In August, I explained in this editorial column why the issue's theme--migraine--was particularly meaningful to me: I had suffered with frequent migraine headaches from childhood up until my mid-thirties. The theme of the current issue is stroke. Why? Namely because Applied Neurology, like dozens of other medical journals, will have a presence at the International Stroke Conference, and this particular issue will be distributed at the conference.
According to data published by the American Heart Association (AHA) in their 2006 update of heart disease and stroke statistics, "on average, someone in the United States suffers a stroke every 45 seconds."1 Furthermore, the AHA reports, approximately 700,000 persons annually experience a new or recurrent stroke, 88% of which are ischemic: however, only "8% to 12% of ischemic strokes result in death within 30 days." Because the majority of persons survive ischemic stroke, there is a need for a broader armamentarium of thrombolytic therapies than that which currently exists.
Intravenous recombinant tissue plasminogen activator (alteplase [Activase]; rt-PA) for the treatment of acute stroke has been shown to increase the likelihood of recovery. A number of studies are examining whether combination therapy with other agents, such as the direct thrombin inhibitor argatroban; the glycoprotein IIb/IIIa inhibitors abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat); and activated protein C (APC), may be safer and more effective.
Observation that an excess of cholesterol, mediated by interaction between the mutant huntingtin protein (mHtt) and a protein associated with cholesterol transport-that accumulates in the brain may eventually guide researchers in how to intervene in Huntington disease (HD) pathology.
Rehabilitative therapy may be effective in patients many months after stroke. Patients who underwent constraint-induced movement therapy (CIMT) within 3 to 9 months after stroke showed significant rehabilitation of the affected limb in a study led by Steven Wolf, PhD, professor of rehabilitation medicine at Emory University in Atlanta
Clinical depression is an increasingly well-recognized sequela of epilepsy (see "Optimizing Treatment of Seizures by Addressing Psychiatric Comorbidities," Applied Neurology, August 2006, pages 41-42). Questions are therefore surfacing as to whether patients with epilepsy are being adequately identified and treated.
On December 8, 1995, Jean-Dominique Baubyshaved, dressed, drank a cup of hot chocolate,and spent the day conducting business as theeditor-in-chief of Elle magazine. By the end ofthat day, 43-year-old Bauby was in a coma,the result of a massive brain stem stroke.
Human herpesviruses 6B and 7 (HHV-6B, HHV-7) may be implicated in some forms of epilepsy. Steven Jacobson, PhD, a senior investigator at the National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, led a team of researchers who identified HHV-6B in the hippocampus of a substantial proportion of resections from patients with mesial temporal lobe epilepsy (MTLE) but not in tissue from neocortical resections. He reported his findings at the 2006 annual meeting of the American Epilepsy Society (AES), which met in San Diego from December 1 to 5.
Just before it left Washington at the tail end of the December lame-duck session, Congress gave physicians a last-minute reprieve from the 5% Medicare pay cut that would have gone into effect on January 1, 2007. Moreover, the House and Senate approved a 1.5% bonus to be added to Medicare reimbursement in the second half of 2007 for physicians who voluntarily report quality-of-care measures.
Is there something to the adage, laughter is the best medicine? Dr Marc Gelkopf and associates in Israel studied a different treatment approach for patients with schizophrenia using funny movies.
Psychotic disorders are a group of syndromes characterized by positive symptoms, including hallucinations, delusions, and thought disorder; and negative symptoms, including mood symptoms, social withdrawal, and reduced motivation. Cognitive deficits also appear with psychotic disorders. Psychotic disorders rank 22nd in the World Health Organization's list of worldwide causes of disability. This ranking is adjusted for the relatively low lifetime prevalence rate for psychosis; the perceived burden of the disease on those affected with psychotic disorders, as well as their relatives and caregivers, is much higher.
Intermittent explosive disorder (IED) is not yet on the radar screens of many psychiatrists, but it is more prevalent than panic disorder and warrants extensive research and attention, 2 experts on IED said recently.
Once reflected on, the concept of acceptance has multifarious implications for modern mental health care. My own work with patients and trainees has convinced me of the significance of acceptance, and I want to illustrate a few examples that may move readers to recognize similar echoes in their own practice
Medications used in the treatment of bipolar disorder are commonly associated with weight gain. Antipsychotic drugs have been implicated in new-onset diabetes.
Beyond demographic characteristics, risk and protective factors for suicide in older adults have been much more clearly defined in recent years by a series of methodologically rigorous, case-controlled psychological autopsy studies.
Substance use disorder (SUD) plays a prominent role in the epidemiology, cause, and course of mental illness. Of the more than 5 million Americans with comorbid mental illness and SUD, fewer than half received treatment at either a specialty mental health or substance abuse treatment facility.
The prevalence of substance use disorders in patients with schizophrenia is greater than the rate observed in the general population, with a dramatic increase since the 1970s. Several theories exist to explain the high rate of comorbidity. The "self-medication" hypothesis suggests that persons may abuse substances to treat underlying psychotic symptoms or adverse effects of medications commonly used to treat schizophrenia.
Weight gain is a major concern in patients with schizophrenia, especially in those taking atypical antipsychotics. Although the exact mechanism of weight gain associated with atypical antipsychotics is unknown, we often hear patients complain about an increase in appetite and a decrease in satiety.
Once his colleagues began to recover from the shock, the death of Dr Wayne S. Fenton triggered a discussion in the professional and lay press about the risks of violence to mental health professionals posed by mentally ill patients. Fenton was found unconscious and bleeding in his office in Bethesda, Md, on Sunday, September 3, 2006. He had been beaten severely around the head and died at the scene.
Psychiatrists certainly do not know all the answers when it comes to the recent spate of school shootings, but we do know some of the most pressing questions. For example, is there a difference in the psychological makeup of adult shooters versus student, or juvenile, shooters? To what degree does untreated psychosis or depression play a part in the shooter's seemingly inexplicable behavior? How important is bullying in motivating some students to seek revenge on their peers? What are the earliest warning signs of an impending attack by an assailant of any age?
The topic of life's meaning is, of course, a primary issue in existential theory.
Borderline personality disorder (BPD) and substance use disorder (SUD) often co-occur. Comorbid BPD and SUD is related to a variety of severe adverse outcomes.
A sharp decrease in visual acuity affecting both eyes developed in a 35-year-old man 3 days after elective abdominal surgery. Six months earlier, acute B cell-type lymphoblastic leukemia was diagnosed in the patient for which he received bone marrow transplantation (BMT). Following BMT, graft-versus-host disease developed in the patient. It was treated with cyclosporine, mycophenolate mofetil (CellCept), sirolimus (Rapamune), and prednisone.
Poetry of the Times by Richard M. Berlin, MD.
How do we help patients manage pain without exacerbating or reactivating an addictive disorder?
There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.
The National Institutes of Health has awarded the Alzheimer's Disease Cooperative Study (ADCS) $52 million to test the effectiveness of therapies to slow the progression and treat symptoms of Alzheimer disease (AD). New initiatives will include 3 studies to explore the effects of therapies on amyloid-β peptide and the tau protein, as well as an initiative to identify new methods for conducting dementia research.
Undertreatment of migraine, while not limited to any particular racial or ethnic group, may be especially pervasive among black persons, according to researchers from Saint Louis University.
Antipsychotic medications for the treatment of agitation, aggression, psychosis, and other symptoms of Alzheimer disease (AD) are no better than placebo and may even be harmful, according to a highly publicized study by a team from the University of Southern California Keck School of Medicine. In a statement to the press, the lead author of the study Lon Schneider, MD, professor of psychiatry, neurology, and gerontology at Keck, commented that after 12 weeks participation in a double-blind placebo-controlled trial, no significant differences were seen in symptom improvement in patients taking an antipsychotic drug compared with patients taking placebo