Major Depressive Disorder

Since its initial description by Kahlbaum (1828-1899) over a century ago, catatonia has been associated with psychiatric, neurologic, and medical disorders. Contemporary authors view catatonia as a syndrome of motor signs in association with disorders of mood, behavior, or thought. Some motor features are classic but infrequent (eg, echopraxia, waxy flexibility) while others are common in psychiatric patients (eg, agitation, withdrawal), becoming significant because of their duration and severity.

Using Antidepressants During Pregnancy: An Update

There are dozens of books on the market aimed at helping the general public recognize depression; there are far fewer that focus specifically on the more subtle forms of bipolar disorder. This disparity has its clinical parallel in the over-diagnosis of unipolar depression among patients who ultimately prove to have a bipolar disorder. Indeed, survey data suggest that there is typically a 7-year delay in the correct diagnosis of bipolar spectrum disorder.

Deep brain stimulation (DBS) may hold promise for patients with treatment-resistant and severe major depression and obsessive-compulsive disorder (OCD). However, it may not be the best choice for patients with Parkinson (PD) disease who display certain compulsive behaviors, reported researchers from the Cleveland Clinic and from Brown Medical School (Providence, Rhode Island) at the annual meeting of the American Academy of Neurological Surgeons, which took place April 22-27 in San Francisco.

A discussion of the epidemiology, assessment, diagnostic dilemmas, and treatment of avoidant personality disorder.

The prevalence and debilitating nature of some of the personality disorders has impeded the study of psychopharmacology in these conditions. However, important advances have been made in the last several years.

Suicidality in patients with borderline personality disorder is chronic. It is important to distinguish these patients from those with classic mood disorders, who are suicidal only when acutely depressed.

The evidence showing a relationship between mental disorders in childhood and adulthood has increased in the last several decades.

An examination of recent research on psychosocial treatments for personality disorders, including randomized controlled trials and empirically supported therapies as well as dialectical behavior therapy.

When assessing a sleep-related problem in a psychiatric patient, investigating all possible causes may be more helpful than assuming the complaint is a result of medication or the underlying condition.

Dr Ronald Pies questions the statements in regards to antidepressant response time from an October 2005 article in Psychiatric Times.

How does the difference between objective evidence and subjective evidence relate to the practice of psychiatry?

With expansion of the concept of bipolar disorder (BD), there has been concern about the potential for overdiagnosis. However, diagnostic errors in bipolar disorder are currently skewed towards underdiagnosis.

The psychiatric community has a need for diagnostic and predictive tests. Some recent techniques have just become available for clinical care.

Dr Muller describes a case of a patient with a paranoid psychosis who clearly needs help, yet refuses treatment.

Should physicians be allowed to assist in their patients' dying, and how can physician-assisted suicide be reconciled with the physician’s role as a healer?

The common sense notion that a child will benefit from an improvement in her mother’s depression has been confirmed in a prospective evaluation.

Antidepressants may have a protective effect on the hippocampal atrophy seen in patients with severe, untreated depression. This atrophy may be caused by an overabundance of glucocorticoids.

How effective is psychotherapy for the treatment of depression in children and adolescents?

Reexamining the Link Between Antidepressantsand Suicidality in Children and Adolescents

Parkinson disease, depression, hallucinations, psychosis, suicidality, motor control, psychiatric adverse effects

A discussion of the current evidence base of psychosomatic medicine in the context of its public health significance and suggestions for the future development of the field.

Emotional maltreatment is of two major types: emotional abuse and emotional neglect. While emotional abuse is easier to identify, emotional neglect is subtler, possibly more damaging, and poses even more challenging barriers to definition and study.

An appreciation of melancholia as the principal definable mood disorderoffers a better guide to diagnosis and treatment than does DSM-identified major depression.

Half of patients with nonpsychotic major depressive disorder can achieve symptomatic remission with no more than two treatments.

Caregivers may face years of continuous exposure to physical and psychosocial demands with burdens that can include physical, psychological, social, and financial problems; embarrassment; overload; and resentment.

The shift toward biologic preeminence has led to psychiatric residency programs de-emphasizing psychotherapy education. How does psychotherapy fit into the “age of the brain”?

Increased demand for accountability is requiring more clinicians to supplement their judgments of patient outcome with standardized and objective protocols. The protocol outlined here is a model or jumping-off point for outcome evaluation.

Childhood adversities associated with suicide risk include childhood maltreatment, problematic family relationships, socioeconomic hardship, and difficult relationships with peers. Acute suicide prevention strategies should focus on the treatment of contributory psychiatric disorders and on the crises that may precipitate suicidal behavior.

The use of psychiatric medications in children, including antidepressants (such as selective serotonin reuptake inhibitors) and drugs used to manage attention-deficit/hyperactivity disorder, are continuing to be reviewed by the FDA.