Funded by the National Institute of Mental Health, the STAR*D project is one of the largest depression treatment studies ever conducted, with more than 4,000 participants. Results from the second phase of the study will be published over the next year. In this issue PT readers will find a preliminary review of data drawn from the first 1,500 enrollees.
Postmortem studies indicate that neural circuit abnormalities in schizophrenia could be reflected in gamma-band synchrony. We review findings of recent studies that demonstrate abnormal synchrony in the gamma band of the EEG in chronic schizophrenia patients, and point to links between gamma oscillations and some of the core symptoms of schizophrenia.
Schizophrenia poses a challenge for diagnosis and treatment at least in part because it remains a syndromal diagnosis without clearly understood neuropathological bases or treatments with clearly understood mechanisms of action. Neuroimaging research promises to advance understanding of the unique pathological processes that contribute to this syndrome, and to foster both better appreciation of how current treatments work, and how future treatments should be developed.
Although several clinical studies suggest that cognitive impairments in schizophrenia are associated with reduced stimulation of dopamine receptors in the prefrontal cortex, mounting evidence suggests that other monoaminergic neurotransmitter systems may also be involved. We provide an overview of neurotransmitters that hold promise as therapeutic interventions for the cognitive deficit in schizophrenia.
It was not too long ago that the management of schizophrenia focused primarily on symptom relief in inpatient and outpatient settings. Over the past two decades, there has been a paradigm shift in our approach in the overall management of schizophrenia, toward preventive and early interventions. What are some of these management techniques, and how well do they work?
Long recognized by peers and students alike for his teaching excellence, Henry Nasrallah, MD, was named Teacher of the Year at the 18th annual U.S. Psychiatric & Mental Health Congress. In an interview with PT, Nasrallah talks about his passion for the field of psychiatry and his clinical research in schizophrenia.
Alcohol and substance use disorders take a tremendous toll on society as a whole and also require significant emergency department (ED) resources. Alcohol use and abuse in the United States accounts for over 100,000 deaths each year1 and costs more than $185 billion annually.2 A study of the effects of alcohol-related disease and injuries found that the number of patients who presented with these conditions increased by 18% from 1992 to 2000.3
Psychological debriefing was developed as a way to intervene with large numbers of trauma survivors in circumstances in which individual evaluation and treatment are not possible, such as after mass trauma, terrorist attacks, or disasters. The most commonly used model of debriefing is Critical Incident Stress Debriefing (CISD), a structured protocol developed by Mitchell.1 CISD has been used quite frequently with rescuers, first responders, and law enforcement personnel. After the terrorist attacks in the United States on September 11, 2001, CISD was widely applied to groups of persons who were affected by the attacks.
The use of benzodiazepines in psychiatry and general medicine is fraught with controversy because of the potential for abuse and dependence. In daily practice, clinicians vary widely in their comfort level with prescribing this class of medications, whether for short-term relief of panic or for long-term prophylaxis of generalized anxiety. The use of benzodiazepines in acutely traumatized persons is particularly controversial.
Assessment and management of dual diagnosis--that is, the comorbidity of substance use disorder in persons with mental illness--is a major challenge for clinicians, especially in the emergency department (ED). It is widely accepted, but perhaps less well appreciated in the clinical realm, that substance abuse comorbidity is more the rule than the exception in persons with serious mental illness.
Proper evaluation of patients for alcohol and substance use disorders is usually time-consuming. When done in a busy emergency department (ED), assessment is often rushed, increasing the likelihood of misdiagnosis and, therefore, mismanagement. Because the evaluation is a patient's first step to effective therapy, it should be conducted as efficiently and effectively as possible.
If done properly, the assessment of alcohol and substance use disorders in the emergency department (ED) or psychiatric emergency service can be the first step toward recovery. A proper assessment, however, can be extremely taxing for both the clinician and the patient. This article offers a paradigm for performing a rapid and comprehensive evaluation in the ED of medically stable adults with alcohol and substance use disorders.
Poetry of the Times
As the new science content editor of Psychiatric Times, long-time contributor and editorial board member Ronald Pies, M.D., will collaborate with editors to expand the depth, breadth and credibility of the publication.
Profile of a Center of Excellence: University of Michigan's Residential Aphasia Program
Aphasia: It's Never Too Late to Offer Patients Hope
Migraine-Preventive Medications:Guidelines for Success
cerebral palsy, neurorehabilitation, chronic fatigue syndrome, CFS-spectrum disorders, Alzheimer disease
neurotoxins, glatiramer acetate, organophosphate exposure, glioma, glioblastoma, lipoprotein-associated phospholipase A2 (Lp-PLA2), C-reactive protein (CRP), stroke, neurorehabilitation, trigeminal neuralgia
epilepsy, multiple sclerosis
Neuroscience 2005: Encouragement for Alzheimer Diagnosis and Treatment
Following reports that psychologists and psychiatrists have been involved in interrogations in Guantanamo Bay, Cuba, and other locations, Dr. Stone calls on the professional organizations for both specialties to make it clear that torture is not condoned by the medical or psychological profession.
Multiple sclerosis, McDonald Diagnostic Criteria
Pay for performance" (P4P) is nothing more than another cost containment scam in a long string of cost containment scams
With its focus on both behavior modification and mindfulness training, dialectical behavior therapy has proven quite effective in treating patients with borderline personality disorder. This article provides a primer on a modified version of this outpatient treatment for borderline patients with substance use disorders, a comorbid condition that may affect as many as two-thirds of patients with BPD.
The U.S. Departments of Defense and Veterans Affairs have developed protocols for assessing soldiers returning from combat operations in Iraq and Afghanistan. With data showing that many veterans do not show psychiatric symptoms until three to six months after returning home, a new post-deployment assessment was created and is ready to roll out. In the meantime, a jump in PTSD cases led to an internal review at the VA.
Smokers with co-morbid psychiatric and substance use disorders smoke at a much higher rate and seem to have more difficulty quitting than those in the general population. Tobacco treatment that is integrated into mental health settings may lead to greater success than non-integrated treatment. As a result, mental health care providers can play a critical role by careful assessments of smoking, employment of motivational techniques and increasing access to pharmacological and behavioral treatments.
The most common club drugs or party drugs are MDMA, ketamine and GHB. How dangerous is continued use of these substances? Can they cause real damage to the brain?
Intimate partner violence is a common problem and a significant public health concern. Substance use is involved in 40% to 60% of IPV incidents. Several lines of evidence suggest that when substance use and IPV co-occur, substance use may play a facilitative role in IPV by precipitating or exacerbating violence. This article will review epidemiological, clinical and treatment research relevant to substance-abusing men with co-occurring domestic violence.
