Psychiatric Times Vol 23 No 13

November 01, 2006

Investigational drugs and novel applications of established agents for psychiatric illness were described in a number of reports at the 46th annual NIMH-sponsored New Clinical Drug Evaluation Unit (NCDEU) meeting in Boca Raton, Fla, June 12-15, 2006.

November 01, 2006

I'm starting out. For 3 years in my Resident's Column, I've shared the excitement, frustration, and even outright anger that I experienced as a second-career psychiatry resident. Because I had completed a different residency years earlier, I was in the position to step back a bit and observe my experiences in a way that would have been impossible the first time around.

November 01, 2006

According to the National Institute on Drug Abuse (NIDA), gender differences can influence the causes, effects, consequences, and treatment of substance abuse disorders. A recent NIDA News Scan focused on several investigations supported by the NIDA.

November 01, 2006

A report issued in September by the Department of Justice citing the prevalence of mental health problems among prisoners in federal and state prisons and local jails was called “an indictment of the nation's mental health care system” by Michael J. Fitzpatrick, MSW, executive director, National Alliance on Mental Illness.

November 01, 2006

A new and greatly improved search engine made its debut this month on the Psychiatric Times Web site (www.psychiatrictimes.com). The engine will facilitate searching for articles archived on the site-but it is designed to go far beyond that to provide a clinician-friendly means of searching the World Wide Web for relevant psychiatric and medical information.

November 01, 2006

Certainly, with the advent of the atypicals, it has become almost too easy to forget about doing an Abnormal Involuntary Movement Scale (AIMS) checklist. Given the time and reimbursement constraints of current psychiatric practice, however, it is close to impossible to find time for clinical rating scales.

November 01, 2006

Concerns about senior suicide and the lack of geriatric mental health services took center stage at hearings in the Senate Special Committee on Aging on September 14. Geriatric psychiatrists reviewed unfavorable trends such as faltering numbers of medical school graduates going into primary care and already small numbers of geriatric psychiatrists getting even smaller.

November 01, 2006

It may come as a surprise, especially given its low repute in the popular mind since the 1980s, but electroconvulsive therapy (ECT) is making a comeback, both as a recommended treatment for depression and in public awareness.

November 01, 2006

Patients with somatization disorder (SD) who are treated using the psychiatric consultation intervention (PCI) may benefit from the addition of cognitive behavioral therapy (CBT) to their regimen. Dr Leslie A. Allen and colleagues recently conducted a randomized controlled trial to determine the outcomes of patients with SD who were treated using a combination of CBT and PCI or treatment with PCI alone. The results were reported in the July issue of Archives of Internal Medicine.

November 01, 2006

Nothing better reflects the difficulties of finding silver bullets for depression treatment than the results of the nearly completed Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the largest clinical trial of its kind. With results imminent from the last of 4 trials in the study, psychiatrists are hoping for considerably more clinical guidance than what the first 3 levels of the trials produced.

November 01, 2006

Addictive disorders are among the leading causes of disability worldwide; however, misuse of and addiction to alcohol and illicit substances is often not appreciated as relevant to the care of older adults.

November 01, 2006

Borderline personality disorder (BPD) is a serious illness involving multiple symptoms and mal adaptive behaviors. According to DSM-IV, “the essential feature of borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects” (p. 650). This pervasive pattern of instability also applies to behaviors that are impulsive and potentially damaging, including excessive spending, sexual promiscuity, reckless driving, binge eating, and substance misuse.

November 01, 2006

Coping with the issue of drug-drug interactions (DDIs) is one of the most challenging aspects of modern psychopharmacology. Psychiatrists are treating patients with medication regimens of ever-increasing complexity.

November 01, 2006

Older adults have higher rates of suicide than younger adults in many industrialized nations.

November 01, 2006

By now, many clinical researchers and practitioners recognize the strong association between cognitive impairment and type 2 diabetes, which, in its early stages, is characterized by hyperinsulinemia and insulin resistance. Although this relationship has not been observed uniformly, more than 20 large-scale epidemiologic studies have reported a link between type 2 diabetes and in creased risk of cognitive impairment and dementia, including Alzheimer disease (AD), the most common type of dementia.

November 01, 2006

The emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).

November 01, 2006

Alzheimer dementia (AD) represents a profound global health concern. By the year 2050, the prevalence of AD in the United States is expected to reach 15 million. At present, there are 4.5 million cases in the United States, which equals an estimated cost of $100 billion each year in medical and family expenses.

November 01, 2006

Initial studies-such as the stepped collaborative care intervention, Texas Medication Algorithm Project (TMAP), and German Algorithm Project (GAP) phase 2-predominantly investigated whether following an expert opinion–based clinical algorithm (irrespective of the content of the algorithm) led to a better outcome than treatment as usual did

November 01, 2006

Many physicians, including psychiatrists, may shy away from seeing elderly patients with symptoms of dementia because they imagine that there are a large number of alternative diagnoses and that differential diagnosis is complicated. In fact, however, the number of possible diagnoses in most situations is relatively small and the diagnosis of dementia in older patients is certainly feasible in primary care psychiatry.

November 01, 2006

Office management of attention-deficit/hyperactivity disorder (ADHD) differs in many important ways from ADHD management conducted in a research environment. In clinical trials, treatments and eligible patients are selected in advance by committees, patients are randomized to different management strategies, and both clinicians and pa tients are blinded to the treatments.

November 01, 2006

In this essay, however, I wish to use another source of data about callings my personal experience of a calling to medicine and, later, to psychiatry.

November 01, 2006

Just how “hot” is the topic of conflict of interest in psychiatry? The answer was brought home to me dramatically this past May at the APA meeting in Toronto. During the meeting, I had the opportunity to chair a symposium titled “Pharmaceutical Industry Influence in Psychiatry.” My copresenters and I showed up well ahead of time to meet and prepare introductions. As we gazed out at the empty seats, we joked that there would be at least 5 people in attendance since, after all, there were 5 presenters.

November 01, 2006

For patients with psychiatric illnesses, the treatment team today often consists of a psychotherapist, psychiatrist, and/or primary care physician-all of whom are motivated to achieve the same goals. These include full remission of symptoms; improvement and restoration of function, quality of life, and relationships; and the delay and preferably prevention of recurrence of symptoms.