A 6-year-old boy presents with tall stature (97th percentile for age), motor delays (walking at 16 months), speech delays (expressive vocabulary of 30 to 40 words with recent use of 2-word phrases), and behavioral differences (poor eye contact, lack of pointing, hyperactive behavior with hand-flapping). More »
It is generally held that the offspring of parents with bipolar disorder (BD) are at risk for BD. The degree of risk is an important question for both clinicians and parents. A recent study of bipolar offspring by Birmaher and colleagues1 sheds light on this issue. More »
It is widely accepted that patients with schizophrenia have some degree of cognitive deficiency and that cognitive deficits are an inherent part of the disorder. Historically, there has been less focus on cognitive deficits in patients with bipolar disorder; however, numerous studies of cognition in patients with bipolar disorder, including several comprehensive meta-analyses of bipolar patients who were euthymic at the time of testing, have recently been undertaken.1-4 Each of these analyses... More »
Pediatric bipolar disorder (PBD) is a serious psychiatric illness that impairs children’s emotional, cognitive, and social development. PBD causes severe mood instability that manifests in chronic irritability, episodes of rage, tearfulness, distractibility, grandiosity or inflated self-esteem, hypersexual behavior, a decreased need for sleep, and behavioral activation coupled with poor judgment. While research in this area has accelerated during the past 15 years, there are still significant... More »
It is usually traumatic when parents learn that their child has an autism spectrum disorder (ASD). Be clear about the diagnosis and let families know that treatment will begin as soon as possible, said Doris Greenberg, MD, associate clinical professor of pediatrics at Mercer University School of Medicine, Savannah, Ga. In her presentation at the US Psychiatric and Mental Health Congress in Las Vegas, Dr Greenberg discussed strategies for talking to the families of children with ASDs. “Don’t talk... More »
In 1944, Hans Asperger published a description of 4 boys who had major social problems despite adequate cognitive and verbal skills. His original term for the condition was Autistischen Psychopathen im Kindesalter, usually translated as autistic psychopathy or autistic personality disorder in childhood. His use of the term “autistic” occurred a year after Leo Kanner’s classic description of the syndrome of early infantile autism but, because of the war, Asperger was likely unaware of Kanner’s... More »
Patients who exaggerate, feign, or induce physical illness are a great challenge to their physicians. Trained to trust their patients’ self-reports, even competent and conscientious physicians can fall victim to these deceptions. In doing so, the treating physician may unwittingly provide support for specious claims of illness or injury by conferring official diagnoses, or by delivering treatments that transform the patient from a pretender into a person with a genuine, although iatrogenic,... More »
A 24-year-old veteran of Operation Iraqi Freedom (OIF) presents to the ED mid-morning on a weekday. While the veteran is waiting to be triaged, other patients alert staff that he appears to be talking to himself and pacing around the waiting room. A nurse tries to escort the veteran to an ED examination room. Multiple attempts by the ED staff and hospital police—several of whom are themselves OIF veterans—are unsuccessful in calming the patient or persuading him to enter a room. More »
When the term “borderline” was first used in 1938 by the psychoanalyst Adolf Stern, he was defining a group of patients who were “extremely difficult to handle effectively by any psychotherapeutic method.”1 In the early 1950s, Robert Knight emphasized their regressive responses to unstructured treatments.2 In hospitals, borderline patients were referred to as “help-rejecting complainers.” More »
The concept of treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition.1 Whether the term refers to nonresponse to 1 or more standard treatments, at what dosages, and for what phases of bipolar disorder is unclear. Treatment resistance in bipolar disorder should always be based on a specific phase of treatment: mania or depression and acute or maintenance. More »
