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I sit with my patient but can't tune into another painful story.

There appears to be a subgroup of children and adolescents who, despite repeated brief hospitalizations, do not improve, but along the way, these patients accumulate medications. During long-term residential treatment, however, these patients do improve and their medications are reduced.

Cognitive-behavioral therapy can be tailored for use with children who have experienced sexual abuse in order to relieve symptoms of PTSD.

There has been much thought and discussion about the relationship between pediatrics and psychiatry, but research on the integration of the two leaves much to the imagination.

Evidence is growing that trauma-focused cognitive-behavioral therapy (TF-CBT) is an effective treatment for sexually abused children, including those who have experienced multiple other traumatic events. This article reviews the research that has examined treatments for sexually abused children and suggests future research priorities in this regard.

Dirt road and forest exhale, crickets rasp,and August pours damp pink light at dusk.

With states set to lose their one-time fiscal relief in June, mental health care services are bound to be hard-hit, particularly for Medicare. What services are the most likely to be cut and how will this affect Medicare beneficiaries?

Educational Issues in Neuropsychiatry

In their introduction to the neuropsychiatry special report, Drs. Yudofsky and Hales recapitulate the evolution of neuropsychiatry over the past 150 years, offering up an answer to the question: "What is neuropsychiatry and how does it differ from the traditional specialties of neurology and psychiatry?"

The past two decades have ushered in a new era of methodological advances in tools for noninvasive imaging of the living brain. The information gleaned from advances in neuroimaging have been used to provide insights into ADHD's etiology, diagnosis and treatment.

Patients with anorexia nervosa often attempt to deceive health care professionals because they do not want treatment for their disorder. Thus, physicians must maintain a high index of suspicion for signs and symptoms of AN due to its potentially fatal complications.

The number of magnetic resonance spectroscopy studies that assess the levels of different neurochemicals in bipolar disorder has increased considerably in recent years. Abnormalities were reported mainly in the brain regions implicated in the pathophysiology of BD: the dorsolateral prefrontal cortex, cingulated gyrus, hippocampus and basal ganglia. Although these findings are not diagnostic, future research in this area may help to elucidate the pathophysiology of BD and monitor treatment effects.

Although eating disorders have been considered to be largely sociocultural in origin, findings from family, twin and molecular genetic studies conducted during the last decade are refuting that perspective. Recent studies have had significant success in isolating specific chromosome regions that may harbor susceptibility loci for anorexia and bulimia nervosa and are helping to shed light on the degree of heritability of eating disorders.

Transcranial magnetic stimulation has been applied in a growing number of psychiatric disorders as a putative treatment. As a focal intervention that may exert lasting effects, TMS offers the hope of targeting underlying circuitry and ameliorating the effects of psychiatric disorders. The ultimate success of such an approach depends upon our knowledge of the neural circuitry involved, on how TMS exerts its effects and on how to control its application to achieve the desired effects. Current challenges in the field include determining how to enhance the efficacy of TMS in these disorders and how to identify patients for whom TMS may be efficacious.

In the United States, approximately 2% to 6% of school-age children are diagnosed with attention-deficit/hyperactivity disorder. Despite more than 50 years of clinical and neuroscientific research, appropriate diagnostic and therapeutic interventions for ADHD are still an issue for many people, and although reports summarize the current knowledge, they use parameters that are still based on the same descriptive determinations that have plagued the field for years.

The field of neuropsychiatry has undergone tremendous growth over the past few decades.

Our evolving understanding of borderline personality disorder and its treatment includes the surprising evidence that this disorder has more significant genetic determinants and many patients have a far better prognosis than had previously been thought. Treatment approaches have also become less intensive and more diverse and specific. This is a disorder that, despite the considerable gains, remains one of psychiatry's most vexsome problems and one of society's major health care priorities.

Another day without timeto write: patients call in crisis,apple trees need stakes,cord wood waits to be stacked,

Assessing and treating patients with suicidal behavior is not an easy task. Acts of suicide cannot be predicted; the best a psychiatrist can hope for is the ability to identify a patient's risk factors and reduce them. With the publication of a new practice guideline, it is hoped that psychiatrists will be better equipped to deal with this particularly vexing challenge.

There has been a significant shift from the view that personality disorder is untreatable; we do have treatments that have at least some efficacy and one of these is psychoanalytic psychotherapy. Evidence from randomized trials has shown that it is effective in treating borderline personality disorder, and follow-up studies confirm that the gains are robust.

Borderline personality disorder is a complex, disabling disorder. The chairperson for the American Psychiatric Association workgroup for the evidence-based practice guideline on its treatment gives an overview of this disorder's etiologies, neurobiology, longitudinal course and recommended treatments. Future directions for both treatments and research are also discussed.

Can supportive therapy be modified to successfully treat patients with borderline personality disorder? By using a previously developed model, NIMH-funded researchers have found supportive therapy helpful in engaging patients in treatment, developing a therapeutic alliance and achieving treatment goals. Their outcome data may provide a new treatment approach for this difficult-to-treat population.

In many preliminary studies, including one presented at the recent 2nd World Congress on Women's Mental Health, the naturally occurring steroid dehydroepiandrosterone has been shown to be an effective treatment for mild-to-moderate midlife depression. Questions remain, however, as to its mechanism of action, the risk of side effects and its interactions with medications.

Patients with borderline personality disorder are at a much higher risk for suicide attempts than patients with almost any other mental illness. Here, a case report and examples are presented to help clinicians assess, diagnose and treat patients with BPD who have attempted or are threatening suicide.

Although the term borderline has been in clinical use since the late 1930s, it only became an official Axis II diagnosis in 1980 with the publication of DSM-III.

With increased concern about suicidal impulses in children taking antidepressants, the FDA has decided to step in. Two committees held a meeting to discuss various plans for classifying suicidal events, along with some of the difficulties in deciding whether certain events qualify as suicide attempts.

I imagine a restored Rolls-Royce Silver Cloud with running boards, an oak trunk, the silver

Three studies over the past three years show that individuals over age 65 who are suffering from depression may still not be receiving the treatment they need. Is integrating treatment into primary care the answer?

This introduction article elucidates how the various contributions to this special report help make psychiatry such a rich and varied field.

Organizational and occupational psychiatry represents the extension of psychiatric knowledge and skill to the day-to-day functioning of individuals in the workplace and their organizations, with the goal of helping both to function better. To this end, psychiatrists have played an important role both in the treatment of workers and consultation to organizations since the early part of the 20th century.