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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.

Adults who are severely mentally ill are over-represented in U.S. jails and prisons, leading to an interface between the mental health and criminal justice systems. New intervention strategies involving both systems, such as mental health courts and forensic assertive community treatment, could divert patients away from the criminal justice system and promote engagement in community-based treatment and support services.

Many psychiatrists limit the application of their skills to individuals whose discomfort matches the phenomenological criteria of DSM-IV-TR. Can psychiatry transcend the concept of "objective cure" and include "subjective perfection" as a goal? Is there a logical reason why the concept of "treatment pills" cannot coexist with that of "lifestyle pills" on the psychiatric prescription pad? Dr. Giannini reflects on whether there can be both "cosmetic" as well as "reconstructive" psychiatry and if a disease is needed in order to be treated.

Hollywood has had a long-standing love affair with psychiatry and its portrayals of electroconvulsive therapy reflect and influence public attitudes toward the treatment. One-third of medical students decreased their support for the treatment after being shown ECT scenes from movies, and the proportion of students who would dissuade a family member or friend from having ECT rose from less than 10% prior to viewing to almost 25% afterward. So what is the legacy of portrayals that have been so abhorrent, and are there any exceptions to the rule?

What are some of the pitfalls of treating patients from varying cultural backgrounds, what cultural issues should psychiatrists be aware of and how can they fit varying culturally based psychiatric disorders into a proper diagnostic framework? Using case studies, Dr. Moldavsky explores the clinical implications of culture in psychiatric practice.

What are the qualities of forensic psychiatry? In reviewing the basis on which forensic psychiatry is defined as a specialty or, more accurately, a subspecialty of psychiatry, the author discusses the altered relation between physician and "subject," the consultative role in relation to the legal system, and the areas of specialized knowledge and skills that attend the field.

New studies show that people may cycle in and out of insurance coverage. This can lead to poor health outcomes as chronic disorders, including mental illnesses, are neglected during times when insurance is lacking. Is true health care reform finally on its way?

Monitoring patients for possible QTC prolongation with psychotropic use can be difficult--even more so in children or adolescents. What screening and treatment techniques should be used for maximum therapeutic benefit with minimum cardiac risk?

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After reading this article, you will be familiar with:The function of the hypothalamic-pituitary-adrenalaxis and the significance of cortisolin the etiology of depression.

Psychopharmacologic management has become increasingly complex, and physicians run the risk of precipitating drug-drug interactions when certain drugs interact via the cytochrome P450 system. In addition, the P-glycoprotein transporter may play a role in certain drug-drug interactions. While physicians currently rely on Web sites and textbooks to avoid potentially morbid and lethal interactions, electronic medical records may play a crucial role in the future.

Since the introduction of the SSRIs in the early 1990s, the rate of antidepressant prescribing has increased dramatically. This look at five national data sets concludes that greater recognition of depression and greater rates of treatment with medication and psychosocial interventions has made a significant contribution to reducing suicide rates.

Anorexia nervosa, bulimia nervosa and binge-eating disorder remain challenging disorders for the practicing psychiatrist. While psychopharmacological agents play an important role in the overall treatment of eating disorders, current empirical evidence does not support their sole use. A recipe consisting of evidence-based psychopharmacological agents together with evidence-based psychotherapeutic approaches is usually required for a successful outcome.

According to a large international study, BD-II mixed depression can easily be misdiagnosed as major depressive disorder. Proper assessment and treatment of mixed depression in BD-II could have a positive impact on outcomes in bipolar disorder.

In modern practice, psychiatrists will invariably have patients who come from different ethnic or cultural backgrounds. Practitioners will need to consider socioeconomic status, diet, use of herbal medications and immigration status, as well as patients' own self-perception of ethnicity, in assessing patients and planning treatment.

A longitudinal study of the nicotine patch for smoking abstinence and a look at new drugs to lower blood pressure in patients with cerebrovascular disease are among the various research studies from Europe, Australia and Asia highlighted in this column.

Several international algorithm projects are underway, some of which have been in use for years. What are the roadblocks for their successful implementation?

A recent survey of 1,200 Australians found that many respondents did not understand how best to help people with depression.

Headache is a frequent somatic complaint in childhood and adolescence, and its prevalence has increased over the last few decades. The presence of a comorbid psychiatric disorder tends to worsen the course of headache by increasing attack frequency and severity, making the headaches less responsive to treatment, and increasing the risk of chronification. Identification and treatment of comorbid psychiatric conditions is, therefore, important for the proper management of headache, especially in children and adolescents.

Despite increased knowledge of child and adolescent mental health disorders worldwide, there is still a dearth of economic and human resources available to meet treatment needs, especially in developing countries. In this article, the impact of developed countries and the dimensions of this problem are discussed.

While the symptoms of somatoform and dissociative disorders are influenced by the patient's culture, these syndromes are heterogeneous and may have overlapping features. Although more frequently reported in non-Western cultures and thought of as exotic and culture-bound, multiple personality disorder may be a North American example of one such disorder.

How does the role of culture affect disease presentation? The author reviews the impact of religion, ideology and upbringing on the epidemiology of OCD in Egypt.

Comparing the consequences of caregiving across countries for a person with a serious mental illness needs to take into account not only different languages, but also different cultures, quality of mental health services and standards of living. So far, one questionnaire has shown the most validity and become the exemplar in cross-national research; yet it is still not free from possible cultural bias or criticism from its creators who acknowledge that much more research needs to be done.

Psychological debriefing is a popular crisis intervention designed to alleviate immediate distress and prevent posttraumatic psychopathology following exposure to traumatic events. Despite a flourishing "debriefing industry," the author argues that there is no convincing evidence that it prevents posttraumatic psychopathology.

One of the spin-offs of the consensus statement is a study of the risk for metabolic disorders with antipsychotic use in children and adolescents. Here, the lead researcher discusses some of the group's initial findings.