FDA Approval of Vagus Nerve Stimulation I am a triple-boarded, long-practicing psychiatrist and have used vagus nerve stimulation (VNS) in several patients so far. I have followed the controversies within the FDA and articles in the national media and was quite impressed by and appreciative of Dr Daniel J. Carlat's article on the sponsorship issues involved in FDA approval of VNS ("Conflict of Interest in Psychiatry: How Much Disclosure Is Necessary?"
Chaput YJA, Lebel MJ. Demographic and clinical profiles of patients who make multiple visits to psychiatric emergency services. Psychiatr Serv. 2007;58:335-341.
The reason that antipsychotic medications cause weight gain is that there is increased activity of the enzyme AMP-kinase in the hypothalamus, the area of the brain that controls hunger. The increase in AMP-kinase levels occurs because antipsychotic medications interfere with the protein histamine. For some time it has been suspected that histamine plays a significant role in weight control, and these findings, from a study conducted in mice by scientists at Johns Hopkins University, confirm this. The researchers hope that these findings will contribute to the development of a new class of effective antipsychotics that do not cause weight gain.
González-Pinto A, Aldama A, González C, et al. Predictors of suicide in first-episode affective and nonaffective psychotic inpatients: five-year follow-up of patients from a catchment area in Vitoria, Spain. J Clin Psychiatry. 2007;68:242-247.
Fliege H, Grimm A, Eckhardt-Henn A, et al. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics. 2007;48:60-64.
HUMAN RECEPTOR ACTIVITY-MODIFYING PROTEIN-1(hRAMP1) may be the switch that turns up the volumeof calcitonin gene-related peptide (CGRP)expression in migraine, according to researchersfrom the University of Iowa in Iowa City.
An analysis of data on nearly 104,000 veterans of the Afghanistan and Iraq wars who sought help from the Department of Veterans Affairs (VA) system confirms that substantial numbers returned from their tour of duty with psychiatric problems.
In the first part of this column (Psychiatric Times, February 2007), I reviewed treatments whose beneficial effects are probably achieved through a discrete biological or pharmacological mechanism of action. These included dietary modifications; supplementation with specific vitamins, minerals, and amino acids; and medicinal herbs. In this part, I will review the evidence for approaches that reduce the risk of relapse, diminish craving, or mitigate withdrawal symptoms but for which there is no evidence for direct biological or pharmacological effect.
Psychiatrists know that it takes longer to interview children and adolescents than adults. Child and adolescent psychiatrists are universally struck by how comparatively easy it is to interview an adult patient, whereas general psychiatrists face the evaluation of a child or adolescent with apprehension.
A complex and heterogeneous condition characterized by a variety of symptoms and marked variability in disease course, bipolar disorder is marked by episodes of depression, hypomania, mania, or psychosis and,patients can experience a mixture of emotional states.
Asthma is one of the most impairing diseases of childhood, affecting more than 6% of children. Each year, it is responsible for 14 million lost school days and $3 billion in treatment costs.
Making the Connection: A Parent's Guide to Medication in AD/HD is a concise, user-friendly book intended for parents of children with attention-deficit/hyperactivity disorder (ADHD).
It begins with a simple request: a patient asks for help in taking time off from work, obtaining disability payments, or seeking other compensation for his or her diagnosis of posttraumatic stress disorder. The requests may come from patients you have been seeing for long periods or from new patients who are sometimes referred by their attorneys.
According to the CDC, in 2004, suicide was the 11th leading cause of death across all age groups and the 10th leading cause of death for persons aged 14 to 64 years; 32,439 people in the United States took their own lives. Women attempt suicide about 3 times more often than men, although men are 4 times as likely to complete suicide. Anderson and Smith3 reported that suicide was the eighth leading cause of death among men in 2001. Of the 24,672 completed suicides among men, 60% involved the use of a firearm (the use of a firearm was the means of suicide in 55% of all cases).
There were only 3 Jewish students in my high school, and I was one of them. In the small, western New York town where I grew up, most people were tolerant. But a small clique of anti-Semites made life tough for us Jewish kids. Most of the time, we just shrugged off the jokes and insults or came right back at these louts with a snappy retort. Sometimes, the bigotry grew more menacing.
A 79-year-old woman recently died in a fire at her Washington, DC, row house when "pack rat conditions" prevented firefighters from reaching her in time. A few days later, 47 firefighters from 4 cities spent 2 hours fighting a fire in a Southern California home before they were able to bring it under control. Floor-to-ceiling clutter had made it nearly impossible for them to enter the house.
"There must be some way out of here," said the joker to the thief."There's too much confusion, I can't get no relief. . . .""No reason to get excited," the thief, he kindly spoke,"There are many here among us who feel that life is but a joke.But you and I, we've been through that, and this is not our fate,So let us not talk falsely now, the hour is getting late."From "All Along the Watchtower," Bob Dylan
Worsening anxiety is a common symptom that may result in psychiatric consultation or evaluation in an emergency setting. Aneurysms are rarely considered in the medical differential for anxiety disorders, and the available literature and research regarding this possible connection are very limited. Overlooking this diagnosis, however, can have disastrous consequences. Here we present 2 case reports as well as a review of the literature regarding a possible relationship between aortic and thoracic aneurysms and psychiatric symptoms.
In The Perfect Storm, Sebastian Junger describes the desperate plight of sailors and fisherman who, in the fall of 1991, were caught out in the Atlantic Ocean as 2 powerful storms converged into 1.1 Like those mariners, emergency department (ED) clinicians find themselves at the confluence of 2 powerful trends in modern society.
The following cases highlight some of the challenges clinicians face when treating patients in whom malingerling is suspected. One key aspect of these evaluations is not overlooking signs or symptoms that point to serious illness.
Recurrent stroke is an important health concern not only from a patient perspective but also from clinical and public health standpoints. Many studies have shown that the risk of a second cerebral infarction is greatest immediately following the primary event. Consequently, clinical management of stroke survivors is focused on preventive therapy to minimize risk.
Statins, alone or in combination with other agents, promote angiogenesis and significantly enhance neuroregeneration in the aftermath of brain injury, including stroke, according to Michael Chopp, PhD, professor and vice chair of the Department of Neurology at Henry Ford Health Sciences Center in Detroit.
Corticospinal tract (CST) integrity may predict the potential for clinical improvement in chronic stroke patients, according to a recent study. Winston Byblow, MSc, PhD, associate professor and director of the Movement Neuroscience Laboratory in the Department of Sport & Exercise Science at the University of Auckland, Australia, and colleagues used transcranial magnetic stimulation (TMS) and MRI to determine factors that predict functional improvement in a patient's upper limbs.1 In patients with motor-evoked responses (MEPs) to TMS, researchers found that meaningful gains were still possible 3 years after stroke, although the capacity for improvement declined with time. The researchers also created an algorithm to predict functional potential for upper limb recovery in this patient population.
Hyperglycemia is a risk factor for stroke and augurs a poor outcome in the aftermath of stroke; however, treating patients with post-stroke hyperglycemia (PSH) with infusions of glucose, potassium, and insulin (GKI) to achieve euglycemia does not provide a survival benefit.
aytime sleepiness is common in patients with parkinsonism but has little to do with the amount of sleep these patients get and everything to do with dopaminergic dysfunction, according to David B. Rye, MD, PhD, associate professor of neurology at Emory University in Atlanta. "The idea is that if I sleep a lot, I shouldn't be so sleepy the next day, and if I sleep little, I should be very sleepy. This is doesn't hold true for patients with Parkinson disease [PD]. The loss of dopamine disrupts that banking system, or the sleep-wake homeostat," he said during a presentation at the 9th annual meeting of the American Society for Experimental Therapeutics, which met March 8 to 10 in Washington, DC. Addressing dopa- minergic tone during sleep might help ameliorate daytime symptoms of parkinsonism in general.
Intensive therapy over short periods provides better outcomes than less intensive regimens performed over longer periods." This was the take-home message about rehabilitation for patients with aphasia from Ronald M. Lazar, PhD, professor of clinical neuropsychology in neurology and neurological surgery, and codirector of the Levine Cerebral Localization Laboratory at the Neurological Institute of New York at Columbia University College of Physicians and Surgeons.
Novel approaches for the evaluation and symptomatic treatment of Huntington disease (HD) were presented at the 59th Annual Meeting of the American Academy of Neurology held April 29 to May 5 in Boston. Interventions included use of tetrabenazine (TBZ) (as yet unapproved for the symptomatic treatment of hyperkinetic movement disorders in the United States but granted orphan drug status in 2004) and deep brain stimulation (DBS) of the globus pallidus externus (GPe).
Chronic primary daily headache may not be a singular disorder but rather one with various subtypes. Chronic migraine (also referred to as evolved migraine or transformed migraine), chronic tension-type headache, newly defined daily persistent headache, hemicrania continua, and post-traumatic headache are now recognized as subcategories of chronic daily headache
Migraine has been shown to cause absenteeism and lower productivity at work as well as reduced quality of life.1 According to the US Headache Consortium Guidelines, migraineurs with severe or moderate attacks should be treated with specific antimigraine medications, and prevention is recommended in those with frequent headaches as well as attacks that remain disabling despite optimal acute treatment.
When a new patient with depression enters your practice, you face a diagnostic dilemma. If you miss bipolar disorder (BD), and prescribe an antidepressant, you can do harm. But if you call a unipolar depression "bipolar," you may also do harm, because lithium, anticonvulsants, and atypical antipsychotics carry significant risk as both short- and long-term treatments. In addition, the label of "BD" currently carries much more stigma than the term "depression."