Psychiatric Times Vol 24 No 10

Impulse control disorders are common psychiatric conditions in which affected individuals typically report significant impairment in social and occupational functioning, and may incur legal and financial difficulties as well.

Major depression is at once simple and complex. At one level, the treatment of this disorder is straightforward. Yet, at a multitude of other levels, it is a complex condition for which available treatments remain suboptimal.

The Substance Abuse Handbook offers a comprehensive, clinically oriented approach to the treatment of addictive disorders. It contains a wealth of useful information, ranging from causes of addiction to different modes of treatment.

If clinical trials data are any indication, the potential impact of placebo treatment on depression outcomes may be potent. Placebo response rates in clinical trials for depression average approximately 30%, with a top range beyond 50%-and the trend is upward.

Mood disorders are among the most prevalent forms of mental illness. Serious depression is especially common; based on a face-to-face survey conducted from December 2001 to December 2002, the past-year prevalence rate of clinically significant major depressive disorder (MDD) was estimated to be 6.6%, affecting at least 13.1 to 14.2 million Americans.

Integrated psychological treatment (IPT)--which was developed by a research group in Bern, Switzerland, for patients with schizophrenia--is a distinctive and practical approach to rehabilitation.

Mood disorders are common in women and typically emerge during the childbearing years. While pregnancy has traditionally been considered a time of emotional well- being, recent data indicate that about 10% to 15% of women experience clinically significant depressive symptoms during pregnancy.

In this article, we use the example of major depressive disorder (MDD) to review research efforts to identify predictors of treatment response, both to antidepressant medications and to psychotherapy. We describe the promises and limitations of this research, with some emphasis on brain imaging studies, and then discuss how this work may be integrated into clinical practice in the future.

In lecturing to medical students, residents, and psychiatrists during the past several years, we have encountered widespread hesitancy in the use of MAOIs and even TCAs, mainly because of concerns about their safety but also because of doubts about their effectiveness compared with newer alternatives. Thus, it is timely to review the literature on the efficacy and safety of TCAs and MAOIs, with a view to maintaining an appropriate place for these 2 drug classes in the pharmacotherapy of depression.

Adherence, in a medical context, refers to the degree to which a patient follows the treatment plan that has been agreed on between the prescriber (usually, but not always, a physician) and the patient.

Although cognitive therapy (CT) is the best-studied form of psychotherapy, its effectivenes compared with antidepressant medication remains controversial. Over the years, there has been some variability in the results of randomized controlled trials and other types of clinical trials, as well as meta-analyses.

Poetry of the Times

Treatment resistance occurs in a variety of psychiatric disorders and presents an ongoing challenge as we attempt to optimize treatments for our patients.

A House committee's passage of a mental health parity bill on July 18 seems to put the House on a collision course with the Senate, raising the possibility that Congress once again will fail to improve on the 1996 law that requires employers already offering mental health benefits to ensure limited parity with physical health benefits.

What factors affect a decision by Medicare beneficiaries to stop taking a medication because they cannot afford it? Dr Kara Zivin Bambauer and colleagues found that depressive symptoms were a significant predictor of cost-related medication nonadherence (CRN) in Medicare beneficiaries. The results of their study were published in the May 2007 issue of Archives of General Psychiatry. The researchers integrated measures of CRN into the 2004 Medicare Current Beneficiary Survey; 2321 nonelderly Medicare beneficiaries with disabilities and 11,514 elderly Medicare beneficiaries were included.

Book Review

Book Review

Of the 7 "deadly" sins that are committed by humans, envy is primarily directed toward the destruction of an external object. Over the centuries, this unfortunate emotion has been the subject of inquiry by many disciplines (philosophy, religion, sociology, fiction, and so on).

Major depressive disorder (MDD) affects a large proportion of the world's population, but much still needs to be done to categorically improve the lives of people with this condition.

One day in 1946 while I was making neurology rounds, a crumpled piece of humanity was wheeled into the ward. When "Ora" came to the hospital for her annual epilepsy checkup, she had not been able to walk for more than a year.

Whether or not sexual offending behavior-or the predisposition to such-is a mental illness, there are patients with traditional mental illnesses who also present with sexually inappropriate and even sexual offending behavior.

New formulations of several opioids were introduced during the past year. This month's column reviews current recommendations for the use of these medications and how they compare with previously available opioids.

Response to Dr Wagner's Methylphenidate Treatment of ADHD in Preschoolers".

Obsessive-compulsive disorder (OCD) is a heterogeneous disorder with a variety of phenotypic expressions. Delineation of clinically distinct subtypes of the disorder may be valuable in predicting treatment response and resistance.

In this article, we discuss recent advances in drug transporters and nutrient-transporter interactions that can impact drug bioavailability in the systemic circulation and the brain. We also present emerging research strategies that may facilitate the discovery and clinical development of predictive diagnostic tests to identify patients at risk for treatment resistance.

John Medina's column, "Chronic Fatigue Syndrome-A Lesson in Big Science", focuses on recent research by the CDC on the genetic aspects of chronic fatigue syndrome (CFS) as reported in Pharmacogenetics and Nature.

There is no disputing that the rapidly escalating rate of incarceration during the past decade in the United States has been associated with an increasing number of imprisoned individuals with a mental illness. Research indicates that as many as 20% of inmates in jail or prison are in need of psychiatric care, frequently because of a serious mental disorder.

Treatment-resistant unipolar major depression appears to be the rule rather than the exception. This view is supported by data from the STAR*D program, a multilevel treatment trial for major depression.

Like medicine in general, psychiatry and psychotherapy have long focused on relieving illness and pain. Traditional psychotherapeutic approaches have often emphasized examination and understanding of painful experiences as a route toward obtaining relief from suffering.

Book Review