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The slight difference between antidepressant and placebo has been referred to as a "dirty little secret" by researchers, a secret that was believed by FDA officials to be "of no practical value."

Weight-based dosing strategies have been used in psychostimulant studies for ADHD in children between the ages of 6 and 12 years. The efficacy of weight-based psychostimulant doses changes throughout early childhood and into adolescence in ways that are not in keeping with weight-based dosing practices. Future treatment and research must explore new possibilities in order to afford patients the most benefit for the least amount of effective drug intervention.

Many adolescents experience depressive symptoms and some have episodes that go beyond transient feelings. Risk factors and predictive strategies are thwarted by the power of individual differences. Communicating with patient families; using the available innovative pharmacological, diagnostic and behavioral tools; and individualizing treatment approaches can improve outcomes.

Epilepsy is one of the most common chronic neurological disorders of childhood. Therapy should consist of education to reduce fears and concerns, psychotherapy to decrease triggers for seizures, and careful medication monitoring to avoid those drugs that reduce seizure threshold or have excessive interactions with antiepileptic drugs.

Catatonia is found in at least 10% of patients admitted to acute psychiatric services, so any young patient with stupor, unexplained excitement or persistent motor signs should be formally assessed for this syndrome. From among the 20 to 40 now-identified features of catatonia, its proper diagnosis must be differentiated from other mental illnesses.

Our perceptions about antidepressant efficacy have been inflated by the "file drawer" effect: the selective publication of positive studies and suppression of negative ones.

They changed the game on me, and I am quite angry about it.

In the last third of the 20th century, psychiatry boldly shook off a 120-year-long philosophical funk and rushed to catch up in the thrilling march of medicine. The biopsychosocial model that once sounded trendy now seems to be an indispensable approach. The pioneers of psychopharmacology who once labored at the margins have now been joined by thousands of bright young doctors who treat patients with depression, psychosis and impulsive aggression and realize that a troubled soul is often expressing the cries of a troubled brain. This issue of Psychiatric Times celebrates the stirring giant that is 21st-century neuropsychiatry--a discipline that derives its immense power and scope from the glad embrace of the twin Enlightenment ideals of humanism and the scientific method.

The Council of State Governments argues that police should be better trained to deal with mentally ill offenders. Increased funding is being requested in Congress to support educational programs for law enforcement.

Although ADHD can be effectively treated and can lead to significant dysfunction if left untreated, negative public perceptions still abound. Proper diagnosis, exploration of comorbid disorders and collaboration with other health care professionals may be the answer to ensuring positive outcomes for children afflicted with this disorder.

First the IV, then diazepam rushed through a vein, lidocaine to scalp, lattice helmet screwed to skull, drill's buzz and vibration, a hole like a wishing well.

Serotonin, the prefrontal cortex, and the amygdala interact with one another in the emergence of impulsive aggression. Which pharmacological and psychosocial treatments prove most effective?

New imaging techniques have shown a dynamic wave of gray matter loss in early-onset schizophrenia. Can this pattern of destruction provide a window of opportunity to combat this disease?

Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite. In some patients, an organic mental syndrome can be part of a migraine attack (Davidoff, 1995). In other patients, an acute psychotic condition is the dominating clinical feature. This presentation, with paranoid delusions, hallucinations and anxiety, has been described in families with hemiplegic migraine (Spranger et al., 1999). Migraine is, therefore, an important differential diagnosis in relation to episodic phenomena with a mixture of somatic and psychiatric symptoms. In addition, psychosocial stress is the most common precipitating factor for a migraine attack (Davidoff, 1995).

After numerous hospitalizations, electroconvulsive therapy and a battery of drug trials, a college senior remained suicidal. Looking for advice on her patient, a psychiatrist brought the case to a team meeting, only to be told by a senior colleague, "You can't save them all."

Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite.

Psychotic episodes following brain injuries can often be mistaken for schizophrenia. How can the presentation of psychotic episodes reframe our understanding of this complex phenomenon?

The tragedy of Sept. 11, 2001, brought so much public attention to mental health care that the National Institute of Mental Health has awarded several grants for the study of the needs incurred following these attacks. Grants were given to Cynthia Pfeffer, M.D.; David Vlahov, Ph.D., and Gerry Fairbrother, Ph.D.; Rose Zimering, Ph.D.; Charles Marmar, M.D.; Hector Bird, M.D.; Edna Foa Ph.D., and Rachel Yehuda, Ph.D.; Joseph LeDoux, Ph.D.; Daphne Simeon M.D.; and Joann Difede, Ph.D. These researchers from various universities and institutions were given grants to support or continue research on topics such as Sept. 11's effects on mental health symptoms, disorders and care service use; posttraumatic stress disorder (PTSD) and other disorders in children as a result of losing a parent in the attacks; and PTSD in clinicians treating victims of the attacks.

With black bags stuffed below their eyes, all the sad doctors come to me now like mourners in the time of plague. Crying in their office bathrooms, carrying boxes of charts home at night, they are too tired to eat, and sex excites them less than a committee meeting. Without dreams, their eyes watch the clock tick off the wounded hours-thousands of doctors writhing on the scarred suture line of American medicine like a cargo of used syringes washed up with drowned birds on an oil-soaked beach.

The World Health Organization (WHO) has distributed for comments the draft of a Manual on Mental Health Legislation as a guide for all the countries of the world. It is to serve as a model for new legislation and as a guide for countries amending their legislation. Given the different legal systems, the cultural diversity and the vast inequalities in economic resources among the nations of the world, one can certainly question the wisdom of the WHO's top-down approach. In addition, everyone who knows the scarcity of competent mental health care professionals and the limited resources in third world countries will recognize that most of the proposals are quite unrealistic. How can nations who cannot feed their poor or meet the basic necessities of public health measures and primary care be expected to provide "incompetent" mental patients with counsel (lawyers) and independent tribunals (courts) before they begin to treat them?

With the failure of previous federal plans to reform health care, other options must be considered. How might this effect the reimbursements for providing care?

Psychopharmacology can be useful in all stages of couples' therapy. Using a high-functioning couple as a case example, the author illustrates how psychopharmacology, together with psychotherapy, can be used to facilitate treatment success.

Psychiatrists, neurologists, primary care physicians, physician assistants, psychologists, psychiatric nurses, social workers and other mental health care professionals. Continuing education credit is available for most specialties. To determine if this article meets the requirements of your specialty, please contact your state licensing board.

While anorexia nervosa was the first eating disorder to be recognized through the 19th century reports of Gull (1874) and Lassque (1873), bulimia nervosa and the less well-defined eating disorder not otherwise specified (EDNOS) syndromes are more common.

How can psychiatrists and psychotherapists optimize their collaboration and individual skills to facilitate treatment success?

There is no question that psychotherapy and psychopharmacology can be successfully integrated. Indeed, there are still many psychiatrists left in this country who talk to patients and families, provide both psychotherapy and psychopharmacology, and care for patients in a biopsychosocial context.

The use of Personal Digital Assistants (PDAs) by medical professionals has many advantages over traditional paper schedulers. The following is a compilation of additional resources offering information for using and integrating this new technology in your practice. For more information on choosing a PDA to enhance your practice, please see the article How Technology Will Affect Your Practice in the June 2002 issue of Psychiatric Times (p36).

As a psychiatrist working in a state hospital, this author defends the long-term commitment of sexual offenders to institutions and offers insights on factors determining prognosis.

What effects will the verdict from the murder case against Andrea Yates have on the public's view of the insanity defense?

When I raise my rates he folds his fifty dollar co-pay and slides it up my desk like an enlisted man on leave easing a big bill in a stripper's G-string. He tells me I'm like his war-time whore who loved him on payday and left when his money ran dry. Each week I lead him in our dance, excite him with my offer to listen to his dreams. And I tell myself I do it to ease his suffering, because I get paid, because I took an oath. But every month, when we devour another round of sessions, I fill out forms for insurance pimps who won't pay unless I reveal the private parts.