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If You Ask Me My Name - Poetry of the Times

It was supposed to only take 100 days, but that was eight years ago. When President Bill Clinton took office in January 1993, an air of expectancy permeated Washington, D.C.'s stuffy corridors, and for a moment it seemed as if the world's most developed nation would finally have a national health care policy.

Dr. Usdin steps down from his role of Psychiatric Times' book review editor after 11 years of service.

There are two goals in the acute treatment setting (e.g., emergency department): initiation of treatment and reducing the symptoms of agitation and aggression that frequently accompany an acute psychotic breakdown. Treatment options and considerations are reviewed.

The FDA approved two new intramuscular, immediate-release formulations of atypical antipsychotics. Both olanzapine (Zyprexa IM) and ziprasidone (Geodon IM) were recommended as safe and effective for the treatment of agitation in patients with schizophrenia.

The SSRIs have become the most widely prescribed antidepressants in the United States. With this increased use has come more information on adverse events associated with their use, such as sexual dysfunction. However, movement disturbances associated with SSRI use can adversely impact treatment. This article explains the pathology of movement disorders and describes confounding variables such as other medications, pre-existing neurological insults and the nature of case reviews. Those at risk include the elderly, patients taking neuroleptics and those exposed to high levels of SSRIs.

A groundbreaking program at UCLA goes into inner-city schools to help students work through trauma. By learning how to deal with the trauma itself and reminders of the trauma, students are able to improve their academic and social performance.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, and it may manifest as mood disturbances in those affected. How can this medical condition be treated in women who have bipolar disorder?

In examining the demographics of a state Medicaid population, we found that members of ethnic minorities, rural residents, women, and patients aged 45 years and older were more likely to receive first-generation antipsychotic medications than the newer, second-generation agents, which have a more favorable side-effect profile.

Patients with schizophrenia have a high risk of committing suicide. Between 25% and 50% attempt suicide at least once, resulting in approximately 3,600 successful attempts each year in the United States. What are the risk factors for suicide one should look for in treating patients with schizophrenia? Herbert Y. Meltzer, M.D., discusses the issue and offers warning signs.

In spite of the enormous success of antidepressants, there are surprisingly few that are available in other than oral form. There is now substantial evidence that intravenous administration is well tolerated and may accelerate onset of therapeutic effect. With the possibility of transdermal delivery3/4a noninvasive and painless route of administration requiring no technical support3/4parenteral antidepressants may become more acceptable in this country and warrant further clinical investigation.

Dietary supplementation of SAM-e--naturally produced and physiologically necessary compound for living cells--is being investigated for its use as a viable treatment for depression.

After a significant delay, the U.S. Congress passed the Victims of Trafficking and Violence Prevention Act of 2000 to provide support and services to victims of domestic violence. Meanwhile, the findings in the Family Violence Prevention Fund's State by State Report Card on Health Care Laws and Domestic Violence shows state legislation has proved disappointing. Which states do the most in assisting physicians and other health care providers to aid victims of domestic violence?

According to a recent article in the Journal of Women's Health and Gender-Based Medicine (2000;9[4]:405-411), more psychiatrists than physicians in other specialties see themselves as the best source of information for victims of domestic abuse.

Psychiatrists can play a vital role in determining whether or not a patient will be a good candidate for an organ transplant. Using a case vignette, Dr. Garton explains how she helps a transplant team make the best possible decision.

Dorrance Publishing; Pittsburgh, 2000 142 pages $13

(Additional information regarding violence and trauma can be found in the Special Report section of the April 2001 issue of Psychiatric Times-Ed.)

Missed Diagnosis

People are different, according to conventional wisdom - the saying generally used in explaining varying opinions, attitudes or ways of thinking. Why then is it not a given that people are different in basic brain functions such as learning and intelligence?

Samantha Meltzer-Brody, M.D., et al. provided data suggesting that fluoxetine (Prozac) exerts a broad-spectrum effect in reducing all symptom clusters in a sample of 53 patients with posttraumatic stress disorder (PTSD). Their results indicated that fluoxetine was most effective in treating the individual symptoms of intrusive recollections and having a sense of failure.

The Most Common Time - Poetry of the Times

A further look at TMS, including synopses of presentations from the 3rd Annual Meeting of the International Society of Transcranial Stimulation.

The 89-year-old woman had undergone hip replacement surgery two days before, had tubes in her arms and couldn't walk. But she blithely announced to her daughter that she was leaving the hospital immediately and started to get out of bed. Astounded, the daughter sought out her mother's physician and asked, "What's going on?"

The author examines how temperature and length of day can affect mood and behavior, both in a general population and a group of inpatients. In both groups, there were two peaks of violent behavior, one in May-June and one in October-November, which correspond with the equinoxes. Is it possible to track violent behavior in various geographical areas depending upon weather and length of day?

In response to encouraging results from a small pilot study of vagus nerve stimulation (VNS) for treatment-resistant depression, researchers are now expanding the study to approximately 200 patients in 20 sites across the United States.

In this overview of research into the biopsychosocial changes caused by traumatic events, Dr. Novac discusses psychopathology, brain development and the effect a traumatic event can have on the victim's family-even long after the event occurred.

"Stalking" is defined as repeated and persistent unwanted communications and/or approaches that produce fear in the victim. The stalker may use such means as telephone calls, letters, e-mail, graffiti and placing notices in the media. A stalker may approach or follow the victim, or keep their residence under surveillance.

Methods for detecting possible abuse and how to help victims (even if they are unable to help themselves or leave their abuser).

Most studies have found clear gender differences in the prevalence of depressive disorders. Typically, studies report that women have a prevalence rate for depression up to twice that of men (Bebbington, 1996; Nolen-Hoeksema, 1987).

Obstetrics Ward, County Hospital - Poetry of the Times