There were only 3 Jewish students in my high school, and I was one of them. In the small, western New York town where I grew up, most people were tolerant. But a small clique of anti-Semites made life tough for us Jewish kids. Most of the time, we just shrugged off the jokes and insults or came right back at these louts with a snappy retort. Sometimes, the bigotry grew more menacing.
A 79-year-old woman recently died in a fire at her Washington, DC, row house when "pack rat conditions" prevented firefighters from reaching her in time. A few days later, 47 firefighters from 4 cities spent 2 hours fighting a fire in a Southern California home before they were able to bring it under control. Floor-to-ceiling clutter had made it nearly impossible for them to enter the house.
"There must be some way out of here," said the joker to the thief."There's too much confusion, I can't get no relief. . . .""No reason to get excited," the thief, he kindly spoke,"There are many here among us who feel that life is but a joke.But you and I, we've been through that, and this is not our fate,So let us not talk falsely now, the hour is getting late."From "All Along the Watchtower," Bob Dylan
Worsening anxiety is a common symptom that may result in psychiatric consultation or evaluation in an emergency setting. Aneurysms are rarely considered in the medical differential for anxiety disorders, and the available literature and research regarding this possible connection are very limited. Overlooking this diagnosis, however, can have disastrous consequences. Here we present 2 case reports as well as a review of the literature regarding a possible relationship between aortic and thoracic aneurysms and psychiatric symptoms.
In The Perfect Storm, Sebastian Junger describes the desperate plight of sailors and fisherman who, in the fall of 1991, were caught out in the Atlantic Ocean as 2 powerful storms converged into 1.1 Like those mariners, emergency department (ED) clinicians find themselves at the confluence of 2 powerful trends in modern society.
The following cases highlight some of the challenges clinicians face when treating patients in whom malingerling is suspected. One key aspect of these evaluations is not overlooking signs or symptoms that point to serious illness.
Recurrent stroke is an important health concern not only from a patient perspective but also from clinical and public health standpoints. Many studies have shown that the risk of a second cerebral infarction is greatest immediately following the primary event. Consequently, clinical management of stroke survivors is focused on preventive therapy to minimize risk.
Statins, alone or in combination with other agents, promote angiogenesis and significantly enhance neuroregeneration in the aftermath of brain injury, including stroke, according to Michael Chopp, PhD, professor and vice chair of the Department of Neurology at Henry Ford Health Sciences Center in Detroit.
Corticospinal tract (CST) integrity may predict the potential for clinical improvement in chronic stroke patients, according to a recent study. Winston Byblow, MSc, PhD, associate professor and director of the Movement Neuroscience Laboratory in the Department of Sport & Exercise Science at the University of Auckland, Australia, and colleagues used transcranial magnetic stimulation (TMS) and MRI to determine factors that predict functional improvement in a patient's upper limbs.1 In patients with motor-evoked responses (MEPs) to TMS, researchers found that meaningful gains were still possible 3 years after stroke, although the capacity for improvement declined with time. The researchers also created an algorithm to predict functional potential for upper limb recovery in this patient population.
Hyperglycemia is a risk factor for stroke and augurs a poor outcome in the aftermath of stroke; however, treating patients with post-stroke hyperglycemia (PSH) with infusions of glucose, potassium, and insulin (GKI) to achieve euglycemia does not provide a survival benefit.
aytime sleepiness is common in patients with parkinsonism but has little to do with the amount of sleep these patients get and everything to do with dopaminergic dysfunction, according to David B. Rye, MD, PhD, associate professor of neurology at Emory University in Atlanta. "The idea is that if I sleep a lot, I shouldn't be so sleepy the next day, and if I sleep little, I should be very sleepy. This is doesn't hold true for patients with Parkinson disease [PD]. The loss of dopamine disrupts that banking system, or the sleep-wake homeostat," he said during a presentation at the 9th annual meeting of the American Society for Experimental Therapeutics, which met March 8 to 10 in Washington, DC. Addressing dopa- minergic tone during sleep might help ameliorate daytime symptoms of parkinsonism in general.
Intensive therapy over short periods provides better outcomes than less intensive regimens performed over longer periods." This was the take-home message about rehabilitation for patients with aphasia from Ronald M. Lazar, PhD, professor of clinical neuropsychology in neurology and neurological surgery, and codirector of the Levine Cerebral Localization Laboratory at the Neurological Institute of New York at Columbia University College of Physicians and Surgeons.
Novel approaches for the evaluation and symptomatic treatment of Huntington disease (HD) were presented at the 59th Annual Meeting of the American Academy of Neurology held April 29 to May 5 in Boston. Interventions included use of tetrabenazine (TBZ) (as yet unapproved for the symptomatic treatment of hyperkinetic movement disorders in the United States but granted orphan drug status in 2004) and deep brain stimulation (DBS) of the globus pallidus externus (GPe).
Chronic primary daily headache may not be a singular disorder but rather one with various subtypes. Chronic migraine (also referred to as evolved migraine or transformed migraine), chronic tension-type headache, newly defined daily persistent headache, hemicrania continua, and post-traumatic headache are now recognized as subcategories of chronic daily headache
Migraine has been shown to cause absenteeism and lower productivity at work as well as reduced quality of life.1 According to the US Headache Consortium Guidelines, migraineurs with severe or moderate attacks should be treated with specific antimigraine medications, and prevention is recommended in those with frequent headaches as well as attacks that remain disabling despite optimal acute treatment.
When a new patient with depression enters your practice, you face a diagnostic dilemma. If you miss bipolar disorder (BD), and prescribe an antidepressant, you can do harm. But if you call a unipolar depression "bipolar," you may also do harm, because lithium, anticonvulsants, and atypical antipsychotics carry significant risk as both short- and long-term treatments. In addition, the label of "BD" currently carries much more stigma than the term "depression."
Bipolar disorder is often accompanied by a host of other medical and psychiatric comorbidities. Recent evidence suggests that the illness is not as benign as originally considered . . .
The role of every emergency clinician is to determine whether the patient has a condition that threatens life or limb. Determining this in patients who malinger can be quite a challenge, because the malingering patient presents with false or exaggerated symptoms for secondary gain.
Assessing bullying behavior and suicide attempts in victims of bullying.
There is growing evidence that individuals with bipolar affective disorder have cognitive impairments, even during periods of symptom remission.
Description
SAN FRANCISCO -- Given the high prevalence of substance abuse in patients with attention deficit hyperactivity disorder (ADHD), psychiatrists need to consider comorbidity in assessment of both conditions.
Suicide is a serious public health problem that ranks as the 11th leading cause of death in the United States. Within the 15- to 24-year-old age group, it is the third leading cause of death.1 Many suicide victims have had contact with the mental health system before they died, and almost one fifth had been psychiatrically hospitalized in the year before completing suicide. A recent review found that psychiatric illness is a major contributing factor to suicide, and more than 90% of suicide victims have a DSM-IV diagnosis.
Physicians are often conflicted regarding prescription medications for pain, especially pain complicated by insomnia and anxiety. Concerns that patients may become addicted to medications, exacerbated by limited time available to get to know patients, can lead to underprescribing of needed medications, patient suffering, and needless surgery. At the other extreme, pressure to alleviate patients' distress can lead to overprescribing, needless side effects, and even addiction.
Few phenomena in medicine aremore confounding than the diagnosesinvolving deception:malingering, Munchausen syndrome,Munchausen by proxy (MBP), and factitiousdisorder.
A recent 16-week, randomized, double-blind, placebo-controlled trial found that treating children and adolescents with metformin (Glucophage, Fortamet) may help curb the weight gain and decrease the insulin sensitivity and abnormal glucose metabolism that often results from atypical antipsychotic use.
In the past few years, a great deal of information has been learned about how the brain processes ambiguous information. Data exist that allow us to view what the brain looks like when we are deliberately trying to deceive someone. In response, a number of corporations have been established that use these data--and the imaging technologies that gave them to us--to create brain-based lie detectors.
This article focuses on 4 issues in psychiatric malpractice: prescribing, liability for suicide, informed consent, and duty to protect under the Tarasoff v Regents of the University of California ruling. Malpractice is a civil wrong actionable by law. There are 2 goals of malpractice suits: the first is to make an injured plaintiff whole by an award of money, and the second is to inform the profession how courts will decide similar cases in the future.
Recent discoveries in neuroscience have ramifications for all aspects of clinical and forensic practice, including diagnosis, treatment, and testimony in civil and criminal justice cases.
Unlike a pure psychiatric disabilityevaluation, mental and emotionaldamage claims require anassessment of causation. Today, treatingpsychiatrists are increasingly asked toprovide this assessment, since mentaland emotional damages are widelyclaimed in the United States as a remedyin legal actions.
