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A Public Health Approach to Intervening With Youth in Schools

Evidence for Use of Neurostimulating Techniques

Intensive psychosocial intervention was found to improve overall functioning in patients with bipolar depression, concluded researchers of the Systemic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial. Results were reported in the September 2007 issue of the American Journal of Psychiatry.

Recent years have witnessed exciting developments in understanding and treating addictions. For example, it seems that almost weekly we get new insights into the neurobiology underlying vulnerability to addiction. Similarly, there have never been more medications available to treat the spectrum of addictive disorders, especially alcohol, nicotine, and opioid dependence. In addition, studies continue to underscore the crucial role of psychosocial treatments in recovery from addiction.

Almost 3 years after the FDA warned of increased mortality in elderly patients who received atypical antipsychotics off-label for neuropsychiatric syndromes of dementia, no medication has been approved as safe and effective for this increasingly challenging problem. Recent publications, however, including a white paper from the American College of Neuropsychopharmacology (ACNP), indicate that clinical investigators are wrestling with the dilemma and considering potential alternatives to antipsychotics.

The goal of this well-intentioned and mostly well-written, small book is to present an "integrated pharmacopsychosocial approach to treatment" of substance addictions and behavioral addictions, such as pathological gambling, eating disorders, and compulsive sexuality. A unified framework for the treatment of addictive disorders has great clinical appeal, given that most people seeking treatment will have multiple addictions as well as co-occurring psychiatric symptoms and disorders. The authors offer valuable advice on principles that increase the likelihood of successful treatment, such as "Less is more--simplification of pharmacotherapy" and "Importance of accurate diagnosis as the basis for treatment." They also correctly emphasize that addiction is a chronic disorder requiring a long-term approach to treatment.

The November death of an Israeli fashion model whose weight had dropped below 60 lb was chilling even in a world that prizes rail-thin models as an ideal of feminine chic. Social critics have long blamed the fashion industry's use of such models for inspiring teenagers and young women to engage in extreme dieting. But at the recent Annual Meeting of the California Psychiatric Association, in Huntington Beach, eating disorders expert Walter Kaye, MD, reminded attendees that the causes of anorexia nervosa (AN) relate more to genetics and neurobiology than to size-zero models on catwalks.1

Having grown up as a "military brat," I have been familiar for decades with how my family's friends coped with war experiences. I did not know the term "PTSD" in those days, but I could see the enduring, horrific marks that posttraumatic stress disorder had left on them. I learned early on that wars could keep killing soldiers long after the peace treaties had been signed and weapons had been rendered silent.

As an educator who still considers textbooks essential tools because of their utility as starting points for learning and exploration, I am pleased that the new edition of Lewis's Child and Adolescent Psychiatry has arrived. The current version lives up to its title; it remains a basic text that provides an overview of child and adolescent psychiatry that is useful and accessible for students and practitioners.

Several new substances and new uses for available products were evaluated in research projects reported at the 47th annual NIMH-sponsored New Clinical Drug Evaluation Unit, held this past June in Boca Raton, Fla. The agonists included a melatonergic compound for depression, 2 new agents for schizophrenia, some g-aminobutyric acid (GABA)-ergic antipsychotics, and several drugs being evaluated for non-approved indications.

This morning my best friend will come with his chain saw and ax, and we'll cut down the ash where a barred owl perched last night and hooted his four-note song. We'll split it and stack it into cords, and I'll be thinking about midnight in January when the air is twenty below zero and the northern lights shimmer purple and blue. My wood stove will be burning today's work at 700 degrees, and I'll be warm enough to open a window wide and listen again for owls and the calls of coyotes yipping at the moon, my monogrammed white coat draped on a peg, washed whiter by the moonlight, hanging around for the next moment of healing, like winter waiting for the earth's heart to thaw.

Public concern about the use of anabolic androgenic steroids by athletes and others has led to enhanced testing for these drugs as well as an improved understanding of their medical and psychiatric effects. This article reviews the pharmacology of these compounds, the prevalence and effects of their use among athletes, and the basics of steroid testing, and it concludes with treatment recommendations. Even though athletes may use other illicit substances, such as stimulants, human growth hormone, and erythropoietin, this article focuses only on anabolic androgenic steroids. Review articles on the psychiatric effects of the other performance-enhancing substances are available elsewhere.1,2

In part 1 of this column, I reviewed research findings of the most substantiated nonpharmacological and integrative treatments for anxiety, such as kava-kava, L-theanine, applied relaxation, yoga, meditation and mindfulness training, virtual reality graded exposure therapy, and biofeedback training.

There have been numerous definitions of culture. Dwight Heath1 offers a simple definition: "It [culture] is a system of patterns of belief and behavior that shape the worldview of the member of a society. As such, it serves as a guide for action, a cognitive map, and a grammar for behavior."

A recent longitudinal study examined the potential relationship between social anxiety disorder during adolescence and young adulthood and the subsequent development of depression.1

In May 2007, the novelist Ann Bauer went public with the tribulations of her autistic son. When catatonia developed, a diagnosis of schizophrenia was made, and antipsychotic medications were prescribed, but with little benefit. When the catatonia syndrome was recognized as independent of schizophrenia and successfully treated, her son returned to a more normal life.1,2

From 1826 to 1827, the great philosopher and political scientist John Stuart Mill was stricken with a devastating bout of depression. Although the genesis of his affliction is far from clear, Mill was able to find a fitting description of his mood in Coleridge's poem, "Dejection": A grief without a pang, void, dark, and drear; A stifled, drowsy, unimpassioned grief Which finds no natural outlet, no relief In word, or sigh, or tear.1

The adage has it that the road to hell is paved with good intentions. It is evident from this revealing portrait of neurologist Walter Freeman--the originator of the infamous "ice pick" lobotomy--that good intentions without sober analysis can indeed have hellish consequences.

Although psychotropic medications have revolutionized the treatment of many psychiatric disorders, the benefits sometimes come at a price.

Precision of psychiatric drug safety assessments, availability of adequately trained psychiatric researchers, and participation of a diverse research population were prominent among the topics of several panels and workshops on research methodology at the NIMH-sponsored 47th annual New Clinical Drug Evaluation Unit (NCDEU) meeting that took place earlier this year in Boca Raton, Fla.

Some studies have linked antidepressants to suicide ideation in children and adolescents, but could adult suicides be linked to antidepressant use? Andrew C. Leon and associates reviewed the medical examiner reports of 1419 adults who completed suicide from 2001 to 2004 in New York City and determined that there does not appear to be a link between the two.

Dr Jeffrey Metzner's brief article, "Evolving Issues in Correctional Psychiatry" (Psychiatric Times, September 2007) related many of the difficulties and complexities of the corrections world; however, it did not mention the greatest problem of all--"deinstitutionalization," which, over the past half century, has resulted in the wholesale diversion of patients with chronic mental illnesses--many of whom cannot be managed as outpatients--from hospitals to jails and prisons.

Making Psychotherapy Work: Collaborating Effectively with Your Patient is an engaging book that will interest most practicing psychotherapists.

It is notoriously difficult to capture in writing the essence of what constitutes ethical practice in contemporary psychotherapy. Authors who take on this daunting task face the potential pit-falls of presenting their ideas in an abstract manner that bores the reader and is clinically irrelevant or risks coming across as overly moralistic and preachy.

Poetry of the Times

The revolution inherent in the move from DSM-II to DSM-III primarily involved a growing emphasis on comorbidity. For several decades before DSM-III, the emphasis had been on diagnostic economy: fewer diagnoses were considered more elegant, more accurate, and more useful in guiding care.

I have been writing Molecules of the Mind every month since 1993. In all that time, I never once broached the subject I will address here--consciousness.

"Positive Psychology: A More Direct Route To Happiness" (Psychiatric Times, September 2007) brought to mind that no one asks an internist to which school of medicine he or she belongs.

Each edition of this book, beginning with the first in 1991, has received much use while sitting on my office shelf. The editions have spanned the modern era of child psychopharmacology and, along with the works of S. P. Kutcher, have offered practical clinical guidance in choosing and monitoring medications in children and teenagers while also providing an overview of the literature that supports child psychopharmacology.

The Senate on September 27 passed what may be the first ever veterans' mental health bill. The Joshua Omvig Veterans' Suicide Prevention Act is named after a young man who came home from Operation Iraqi Freedom with posttraumatic stress disorder (PTSD) and was unable to get mental health care from the Department of Veterans Affairs (VA).