Concern about the rising number of preschool-age children receiving atypical antipsychotics, α-agonists, or other psychotherapeutic medications recently motivated pediatric mental health professionals to develop best-practice algorithms for psycho-pharmacological treatment of young children. It also prompted some states and mental health providers to initiate medication monitoring and consultation programs.
This is the last installment in a 3-part series discussing the behavioral, cellular, and molecular characteristics of posttraumatic stress disorder (PTSD). In Part 1, I described some basic clinical observations of PTSD and the challenges these observations pose to researchers attempting to understand underlying biological substrates.1 Part 2 examined progress on addressing these challenges at the level of the tissue and cell.2 In Part 3, I will discuss efforts to understand PTSD at the level of DNA, including potential genetic underpinnings and heritable risk factors.
It is estimated that at least half of persons who begin antidepressant treatment will not respond to monotherapy.
The number of prescriptions for antipsychotic treatment of teenagers has increased sharply in office-based medical practice. Adolescents with psychotic symptoms frequently present for clinical evaluation, and early-onset schizophrenia spectrum disorders (onset of psychotic symptoms before the age of 18 years) represent an important consideration in the differential diagnosis in these youths
Treatment of negative symptoms of schizophrenia -- eg, problems with motivation, social withdrawal, diminished affective responsiveness, speech, and movement -- is associated with a variety of improved functional outcomes and is a vital unmet clinical need.
Poetry of the Times
In Defense of Childhood, by Chris Mercogliano, is an elegant book about societal challenges to children's innate spontaneity and exuberance. It is based on the author's more than 3 decades of experience as teacher and, ultimately, director of the Albany (New York) Free School.
Congress substituted a 0.5% increase in Medicare fees for the first 6 months of 2008 for the 10% reduction that would otherwise have been enacted. That reduction in what is called the Medicare fee "update" was predetermined by a formula Congress itself put in place.
There are no books written by, or even about, locum tenens psychiatrists. Why is that? Why is their story-the story of psychiatrists who "hold a place," participate a bit, and then move on-not shared? Is there nothing in their experience worth sharing?
It's often said that the word "crisis" is expressed in Chinese by two characters representing "danger" and "opportunity." In truth, the Chinese word for "crisis" (weiji) is better translated as "danger" (wei) and "crucial moment" (ji).
There have been nearly 1.5 million military deployments to the southwest Asian combat zone since the start of the Afghanistan operation and Iraq war in 2001 and 2003, respectively. There have been many casualties, some of which have been highly profiled, such as service members being killed in action, losing limbs, or suffering blast injuries to their brain.
Reading crystal balls has always been difficult. Nevertheless, it may be a worthwhile exercise to stop and make some educated guesses about where the field of psychopharmacology will stand 10 years from now--knowing full well that insights and discoveries we cannot predict or anticipate now may pop up to dramatically change the course and direction of clinical psychopharmacology.
The idea that there may be genetic influences on how we think about God and politics is usually greeted with disbelief, even scorn. "Ludicrous," was the intense response of a distinguished psychologist-friend upon hearing me explore this topic in a brief paper.
Anxiety disorders are the most prevalent disorders among children and adolescents in both community and clinical settings. The high prevalence of anxiety disorders in children and adolescents leads to increased interest in the development and implementation of effective treatments.
The FDA recently approved the use of aripiprazole (Abilify) in combination with antidepressant medication for the treatment of major depression in adults. Although a variety of agents have been used in efforts to augment the effect of antidepressants, this first approved adjunct is likely to increase this use of atypical antipsychotics.
The use of cannabinoids for medical indications is the subject of ongoing debate. Some medical professionals and patients argue that cannabinoids have marked analgesic properties, while other physicians, who cite the still relatively scant literature supporting their use, are skeptical about their efficacy, especially in comparison with other currently available analgesics.
Cortical development in children with attention-deficit/hyperactivity disorder (ADHD) generally lags behind that in other children by several years, NIMH researchers reported recently.
This is the second installment in a 3-part series discussing the behavioral, cellular, and molecular characteristics of posttraumatic stress disorder (PTSD). The first installment described clinical aspects of PTSD and how these characteristics make understanding the underlying biological substrates so challenging. In this installment, I discuss progress addressing these challenges at the tissue and cell level. In the final installment, I will review potential genetic underpinnings of PTSD, with emphasis on potentially heritable risk factors.
For many years, research on mood disorders has focused on neurotransmitters, particularly on the monoamines (serotonin, norepinephrine, and dopamine) and their action at the neuronal junction, or synapse. Although the monoamine theory helps explain the action of tricyclics, monoamine oxidase inhibitors, and SSRIs, it fails to account for many other things.
Panic disorder with or without agoraphobia is a chronic, debilitating psychiatric illness that affects about 4.7% of the general US population.
On a hypothetical morning, you've arrived early at your office to answer e-mails and respond to prescription requests without interruptions. The following voice mail, left for you much earlier that day, awaits your attention: "Doctor, I need to discuss my mother's behavior with you. The medications she's taking might be calming her down during the days, but she's not okay at night."
No other psychiatric diagnosis has more profound negative implications than autism. On the surface, autism impacts social, emotional, behavioral, and academic functioning. However, autism is pervasive in ways less immediately observable, and, as a result, children with autism require developmental and educational interventions that are different in both form and intensity from those required by children with other special needs.
Both cognitive-behavioral and pharmacological treatments for panic disorder have been found to be effective over the short term. Not all patients, however, can tolerate or fully respond to these approaches, and the effectiveness of these interventions over the long term remains unclear.
Anxiety disorders are some of the most common mental health problems that confront clinicians, either as a primary diagnosis or as comorbid conditions.
When a suicidal patient in crisis calls the psychiatrist and hears the recorded message, "If you have a 'true' emergency, go to your nearest emergency room or call 911," the patient's risk of suicide may increase.
It is my great honor and pleasure as a psychiatric educator to teach many excellent medical students and residents. These young and not-so-young men and women are by and large diligent, highly professional, and caring.
Although valiant efforts have been made to reduce access to the chemical precursors of methamphetamine, it is likely that methamphetamine will remain accessible and inexpensive, and costs associated with increased use will continue to rise.
Momentum is picking up in Congress to expand the frontline federal grant program that provides money to local prisons and jails for handling of nonviolent offenders who have mental health problems.
Although the percentage of US adolescents who use illicit drugs or drink alcohol continued a decade-long reduction in 2006, according to the Monitoring the Future (MTF) survey,1 the use of prescription drugs, such as narcotics, tranquilizers, sedatives, and stimulants remains at relatively high levels. Concerns about marijuana and alcohol, which are easily the most prevalent substances misused by adolescents, have obscured the increasing problem of prescription drug misuse in youth. This article presents information on prescription drug misuse and diversion based on surveys of high school and college students.
Many veterans face mental illnesses on return from duty, but for how long and to what extent? Psychiatrist Charles S. Milliken and colleagues are on a mission to measure the mental health needs of returning soldiers from Iraq, including soldier assessment and use of mental health care, using 2 surveys--the Post-Deployment Health Assessment (PDHA) and the Post-Deployment Health Reassessment (PDHRA). The results of their analyses were reported in the November 2007 issue of JAMA.
