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While teen drug use continues to decline, it is the baby boomers who are suffering the greatest losses from substance abuse, and whose plight is largely overlooked by policy makers.

The 5 papers in this Special Report on neuropsychiatry provide compelling evidence for the renaissance of neuropsychiatry as a clinical discipline. Wehave every reason to hope that this will lead to a better understanding of the complex interactions between brain and behavior and will reduce the artificial distinction between neurology and psychiatry.

Poetry of the Times--Good Fathers.

There is no shortage of evidence for the notion that society places a low value on the treatment of mental illness. Have psychiatrists bought into the attitude that mental health is less valuable than physical health?

Prescriptions for psychotropic drugs for adolescents increased by 250% between 1994 and 2001. Researchers note that this trend coincides with the 6-fold increase in direct-to-consumer drug advertising.

A black box warning about increased suicidality in pediatric patients is now required for all antidepressant medications. This column reviews a number of studies on this topic that were published after the FDA advisory was issued.

First described more than 500 years ago, phantom limb pain affects as many as 50% to 80% of patients who undergo amputation. Although it is easy to recognize and diagnose, its cause remains unclear, it can be difficult to manage successfully, and health care professionals often do not address it.

In the late 18th century, a French surgeon named Pouteau performed 120 successive lithotomies with an extraordinarily low mortality rate. His secret was the use of innovations used widely today. Why weren't his methods more widely adopted by other physicians in his time?

Each year, more than 2 million individuals in the United States sustain a traumatic brain injury. Increased vigilance for previously undiagnosed or incidental TBIs in general mental health populations may lead to more effective clinical management.

While an antipsychotic medication is the first step of treatment for schizophrenia, it is increasingly recognized that comprehensive care requires the integration of adjunctive therapies and attention to long-term treatment goals.

During and after menopause, many women report impairments in cognitive functioning. Should hormones be prescribed in an effort to mitigate cognitive symptoms of menopause?

Cannabis, or marijuana, has been consumed by humans for centuriesand remains one of the most widely and commonly used illicitsubstances. The authors review the evidence supporting and refutingthe association between cannabis exposure and psychotic disorders.

The recent evolution of neuropsychiatry/behavioral neurology as a subspecialty represents a paradigmatic shift regarding the responsibility of psychiatrists in diagnosing and managing behavioral disorders with concomitant and demonstrable brain pathology such as dementia or head injury. This authors define the clinical usefulness of electroencephalography in evaluating neuropsychiatric disorders.

The cost-effectiveness of treatment for Alzheimer disease has been questioned. But until the next generation of therapeutics arrives, cholinesterase inhibitors and memantine will probably remain essential components of therapy for cognition and function.

Sleep-associated movement disorders are common in the general population. When patients complain of sleep disturbance, psychiatrists should consider,and question for, features of nocturnal movement disorder.

The FDA advisories warning of increased suicide risk among children and adolescents beginning antidepressant therapy have alarmed the health care community--but it may actually be a disservice to withhold these medications from those who need them.

As many as 90% of Americans are exposed to at least one traumatic event in the course of their lives. Many more are exposed to more than one traumatic event. Short- and long-term sequelae of traumatic exposure vary greatly and range from complete recovery, to severe and debilitating PTSD.

Many of our female patients are more worried about breast cancer than heart disease. Because psychiatrists will almost certainly care for patients who have a history of breast cancer, Dr Riba reviews some of the major issues to consider.

According to recent estimates,chronic medical conditionsaccount for 7 of every 10 deathsin the United States and have been foundto severely limit daily functioning in morethan 1 of 10 Americans, or 25 millionpeople This tremendous disease burdenaccounts for most of the dollars spenton health care annually in the UnitedStates.

Pilot studies show that preventing PTSD after vulnerable persons are exposed to extreme life-threatening trauma is possible, although we are in the very early stages of knowing exactly what to do.

Psychiatrists specialize in mental phenomena, but this special expertise does not confer license to ignore the additional information that can be gathered from physical signs.

Noninvasive ventilation (NIV) has been shown to ameliorate respiratory impairment, which, as the disease worsens, is often responsible for death in patients with amyotrophic lateral sclerosis (ALS). Its use, however, is uncommon, and its overall value in improving quality of life and survival has been debated. Findings of a randomized controlled study by a team from the University of Newcastle upon Tyne, UK, may shift clinicians' attitudes about the intervention.

About 25% of patients seen in epilepsy clinics and monitoring units who do not respond to antiepileptic drugs (AEDs) have received a misdiagnosis.1-3 The eventual diagnosis for most of these patients will be psychogenic nonepileptic seizure (PNES)1,4-a somatoform conversion disorder. It is treatable, but diagnosis, delivery of the diagnosis, and management present significant challenges. A major barrier to care has been the stigma associated with the label "psychogenic."

Measuring amyloid-beta (Abeta) protein levels in cerebrospinal fluid (CSF) and using positron emission tomography (PET) to image amyloid in the brain might become the best diagnostic test for presymptomatic Alzheimer disease (AD), according to a study published online in December 2005 and appearing in the March issue of Annals of Neurology.

The most comprehensive evidence-based recommendations for preventing a second stroke have been released by the American Heart Association and the American Stroke Association's Stroke Council.1 In contrast with previous clinical practice guidelines, the new guidelines tie transient ischemic attack (TIA) with stroke, said Ralph Sacco, MD, chair of the American Stroke Association's Secondary Stroke Prevention Guidelines Committee.

When Medicare enrollees became entitled to the first-ever outpatient prescription drug benefit in January, the program was introduced with great fanfare and with the mission of Medicare Part D programs to make drugs more affordable for the elderly and disabled. The Medicare drug benefit issue, however, has been mired in controversy since Congress took it up years ago.

cognitive enhancement, cosmetic neurology

When a stroke occurs, transportation to the emergency department (ED) by ambulance will get a patient care faster-a factor that so often makes a difference about whether tissue plasminogen activator will be administered-according to poster studies presented at the International Stroke Conference in February in Kissimmee, FL.

Dementia is characterized as a progressive and chronic decline in cognitive function, not limited to memory impairment, which significantly interferes with baseline daily functioning and frequently involves behavioral disturbances. It is known that behavioral problems in dementia negatively affect patients and caregivers. These disturbances lead to institutionalization, increased costs and caregiver burden, and a poorer prognosis.

Parkinson disease