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Psychiatrists certainly do not know all the answers when it comes to the recent spate of school shootings, but we do know some of the most pressing questions. For example, is there a difference in the psychological makeup of adult shooters versus student, or juvenile, shooters? To what degree does untreated psychosis or depression play a part in the shooter's seemingly inexplicable behavior? How important is bullying in motivating some students to seek revenge on their peers? What are the earliest warning signs of an impending attack by an assailant of any age?

The topic of life's meaning is, of course, a primary issue in existential theory.

Borderline personality disorder (BPD) and substance use disorder (SUD) often co-occur. Comorbid BPD and SUD is related to a variety of severe adverse outcomes.

A sharp decrease in visual acuity affecting both eyes developed in a 35-year-old man 3 days after elective abdominal surgery. Six months earlier, acute B cell-type lymphoblastic leukemia was diagnosed in the patient for which he received bone marrow transplantation (BMT). Following BMT, graft-versus-host disease developed in the patient. It was treated with cyclosporine, mycophenolate mofetil (CellCept), sirolimus (Rapamune), and prednisone.

Poetry of the Times by Richard M. Berlin, MD.

How do we help patients manage pain without exacerbating or reactivating an addictive disorder?

There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.

The National Institutes of Health has awarded the Alzheimer's Disease Cooperative Study (ADCS) $52 million to test the effectiveness of therapies to slow the progression and treat symptoms of Alzheimer disease (AD). New initiatives will include 3 studies to explore the effects of therapies on amyloid-β peptide and the tau protein, as well as an initiative to identify new methods for conducting dementia research.

Undertreatment of migraine, while not limited to any particular racial or ethnic group, may be especially pervasive among black persons, according to researchers from Saint Louis University.

Antipsychotic medications for the treatment of agitation, aggression, psychosis, and other symptoms of Alzheimer disease (AD) are no better than placebo and may even be harmful, according to a highly publicized study by a team from the University of Southern California Keck School of Medicine. In a statement to the press, the lead author of the study Lon Schneider, MD, professor of psychiatry, neurology, and gerontology at Keck, commented that after 12 weeks participation in a double-blind placebo-controlled trial, no significant differences were seen in symptom improvement in patients taking an antipsychotic drug compared with patients taking placebo

Upcoming recommendations from a bipartisan presidential commission on possible long-term changes in the Medicaid program have mental health advocates sitting on the edge of their seats.

A new study comparing the benefits of second-generation antipsychotics (SGAs) with their older counterparts in patients with schizophrenia has yielded a surprising result. The study, funded by the UK National Health Service, found that the overall differences between first- and second-generation antipsychotics did not reach statistical significance.

Bipolar disorder is often seen as a perplexing illness by patients and clinicians alike. In recent years, there has been a growing appreciation in psychiatric circles of the disorder's prevalence. This increased attention has filtered its way down to the general public, which, in turn, has produced sometimes sensationalistic media portrayals of manic depression, a number of speculative books about historic figures and noted artists who purportedly had the illness, and an array of self-help books marketed to individuals (and their families) afflicted with the disorder.

Patients with a serious mental illness (SMI), such as schizophrenia or bipolar disorder, may underreport co-occurring medical conditions. Dr Amy Kilbourne and colleagues performed a cross-sectional analysis of 35,857 patients from the Department of Veterans Affairs (VA) National Registry to determine whether SMI patients were less likely to report a co-occurring medical condition. Results were published in the August 2006 issue of The Journal of Nervous and Mental Disease.

The Centers for Medicare and Medicaid Services (CMS) wants to again cut its payment to hospitals and community mental health centers (CMHCs) for outpatient psychiatric care in 2007. The benefit on which the CMS is focusing is called partial hospitalization; it is paid to a facility for treatment of a patient recovering from an acute psychiatric episode. Physicians must certify that in the absence of treatment in the partial hospitalization program (PHP), a patient would require inpatient psychiatric care. Typically, patients in a PHP spend 4 to 8 hours a day, 4 days a week, receiving intensive outpatient psychiatric care.

A 50% improvement in function was seen in patients treated with botulinum toxin type A (BTX-A, Botox) for the reduction of spasticity in the wrist, finger, or arm after stroke.

Predicting extent of neurologic recovery is crucial. The most accurate and standardized method is clinical neurologic examination using the International Standards for Neurological Classification of Spinal Cord Injury.

On March 13 at this year's meeting of the American College of Cardiology (ACC) in Atlanta, investigators from the United Kingdom unveiled the results of the Migraine Intervention with STARflex Technology (MIST) trial. The MIST trial is the first controlled study to examine the effect of patent foramen ovale (PFO) closure on migraine headache.

Characterized by a triad of symptoms including inflammation, demyelination, and gliosis, multiple sclerosis (MS) affects approximately 1.1 million persons worldwide.1 The disorder is accompanied by neurologic symptoms that include disturbances of sensation, coordination, and vision along with changes in sexual function, bladder and bowel function, gait, and endurance.

To evaluate the degree to which newer antipsychotic agents are implicated in parkinsonism and whether drug-induced parkinsonism (DIP) is being adequately recognized, Christine D. Esper, MD, clinical instructor in neurology, and Stewart A. Factor, DO, professor of neurology at Emory University in Atlanta, performed a retrospective review of 354 consecutive patients in whom parkinsonian symptoms were newly diagnosed at a movement disorders clinic in 2004-2005

Because we are an open-access journal, anyone performing a Web search can stumble upon articles that have appeared in Applied Neurology. Thus, we've begun to receive provocative letters from persons who have sought treatment for Lyme disease.

They can't reproduce, but mature neurons can grow. Indeed, for more than a century, neurologists have been able to restore at least partial function to severed peripheral nerve networks through neuronal transplantation. But the CNS has proved more recalcitrant: there, scar tissue and a complex molecular brew stymie the efforts of damaged axons to sprout new fibers and restore old connections.

Lack of adherence to therapeutic regimens for Parkinson disease (PD) is a serious problem that not only greatly impacts health care utilization resources but also throws a monkey wrench in clinicians' attempts to ameliorate disease progression and maintain patients' function and quality of life (QOL).

MTV isn't just broadcasting music videos and reruns of The Real World anymore. In November, its sister network aimed at college campuses-mtvU-began a new campaign called "Half of Us," which provides information and support to students attending colleges across the country.

The study found that both young men and young women with psychiatric disorders were at greatest risk for being involved in abusive relationships. In addition, after controlling for a history of disorder at age 18 and for lifetime conduct disorder, findings from the study imply a connection between being in a clinically abusive relationship (defined as resulting in injury and/or official intervention) and a woman's risk at age 26 of major depressive episodes, marijuana dependence, and posttraumatic stress disorder.

Progesterone may reduce the risk of disability and death in persons who have sustained moderate traumatic brain injury (TBI). The first double-blind placebo-controlled safety trial of the agent in humans showed that progesterone was safe, being associated with no more adverse effects than placebo.

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The need for effective management of SCI-related pain may be apparent, but it's far less clear which of a multitude of therapeutic options if any will ultimately provide pain relief in a patient with SCI.

Nontraumatic headaches are challenging for general practitioners (GPs) and emergency department (ED) physicians to diagnose. Studies have shown that migraine headaches in these settings are often misdiagnosed and that patients do not receive proper treatment.

More than 1 in 20 adults nationwide suffer from compulsive buying, according to a telephone survey of 2500 adults. And contrary to popular opinion, “compulsive buying appears to be almost as common in men as in women,” according to Lorrin M. Koran, MD, first author of a recently published prevalence study of compulsive buying behavior in the United States. Six percent of women and 5.5% of men in the study reported symptoms considered to be consistent with compulsive buying disorder.