News

This is the second installment in a 3-part series that discusses some of the mechanisms behind functional magnetic resonance imaging (fMRI) technology. As you may recall, the genesis for this series was reactive…I got mad while sitting on an airplane reading a magazine article about how fMRIs can predict everything from product preferences to political inclination. The article hinted at something I have been noticing with increasing alarm-the confusion about what fMRI can and cannot reveal about information processing in the brain. I decided to write this series hoping that knowledge of the basic science behind fMRI technology could contribute to making more nuanced conclusions about the data it reveals.

Research emerging from the field of emotion science suggests that individuals who have anxiety and mood disorders tend to experience negative affect more frequently and more intensely than do healthy individuals, and they tend to view these experiences as more aversive, representing a common diathesis across anxiety and mood disorders.1-5 Deficits in the ability to regulate emotional experiences, resulting from unsuccessful efforts to avoid or dampen the intensity of uncomfortable emotions, have also been found across the emotional disorders and are a key target for therapeutic change.

We have already gone past the midway point of the time allotted for the preparation of DSM-V. I realized that not enough has been accomplished and that most of what is being suggested is headed in a very wrong direction. Particularly troubling is the almost total lack of recognition that changes in an official manual of diagnosis can have devastating unintended consequences. Before it is too late, I feel a responsibility to help DSM-V avoid mistakes by sharing the lessons learned during the past 30 years working on the 3 previous revisions of the DSM. Perhaps my comments may help the DSM-V Task Force avoid some of the hidden landmines I think they are dancing around.

We should begin with full disclosure. As head of the DSM-IV Task Force, I established strict guidelines to ensure that changes from DSM-III-R to DSM-IV would be few and well supported by empirical data. Please keep this history in mind as you read my numerous criticisms of the current DSM-V process. It is reasonable for you to wonder whether I have an inherently conservative bias or am protecting my own DSM-IV baby. I feel sure that I am identifying grave problems in the DSM-V goals, methods, and products, but it is for the reader to judge my objectivity.

Two randomized controlled trials have shown the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program to be effective in reducing the intensity of core aspects of borderline personality disorder (BPD), Dr Donald Black and social worker Nancee Blum announced at the annual meeting of the American Psychiatric Association held recently in San Francisco. Black summarized, “Data from several studies show that STEPPS reduced global severity as rated by clinicians and patients, borderline personality disorder symptoms, and depressive symptoms.”

The fear of death has been hardwired into all of us, but therapists can help patients with death anxiety by providing powerful ideas along with a powerful human connection, said Irvin D. Yalom, MD,1 professor emeritus of psychiatry at the Stanford University School of Medicine, California. He is the author of a number of books on existentialism and psychotherapy, and most recently has written Staring at the Sun: Overcoming the Terror of Death.

Transcranial magnetic stimulation produced improvements in key areas of cognition and in short-term verbal memory in patients with major depressive disorder, and no adverse cognitive effects were shown. The results of this research were presented by Mark Demitrack, MD, vice president and chief medical officer of Neuronetics, Inc, and colleagues at the annual meeting of the American Psychiatric Association in May.

Researchers have found an association between electronic media exposure and the onset of depression in young adults, especially in males.

Low-income mothers with pre-pregnancy or gestational diabetes have a higher risk of experiencing depression during the perinatal and postnatal periods than women without diabete, according to a researchers.

Second-generation (atypical) antipsychotic drugs may not have an advantage for cardiovascular risk over typical antipsychotics, according to a recent, large retrospective cohort study. Researchers at the Vanderbilt University School of Medicine in Tennessee found that risk of sudden cardiac death is heightened with antipsychotics, whether typical or atypical, and the risk increases significantly with increasing doses.

Mortality in elderly patients with dementia markedly and progressively increases with extended use of antipsychotics, according to the first long-term controlled study of risk in this population. Earlier evidence of this risk was from short-term trials not exceeding 14 weeks.

Because “the prescribing process is complex, and automating the process is equally complex,” the AMA has designed an online electronic prescribing (ePrescribing) learning center to encourage physicians and to simplify the confusion posed by ePrescribing.1 The center offers a range of services to bring physicians up to speed and in compliance with the recently passed Medicare Improvements for Patients and Providers Act of 2008.

The epidemiology and management of psychiatric disability have gained increased attention for a variety of reasons in the past 3 decades. There are issues of empowerment, advocacy, and reduction of stigma. There are also concerns about cost containment as well as reliability, validity, and efficacy of the determination process.

Although depressive and anxiety disorders are classified as distinct groups of illnesses, studies document their frequent co-occurrence and provide evidence of a common biological substrate and a shared vulnerability.

Fewer than a handful of books have been published on the ethical dimensions and challenges in treating and helping persons living with an addiction. Therefore, this book is a welcome contribution to the literature almost from the start. The contributors in this 9-chapter text range from community- and hospital-based professionals to behavioral program directors to ethics center directors and researchers to psychology, neurology, and psychiatry professors and fellows. The book aims to provide general advice on central issues encountered routinely by those experienced in addiction services and research. Contrary to the book’s rather biblical and authoritative title, the editors “offer this work modestly,” given the relative newness of focused ethical analysis in addiction treatment and care.

An array of military-related presentations were given at this year’s American Psychiatric Association (APA) conference, addressing the rise of psychiatric issues in returning veterans and their families.

A new study recently posted online by researchers at Kaiser Permanente in Oakland, Calif, offers prospective parents one more reason to worry. The study showed that pregnant women who have symptoms of depression are at increased risk for giving birth prematurely.1

Attention-deficit/hyperactivity disorder (ADHD) is one of the most widely diagnosed disorders: an estimated 8% to 12% of children are affected worldwide. Although many studies about treatment options have been published, the genetic components that underlie the disorder are still being discovered. A special issue of the American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics, highlights recent research and includes results from the first genome-wide study of patients with ADHD. Genome-wide studies have successfully identified variants associated with obesity and such diseases as age-related macular degeneration, diabetes, and prostate cancer.

In response to the resolution made in 2008 by the US Congress that proclaimed May to be borderline personality disorder (BPD) awareness month, the American Psychiatric Association (APA) decided to make BPD a key track of this year’s meeting. Among the several excellent presentations on BPD was Dr John G. Gunderson’s lecture on the ontogeny of the disorder. Having spent the past 30+ years studying BPD, both as a researcher and a clinician, Dr Gunderson of McLean Hospital of Harvard Medical School is an expert on the history of BPD.

Der Spiegel has anointed Fatih Akin the new face of the German film industry. Of Turkish descent, Akin has no interest in the ghosts of Germany’s past or in facing history through films such as The Reader-which still attract large audiences and Oscar nominations in America. Akin finds his inspiration in the new Europe and in the lives of people like himself who are the rising generation of Europe’s immigrants.

who remarked that the problem with most new books he reads these days is that there is “too much space between the covers.” After all, he queried rhetorically, “Do I really need more than 250 pages or so on any one subject?” Days before this conversation, I had accepted an invitation to write a review of Psychotherapy Supervision and had received the 632-page tome by mail.

In “Changes in Psychiatric Diagnosis” (Psychiatric Times, November 2008, page 14) Michael First relates the sad fact that the reorganization of DSM is still without formal guidelines and continues to be subject to the vicissitudes of groupthink and vocal constituencies. He relates that he and Allen Frances envisioned the application of biologically based diagnostic criteria when summarizing the work of DSM-IV, but complains that no criteria are forthcoming as yet.

I first met 22-year-old “Linda” when she was brought to the emergency department (ED) after a drug overdose. Although the drug Linda had ingested-clonazepam-was a CNS depressant, she did not appear groggy or sedated. In fact, her speech was rapid and pressured; she showed marked psychomotor agitation, which was demonstrated by her twitching feet and the incessant twisting of her hair. This presentation suggested a paradoxical response to her medication. Her chief concern was, “I feel as if I am going to come out of my skin.” I was puzzled.

Every August, during my lakefront vacation, I kayak to the middle of Otter Pond, lay the paddle across my knees, and drink in the tranquil scene around me. Sunshine glints hypnotically off the rippling water. Every muscle relaxes, my cares recede. But this past summer, my annual reverie was interrupted by the shriek of a young child. “Let me out, let me out!” he cried, teetering halfway out of a passing paddleboat. “I want to swim back to the house!”

From time to time, health conditions emerge that are relative “orphans” when it comes to having the resources of a health care discipline or subspecialty to take ownership or accept responsibility for developing the body of knowledge that underlies their systematic evaluation and treatment. Female sexual dysfunction (FSD) is such a class of conditions.

The study and treatment of human sexual problems should fall under the purview of clinical psychiatry. Sexual behavior is an important factor in most of our patients’ lives and may help define their sense of competence and serve as a force leading to interpersonal bonding

Because of recent scandals, pedophilia is one of the few psychiatric disorders widely known to the general public.

The foreword to the Textbook of Vio­lence Assessment and Management promptly reminds readers that the mental health system has been invested in the prediction and prevention of violence since its inception. In a field dedicated to promoting wellness via the management of cognition, emotion, and behavior, violent thoughts, feelings, and actions are of primary concern. When psychiatric illness or psychological distress manifests as violence, the costs in terms of human suffering are extreme, wreaking havoc in the lives of patients, clinicians, and society at large-often with irrevers­ible consequences.

Psychiatry is eminently corruptible. Soviet psychiatrists of the 1950s disgracefully organized themselves into the medical arm of the Gulag state. Political dissidence became prima facie evidence of impaired reality testing, of “sluggish schizophrenia.” We like to believe in the benefits of scientific progress, but for Soviet inmates, progress was prefixed with a minus sign; every apparent advance in psychiatric technology left them more tightly controlled and worse off.

Whether you credit the idea to Niels Bohr or Yogi Berra, it is true that predictions are very difficult to make, especially about the future. It is a daunting task, yet obviously an intriguing one, to try to imagine what our field will be like in 10 years or more.