly ever have sexual thoughts or fantasies.

Houston, we have a problem. There is a critical shortage of psychiatrists. And the problem is not in Houston alone-it includes the entire state of Texas, and every other state in the union (Mid-town Manhattan, Boston’s Beacon Hill, and Sacramento Street in San Francisco might be exceptions).

Efficacy and safety of bupropion and SSRIs in comorbid depression and restless legs syndrome? Which psychiatric scale has proven useful for tracking depression when Electroconvulsive Therapy is involved? These questions and more in this week's Mine Your Mind quiz.

Keys to diagnosis, assessment, and management.

I offer all of this as a way of describing how I became involved in intensive psychotherapeutic efforts with several adolescents who I then continued to see, often for many years following their inpatient experiences.

When I was an undergraduate studying molecular biology in the early 1990s when the Human Genome Project had just begun, my required coursework included several lectures on the ethical implications of sequencing, understanding, and ultimately being able to manipulate the “code of life.”

Consider the predicament of Mrs M-a 38-year old premenopausal mother of two. Mrs M tells her primary care physician, “I just don’t have a strong desire for sex."

The risk of breast cancer recurrence related to some SSRI antidepressants interacting with and reducing the effectiveness of tamoxifen was quantified in 2 epidemiological studies published in February.

How regularly do you use outcome measures to assess how well your patients with depression are doing? Research suggests many psychiatrists avoid such measures, believing that they are aren’t trained to use them; that they take too much time; or that they aren’t clinically helpful.1

Transcranial magnetic stimulation (TMS) is noninvasive focused brain stimulation that uses pulsed magnetic fields. The underlying mechanism depends on the principle of electromagnetic induction, the process (discovered by Faraday in 1839) by which electrical energy is converted into a magnetic field and vice versa.1

The recently posted draft of DSM5 makes a seemingly small suggestion that would profoundly affect how grief is handled by psychiatry.

This is the second installment of a new series in which clinically relevant research is briefly discussed and, perhaps more important, a few tips on how to read and interpret research studies are presented. Your feedback, suggestions, and questions are eagerly solicited at rajnish.mago@jefferson.edu.

The overall effectiveness of electroconvulsive therapy (ECT) is well known, but its speed of action is much less talked about. Here I review what is known about the time course of action of ECT in depression.

Houston, we have a problem. There is a critical shortage of psychiatrists.

In 5 minutes, so much can be accomplished.

Sometimes you spot a serious problem and figure out a very well-intended solution, only to discover eventually that your solution created as much trouble as the original problem. The workers on DSM5 have spotted an enormously worrying problem-the wild overdiagnosis of childhood bipolar disorder (BD) which has led to a massive increase in the use of antipsychotic and mood stabilizing medications in children and teenagers.

Help in Clinical Decision Making

Mark Twain observed that "the past may not repeat itself, but it sure does rhyme." An unfortunate rhyme in psychiatric history is the recurrence of fad diagnoses. Childhood Bipolar Disorder is the most dangerous current bubble, with a remarkable forty-fold inflation in just one decade.