Mania

Catatonia is found in at least 10% of patients admitted to acute psychiatric services, so any young patient with stupor, unexplained excitement or persistent motor signs should be formally assessed for this syndrome. From among the 20 to 40 now-identified features of catatonia, its proper diagnosis must be differentiated from other mental illnesses.

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."

Patient Drug Information From Mass Media Sources

E. Fuller Torrey, M.D., explores the battle for control of the state asylums in the late 1800s. Using everything from rational arguments to blatant defamation of character, William Hammond's neurologists and John Gray's psychiatrists duked it out in New York as other states watched carefully in pursuit of what might follow.

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.

When treating alcohol-dependent patients, clinicians may be well advised to integrate disulfiram into the treatment plan. Who are good candidates, and who are not? How can you enlist the aid of family members and friends to ensure compliance?

With an increasing number of drugs in the pipeline, the efficacy and safety of drug trials become even more important. Who are the various entities sponsoring these trials, and what are their goals?

There are two goals in the acute treatment setting (e.g., emergency department): initiation of treatment and reducing the symptoms of agitation and aggression that frequently accompany an acute psychotic breakdown. Treatment options and considerations are reviewed.

The FDA approved two new intramuscular, immediate-release formulations of atypical antipsychotics. Both olanzapine (Zyprexa IM) and ziprasidone (Geodon IM) were recommended as safe and effective for the treatment of agitation in patients with schizophrenia.

The author examines how temperature and length of day can affect mood and behavior, both in a general population and a group of inpatients. In both groups, there were two peaks of violent behavior, one in May-June and one in October-November, which correspond with the equinoxes. Is it possible to track violent behavior in various geographical areas depending upon weather and length of day?

The National Alliance for Research in Schizophrenia and Depression awarded the 2000 Nola Maddox Falcone Prize. A brief description of each recipient's contributions to research with affective disorders is given.

Because there is intense pressure by managed care to shorten the hospital stay for patients with anorexia nervosa, there is a need for partial-hospitalization treatment programs. Since patients gain an average of 0.5 lbs/week to 1.5 lbs/week in these less-monitored programs, as opposed to 2 lbs/week to 3 lbs/week in the inpatient behavioral specialty programs, Angela S. Guarda, M.D., and colleagues (Symposium 21B) described components that would improve the partial treatment program.

More patients are reaching the old-old demographic-those age 75 and above-with psychiatric conditions such as treatment-resistant depression. Research has shown that with some careful screening and precautions, ECT is a safe, effective treatment option for these patients.

Bipolar disorder (BD) in children and adolescents is severe and has significant adverse effects on academic, social and family functioning. The high rate of relapse and suicide attempts in youth with BD makes effective treatment essential.

Intrigued by preliminary research indicating that omega-3 polyunsaturated fatty acids found in fish, fish oil and flaxseed may ameliorate symptoms in bipolar disorder (BD), schizophrenia and other psychiatric disorders, investigators have launched a series of double-blind trials evaluating fatty acids as adjunctive treatment. This article will discuss studies on bipolar disorder.

Three reports on olanzapine (Zyprexa) as a possible treatment for bipolar affective disorder, presented at a National Institute of Mental Health-sponsored meeting in June, reflected pursuit of this indication-despite the initial "nonapprovable" letter from the U.S. Food and Drug Administration that was issued October 1998.

As chief of the division of sleep and chronobiology in the department of psychiatry at the University of Pennsylvania School of Medicine, David F. Dinges, Ph.D., focuses on ways sleep and the endogenous circadian pacemaker interact to control wakefulness and waking neurobehavioral functions such as physiological alertness, attention, cognitive performance, fatigue, mood, neuroendocrine profiles, immune responses and health. In an interview with Psychiatric Times, Dinges discussed neurobehavioral consequences of sleep loss, factors that impair sleeping, the pervasiveness of sleepiness and new ways to manage sleepiness.

Mood-stabilizing drugs slipped into the vocabulary of psychiatrists during the last 15 years without a proper discussion of their definition. Consequently, these medications have been used in ways that have no empirical justification.

Daniel F. Kripke, M.D. has studied the relationship between biological rhythms and depression since the early 1970s. He states that seasonal responses in many mammals are controlled by the photoperiod. Therefore, it seemed that depression might be analogous to winter responses and that light might be an effective treatment.

Atypical antipsychotic treatment for borderline personality disorder (BPD) and augmentation therapy with olanzapine (Zyprexa) or estrogen replacement therapy (ERT) for patients with mood disorders were among the research questions addressed at the American Psychiatric Association's annual meeting in Toronto. Following are some brief reports of selected presentations.

Every year, more than half of newly approved drugs and biologics considered likely to be prescribed for children lack labeling information on safe and effective use. Seeking to rectify this situation, the FDA recently issued final regulations requiring new drugs and biologics that are therapeutically important for children or will be commonly used in children to have labeling information on safe pediatric use.

The guidance answers the most commonly asked questions about how ADA affects persons with psychiatric disabilities, said EEOC chairman Gilbert F. Casellas. "It provides practical instruction to employers and persons with psychiatric disabilities on their respective rights and responsibilities."

Mood disorders and their impact on women and their families was the topic of a half-day conference held at New York City's Algonquin Hotel;, former haunt of the famous-and depressed- writer Dorothy Parker, who made at least one suicide attempt there in the early 1900s.

Since 1980, criteria for diagnosing bipolar disorder in adults have also been used to diagnose mania in children, with some modifications to adjust for age.

At this time, both patients and professionals seem to have an unprecedented interest in circadian rhythms. We now know that the body's clock is located in the suprachiasmatic nucleus (SCN) of the hypothalamus, and that the SCN regulates the pineal gland's secretion of the hormone melatonin.