Major Depressive Disorder

After numerous hospitalizations, electroconvulsive therapy and a battery of drug trials, a college senior remained suicidal. Looking for advice on her patient, a psychiatrist brought the case to a team meeting, only to be told by a senior colleague, "You can't save them all."

Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite.

Psychiatrists, neurologists, primary care physicians, physician assistants, psychologists, psychiatric nurses, social workers and other mental health care professionals. Continuing education credit is available for most specialties. To determine if this article meets the requirements of your specialty, please contact your state licensing board.

There is no question that psychotherapy and psychopharmacology can be successfully integrated. Indeed, there are still many psychiatrists left in this country who talk to patients and families, provide both psychotherapy and psychopharmacology, and care for patients in a biopsychosocial context.

How has the emphasis on economics and mental health care affected the quality of care? Has it improved under managed care? Implementing prevention strategies and improved quality, although initially costly, may save money in the long term.

In the 1800s there was widespread concern over the increase in the number of individuals with severe mental illnesses. Evidence from the 20th and 21st centuries is building that shows a similar trend. Why, then, is this increase not being currently addressed?

A report released by former Surgeon General David Satcher, M.D., outlines the disparity in mental health diagnoses and treatment between majority and minority ethnic groups. The report also discusses ways of closing the gap in mental health treatment.

Many options exist for the pharmacological treatment of anxiety disorders. Are some more appropriate under certain conditions or for some patients? Mechanisms and efficacy of medicinal treatments, as well as some common herbal remedies, are reviewed.

Compared with Caucasians, African Americans receive an excess of schizophrenia-spectrum diagnoses. Potential explanations for the ethnic differences in clinical assignment of psychiatric diagnoses are reviewed.

Social anxiety disorder, the third most common mental disorder, is often underdiagnosed and undertreated. A leading expert on SAD provides an overview, including highlights of the barriers to diagnosis, a differential diagnostic approach and treatment options for social anxiety disorder.

As the field of addiction psychiatry continues to evolve, researchers and clinicians are looking at old problems with new vision.

Neurofeedback, a way for patients to learn to create and maintain desirable brainwaves, may be an affective adjunct therapy for many psychiatric disorders. Which procedures are most effective, and what are the benefits and risks?

Neurofeedback, also called electroencephalogram (EEG) biofeedback or neurotherapy, is an adjunctive treatment used for psychiatric conditions such as attention-deficit/hyperactivity disorder, generalized anxiety disorder, posttraumatic stress disorder, phobic disorder, obsessive-compulsive disorder, bipolar disorder, depression and affective disorders, autism, and addictive disorders (Moore, 2000; Rosenfeld, 2000; Trudeau, 2000).

Diabetes doubles the likelihood of comorbid depression, which impairs functioning and quality of life. This mood disorder has a unique importance in diabetes because of its associations with treatment noncompliance, insulin resistance, hyperglycemia and an increased risk for diabetes complications.

In this second article of a series, innovative research and technologies presented at the 41st Annual New Clinical Drug Evaluation Unit meeting are highlighted.

Dr. Genova offers the antidote to the complexities of manualized and proceduralized psychotherapy that have arisen in imitation of procedural, technology-driven medicine. Supportive, directive and relational types of therapy and their correlation with various power structures within the doctor-patient relationship are described.

In the glossary of our book The Culture-Bound Syndromes, Charles C. Hughes, Ph.D., listed almost 200 folk illnesses that have, at one time or another, been considered culture-bound syndromes (Simons and Hughes, 1986). Many have wonderfully exotic and evocative names: Arctic hysteria, amok, brain fag, windigo.

In the first of this series of articles, some of the innovative research and technologies presented at the 41st annual New Clinical Drug Evaluation Unit meeting in Phoenix in May are discussed.

Although many of the physiological functions of neurosteroids are currently unknown, evidence suggests that these endogenous molecules may play a role in the pathophysiology of psychiatric disorders and treatment strategies. Neurosteroids have been linked to SSRI action and may be relevant to antipsychotic drug effects. Do neurosteroids have neuroprotective properties or HPA axis effects?

What is abandonment? Who is responsible? Where is the line drawn between no liability to treat and abandonment? Read how psychiatrists can protect themselves from the legal ramifications of abandonment.

Were you unable to attend the annual meeting of the American Psychiatric Association in May? Read the first part in a series of summaries of important new research presented there.

In this narrative of his patient, the author illustrates how the involvement of managed care in mental health treatment can thwart the therapeutic process and demean both doctors and patients.

Can brain scans show a difference between drug therapy and psychotherapy? A researcher at University of California at Los Angeles uses positron emission tomography to observe the difference in brain changes between these two types of treatment for major depression.

Is there a difference between bifrontal, bitemporal and right unilateral? In addition to talking about other research into optimal strength and electrode placement, Max Fink, M.D., outlines some of his own ongoing research.

This is the second part of an article series discussing the high risk of suicide attempts in patients with schizophrenia. Herbert Y. Meltzer, M.D., continues the discussion with treatment options and efficacy.

Evidence is accumulating that untreated depression can impede comorbid medical treatment and increase mortality. The author reports on the latest research and treatment recommendations for depression that accompanies cardiovascular disease, stroke and Parkinson's disease.

In spite of the enormous success of antidepressants, there are surprisingly few that are available in other than oral form. There is now substantial evidence that intravenous administration is well tolerated and may accelerate onset of therapeutic effect. With the possibility of transdermal delivery3/4a noninvasive and painless route of administration requiring no technical support3/4parenteral antidepressants may become more acceptable in this country and warrant further clinical investigation.

Samantha Meltzer-Brody, M.D., et al. provided data suggesting that fluoxetine (Prozac) exerts a broad-spectrum effect in reducing all symptom clusters in a sample of 53 patients with posttraumatic stress disorder (PTSD). Their results indicated that fluoxetine was most effective in treating the individual symptoms of intrusive recollections and having a sense of failure.

A further look at TMS, including synopses of presentations from the 3rd Annual Meeting of the International Society of Transcranial Stimulation.

In response to encouraging results from a small pilot study of vagus nerve stimulation (VNS) for treatment-resistant depression, researchers are now expanding the study to approximately 200 patients in 20 sites across the United States.