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Pantoum From a Line by Pablo Neruda

Patients with HIV infection are at risk of developing psychiatric symptoms and disorders similar to those seen in the general population. What unique biological, psychological and environmental factors are involved in treating this population?

The United States is facing accelerated growth in the number of older citizens due to the aging baby boomer generation. It is expected that this emerging cohort will have more licensed drivers who will drive longer distances more frequently and later into life than preceding generations. What are the risks from elderly drivers and how can we help them drive safely?

Elderly patients are a heterogeneous population with myriad issues facing them. The group of articles in this Special Report should stimulate thinking, discussion and future research in a variety of areas.

Three psychiatrists give their perspective on helping victims of one of the nation's worst natural disasters.

Published a decade ago, the original National Comorbidity Survey focused largely on anxiety and depression. In an exclusive interview, the survey's designer, Ronald C. Kessler, Ph.D., talks with Psychiatric Times about the just-published replication study, which found that the combined lifetime prevalence of impulse control disorders is higher than that for either mood or substance use disorders.

Insights Into Depression and Anxiety:What Roles Do Anxiety Disorders Play in the Treatment of Depression?

Carpenter LL, Schecter JM, Underwood JA, et al. Service expectations and clinical characteristics of patients receiving psychiatric emergency services. Psychiatr Serv. 2005;56:743-745.

Affected patients with intractable epilepsy are treated, often for years, with antiepileptic drugs and other interventions that can promote further morbidity.

Parkinson disease, Disease management

pay for performance, reimbursement

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epilespy, focal epilepsy, temporal lobe epilepsy, 3 Tesla phased array MRI, surgical intervention for epilepsy

epilepsy, seizures

Two new recommendation papers--one on the use of serum prolactin (PRL) in the differential diagnosis of epileptiform seizures and the other on use of carotid endarterectomy (CE) in stroke prevention--were released this past September by subcommittees of the American Academy of Neurology (AAN).

Alzheimer disease, dementia, Parkinson disease, multiple sclerosis, caregiver, caregiving

Creutzfeldt-Jakob disease, wheelchair, Parkinson disease, rasagiline, selegiline

HIV/AIDS, peripheral neuropathy, sensory neuropathies, subjective peripheral neuropathy screen

Opiate detoxification in the outpatient setting often depends on what services are available in the community. Many clinicians think that a methadone maintenance or taper regimen, combined with substance abuse treatment therapy, offers the best chance to prevent relapse. If possible, enrolling a patient promptly in such a program should be considered. Regardless of detoxification method, referral for psychosocial drug treatment is indicated.

A number of highly publicized cases in the lay press have underscored the significance of, and dangers associated with, perinatal psychiatric illness. Unfortunately, the field of psychiatry has failed to use these tragic cases to disseminate accurate information and educate the public about the high frequency of perinatal depression and anxiety, as well as the relative rarity of postpartum psychosis and infanticide. Moreover, psychiatrists continue to have difficulty in educating their medical colleagues about the need to screen for these illnesses, so most obstetricians and pediatricians still do not screen for perinatal depression and anxiety, much less manage it effectively. Decisions about appropriate treatment are further complicated by a lack of empiric outcome data.

Over the past decade, there has been increasing attention to the identification and management of mood and anxiety disorders related to childbearing. Emergen- cy physicians, including psychiatrists, primary care providers, obstetricians, gynecologists, and pediatricians, encounter women who are struggling with mental health issues in the context of reproductive events, such as pregnancy, pregnancy loss, and the postpartum adjustment period. In some cases, the reproductive event may precipitate a mental health crisis. In others, it may exacerbate an underlying mental health condition that, in turn, may need to be managed differently because of issues related to pregnancy or breast-feeding.

New mothers may present to the emergency department (ED) with symptoms ranging from mild anxiety to severe psychosis. Postpartum psychosis has abrupt onset and severe symptoms and usually occurs in the immediate postpartum period. Patients who have had a previous episode of postpartum psychosis or have first-degree relatives with postpartum psychosis or bipolar disorder are at higher risk.

Pregnancy and new motherhood are considered happy and hopeful times. Bad outcomes, such as miscarriages and stillbirths, occur, however, and even with good outcomes, psychiatric disorders can present or worsen at this time. The incidence of depression in women during pregnancy is about the same as that for matched controls, and because depression is common in all women, this is a significant public health issue. More than 10% of women with panic disorder describe first symptoms as occurring around pregnancy, and there is evidence that pregnancy exacerbates psychotic disorders. Within a few days of giving birth, 25% to 75% of new mothers experience emotional lability, or the "baby blues," and 10% to 20% of new mothers experience postpartum depression. The peripartum is thus a time of great joy potentially complicated by the entire range of psychiatric illness.

Women with postpartum depression frequently experience intrusive, obsessive ruminations that are part of a depressive episode. Many women with postpartum depression have significant anxiety, and many reach the level of meeting criteria for full-blown anxiety disorders. An anxiety disorder may also precede and contribute to the development of a depressive episode.

There is growing epidemiologic and clinical data that confirm progressive hypothalamic-pituitary-gonadal hypofunctioning in aging men. What role does the HPG axis play in the complex psychobiology of male sexual and affective disorders? The treatment rationale, clinical indications and risks in using exogenous testosterone for late-life depression are explored.

In recent years, depression and stress have emerged in the discussion of the impact of psychosocial aspects on coronary heart disease. Several studies indicate that these factors result in risk elevation comparable to hypercholesterolemia and hypertension.

An expert in the topic explores the historical background that led to problems with boundary violations in psychotherapeutic practice and describes community standards for professional boundaries when practicing psychotherapy. The difference between boundary crossings and boundary violations is clarified and discussed, as are the psychological types most likely to violate those boundaries. Possibilities for rehabilitation and the format for rehabilitation are also provided.

Is there such a thing as a placebo effect? If so, at what point does the drug effect really occur? How do we distinguish between the two?

Health-related quality of life can provide a simultaneous and net assessment of the therapeutic and adverse affects of psychiatric treatments for depression. While the cognitive side effects of ECT might be thought of as a limiting factor in HRQOL gains, they have not been systematically studied until recently. Find out what quantitative assessment of HRQOL following ECT for major depressive disorder shows.

Seasonal affective disorder affects 1% to 3% of the North American population. Evidence exists for the efficacy of high-intensity bright, fluorescent light. Pharmacological management with SSRIs has shown equivalent efficacy to light therapy. How can these two therapies be combined? What other therapies are available?