Polypharmacy is used increasingly in the treatment of depression.1 Although it can be beneficial-and at times may even be unavoidable-it can also be overused, resulting in drug-drug interactions, accumulation of adverse effects, reduced treatment adherence, and unnecessary increases in the cost of health care.2 This article describes current trends in psychiatric polypharmacy in the treatment of depression along with ways to use polypharmacy to optimize treatment outcomes.
Cynthia Geppert has done it again! She has written a timely article that expresses what I have thought for a long time (“Why Psychiatrists Should Read the Humanities,” Psychiatric Times, February 2008, page 10). Recently, I was sitting in a nonscience course for first-year medical students wondering why it was difficult for some of them to respond to the professor’s questions.
This review provides an overview of the efficacy, safety, and mechanisms of action in the treatment of depression.
While tremendous therapeutic advancements have been made, patients with rheumatoid arthritis (RA) have a myriad of comorbidities, including fatigue, depression, and sleep disturbances. Data on the comorbidity of psychiatric disorders with arthritis are also striking: according to the NIMH Catchment Area program, the lifetime prevalence of psychiatric disorders among patients with RA is 63%.
When I started out in medicine,before I married and beforeI had written a single poem,I read your poetry like a hiker
Drugs approved by the FDA just before mandated deadlines are more likely to have safety issues after entering the market than those approved at other times, according to a study in the March 27 New England Journal of Medicine.1 Coincidentally, on that date, the FDA announced the first group of marketed medications, including the atypical antipsychotic clozapine (Clozaril), for which it is requiring additional safety plans under the FDA Amendments Act of 2007.
Congress will undoubtedly set aside, one more time, a scheduled, drastic cut in Medicare fees for psychiatrists and all other physicians sometime this summer based on action in Congress before its Fourth of July recess. The House and Senate almost agreed to replace the 10.6% cut in fees scheduled for July 1 with a 1.1% increase through the end of 2009. But various political difficulties interceded, and the Bush administration stepped in and ordered a 10-day halt to any fee cuts until Congress returned to Washington.
The estimated number of patients with cancer in this country is 10.5 million. Close to a million and a half are new cases, and it is estimated that 560,000 people die of cancer each year.1 There is clearly a large group of cancer patients and their families at high risk for serious psychiatric illness. In this article, I focus on the advantages of a psychodynamic approach and address how this approach is helpful in the liaison function and psychotherapy of cancer patients and their partners.
The Supreme Court has staked out new legal ground by ruling that a judge has the right to deny a patient with schizophrenia (or anyone with a mental illness) the right to represent himself or herself in a trial-even though the court deemed him mentally qualified to stand trial.
Depression is a risk factor for cardiovascular disease and death in many ways, directly and indirectly. It is independently linked to smoking, diabetes, and obesity-all of which are risk factors for coronary heart disease (CHD).1 Depressed patients are more likely to be noncompliant with treatment recommendations, including diet, medications, and keeping appointments, and are more likely to delay presentation for treatment with an acute coronary event.2-4
Agitation in older adults is frequently associated with multiple psychiatric and medical conditions and comorbidities. It commonly occurs in patients with anxiety, affective illness, psychosis, dementia, stroke, brain injury, delirium, or pain.
We are growing older. In ancient Greece, the expected life span was 20 years. In Medieval Europe, it went up to 30 years. In 1900, people reasonably could expect to live to the ripe old age of 47 years, and 39% of those born at that time survived to age 65 years in the United States. Currently, the average life span in the United States is 78 years, and 86% of those born will survive to age 65 years. The very old-people older than 85 years-are the fastest-growing population group in the country, and there are 120,000 Americans over the age of 100 years. And the trend continues.
Education is a cornerstone for the effective treatment of bipolar disorder. The Bipolar Disorder Answer Book is a recent addition to the resources available for patients and their families. Each of the newly emerging self-help books offers different perspectives and emphasis. This book sets out to cover a broad range of relevant topics. Although it begins with the usual discussion of diagnosis and treatment, it quickly moves on to specific issues, such as securing care (both outpatient and inpatient), relapse prevention, comorbid illnesses, “survival tips” for friends and family, insurance coverage, and disability resources.
A review of targeted treatment strategies for symptom domains when impulsivity and compulsivity become dysfunctional.
Although Demystifying Love: Plain Talk for the Mental Health Professional is economy-sized at 200 pages, the book is a useful attempt by the well-known psychiatrist and sex therapist Stephen Levine to condense a lifetime of knowledge from clinical practice, personal growth, and extensive reading about a complex subject. Not surprisingly, his case vignettes remain uppermost in the memory while the whirlwind tour of the many meanings of love, processes of getting into and out of love, erotic transference, psychological intimacy, and sexual desire gets a bit blurry
Success with new approaches to the psychotherapeutic treatment of borderline personality disorder (BPD) and other DSM-IV personality disorders has been reported in several studies recently, raising hopes that an intractable set of illnesses may not be as hopeless as once thought.
Northwest light, pine trees and open sea,a pair of eagles circling Manana Island,the Laura B gliding into harbor,picking up mail and passengers for the tripinshore, the sound of the sea poundinggranite cliffs, cries of ravens and gulls,one last summer fly buzzing at the window,a room arrayed with easels, drying racks,brushes and brooms, the smell of spirits
The guideline divides the therapies it reviewed into nonpharmacological, nonsurgical, and pharmacological categories. The nonpharmacological category includes a wide range of modalities from treatments that patients can perform themselves, such as yoga and exercise, to psychotherapy, acupuncture, and a variety of physical therapy techniques, including heat and laser treatments.
Depression complicates medical illnesses and their management, and it increases health care use, disability, and mortality. This article focuses on the recent research data on diagnosis, etiopathogenesis, treatment, and prevention in unipolar, bipolar, psychotic, and subsyndromal depression.
This month I will examine the relationship between alcohol use disorder, stress, and a neuropeptide called substance P (SP). The data that led directly to research with human subjects came from the mouse-based genetic manipulation of a gene called neurokinin-1 receptor (NK1R), the receptor for SP. To understand this research thread, I will need to review some basic biology behind a class of biochemicals called tachykinins, of which SP is its most famous member. I begin, however, with an attempt to understand the relationship between the experience of stress, relapse rates in alcohol-dependent populations, and how mouse research ended up helping a cohort of stressed-out patients.
Two recent studies present clinical evidence that the use of stimulants to treat boys with attention deficit hyperactivity disorder (ADHD) does not increase their risk of later substance use disorders. This evidence provides clinicians and families with much needed reassurance.
Contemporary Western psychiatry subsumes diverse perspectives on the so-called mind-body problem, but there is still no consensus on a single best or most complete explanatory model of mind-body interactions. Western psychiatry describes brain function in terms of dynamic properties of neurotransmitters and electromagnetic energy fields.
The rising prevalence and dispersion of obesity in North America in the past decade is analogous to a communicable disease epidemic. Longitudinal and cross-sectional associations between major depressive disorder, schizophrenia, and obesity have been established. Existing evidence also indicates that there is an association between bipolar disorder and obesity.
The loss of a loved one is one of the most traumatic events in a person’s life. In spite of this, most people cope with the loss with minimal morbidity. Approximately 2.5 million people die in the United States every year, and each leaves behind about 5 bereaved people.
Concern is on the rise about psychotropic medications-especially atypical antipsychotics-given to foster children covered under Medicaid. Two state Medicaid officials and a representative of the American Academy of Pediatrics (AAP) spoke at hearings of the House Ways and Means Subcommittee on Income Security and Family Support on May 8. Rep Jim McDermott, MD (D, Washington), the only psychiatrist in Congress, has introduced legislation that requires states to improve care coordination for foster children.
The leading edge of the baby boom generation is rapidly moving into the treatment realm of geriatric psychiatry. As a cohort, baby boomers experimented more with alcohol and illicit drugs than did previous generations.
Older adults can present with anxiety or worries about physical health (illness, changes in vision or hearing), cognitive difficulties, finances, and changes in life status (widowhood, care-giving responsibilities, retirement). Clinicians need to be aware that older adults may deny psychological symptoms of anxiety (fear, worry) but endorse similar emotions with different words (worries, concerns).
Concern is on the rise about psychotropic medications-especially atypical antipsychotics-given to foster children covered under Medicaid. Two state Medicaid officials and a representative of the American Academy of Pediatrics (AAP) spoke at hearings of the House Ways and Means Subcommittee on Income Security and Family Support on May 8. Rep Jim McDermott, MD (D, Washington), the only psychiatrist in Congress, has introduced legislation that requires states to improve care coordination for foster children.
News accounts and court records of detainee interrogations in such settings as the Guantnamo Bay detainment camp and the Abu Ghraib prison have sparked controversy over involvement of mental health professionals and behavioral scientists. Authors of articles in medical, psychological, legal, and scientific journals have struggled with complex ethical questions about psychiatrists and psychologists who participate in planning or implementing detainee interrogations.
Despite its wretched history, psychosurgery is back with a new name-neurosurgery for mental disorders-and with renewed confidence in its benefits.1 Two technologies are now available that produce small lesions in the brain: stereotactic microablation and gamma knife radiation (no burr holes necessary). Concomitant functional imaging allows for precision targeting that makes these procedures state of the art, but it is possible that deep brain stimulation (DBS), which has shown early promise in clinical trials and is an exciting research tool, may replace ablative procedures that destroy brain cells. Both new stereotactic neurosurgery and old psychosurgery were the focus of recent mass media reports.
