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Refinements in ECT TechniquesWith ECT‚ the response rate for treatment-refractory patients is sobering‚ and the treatment is not without risks and adverse effects.
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Adjunctive Treatment Options for Patients With Residual Symptoms of DepressionPatients with residual symptoms of depression may continue to experience significant occupational and social impairment. The focus of this article is on the residual burden that so often remains after remission is achieved.
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Suicidal Behavior in the ElderlyAssessing and treating suicidal behavior in the elderly can be difficult. What are the risk factors and how can this population best be treated?
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Treatment Options in Late-Life Treatment-Resistant DepressionThis article sheds light on the strengths and weaknesses of various approaches to TRD management in adults 60 years and older.
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Taking a Leave of Absence from Your Medical PracticePlanning a break from your practice for a while? Here are some tips to help you work with your partners and patients for a meaningful long-term absence.
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Chronic Disease Self-Management Programs in PsychiatryThrough patient self-management, mental health clinicians can transfer the focus from managing symptoms to allowing patients to live well in the context of their mental illness and medical comorbidities.
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Treatment Resistance: Anorexia Nervosa in a Middle-Aged WomanEating disorders like anorexia nervosa are resistant to treatment. This case briefly outlines a treatment approach using a community-based, patient-centered model of care.
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Heritability of Childhood AnxietyAnxiety disorders are highly prevalent and potentially debilitating psychiatric conditions. Is heredity linked to anxiety disorders? The importance of early identification and management of children at risk for anxiety disorders is emphasized.
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Two Mentors and an Inspiration From the PastOne doctor shares how 2 mentors and a notable artist from history have inspired her.
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Eating Disorders in SchizophreniaEating disorders in patients with schizophrenia have been underappreciated and poorly studied. Profiling characteristic phenotypic patterns will help clarify the distinctions among eating behaviors that are part of the spectrum of schizophrenia, those that represent distinct coexistent entities, and those that represent overlapping comorbidity.
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Cognitive Impairment in Patients With Bipolar DisorderIt 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 found that cognitive impairment persists during periods of remission, mainly in domains that include attention and processing speed, memory, and executive functioning.4
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Brain Aging and Dementia: Practical Tips From Clinical ResearchAge is a major risk factor for the development of Alzheimer disease and other dementias. New technologies in brain imaging represent major advances in our ability to diagnose age-related cognitive and behavioral disorders.
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Depression During PregnancyMajor depressive disorder is common during childbearing. Depression that interferes with function develops in an estimated 14.5% of pregnant women. Some statistics are troubling in that only 13.8% of pregnant women who screen positive for depression actually receive treatment.
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Panic Disorder and Pregnancy: Challenges of Caring for Mother and ChildPanic disorder is a common psychiatric illness that can have a chronic, relapsing course. The question of whether pregnancy represents a time of increased risk for recurrence of panic symptoms has been a matter of debate.
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Interviewing in the Emergency SettingAcute intoxication is the most likely culprit for an increased risk of violence or agitation, but personality, psychosis, and cognitive problems can all play a role. A skilled clinician can glean a great deal of information in a short period of time.
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Antidepressants in Pregnancy: Balancing Needs and Risks in Clinical PracticeThis article summarizes the risks of untreated psychiatric illness during pregnancy as well as the risks and benefits of antidepressant use.
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Shelter-Based Collaborative Mental Health Care for the HomelessHomelessness rates in both Canada and the United States have increased dramatically over the past 10 years. Among the homeless, there is a high prevalence of mental illness and substance use disorders.
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Mini Quiz: Neurobiology of Borderline Personality DisorderWhat do functional magnetic resonance neuroimaging findings reveal about the neurobiology of borderline personality disorder? Take the quiz and learn more.
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A Practical Update on Neuroimaging for Psychiatric DisordersWhich neuroimaging test for which psychiatric patient-and when? What to ask the neuroradiologist?
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The Influence of Diet on ADHDThere is good emerging evidence that aspects of diet can indeed affect ADHD. Clinical recommendations here.
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Inflammation, Psychosis, and the BrainWhen the solution to a clinical or scientific puzzle eludes us for more than a century, as with schizophrenia, we need new methods to examine the pathology. If we want to make an impact on the disease we must shift research paradigms and focus on the early detection, early intervention, and new avenues of treatment that address different symptoms of schizophrenia.
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The Brave New World of Behavioral Therapies for Alcohol Use DisordersIn addition to the approval of novel medications for alcohol use disorders, the past several years have been marked by an emphasis on development, standardization, and dissemination of new behavioral therapies, including computer-based interventions.
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Sexual Harassment and Alcohol UseSince the 1990s there has been an increase in research on sexual harassment and its mental health consequences. These researchers discuss the use of alcohol to self-medicate harassment-engendered distress and the need for greater attention to potential alcohol-related consequences of harassment experiences.
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Child and Adolescent Clinical Psychopharmacology, 4th ed.Each edition of this book, beginning with the first in 1991, has received much use while sitting on my office shelf. The editions have spanned the modern era of child psychopharmacology and, along with the works of S. P. Kutcher, have offered practical clinical guidance in choosing and monitoring medications in children and teenagers while also providing an overview of the literature that supports child psychopharmacology.
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Substance Abuse in Women: Does Gender Matter?There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.
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ADHD and Substance Use: Current Evidence and Treatment ConsiderationsBecause comorbid substance abuse is the rule rather than the exception in individuals with ADHD, accurate diagnosis, prognosis, and management of ADHD is challenging even for the most skilled practitioners.
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Treatment of Non-Suicidal Self-Injurious Behavior in AdolescentsThis CME article provides an understanding of the treatment modalities for the management of nonsuicidal self-injury (NSSI) in adolescents.
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Transplant Psychiatry: Issues for CliniciansThe role of transplant psychiatrists is to assess both transplant and donor candidates to determine capacity to consent to the surgery, recent stressors and coping skills, social supports and availability of caregivers, and whether there are psychological or substance abuse issues that would affect outcomes.
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A New Focus on Reducing Misdiagnosesepilepsy, migraine, headache, Parkinson disease, parkinsonism
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The Role of Social Media in Private PracticeThe challenges of using social media can be as numerous as the benefits.
