News

New formulations of several opioids were introduced during the past year. This month's column reviews current recommendations for the use of these medications and how they compare with previously available opioids.

Response to Dr Wagner's Methylphenidate Treatment of ADHD in Preschoolers".

Obsessive-compulsive disorder (OCD) is a heterogeneous disorder with a variety of phenotypic expressions. Delineation of clinically distinct subtypes of the disorder may be valuable in predicting treatment response and resistance.

In this article, we discuss recent advances in drug transporters and nutrient-transporter interactions that can impact drug bioavailability in the systemic circulation and the brain. We also present emerging research strategies that may facilitate the discovery and clinical development of predictive diagnostic tests to identify patients at risk for treatment resistance.

John Medina's column, "Chronic Fatigue Syndrome-A Lesson in Big Science", focuses on recent research by the CDC on the genetic aspects of chronic fatigue syndrome (CFS) as reported in Pharmacogenetics and Nature.

About 60% of users of illegal prescription drugs receive them free from friends or relatives, H. Westley Clark, MD, JD, director, Center for Substance Abuse Treatment (CSAT), of the federal Substance Abuse and Mental Health Services Administration (SAMHSA), told attendees at the American Society of Addiction Medicine 38th Annual Medical-Scientific Conference

There is no disputing that the rapidly escalating rate of incarceration during the past decade in the United States has been associated with an increasing number of imprisoned individuals with a mental illness. Research indicates that as many as 20% of inmates in jail or prison are in need of psychiatric care, frequently because of a serious mental disorder.

Treatment-resistant unipolar major depression appears to be the rule rather than the exception. This view is supported by data from the STAR*D program, a multilevel treatment trial for major depression.

Like medicine in general, psychiatry and psychotherapy have long focused on relieving illness and pain. Traditional psychotherapeutic approaches have often emphasized examination and understanding of painful experiences as a route toward obtaining relief from suffering.

In the 1960s, the treatment of Parkinson disease (PD) was revolutionized by the introduction of levodopa. Soon after its discovery, however, it was observed that continuous treatment was complicated by the emergence of choreoathetoid movements and off episodes.

A few days passed in August when I was blanking out on people's names in mid-sentence. I thought, "Oh no, it's dementia!

In many ways, the frustration experienced bypatients struggling with mild cognitive impairment(MCI) is matched by the frustration ofclinicians facing the challenge of managing thisheterogeneous condition. The prognosis can bevariable, and no proven therapies exist.

During the past decade, a great deal of research has been undertaken to better understand the pathogenesis of neurodegenerative diseases. Data from stroke models has shown that the semisynthetic tetracycline antibiotic minocycline can mediate neuroprotection in neurodegenerative diseases by inhibiting caspase-1 and inducible nitric oxide synthase (iNOS) activity.

Defined as a clinical syndrome involving progressive deterioration in multiple areas of cognitive functioning, dementia is a major cause of disability, institutionalization, and increased mortality among the elderly. Although it can occur in younger persons too, dementia is typically associated with aging. It is often seen as a disease that cannot be prevented or cured. However, there is increasing evidence that some types of dementia can be successfully treated or even reversed.

Insights Into Neuropathology Elucidated Through the Science of Sleep

Book Review

From a research perspective, it is always a joy when molecular mechanisms that were first characterized in petri dishes are confirmed inside a living animal. As molecular techniques have become more sophisticated, such dual results are increasingly commonplace. This month's column is about just such an achievement and takes its cue from a topic I considered in last month's article.

Department of Defense (DOD) medical centers, community hospitals, and clinics throughout the United States were tasked with hiring 44 "contract" psychiatrists over the summer as a response to growing concerns about inadequate mental health care for soldiers in Iraq and Afghanistan and those returning home.

Figures 1 and 2 from the article, "Recognizing the Needs of Bipolar Patients With Comorbid Psychiatric Conditions," by Charles L. Bowden, MD, in the June 2007 Psychiatric Times Reporter, "A Review of Comorbid Psychiatric Conditions and Special Populations in Bipolar Disorder," were printed incorrectly.

Poetry of the Times

Perceptions

Book review

Sexual dysfunctions as distinct syndromes were first identified in DSM-III in 1980. At that time, sets of criteria were specified for inhibited sexual desire, inhibited sexual excitement, inhibited female orgasm, inhibited male orgasm, premature ejaculation, dyspareunia, and functional vaginismus.

The comorbidity of anxiety disorders with bipolar disorder is a rule, not an exception, with a negative impact on both course and treatment outcome. So far, there are no guidelines or consensus for the treatment of this comorbidity.

There are occasions in which one's best psychotherapeutic efforts are not effective or help only modestly. If the effort has taken place for a relatively long period, the therapist has several options. One is to ask a colleague for consultation. A second is to reexamine one's understanding of the patient's dilemma.

Premenstrual dysphoric disorder (PMDD) is a distinct cyclical disorder in which women experience distressed mood and behavioral symptoms in the late luteal or premenstrual phase of their menstrual cycle. PMDD is the most extreme or severe form of premenstrual syndrome (PMS).

In our presentation at the 2006 annual meeting of the American Academy of Child and Adolescent Psychiatry, we suggested that child psychiatrists who come across a child with the profile of the following hypothetical case should consider whether the child may have deficits that are not currently covered by DSM-IV nosology: either a nonverbal learning disability (NVLD) or a sensory processing disorder (SPD).

An item in the Boston Globe recently caught my eye. Apparently, a man who was fired by a large corporation for visiting an adult "chat room" while at work is suing the company. The man is claiming he is an "Internet addict" who "deserves treatment and sympathy rather than dismissal." Another item reported recently concerned a lawyer who argued that her client was not responsible for a rampage that he had committed because he "had been obsessed with comic book superheroes as a kid."

In this article we discuss psychoneuroendocrine influences on sexual orientation and the psychodynamics of internalized homophobia. Because of space limitations, we focus on homosexual orientation, although research in this area sheds light on heterosexual and bisexual orientation as well.

Among 25 to 30 million Americans in whom depression is diagnosed annually, 18 to 25 million are treated with antidepressants, of which 90% are SSRI or non-selective serotonin reuptake inhibitor (SRI) antidepressants, the most frequently prescribed medications for all outpatients aged 18 to 65 years.