News

The field of psychopharmacology is evolving rapidly. New research and medications appear, and practice changes. This book was up-to-date when it went to press; however, it does not include the most recent findings from the CATIE, STAR*D study, and CATIE-AD study. There is no mention of paliperidone, intramuscular aripiprazole, selegiline transdermal system, varenicline, or depot inject- able naltrexone. One wonders whether books are becoming obsolete as a medium for communicating the state of the art.

The FDA has approved less restrictive labeling for the catechol-O-methyltransferase inhibitor tolcapone (Tasmar). The agent has been useful in increasing "on" time in patients with Parkinson disease (PD) when used as an adjunct to levodopa/ carbidopa therapy. Tolcapone has been subject to restrictive labeling because 3 reports of fulminant hepatic failure, resulting in death, were traced to its use.

The FDA has approved less restrictive labeling for the catechol-O-methyltransferase inhibitor tolcapone (Tasmar). The agent has been useful in increasing “on” time in patients with Parkinson disease (PD) when used as an adjunct to levodopa/ carbidopa therapy. Tolcapone has been subject to restrictive labeling because 3 reports of fulminant hepatic failure, resulting in death, were traced to its use.

AC-1202 Improves Cognition in APOE*E4-Negative Patients with AD. A medium chain triglyceride that converts to ketone bodies and counteracts reduced glucose metabolism improves cognitive scores in patients with mild to moderate Alzheimer disease (AD) who do not have the e4 allele of the apolipoprotein E (APOE*E4) gene.

Intensive Melodic Intonation Therapy (MIT) results in significant gains in speech production, and functional improvements are matched by longlasting neural changes, according to research by a team led by Gottfried Schlaug, MD, PhD, associate professor of neurology at Harvard Medical School and director of neuroimaging at Beth Israel Deaconess Medical Center in Boston.

Intensive melodic intonation therapy (MIT) results in significant gains in speech production, and functional improvements are matched by long-lasting neural changes, according to research by a team led by Gottfried Schlaug, MD, PhD, associate professor of neurology at Harvard Medical School and director of neuroimaging at Beth Israel Deaconess Medical Center in Boston.

In what was billed as the first randomized controlled study to simultaneously evaluate antidepressant therapy and short-term psychotherapy for depressed patients with coronary artery disease (CAD), treatment with an SSRI led to significant improvement, while addition of interpersonal psychotherapy provided no added benefit.

Patients with severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to have experienced trauma in childhood, adolescence, and throughout their adult lives than the general population. This high exposure to traumatic events such as physical and sexual abuse and assault takes a heavy toll.

Traumatic experiences are linked with a continuum of mental disorders and physical complaints. In the United States, posttraumatic stress disorder (PTSD) occurs in approximately 8% of adults during their lifetime, with different trauma types associated with varying rates of illness. PTSD is commonly associated with comorbid mental conditions such as depressive disorders, other anxiety disorders, impulse control disorders, and alcohol abuse.

The traumatic events surrounding the recent school shootings at Virginia Tech remind us that a disturbing aspect of our current culture is the rate at which America's youth are exposed to violence. Whether it is graphic episodes of violence on television, violent music, aggressive video games, hearing about or witnessing violence in the home or neighborhood, or being the direct victim of violence--violence is a pervasive part of society that disproportionately affects youth.

Rape is a crime that is defined as an unwanted sexual act that results in oral, vaginal, or anal penetration. Generally speaking, there are 2 major types of rape. Forcible rape involves unwanted sexual penetration obtained by the use of force or threat of force. Drug- or alcohol-facilitated rape occurs when the victim is passed out or highly intoxicated because of voluntary or involuntary consumption of alcohol or drugs. Rape can happen to boys and men as well as to girls and women but this article will focus primarily on women.

The addition of an antidepressant to a mood stabilizer did not add any benefit for patients with bipolar depression, according to an NIMH-sponsored research project reported in April in the New England Journal of Medicine. In the multicenter study, adding an antidepressant to the regimen also did not increase affective switching to mania.

Methamphetamine (MA) abuse is not a new problem in the United States, but the current epidemic is more widespread and presents with more pernicious consequences than in the past. MA, frequently called "speed," "crystal," "crank," "ice," or "tina," is a potent psychostimulant that can be swallowed in pill form or administered via intranasal, intravenous, or smoking route.

Up Against the Wall

A major physical illness or procedure, such as a myocardial infarction (MI), a transplant operation, or a life-threatening attack of asthma, can be emotionally traumatic,1,2 but the study of posttraumatic reactions in the medically ill is relatively new. Only in the past 2 decades or so it has been recognized that, in fact, medical illness and its treatment can be traumatic, and only since the publication of DSM-IV in 1994 has medical illness been included as a potentially traumatic event that may lead to the development of posttraumatic symptoms.

Grand mal convulsive seizures are characterized by the sudden loss of consciousness and motor inhibition, followed by tonic flexion and extension, repetitive clonic movements, and motor relaxation and lassitude. Seizures are elicited in all vertebrates that have been tested. The loss of both vigilance and the defenses of fight or flight incur life-threatening risks to the individual. In evolutionary history, we would expect this behavior to be extinguished. Its persistence prompts the query: What are the benefits of seizures?

He was young, schizoid, and had experienced brief periods of psychotic-like disorganization. We worked together in psychotherapy for many years. None of the then available psychotropic agents were helpful. He believed, however, that marijuana was helpful, and, if he smoked a joint in the hours preceding a session, his way of relating to me was different. He was less "there," more deeply into himself. His descriptions of the marijuana experience never varied. "I am," he would say, "at peace. I feel connected to everything. I am part of the universe, part of nature, part of God." He was, I thought, a person with significant ego boundary problems who, for the most part, maintained his basic sense of self by distancing himself from both the world and inner turmoil. Marijuana appeared to lead to the internal experience of greater connectedness and peace, although I felt he was less available to me after using it.

NSAIDs have long been considered first-line treatments for a variety of pain conditions--most notably, musculoskeletal pain. Many NSAIDs are available in over-the-counter preparations, so they are inexpensive and, for better or worse, can be obtained without consulting physicians or health care professionals. For most patients, these drugs were considered safe, except in those who are at risk for GI bleeding or who have renal dysfunction. The most common adverse effect associated with NSAID use is GI distress.

After wading through the initial shock and horror of the murder of 32 students and faculty at Virginia Tech on April 16 by student Seung-Hui Cho, there is a natural impulse to rush to enact laws to prevent this type of tragic event from ever happening again in our schools. As professionals, as parents, as concerned members of a community, we have a felt need for an immediate response to ensure that schools are safe and secure places to learn and grow. Action is demanded. Not only must this opportunity/obligation not be squandered, but we must make sure that by our actions we do not make things worse.

children, Psychotherapy

Dr Penelope Ziegler's article was correct in the assertion that treating pain in a patient with a substance use disorder can be very difficult and requires consideration of multiple factors ("Safe Treatment of Pain in the Patient With a Substance Use Disorder," Psychiatric Times, January 2007, page 32); however, I believe several topics discussed require further clarification.

Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after severe psychological stress, eg, assault, combat, natural disasters, terrorism, or other stressors.

Four physicians work on the same patient for days at a time, continually returning to a white board, where they list the patient's changing symptoms and their own differential diagnoses. They think inside and outside the box. As data come in from tests and as interventions succeed or fail, they remain flexible in their way of thinking. The attending physician's main lesson to his 3 fellows is to remain unencumbered by preconceived notions and to constantly revise their thinking to fit the data. Only then, he tells his trainees, is there any chance of a correct diagnosis and medical treatment.

Delirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. Approximately 15% of elderly patients admitted to the hospital have delirium as a presenting or associated symptom. Delirium will develop in another 15% of elderly patients during hospitalization.

In the aftermath of the tragic events at Virginia Tech, we would like to suggest some ways in which psychiatrists, psychologists, and college personnel can help identify and treat students who have severe psychiatric disorders--and perhaps prevent another mass murder.

One of the most hotly debated questions within oncology over the past decade has been whether the promotion of psychological wellness can extend survival for patients with advanced cancer. The converse--that psychiatric disorder shortens survival--seems true, with mechanisms of poor self-care and reduced adherence to anticancer treatments resultant from depressive or psychotic disorders explaining this outcome.

It is a widely known fact that Fyodor Dostoevsky, the famous 19th-century Russian novelist, suffered from epilepsy for most of his life. However, not too many persons are aware that Dostoevsky also had a sleep disorder called delayed sleep phase syndrome, which may have contributed to his seizures.1 Although no one knows for certain, it is quite conceivable that Dostoevsky's sleep disorder worsened his epilepsy, according to Carl Bazil, MD, PhD, director of Clinical Anticonvulsant Drug Trials and director of the Neurology Division, Columbia Comprehensive Sleep Center, Columbia University, New York.

Diabetic polyneuropathy (DPN) has a major impact on quality of life and can contribute to significant morbidity and mortality. In the United Kingdom, the prevalence of distal symmetrical polyneuropathy, as seen in specialty care, is about 28.5%, and prevalence increases with age.

A 5-month-old girl was brought to her local emergency department because she displayed increasing fussiness and back arching for 3 days. She vomited once and was febrile on the day of presentation. Meningitis was suspected. A lumbar puncture was performed. It revealed a cerebrospinal fluid (CSF) protein level of 120 mg/dL and a CSF white blood cell count of 10/µL, with 50% polymorphonuclear cells. Antibiotics were empirically administered, and the infant was transferred to a tertiary care facility for further treatment.

To kick-start his presentation on reversal of coagulopathy during a symposium at the International Stroke Conference (ISC) that took place in San Francisco in early February, J. Claude Hemphill III, MD, professor of neurology at the University of California, San Francisco, displayed a CT scan illustrating a modest intracerebral bleed in the brain of a 64-year-old woman who had been taking warfarin for the treatment of atrial fibrillation. Hemphill noted that standard care, including administration of vitamin K and fresh frozen plasma (FFP), was given.