Schizophrenia/Psychosis

Some months ago, I received a stern admonition from my family doctor. My fasting blood sugar of 99 mg/dL was “right on the border”, he said, and I had better work on bringing it down. “But,” I protested, “when I was in medical school (in the 70s), the normal FBS range went up to 110 mg/dL!” "Well,” he replied a bit huffily, “they changed the criteria!”

The articles by Arline Kaplan and Hagop Akiskal, MD, in the November 2011 issue of Psychiatric Times highlight the race to patent bio-tests for schizophrenia and depression.

Biomarkers for mental disorders is a field whose time has come. Optimists will say within a few years, pessimists might say a decade or beyond.

Researchers have tried lots of different kinds of tests from EEGs to blood-based biomarkers. Now genetic tests are a very popular means of trying to understand different psychiatric disorders.

When I was a first-year resident, a revered supervisor of mine made the statement-half-facetiously-that, “In psychiatry, you can do biology in the morning and theology in the afternoon!”

A depot antipsychotic regimen is less likely to be discontinued than an oral dosage form . . .

Increased activity of the enzyme phospholipase A2 (PLA2) has been documented in schizophrenia and is now reported to occur in patients with temporal lobe epilepsy . . .

A bidirectional relationship between schizophrenia and epilepsy emerged from an analysis of a health insurance database . . .

This column has always been about the world of molecular mental health research. I revisit the technology in this column, now aimed at one of molecular neuropsychiatry’s most intractable, frustrating lines of research: the molecular/cellular basis of schizophrenia.

On the wide range of symptoms in schizophrenia, including alterations of the dopaminergic and/or glutamatergic systems, abnormal neurodevelopment, and the theory of immune system imbalance.

Depression, PTSD, panic disorder, and abuse of alcohol and drugs are more insidious, quieter forms of illness that can cause the same desperation and disability as psychotic disorders.

A review of some of the latest study findings on the pharmacological treatment of prodromal psychosis.

In my view, Dr Angell’s assertions reflect both a serious misunderstanding of psychiatric diagnosis, and-equally important-a failure to address the core philosophical issues involved in her use of the terms “subjective,” “objective,” “behaviors,” and “signs.”

Psychosis Risk (AKA attenuated psychotic symptoms disorder) has always had 3 strikes against it.

Regretfully, if we are to judge the progress of DSM-5 by the incoherence of a recent commentary by the Chair and Vice-chair of the DSM-5 Task Force, we have a lot to worry about.

Hoarding has broad-reaching implications, including a substantial public health burden linked to occupational impairment, poor physical health, and demand for social services.

Dear Mrs. -- You have asked me about the cause of your mood disorder, and whether it is due to a "chemical imbalance."

We are living in an evidence-based era in all fields of medicine, including psychiatry. For the most part, this represents progress because clinicians can start to base their interventions on treatments that have been supported by the results of research studies.

Newly developed blood tests for schizophrenia and for depression designed to augment current diagnostic approaches have attracted increased attention at recent major scientific meetings.

The British Psychological Society is a highly esteemed organization representing 50,000 members. Recently, it released an open letter to the American Psychiatric Association offering a harshly critical view of DSM-5.

This article addresses the epidemiology, diagnosis, and treatment of mild TBI among combat veterans, with a particular focus on blast injury and the presence of comorbid posttraumatic stress disorder (PTSD).

DSM-II was published in 1968. DSM-5 will be published in 2013. How much progress have we made? I propose that we approach this question with a quiz.

The legend of the “chemical imbalance” should be consigned to the dust-bin of ill-informed and malicious caricatures.

During the past year, I have been involved as an expert witness for the defense in 14 SVP cases (tried in California, Washington, and Iowa). My role has been to clarify what is meant by the wording of the Paraphilia section in DSM-IV. And it certainly does badly need explaining.

Treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition. Numerous evidence-based treatments exist for all phases of bipolar disorder, and these should be optimized and fully explored.

A balanced review of the safety and efficacy of ECT is needed, which does not mean weighing anecdotal reports of memory loss equally with systematically collected clinical data.

Dr McGorry’s promotion of primary prevention has been well-intended but is clearly premature and carries with it considerable risks of harmful unintended consequences.

Talking to Families About Mental Illness aims to help primary care providers who want to offer family psychoeducation. This book targets non-psychiatrists who diagnose and treat mental illnesses.

Although the foundational and antifoundational traditions differ in their language and claims, both call into question the legitimacy of psychiatric diagnosis and treatment.

Dr Feinberg takes exception to much of what we wrote, or what he thinks we wrote, in our article “Early Antecedents and Detection in Schizophrenia”. We will do our best to reply to his criticisms of what we did write and try to point out where he is shadowboxing at issues that he has created but that we do not hold or endorse.