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Minimal Brain Dysfunction

Psychiatric Effects of Toxic Exposures

Psychiatric effects of environmental and chemical toxins. ©Lightspring/Shutterstock.com.

Minimal Brain Dysfunction

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.”

Parkinson disease (PD) is the second most common neurodegenerative illness in the United States, affecting more than 1 million persons. Disease onset is usually after age 50. In persons older than 70 years, the prevalence is 1.5% to 2.5%.1 While the primary pathology involves degeneration of dopaminergic neurons in the substantia nigra, circuits important in emotion and cognition—such as the serotonergic, adrenergic, cholinergic, and frontal dopaminergic pathways—are also variably disrupted.

Another lifetime ago—just after leaving residency—I took a job as a psychiatric consultant at a large, university mental health center. Had I known the poisoned politics of the place, I would have headed for someplace safe—like, say, Afghanistan.

Many people assume that it is the emotional and psychotic symptoms that make it difficult for a person with schizophrenia to function in everyday life. In fact, research indicates that cognitive impairment is a major reason why functional outcome is so poor.1

Depression complicates medical illnesses and their management, and it increases health care use, disability, and mortality. This article focuses on the recent research data on diagnosis, etiopathogenesis, treatment, and prevention in unipolar, bipolar, psychotic, and subsyndromal depression.

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