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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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Of all the misconceived DSM-5 suggestions, the one touching the rawest public nerve is the proposed medicalization of normal grief into a mental disorder. Fierce opposition has provoked two editorials in Lancet, a front page New York Times story, and incredulous articles in more than 100 journals around the world.

The FDA finds itself straddling a data divide as it decides how to rewrite the black box warnings on the labels of SSRI antidepressants. The agency will almost certainly mandate that the existing black box warning, which addresses suicidality in children and adolescents, be expanded to include young adults up to age 25 or 30. But in what might be a pioneering move for the FDA, the agency will probably also include new verbiage in the warning related to the benefits of antidepressants to people over the age of 30 years.

There are any number of ways to measure the effects of psychoactive medications, ranging from objective assessments of behavioral change to neuropsychological testing to subjective global ratings by physicians or patients. Several recent studies have examined the question of whether medication-induced improvements in neuropsychological test performance correlated with gains in healthful functioning.

This is a film for psychiatrists who are concerned about women's issues and for anyone else who struggles to reconcile an enlightened humanism with the constraints of religious tradition.

According to the Centers for Disease Control and Prevention (CDC), there are approximately 50,000 violent deaths each year in the United States. Until recently, there were no comprehensive data available to the public regarding these deaths. It was with this in mind that the National Violent Death Reporting System (NVDRS) was created, not only to provide statistics of reported violent deaths, but also to educate and possibly prevent more violent deaths from occurring.

Treatment interventions via telephone, Internet, and through other telemedical services are gaining popularity, especially in rural areas where licensed clinicians might not be available. Dr Per Carlbring and colleagues recently evaluated a 10-week, Internet-based, self-help program with weekly telephone calls for patients who had panic disorder with or without agoraphobia. The results were published in the December 2006 issue of the American Journal of Psychiatry.

Increased plasma cortisol levels (correlated with increased hypothalamic-pituitary-adrenal axis activity) may be associated with more rapid disease progression in Alzheimer-type dementia (AD). In a study conducted at the Washington University School of Medicine in St Louis, Dr John Csernansky and colleagues assessed 33 patients with very mild or mild AD and 21 persons without AD annually for up to 4 years, using the Clinical Dementia Rating Scale and various neuropsychological tests. Plasma was obtained from each patient and assessed for cortisol level.

This month, I decided that the time had finally come the time to throw out the 4 boxes I had stored in my attic since leaving my childhood home. These boxes lay piled in a corner with 30 years of dust and dirt on their lids. Unopened in all these years, they were filled with things I didn't need or miss. But before tossing them out, I decided to take a look inside.

In 2006, Psychiatric Times upgradedits Web site (www.PsychiatricTimes.com) to make it more user-friendlyand to provide more features of interestto our readers. As another step to enhancethe value of the Web site, PsychiatricTimes recently introduced a newsearch engine SearchMedica/Psychiatry.

Treatment interventions via telephone, Internet, and through other telemedical services are gaining popularity, especially in rural areas where licensed clinicians might not be available. Dr Per Carlbring and colleagues recently evaluated a 10-week, Internet-based, self-help program with weekly telephone calls for patients who had panic disorder with or without agoraphobia. The results were published in the December 2006 issue of the American Journal of Psychiatry.

The price and availability of psychiatric drugs is expected to be one of the major issues as Congress decides whether to try to find a way to force pharmaceutical manufacturers to lower the prices they charge Medicare Part D drug plans. Antidepressants, antipsychotics, and anticonvulsants are among the 6 categories for which Part D formularies must make available "all or substantially all" medications. As a result, the formularies are unable to bring to bear the drug price reduction strategies they use in other categories.

Damage to part of the brain may cause persons addicted to nicotine to "forget" to smoke, a recent press release from the National Institute on Drug Abuse (NIDA) claims. Preliminary research showed that smokers may find it easier to quit after suffering damage to the insula.

I was disappointed to see the Figure titled Olanzapine and fluoxetine in the treatment of TRD in the article Treatment-Resistant Depression: Strategies for Management" ( Psychiatric Times, page 34) in the October 2006 special bonus edition.

Considerable debate exists about the value and wisdom of initiating "definitive" pharmacotherapies, particularly antidepressants, in the psychiatric emergency setting. In this article, the nature and prevalence of medication prescriptions for patients discharged from an urban psychiatric emergency service (PES) and the extent to which pharmacotherapy initiation was predictive of patient follow-through with aftercare were evaluated.

The review article, case presentations, and commentary on delirium in this issue of Psychiatric Issues in Emergency Care Settings provide a comprehensive overview of a challenging medical disorder. This issue is particularly useful for physicians and mental health care providers who work in emergency departments (EDs), on psychosomatic services, and on inpatient units with a significant geriatric population.

This study determined the prevalence of at-risk drinking in a psychiatric emergency service (PES) and compared the characteristics and functioning of at-risk drinkers with schizophrenia or bipolar disorder with those of at-risk drinkers with depression or anxiety disorders. Of the adult patients who entered the PES and met study criteria, 148 had schizophrenia or bipolar disorder and 242 had depression or anxiety.