Medical-psychiatric comorbidity predicts poorer outcomes and increased health care utilization and cost. The collection of articles in this Special Edition is clinically informative and an illustrative set of examples of the unique practice of psychosomatic medicine in different medical-surgical settings.
Comorbid substance use disorders may complicate treatment for both the hepatologist and psychiatrist. Comprehensive assessment of psychiatric illness and psychopharmacological management may be critical.
Attempts have been made to integrate psychiatry and medicine as far back as Benjamin Rush, a physician and signer of the Declaration of Independence. Recent advances in research, clinical practice and organizational makeup, however, now make integration seem more plausible than ever. Find out what's happening to bring these two fields closer together.
Research on amyloid-beta immunotherapy for use as a therapeutic modality for Alzheimer disease (AD) is back on track, and new study results are promising.
Management of diabetic peripheral neuropathy (DPN) centers on proper footcare, offloading, and various orthotic devices to prevent the development of ulcers. Management trends, however, show that off-label use of some pharmaceutical agents is common and that these agents are proving beneficial in relieving the pain that can accompany DPN in up to 35% of patients. In addition, innovations in orthotic devices and new technologies for patient monitoring are being rolled out.
MRI has provided important insights into the pathophysiology of multiple sclerosis (MS).1 However, conventional MRI scans furnish only gross estimates of the nature and extent of tissue damage associated with MS,2 and the data correlate poorly with measures of concurrent disability in patients.
Published research is now backing up what would appear to many to be a clear heart and brain connection. As more of this research is circulated, it could have a direct impact on how neurologists practice medicine and on how neurologists and primary care physicians treat patients and interact with each other.
How high is your knowledge quotient on special considerations in the treatment of women with epilepsy? In a presentation on managing epilepsy in special populations, Trevor J. Resnick, MD, director of the Division of Pediatric Neurology at the University of Miami, cited survey results published back in November 2000 in The Journal of Women's Health and Gender-Based Medicine,1 which illustrated that only 5% of the 3535 practitioners surveyed answered two thirds of the questions correctly. "Almost a quarter didn't know that there was a relationship between seizures and hormonal cycles. Over 80% didn't know that women with epilepsy have lower fertility rates. Two thirds didn't know that women are at a higher risk for osteoporosis and osteopenia. Three quarters didn't know which antiepileptic drugs-and this is very important-interacted and which did not interact with oral contraceptives," stated Resnick in his presentation at a symposium on advances in neurology held recently in New York City.
ISC Meeting Highlights: Latest Advances and Updates in Stroke Rehabilitation
Biogen Idec and Elan Corporation voluntarily withdrew natalizumab (Tysabri) from the market on February 28 and suspended clinical trials. The move came after 1 patient died and suspected progressive multifocal leukoencephalopathy developed in another.
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 that heart health is related to cognitive health and that cognitive decline can be a risk factor for stroke. The implications for neurologists and primary care physicians include potential changes in the way you interact with each other and with your patients. Questions are arising about how primary a neurologist's care should be and about how neurologic a primary care physician's practice should be. We offer a discussion of these issues starting on page 17, and we'd love to hear your thoughts.
With all the talk about electronic medical records (EMR) and hundreds of products flooding the market, why aren't more physicians adopting the technology? The Institute of Medicine's 1991 watershed report on computer-based patient records1 spurred widespread excitement and inspired many information technology (IT) companies to invest in the development of new health care products.
Three recently published studies uncovered some answers to the genetic underpinnings of depression. Familial vulnerability was shown to increase with each generation affected by depression. Two genetic variants pointed in opposite directions: one showed an increase risk of depression and the other predicted responsiveness to antidepressants.
A joint research effort from Japan and the Mayo Clinic has identified an antibody that can help differentiate Devic syndrome-or neuromyelitis optica (NMO)-from multiple sclerosis (MS). NMO is generally considered to be a rare disease, but it may be underrecognized and is often misdiagnosed as MS, although it demands a treatment protocol that differs from that of MS. Indeed, in some countries, misdiagnosis may be as high as 30%, according to Mayo Clinic estimates. A research team hailing from the Department of Immunology and Neurology at the Mayo Clinic in Rochester, NY, led by neuroimmunologist Vanda A. Lennon, MD, PhD, in collaboration with a research team from Tohoku University School of Medicine in Japan, identified the autoantibody NMO-IgG, which appears to be a reliable marker for differentiating NMO from MS.
"No longer a pipe dream," is the suggestive lead-in of a widely distributed press release issued last October touting the potential benefits of cannabinoid compounds in the treatment of Parkinson disease (PD), Lou Gehrig disease-or amyotrophic lateral sclerosis (ALS)-and a number of other debilitating conditions, as reported during last fall's 2004 annual meeting of the Society for Neuroscience. According to Daniele Piomelli, PhD, an expert in cannabinoid research and professor in the Department of Pharmacology at the University of California, Irvine, certain cannabinoid compounds can be harnessed to "provide select benefits to patients while avoiding some of the unwanted effects" associated with marijuana use. Compounds of greatest interest have been WIN 55212-2, delta(9)-tetrahydrocannabinol (THC), and anandamide.
Painstaking elucidation of a patient's symptoms is the key component of the diagnostic workup for dizziness and vertigo. A rational, straightforward, and cost-effective approach that uses minimal, selective diagnostic testing can get to the root of an individual's specific problem.
Long before the term "neurology" was coined and the brain was wholly mapped and labeled in illustrations by Thomas Willis (English anatomist and physician) in the mid-1600s, healers were trying to understand the cause of headaches and bring relief to sufferers. Willow bark, the "natural aspirin," has been in continual use for headache relief for more than 2000 years by Native Americans and Europeans. Once a contemporary of such therapies as the application of an electric catfish to an aching head (Egypt), and cutting a hole in the skull and inserting a clove of garlic for 15 hours (Arabia), it has withstood the test of time.
The post-stroke patient is at significant risk for various psychiatric syndromes. The most commonly reported of these in the literature are post-stroke depression (PSD) and post-stroke dementia (PSDem), which may present simultaneously with overlapping mood and cognitive symptoms. In this article, we offer a review of current literature on post-stroke psychiatric syndromes and an integrated clinical approach to screening, diagnosis, and pharmacologic intervention.
Some patients with epilepsy have more treatment options today because of constantly expanding computer power, the development of model neurons and neuronal networks, and the ability of neurologists and neurosurgeons to translate medical and scientific research into clinical practice.
Given that A. Lee Dellon, MD, has yet to see an ulceration in any of the neuropathic limbs he's treated with surgical decompression, it may not be surprising that most of his patients eventually undergo the procedure in both limbs. But a report by him and colleagues in the December 2004 issue of Annals of Plastic Surgery (about ulceration rates in the contralateral limbs of those treated only once) underscores the effectiveness of the procedure.
Although previous findings have suggested that certain gait impairments in patients with diabetes are specifically linked to neuropathy, researchers from Loma Linda University in California also have found gait abnormalities in patients with type 2 diabetes who did not have neuropathy.
As a blizzard rumbled up the East Coast on Saturday, January 22, about 140 people didn't let its imminent arrival in Boston deter them from meeting with a group of neurologists who had set aside their time for a public forum. It was the first-ever Frontiers in Neurology Town Hall Meeting sponsored by the American Academy of Neurology (AAN). Actress Teri Garr also came, as ambassador for MS Lifelines, to speak about her battle with multiple sclerosis (MS), which she described in her typical humorous way: "MS is to disease what Enron is to accounting." Still, she said, she was there to promote a positive mental attitude and to encourage patients and doctors to keep talking to each other.
Since the 1990s there has been an increase in research on sexual harassment and its mental health consequences. These researchers discuss the use of alcohol to self-medicate harassment-engendered distress and the need for greater attention to potential alcohol-related consequences of harassment experiences.
In the past decade, important advances have been made in detecting and treating substance abuse disorders. In addition, research has revealed influences on the etiology and course of SUDs. Dr Pettinati introduces this Addictive Disorders Special Report, noting that the articles add to this knowledge base.
Dr. Cummings, the originator of Psychiatric Times' "Brain and Behavior" column, looks back over his career in neurology. Looking forward, he predicts that psychiatry and neurology will become ever-more intertwined.
What actually happens neurochemically in the brain to cause addiction? A well-known researcher discusses her findings on the role that dopamine levels play in addiction and aversion to cocaine.
With the immediate survival needs of tsunami survivors being addressed, international and national organizations and agencies are now tackling mental health concerns. The World Psychiatric Association (WPA) has created a Tsunami Committee, is taking steps to provide technical assistance to the affected areas and has established a disaster fund.
Patients with multiple sclerosis often ask about exercises that may improve their condition, according to research. Here is a review of studies in endurance training, aquatic fitness programs, and progressive resistance exercises to help answer their questions.
Mind-controlled artificial limbs were once the stuff of sci-fi and then were regarded as a concept that would not see clinical application until a far distant future. However, clinical application may be only a few years away.
Neurologists and other physicians can expect Medicare reimbursements, medical liability reform, and prescription drug issues to be revisited this year as President Bush and Republican leaders attempt to leverage the fall election gains in the House and Senate. But enacting key measures is far from certain. Despite titular control of 55 seats in the Senate, Republicans are still shy of the 60 votes needed to overcome a Democratic filibuster. Passing such bills “is not going to be a slam-dunk,” said Jacque J. Sokolov, senior partner of Sokolov, Sokolov, Burgess, a health care consultancy in Scottsdale, Ariz. “But the likelihood of it happening is greater in a Bush- Republican Congress environment than it would have been in a Kerry environment.”
