Psychiatric Times Vol 23 No 11

Treatment-Resistant Anxiety Disorders: Neurotrophic Perspectives

October 31, 2006

Anxiety disorders are the most prevalent psychiatric disorders in the United States. Although effective treatments are available, such as the SSRIs and cognitive-behavioral therapy (CBT), it is estimated that in about 40% of patients, anxiety disorders are partially or completely resistant to first-line treatment.

Enlisting Family Members to Address Treatment Refusal in Substance Abusers

October 31, 2006

Anyone who is close to someone who abuses alcohol or drugs knows all too well that substance abusers do not typically seek treatment until they have experienced years of substance-related problems. During the first year after onset of a diagnosable substance use disorder, only 1 of 5 alcohol-dependent persons and 1 of 4 drug-dependent persons receive treatment.

Neurotransmitters, Pharmacologic Synergy, and Clinical Strategies

October 31, 2006

Although studies now suggest that some psychotropic medication regimens have a somewhat higher success rate than the one-third rule would have predicted, psychiatrists are still left with the problem of why it is that only one third to one half of patients who are treated get better, and why fewer still sustain that improvement over time

Pathology and Management of Treatment Resistance in Bipolar Disorder

October 30, 2006

The problem of treatment resistance in bipolar disorder begins with its definition. Characterizing the phases of bipolar disorder as manic, mixed, hypomanic, or depressed does not do justice to the reality for many persons with this disorder.

Treatment Resistance in Schizophrenia: The Role of Alternative Therapies

October 30, 2006

In 1931, Gananath Sen and Kartick Chandra Bose reported on the use of an alkaloid extract from the Rauwolfia serpentina plant in the treatment of hypertension and "insanity with violent maniacal symptoms." They noted that dosages "of 20 to 30 grains of the powder twice daily produce not only a hypnotic effect but also a reduction of blood pressure and violent symptoms

Book Review: Pediatric Neuropsychiatry

October 01, 2006

The editors of Pediatric Neuropsychiatry must have drawn on their experiences and the feedback they received on their first book, Textbook of Pediatric Neuropsychiatry (American Psychiatric Press, 1998), for this text.

Better Tools Needed to Measure Treatment Outcome

October 01, 2006

The need for better tools, as well as better use of existing tools, to measure treatment response in clinical trials was a principle focus of the 46th annual NIMH-sponsored NCDEU (New Clinical Drug Evaluation Unit) meeting, held June 12-15 in Boca Raton, Fla. Improved clinical research techniques are needed to better separate treatment effect from placebo response, to distinguish between active comparators, and to facilitate development of novel treatments, according to several presenters at the conference.

NIDA Confirms Benefit of Drug Treatment Programs for Criminal Offenders

October 01, 2006

Effective treatment of drug abuse and addiction in the criminal justice system saves the community money and reduces crime, the NIH's National Institute on Drug Abuse (NIDA) reported in a recently released booklet, Principles of Drug Abuse Treatment for Criminal Justice Populations.

IOM Report Takes on Medication Errors . . . Again

October 01, 2006

In its latest report on medication errors, a committee assembled by the Institute of Medicine (IOM) included some sidebars on psychiatric drugs. The report, issued in July, said that there is too little data on misadministration of psychiatric drugs and that clinical trials with psychiatric drugs have been small and incapable of providing pragmatic, comparative information.

Book Review: Principles and Practice of Psychopharmacotherapy, 4th Edition

October 01, 2006

A new edition of an established text is an opportunity for its authors and editors to review new information and prune what is no longer useful. The 4th edition of Principles and Practice of Psychopharmacotherapy is more successful at the former than it is at the latter.

BasicNeeds: Successful Mental Health Programs With Scarce Resources

October 01, 2006

Ahmed Abdullai often wandered aimlessly and slept in a graveyard in Tamale, northern Ghana. Now, with the help of BasicNeeds--an international development charity--Abdullai takes medications to stabilize his mental illness, learns gardening skills, lives at home, contributes to the family farm, and feels like a "human being once again."

Book Review: Psychiatric Aspects of HIV/AIDS

October 01, 2006

In the era of Google and PubMed, a medical reference book finds itself in a precarious position. Is there a role for a bundled, unchangeable hard copy of data that may become outdated in the near (and more easily accessed) future?

Youth Aggression: Economic Impact, Causes, Prevention, and Treatment

October 01, 2006

The increase in youth violence and aggression in the past 50 years has been called an "epidemic." This epidemic has had a tremendous impact on society. From an economic and public health perspective, primary prevention of youth violence is obviously desirable.

Treating Delirium: When the Brain Goes Off Track

October 01, 2006

Typically, delirium worsens at night ("sundowning"), with lucid intervals often present in the morning. It is important to realize that delirium may appear before any abnormal laboratory values are detected and may persist after the resolution of these abnormalities.

Cortisol and Seasonal Changes in Mood and Behavior

October 01, 2006

The degree to which season changes affect mood, energy, sleep, appetite, food preference, or desire to socialize with others has been called "seasonality." Identification of a seasonal pattern can only be made if both the patient and physician actively look for it.

Children's and Parents' Attitudes About Participation in Treatment Research

October 01, 2006

Since children are a vulnerable population, ethical issues in the conduct of medication studies involving them are extremely important. We recently reported the results of a study that examined youths' and parents' attitudes about, and experiences with, participation in psychopharmacology treatment research.

Addressing Psychiatric Comorbidities in Patients With Epilepsy

October 01, 2006

In a presentation given at the midyear meeting of the American Epilepsy Society, Andres Kanner, MD cited studies from the literature showing that the rates of depression, anxiety, psychosis, and attention-deficit/hyperactivity disorder (ADHD) are significantly higher among persons with epilepsy than among the general population

Understanding and Using the Placebo Effect

October 01, 2006

Most physicians make at least some use of the placebo effect to enhance treatments, whether they realize it or not. This article examines the extent of the placebo effect in patients with psychiatric illness, and reviews what is known about how placebos work.

Treating Adolescents With Major Depression and an Alcohol Use Disorder

October 01, 2006

Alcohol is the drug of choice for adolescents, with cigarettes and marijuana being second and third. Contrary to widespread belief, alcohol dependence is most common in 18- to 20-year-olds, with progressively decreasing rates of alcohol dependence in older age groups.

Depression Management in Cancer Patients

October 01, 2006

Depressive disorders and symptoms are common in cancer patients (up to 58% have depressive symptoms and up to 38% have major depression), worsen over the course of cancer treatment, persist long after cancer therapy, recur with the recurrence of cancer, and significantly impact quality of life.

Bipolar Disorder: Defining Remission and Selecting Treatment

October 01, 2006

The longitudinal course of bipolar disorder (BD) is characterized by a low rate of recovery, a high rate of recurrence, and poor interepisodic functioning. There is a need to invoke a chronic disease management model (CDMM) when treating individuals with BD.

Should Emergency Medicine Physicians Screen for Psychiatric Disorders?

October 01, 2006

Emergency department (ED) visits have increased from 89 million in 1992 to more than 110 million in 2002, while the number of EDs decreased by about 15% during the same period. One suspected consequence of ED overcrowding is an increased tendency to disregard a psychiatric problem, especially if it is not the chief complaint.

The Camelford Hysteria: A Lesson for ECT?

October 01, 2006

Complaints of persistent memory loss in otherwise well-functioning individuals after recovery from a psychiatric illness through electroconvulsive therapy (ECT) are best viewed as a conversion reaction or a somatoform disorder. The Camelford experience is a model for the complaints of ECT's profound personal memory losses.

Diabetic Peripheral Neuropathic Pain

October 01, 2006

Diabetes mellitus (DM) has been a significant public health problem for many years. However, the number of cases is continuing to grow at such an alarming rate that some have suggested we are facing or are already experiencing a diabetes epidemic.

Combining Drug Therapy and Psychotherapy for Depression

October 01, 2006

It was just over a generation ago that the routine combination of psychotherapy and drug therapy seemed impossible. Then, one meta-analysis found that combined treatment with psychotherapy and medication was found to be notably superior to either treatment alone.

Alternative Brief Interventions for Mild Depression

October 01, 2006

Depression has long been recognized as a primary concern for health care providers. Many approaches to treating depression have been developed, ranging from medications, to long-term psychotherapy, to shorter, more structured cognitive-behavioral treatments--all of which help some of the patients, some of the time, to some extent.

Treatment-Resistant Depression: Strategies for Management

October 01, 2006

Despite advances in our understanding of depression therapy, many patients with depression remain unresponsive to treatment. As many as 50% of patients who begin treatment with an antidepressant do not respond.