Trauma in Psychiatric Practice

Members of the military returning from combat operations have high rates of substance abuse. They also often exhibit a co-occurring triad of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and pain, which complicates the problems with substance abuse.

The suicide rate in the US military has steadily climbed over the past 5 to 7 years despite aggressive efforts by the military and the mental health community to counter this trend.

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).

Most military families successfully adapt to a service member's deployments for military duties. Nevertheless, almost a decade of wartime stress associated with the current wars in Iraq and Afghanistan has presented unprecedented challenges for military families.

This Special Report aims to address those symptoms and syndromes most commonly seen by clinicians who treat service members. The 5 articles of the Special Report cover the most challenging aspects of their care, and the authors hope to expand the reader’s understanding of the recent conflicts’ tragic consequences.

The concept of treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition. Treatment resistance in bipolar disorder should always be based on a specific phase of treatment: mania or depression and acute or maintenance.

Patients who are seen in clinical practice commonly have multiple problems, yet efficacy data often reflect treatment of a single illness. Thus, it is useful to know how standard treatment approaches need to be modified for comorbid disorders.

Advances in the fields of neuropsychological assessment and neuroimaging have enormously expanded our knowledge about the profile and severity of cognitive deficits in patients with substance use disorders.

The COMBINE study was only one trial designed by academics to maximize internal scientific validity. It excluded individuals with other significant psychiatric and medical illnesses (more often the rule than the exception in some clinical settings)—individuals deemed too severely ill or who needed hospitalization.

In this Special Report, Helen M. Pettinati, PhD, and William D. Dundon, PhD, discuss prevalence, assessment, clinical features, and treatment issues with respect to individuals with co-occurring major depression and alcohol dependence.

Excellence in psychopharmacology demands sensitivity to the associated ethical considerations. The key considerations of psychiatry are both complex and dynamic, and psychiatrists who develop and refine their ethics skill set will be in a better position to anticipate and respond to ethical dilemmas as they arise in their practice.

Like every drug or technology that has therapeutic value, MDMA (3,4-methylenedioxymethamphetamine) has potential risks and benefits. Unlike most other drugs under clinical investigation, MDMA has a complex and controversial history that has delayed dispassionate scientific investigation into its therapeutic use.

The treatment of adults with bipolar depression may begin with an FDA-approved agent such as quetiapine or an olanzapine/fluoxetine combination. The evidence-based approach to bipolar depression includes treatment with lithium, conventional unimodal antidepressants, lamotrigine, or divalproex.

Antidrug vaccines represent an exciting area of development in the pharmacological treatment of chemical dependency. In addition to the clinical trials being conducted on vaccines for cocaine and nicotine dependence, preclinical development of vaccines for methamphetamine and heroin is ongoing.

The focus of this Special Report is on some future-oriented aspects of psychopharmacology. First, it is an eclectic set of articles that cover treating resistant depression, using currently illegal drugs to treat psychiatric problems, and finally the potential of using vaccines to treat substance use disorders.

Schizophrenia is associated with severe cognitive deficits that interfere significantly with daily functioning and quality of life.

Much resistance to disorder status for the psychosis-risk syndrome stems from the fact that only a minority of those given the diagnosis really have the disorder.

Developmental delays are described premorbidly in samples of children and adults with schizophrenia. More recently, the notion that ASD and schizophrenia can present comorbidly in a subset of patients has received further attention in the literature.

Clinicians have long recognized that many of the psychiatric disorders lack clear boundaries, and that there is a substantial overlap in phenomenology and etiopathophysiology of various disorders.

Whether by traditional means or via cyberspace, bullying and peer victimization puts adolescents at increased risk for suicide, especially when comorbid psychopathology is present.