The discipline of psychopharmacology has expanded enormously during the last several decades. As this Special Report illustrates, while the treatment of mental illness with medication has definitely advanced, it is neither quick nor easy. Instead, it has become more complex and complicated.
Psychiatric evaluation of juveniles who commit murder is perhaps one of the most difficult tasks in forensic psychiatry. A study has shown that these inmates are more likely to have been abused, be addicted to drugs or alcohol, or have a serious psychiatric disorder. Additionally, they are more likely to engage in risky behavior without thinking about the consequences.
Drug Company Dinner
Psychiatric Reporter:Insomnia and Its Risks: Causes, Consequences and Treatment
Locomotor training is an emerging rehabilitation intervention to help patients who have spinal cord injuries or who are recovering from stroke walk again. The basis for the intervention lies in understanding the neurobiology of walking and the nervous system's capacity for activity-dependent plasticity.
Alzheimer disease (AD) affects between 6% and 8% of Americans older than 65 years. As the population of older adults increases, the number of persons with AD is expected to rise from 4.5 million in 2000 to 13.2 million by 2050.1 This disease is important not only because of the number of patients affected but also because it leads to significant physical and emotional burdens on families and caregivers.
Recent medical meetings provided platforms for researchers to present their latest findings and for practicing physicians to catch up on the latest developments in their fields. Following are summaries of some of those presentations, and more will follow in the next issue.
Of the 2300 research papers submitted for presentation at the American Academy of Neurology (AAN) annual meeting in Miami Beach last month, 1400 were accepted. John H. Noseworthy, MD, chair of neurology at the Mayo Clinic College of Medicine in Rochester, Minn, and chair of the AAN's science committee for the meeting, had the difficult task of boiling down all that research into what the committee considered the top 10% of papers to discuss at the scientific highlights session. The presentations covered the full scale of basic science to clinical practice, and Noseworthy summed up the results in a nutshell: "We've enjoyed a superb week."
On March 31, Johnson & Johnson's Ortho-McNeil Neurologics unit added a warning to its prescribing label for galantamine hydrobromide, known commercially as Reminyl, a treatment approved for individuals who have mild to moderate Alzheimer disease (AD). On April 11, the company changed the commercial name of the drug to Razadyne.
Often, a clinical diagnosis of AD comes too late for an individual to benefit from treatment. Clinicians can assign the diagnosis of mild cognitive impairment (MCI) to patients with memory complaints, but they cannot state emphatically which of these individuals will progress to AD. Typically, about 10% to 15% of persons diagnosed with MCI convert to AD within a year, while 30% to 40% do not convert--at least not for another 6 to 8 years.
Psychiatric Reporter: Breaking the Frontier: Update on Etiology and Treatment of Alcohol Abuse and Dependence
Joseph I. Sirven, MD, and Joseph F. Drazkowski, MD, neurologists at the Mayo Clinic in Phoenix, led a recent study in partnership with the Walter Cronkite School of Journalism and Mass Communication at Arizona State University (ASU) to determine how well medical risks and treatment advances for neurologic conditions are conveyed in US newspaper articles.1 Their findings reveal that coverage of neurologic disorders does not always correlate with the prevalence of the disorders and that more collaboration is needed between journalists and neurologists to better educate the public.
Sometimes, medically and scientifically backing up what otherwise would appear to be obvious can take a long time. This is no more evident than in our cover story for this issue, "Heart and Brain: A Clearer Connection." Recently published research is offering evidence
Sildenafil (Viagra, Pfizer) may help patients recover from stroke by aiding regeneration of brain cells. After successfully proving that the drug stimulates cortical neurogenesis in experimental models of stroke, researchers from the Henry Ford Hospital in Detroit have now embarked on a clinical trial of sildenafil and plan to recruit 84 patients who have suffered a moderate stroke within 72 hours of entering the study.
Congress and the Bush Administration are wrangling over how to strengthen the drug safety oversight activities at the FDA in the wake of the recent controversies over cyclooxygenase-2 inhibitors and pediatric antidepressants. The White House intends to create an independent Drug Safety Oversight Board (DSB) within the FDA. Several key senators like the idea but insist that the DSB be separate from the FDA to keep it from being "under the thumb" of that agency.
"Pseudodementia" needs a third look. Always a "soft" diagnosis, it has never had objective, explicit diagnostic criteria or a spot in an official nomenclature.
Research presented in late February at the annual meeting of the American Academy of Orthopaedic Surgeons underscores the increasing importance of functional assessment tools to quantify outcomes after spinal intervention, whether in measuring the effectiveness of a specific procedure or in better understanding the risks faced by patients who undergo spinal surgery in general.
Osteoporosis is a disorder characterized by low bone mass and microarchitectural deterioration with resulting compromised bone strength and increased risk of fracture.1 The World Health Organization defines osteoporosis based on T-scores, which reflect bone mineral density (BMD) relative to mean BMD for healthy 25-year-old same-sex populations. A T-score between 0 and 21 is considered normal density, a score between 21 and 22.5 indicates osteopenia, and a score of less than 22.5 signifies osteoporosis.2 Severe osteoporosis is defined as a T-score of less than 22.5 combined with a fragility fracture.2
More than 100 neurologic diseases, injuries, and intoxications are known to prominently or exclusively involve the white matter of the brain.
Since its 1999 appearance in New York, West Nile virus (WNV) has spread relentlessly westward each year, opening up new fronts in the Midwest and the mountain states until pummeling California in the summer of 2004. The flavivirus, which is spread primarily by mosquitos, affects a variety of animals, including humans, horses, and nearly 300 bird species. As of October 15, 2004, about 940,000 Americans had been infected, of whom 190,000 became ill and 6790 developed WNV's most feared complications: neuroinvasive disease, including meningitis, encephalitis, and acute flaccid paralysis.1
When Hillel Panitch, MD, decided last summer to accept an invitation to make a presentation on the status of multiple sclerosis (MS) clinical trials at the annual meeting of the American Society for NeuroTherapeutics (ASENT), he did not realize just how timely his presentation would be. "This turned out to be a little more topical than I thought it would be, because of the news over the last few days," he told attendees of the session on March 4 in Washington, DC. "The news," of course, was the withdrawal from the market of natalizumab (Tysabri, Elan Corporation/Biogen Idec), a newly approved drug for MS, and the discontinuation of clinical trials after 1 fatality and an occurrence of another serious disorder in one of the trials.
Levodopa (l-dopa) and dopamine agonists are the main treatment for Parkinson disease (PD), but these therapies are of limited value in the long course of the illness because they counter a neurotransmitter deficit but do not halt neurodegeneration. In this main article and in an accompanying story, we offer an update on the status of Parkinson treatments today.
Nerve root injections can help patients with lumbar radicular pain avoid surgery for at least 5 years, according to research from Washington University in St Louis that was presented in late February at the annual meeting of the American Academy of Orthopaedic Surgeons.
As a neurosurgeon with more than 30 years' experience in the field, and as medical director of a local hospital, I must take serious issue with the published and highlighted remarks of Dr Jung Ahn that "pressure sores in spinal cord injury are, as far as I'm concerned, preventable" (Watanabe ME. Spinal cord injury: dealing with more than inability to move. Appl Neurol. 2005;1[1]:32-34).
Are older adults highly susceptible to epilepsy and not getting the right diagnosis when a seizure occurs? R. Eugene Ramsay, MD, thinks so. Ramsay, a professor of neurology and psychiatry and director of the International Center for Epilepsy at the University of Miami, is working hard to get that word out to neurologists and primary care physicians. He's written articles,1,2 conducted clinical trials, and made presentations, one of which I attended in Philadelphia in March during the joint conference of the National Council on the Aging and the American Society on Aging.
With one in six Iraqi War veterans exhibiting mental health problems, psychiatrists are faced with the challenge of reducing or averting the psychological wounds of war and preventing long-term, service-connected disabilities. At the 13th Annual Medicine Meets Virtual Reality Conference, new therapies using virtual reality were put to the test.
Poetry of the Times
Little attention has been paid to the prevalence of sexual assault and its sequelae among military men. The past-year prevalence of sexual assault among enlisted men ranges from 0.4% to 3.7%, a figure equal to or exceeding the lifetime prevalence among civilian men in some studies. Increased awareness and understanding of male sexual assault as well as routine screening of all patients, regardless of gender, for exposure to sexual victimization will enhance their recovery.
The dozens of journalists killed while covering the current war in Iraq gives currency to the dangers encountered by those who bring us the news from the world's conflict zones. Despite the risks inherent in their profession, it is only recently that the psychological health of war reporters has been captured in a systematic and empirical manner.
Road rage is well known in popular culture and to many people it is a common and dangerous experience. Alcohol problems, illicit drug use and general psychiatric distress are associated with road rage perpetration. Road rage incidents may also result in psychiatric distress. Although treatment for road rage has received little research attention, encouraging results have been reported from specialized programs.
