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In his column "Concerns About [Clinical] Practice Guidelines" or CPGs (Psychiatric Times, December 2006, page 28), Dr Michael A. Fauman addressed questions from his readers about a previous column, including the question, "How can physicians be sure that CPGs are free of bias from managed care and insurance companies?" He noted that CPGs are created through a process of expert consensus, and went on to say, "It is reasonable to question how these experts were selected and why they should be considered more qualified to draw conclusions from the research data."

Several months ago, a new psychiatrist came from a prestigious university in the Northeast to work in the VA hospital out West where I practice. During one of our initial conversations, he expressed the emphatic view that "benzodiazepines are only useful for acute alcohol withdrawal or psychiatric emergencies and other than that they have no place in pharmacology." I juxtaposed this position with that of several of our older clinicians, who are equally strong advocates of the generous use of benzodiazepines for a variety of psychiatric symptoms.

Surveys of ECT use in the United Statesshow disparate applications, with theprincipal use in academic medical centers.While more than half the treatmentsare given to outpatients, wholepopulations are underserved.

The increase in diagnostic and therapeutic options has made the selection of the best medical strategy more complex. Physicians are often forced to work and make decisions under time pressure, which complicates matters.

Treatment with second-generation antipsychotic medications produced only modest improvement in the psychosocial functioning of patients with schizophrenia, a follow-up report from investigators of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) concluded.

I recently read issues of 2 research journals that collectively must hold some kind of scientific publishing record. The first journal, Pharmacogenomics, printed 14 papers back-to-back, all devoted to a single, large-scale study: discovering the genetics of chronic fatigue syndrome (CFS). By contrast, the journal Nature was more typical, printing single articles that described mostly research from single studies, and 1 that listed more than 100 authors. These authors are part of the Allen Brain Project, which consists of dozens of scientists who are mapping gene expression profiles of the mouse brain. By the time I finished reading about these monumental efforts, my head ached.

Successful intervention for Alzheimer disease requires an early and timely diagnosis. Caregivers of persons with AD often state that an average of 2 years passes from the onset of symptoms to a formal diagnosis.

Compared with schizophrenia, adherence behavior has been relatively overlooked in depression and other mood disorders. Major depression is increasingly thought of as a chronic illness. In most chronic illnesses, ideal concordance is the exception, not the rule.

Driven by a wave of neuroscientific advances, no area in the field of psychiatry has grown more explosively in the past few decades than psychopharmacological practice.

My teachers or supervisors never mentioned God 50 years ago when I was a resident. Psychoanalytic theory dominated the teaching program; in retrospect, the silence about God, religious beliefs and activities, and spirituality in general almost certainly reflected in part an unspoken allegiance to Freud and his negativity about religion.

Although treatment-resistant depression is defined in terms of a person's depression being resistant to medication, it usually also means that the patient has been unresponsive to whatever psychotherapy has been tried along the way. What might not be clear from the above but is known by all clinicians is that patients with TRD experience much internal suffering and misery.

Over the past 50 years, psychiatry has increasingly become psychiatric medicine coincident with the enormous developments in our understanding of and ability to effectively use clinical psychopharmacology to treat patients with psychiatric illnesses. There have been both increased understanding of the molecular mechanisms underlying the effects of psychiatric medications and increased numbers of psychiatric medications. The latter has occurred in tandem with a similar explosion in the availability of medications to treat a host of other medical conditions. In fact, the repertoire of available medications expands virtually every few weeks.

Challenges related to the mechanisms of care, trust, and personal belief systems keep ethnic patients with Parkinson disease (PD) from participation in clinical trials, according to a study by researchers affiliated with National Institutes of Neurological Disorders and Stroke (NINDS) from the Medical University of South Carolina in Charleston. These researchers highlighted findings from 2 futility trials conducted by researchers from NINDS revealing that of 413 patients recruited, 91% were white persons and only 3% each were African American, Asian, and Hispanic persons.

When friends and family need medical advice, they often consult me even though I'm nothing more than a medical news writer. Folks think it is worthwhile to tell me rather than a real medical professional about the curious pain that occasionally shoots through their leg or their heart or their head. They ask my advice about what new intervention they might try for a chronic condition or whether they really need to get that prescribed vaccine or take those antimicrobials before going off to Madagascar or some such place.

Patients who experience seizure 24 hours after stroke onset may be at increased risk for death, according to Angela Rackley, MD, a clinical neurophysiology fellow in epilepsy, and coresearchers at the University of Cincinnati. Rackley presented an abstract on the incidence of seizures within 24 hours after acute stroke at the annual meeting of the American Epilepsy Society in San Diego this past December. She and colleagues found a higher 30- day mortality rate among patients who had a seizure within hours of stroke compared with patients who did not experience poststroke seizure.

How is conflict of interest-or the perception of it-to be addressed when academia and industry collaborate on drug development? This was the question posed by Cheryl Bushnell, MD, assistant professor of neurology at Duke Medical Center in Durham, North Carolina, who chaired a brainstorming session on the issue at the 9th annual meeting of the American Society for Experimental Neurotherapeutics (ASENT), which took place March 8-10 in Washington, DC.

Dandelions

As I approach retirement, I have been looking back over the patients I have seen. Although I was trained as a psychoanalyst, most of the therapeutic procedures I have engaged in have, of necessity, been adaptations of my analytic skills in order to meet the needs of particular patients.

Antiepileptic drugs (AEDs) were first demonstrated to cause bone density loss (BDL) more than 40 years ago-since then, researchers have been determining which therapies cause BDL, why BDL occurs, and how BDL should be prevented and treated. Methods to monitor, prevent, and treat BDL in these patients differ greatly, and some physicians are calling for better guidance in this area.

Fragile X-associated tremor/ataxia syndrome (FXTAS), a late-onset progressive neurological disorder, is found in carriers of a fragile X mental retardation 1 (FMR1) premutation (55 to 200 CGG repeats). Studies are showing that the disorder affects up to 1 in 3000 adult men older than 50 years and is less common in women.

A previously healthy 35-year-old woman was admitted to a New York City hospital after presenting to the emergency department (ED) with a 10- to 14-day history of generalized weakness, progressive frontal headache, and lethargy. She immigrated to Brooklyn, New York, from urban Haiti 9 years previously and had not returned to Haiti since. She denied any recent travel elsewhere and had no pets. An HIV antibody test, performed 4 months before ED presentation, was negative.

Five words that are guaranteed to annoy your patientwith a diagnosis of psychogenic movementdisorder (PMD) are It's all in your head.It's the worst thing you can say, said Katie Kompoliti,MD, associate professor of neurological sciencesat Rush University Medical Center in Chicago.

Syncope is responsible for 1% to 6% ofhospital admissions and up to 3% of visitsto the emergency department (ED). Thissudden, brief loss of consciousness resultsfrom a decrease in or cessation of cerebralblood flow and is followed by spontaneousrecovery. The causes range from benignto life-threatening.

Depression and cognitive impairment are common in patients with multiple sclerosis (MS) but often are overlooked. These complications affect not only general quality of life but also complicate core symptoms of the disease. Depression in MS is well documented and easily treated while cognitive impairment sometimes needs a sharper eye to detect.

A great deal of data exists about the dangers of polypharmacy. Persons with psychiatric disorders experience increased risk for adverse drug interactions because of the great frequency with which multiple medications are used.

Just 2 minutes before an episode of the television show Boston Legal aired, Roger Pitman, MD, professor of psychiatry at Harvard Medical School, received a telephone call from his sister-in-law informing him that the show would include a segment on propranolol, a drug he was researching for the prevention and treatment of PTSD.

Essential tremor significantly compromises patients' professional and personal lives.

What is comorbidity? Psychiatric comorbidity refers to the occurrence of 2 or more mental or substance use disorders within a certain period. Research shows that comorbidity of substance use and other psychiatric disorders is common and often worsens the prognosis for each disorder.

To improve the prediction of stroke risk after atransient ischemic attack (TIA), researchers havecombined the California and ABCD risk scores tocreate a new unified score, ABCD2.

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