Major Depressive Disorder

Recently, 3 reports that shed further light on the short- and long-term mental health consequences for children of depressed parents were published.

The skin is the largest organ of the body and functions as a social, psychological, and metabolically active biologic interface between the individual and the environment.

Investigational drugs and novel applications of established agents for psychiatric illness were described in a number of reports at the 46th annual NIMH-sponsored New Clinical Drug Evaluation Unit (NCDEU) meeting in Boca Raton, Fla, June 12-15, 2006.

Concerns about senior suicide and the lack of geriatric mental health services took center stage at hearings in the Senate Special Committee on Aging on September 14. Geriatric psychiatrists reviewed unfavorable trends such as faltering numbers of medical school graduates going into primary care and already small numbers of geriatric psychiatrists getting even smaller.

Prevalence of depression in PD is estimated to range from 7% to 76%. The variation is largely attributed to the diversity of the populations under study, differences in the definition of depression, and the fact that some studies used point prevalence and other studies used monthly prevalence. Also, the prevalence of depression varies with fluctuations of cognitive status and other comorbidities that are an integral part of PD.

Borderline personality disorder (BPD) is a serious illness involving multiple symptoms and mal adaptive behaviors. According to DSM-IV, “the essential feature of borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects” (p. 650). This pervasive pattern of instability also applies to behaviors that are impulsive and potentially damaging, including excessive spending, sexual promiscuity, reckless driving, binge eating, and substance misuse.

Older adults have higher rates of suicide than younger adults in many industrialized nations.

The emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).

Alzheimer dementia (AD) represents a profound global health concern. By the year 2050, the prevalence of AD in the United States is expected to reach 15 million. At present, there are 4.5 million cases in the United States, which equals an estimated cost of $100 billion each year in medical and family expenses.

Initial studies-such as the stepped collaborative care intervention, Texas Medication Algorithm Project (TMAP), and German Algorithm Project (GAP) phase 2-predominantly investigated whether following an expert opinion–based clinical algorithm (irrespective of the content of the algorithm) led to a better outcome than treatment as usual did

Just how “hot” is the topic of conflict of interest in psychiatry? The answer was brought home to me dramatically this past May at the APA meeting in Toronto. During the meeting, I had the opportunity to chair a symposium titled “Pharmaceutical Industry Influence in Psychiatry.” My copresenters and I showed up well ahead of time to meet and prepare introductions. As we gazed out at the empty seats, we joked that there would be at least 5 people in attendance since, after all, there were 5 presenters.

Anxiety disorders are the most prevalent psychiatric disorders in the United States. Although effective treatments are available, such as the SSRIs and cognitive-behavioral therapy (CBT), it is estimated that in about 40% of patients, anxiety disorders are partially or completely resistant to first-line treatment.

The treatment of unipolar major depression presents a substantial challenge for the clinician. Major depression is a common disorder with a high propensity for relapse and recurrence.

The problem of treatment resistance in bipolar disorder begins with its definition. Characterizing the phases of bipolar disorder as manic, mixed, hypomanic, or depressed does not do justice to the reality for many persons with this disorder.

A small group of patients with treatment-resistant major depression achieved symptom relief within hours of receiving a single low-dose intravenous infusion of ketamine. The low-dose anesthetic apparently triumphed in these patients where other treatments including oral antidepressants, which can take 8 weeks or longer to "kick in" failed.

Despite the progressive increase in the number of available antidepressants, many patients with depression continue to be symptomatic.

The degree to which season changes affect mood, energy, sleep, appetite, food preference, or desire to socialize with others has been called "seasonality." Identification of a seasonal pattern can only be made if both the patient and physician actively look for it.

Since children are a vulnerable population, ethical issues in the conduct of medication studies involving them are extremely important. We recently reported the results of a study that examined youths' and parents' attitudes about, and experiences with, participation in psychopharmacology treatment research.

In a presentation given at the midyear meeting of the American Epilepsy Society, Andres Kanner, MD cited studies from the literature showing that the rates of depression, anxiety, psychosis, and attention-deficit/hyperactivity disorder (ADHD) are significantly higher among persons with epilepsy than among the general population

Alcohol is the drug of choice for adolescents, with cigarettes and marijuana being second and third. Contrary to widespread belief, alcohol dependence is most common in 18- to 20-year-olds, with progressively decreasing rates of alcohol dependence in older age groups.

Depressive disorders and symptoms are common in cancer patients (up to 58% have depressive symptoms and up to 38% have major depression), worsen over the course of cancer treatment, persist long after cancer therapy, recur with the recurrence of cancer, and significantly impact quality of life.

The longitudinal course of bipolar disorder (BD) is characterized by a low rate of recovery, a high rate of recurrence, and poor interepisodic functioning. There is a need to invoke a chronic disease management model (CDMM) when treating individuals with BD.

Sleep disorders are very common and are often underrecognized and underreported in children. If left untreated, these disorders can cause serious developmental and physiologic problems.

Depression has long been recognized as a primary concern for health care providers. Many approaches to treating depression have been developed, ranging from medications, to long-term psychotherapy, to shorter, more structured cognitive-behavioral treatments--all of which help some of the patients, some of the time, to some extent.

Stress Neurobiology and Corticotropin-Releasing Factor

Attention-deficit/hyperactivity disorder (ADHD) in girls may be more persistent than originally thought and may also be associated with a variety of behavioral and mental health consequences such as eating disorders, depression, and substance abuse.

Adolescents reject their parents’ icons and seek out and empower their own. Antiheroes seem deliberately provocative, assailing almost every social convention of the adult generation, and parents often fear they are leading youth astray.

A young mother has just learned from her gynecologist that she is 2 months pregnant. She has had 7 major depressive episodes over the past 8 years, 3 of which were accompanied by serious suicide attempts. She is asking you if she should stop taking the antidepressant at this time. What do you advise?

While dementia is marked by such cognitive deficits as disorientation, memory loss and changes in intellectual functioning, these are not the symptoms that cause the most distress to caregivers.

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.