News

Poetry of the Times

In September, Gov Rod Blagojevich (D, Ill) signed Senate Bill 234 into law, allowing early state intervention for persons with severe mental illnesses. Before this enactment, the state required that persons must be a danger to themselves or others before court-ordered treatment could take place.

The role of the forensic psychiatrist frequently requires straddling a fence. On the one side lie the standard function and commensurate ethics of a physician; on the other are the needs of the legal system calling for objectivity, truth, and justice.

Adolescence is a time of great importance during which children make extraordinary developmental strides. According to Erik Erikson, adolescents consolidate a self-concept by struggling with essential questions such as Who am I? and What is my role in life?

Ataxia is a relatively rare, genetic neuromuscular disorder, affecting about 150,000 persons in the United States. It is one of those disorders for which knowledge is growing but is slow to get to the practicing clinician. Hence, many persons with ataxia go for years with no diagnosis or a misdiagnosis. Alternately, because ataxia is a progressive disorder without a cure, many patients are given a stark diagnosis and sent home to cope with the disorder on their own.

Widespread media reports and billboard campaigns decrying a methamphetamine epidemic are drawing attention away from the greater and more entrenched use of cocaine, according to a National Institute of Drug Abuse (NIDA) scientist speaking at the American Society of Addiction Medicine's (ASAM) 38th Annual Medical-Scientific Conference, held in Miami, April 26 to 29.

Of the many bits of wisdom my parents shared with me as a teenager, one stands out as particularly useful: "John, 90% of the things you worry about will never happen to you!" I still think about this comforting observation from time to time, especially now that I have my own children, and I furrow my brow because I wonder how they--or anybody else--could come up with such an optimistic statistic.

When offered a gift by a patient or a patient's family, a psychiatrist faces a significant practical challenge to negotiate "the poles of rule-bound rigor and individually tailored flexibility," the McLean Hospital Ethics Committee wrote in a recent article.

Virtual games, such as World of Warcraft, The Sims, and Second Life, are played by thousands every day, allowing people, worldwide, to connect and share information. In fact, the virtual "worlds" that can be created in these games are now being used to make money (through buying and selling virtual objects), to form partnerships and friendships, and even to conduct business; it is easy to see how many become engrossed in this alternative life.

Many psychiatrists feel intimidated by or frightened about courtroom testimony. However, with the proper preparation, the psychiatrist need not have a difficult experience. It is the role of an expert witness to educate the court on matters that are beyond a layperson's understanding.

Part 1 of this article, discussed a general approach to treating psychiatric emergencies in patients with bipolar and related disorders, as well as the assessment and management of agitation and impulsive aggression. Part 2 focuses on psychosis, suicidality, and specific treatments relevant to patients in emergency settings who are agitated or have bipolar disorder.

Many of the things that we busy ourselves with have no apparent utility. Blogging, playing games, and collecting come to mind. To declare that we are compelled to do these things may be too strong, but we do pursue these activities with little deliberation and without concern as to their usefulness. The ubiquity of these pursuits suggests that these activities or their variants helped humans survive at some point and that they now rest on innate brain programs.

Marijuana is the most commonly used illicit drug in the United States and worldwide. Initiation of use typically occurs during adolescence. The most recent epidemiological data indicate that in the United States, 42% of high school seniors have tried marijuana, 18% have used it in the past 30 days, and 5% use it daily.

There are hundreds of studies that show that pharmacotherapy is used to treat depression in adult and geriatric populations. There are far fewer studies that test the efficacy of psychotherapies and even fewer studies that focus on combined treatment for older patients.

Almost one third of US mental health care costs (approximately $50 billion) go toward the treatment of anxiety disorders. Conventional pharmacological treatments for anxiety are often beneficial but have limited efficacy.

One consequence of the "graying" of the world's population is that psychiatrists, along with all health care professionals, will increasingly be providing services to older adults. In the United States, the first set of people belonging to the baby boom generation turned 60 in 2005, and the number of people older than 60 will soonoutnumber children for the first time in recorded history.

Parkinson disease (PD) is a progressive neurodegenerative disorder affecting 1% of people 65 years and older. The core symptoms include the motor manifestations of tremor, bradykinesia, and rigidity.

Contributing to the problem is the relative unreliability of EEG tracings recorded from patients during the interictal period. Although these tracings can reveal certain abnormalities that are characteristic of epilepsy, such as spikes, they tend to be relatively nonspecific. Interictal spikes, for instance, occur inconsistently; they are present in some persons who do not have epilepsy and absent in others who do.

Many persons with epilepsy have comorbid conditions that are treated with concomitant medications. However, patients for whom first-generation antiepileptic drugs (AEDs) are prescribed have been shown to be at high risk for drug interactions with medications that involve the cytochrome P-450 pathway, specifically antipsychotics, contraceptives, tricyclic antidepressants (TCAs), calcium channel blockers, and warfarin.

A 35-year-old right-handed white man presented with an 8-day history of left leg weakness and difficulty in walking. A day after the onset of symptoms, he self-medicated with oral prednisolone for 1 day and tapered the medication over 6 days. The leg weakness improved over the course of treatment but worsened afterward. His medical history is significant for multiple sclerosis (MS) and restless legs syndrome. He had 1 previous exacerbation of MS 3 years ago.

Perceptions

Vision Restoration Therapy (VRT) is an FDA-cleared device for treatment of visual field defects caused by stroke or traumatic brain injury. The therapy works by stimulating the brain to form new connections, according to NovaVision, the device's manufacturer. But critics maintain that VRT is nothing more than a pricey way to promote saccadic eye movement.

In the early 1990s, researchers began looking at potassium channel openers for seizure control. Over the past 10 years, in vitro research and animal studies demonstrated that potassium channel openers could control seizure activity in a dose-dependent way. Clinical trials are now confirming these findings.

The degree of asphyxia is best ascertained by measuring the amount of fetal acidosis determined by umbilical arterial blood. An umbilical arterial pH of less than 7.0 is seen in about 0.3% of deliveries.1 It indicates a severity of acidosis that places the fetus at risk for permanent neurological damage because of asphyxia. However, the outcome of infants with umbilical cord pH of less than 7.0 who required neonatal intensive care is relatively good. Eighty-one percent can be expected have a normal examination at discharge.

Washington Report

Since April 2006, I have traveled 3 times to the Central Asian Republic of Tajikistan to work with migrants on the risk of HIV/AIDS. According to the United States Agency for International Development, Central Asia has the fastest growth rate of HIV/ AIDS in the world.

Voluntary informed consent is, with rare exceptions, a necessary, albeit not sufficient, defining precondition of ethical clinical treatment, and it is essential for enrollment in clinical research trials.

The clinical management of patients with psychopathy and other psychopathic disorders presents a vexing challenge for mental health professionals. The issues of hospital treatment and civil commitment can be especially confusing.

Depression is primarily a mood disorder, but it can also be viewed as a cognitive disorder for many older adults.

A new strategy that normalizes neurotransmitter deficits common in withdrawal from long-term cocaine use may reduce cocaine-seeking behaviors.