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Treatment successes can be hampered by treatment-refractory mood disorders. Nine key concepts are outlined to help guide the treatment of these patients.

Clinical observations have shown that patients who do not respond to antidepressants may show dramatic improvement if atypical antipsychotics are added to their regimen. How can successful patient outcomes be maximized?

Addiction-as-disease or addiction-as-choice may be better defined by delineating initial experimentation with addictive drugs from ongoing drug use. Repeated exposure to addictive substances changes the molecules and neurochemistry of the addict. Addiction-as-disease accepts the responsibility of the health care professional to treat the patient and precludes the stigmatization that addiction is a choice.

Many patients, particularly those living in colder climates, can suffer from seasonal affective disorder (SAD). What causes SAD and what are the treatment options for these patients?

College students are far less likely to kill themselves than are nonstudent peers, according to a 10-year research study examining suicide rates at 12 Midwestern campuses.

More women than men are diagnosed with depression. Yet, men who are troubled by depression are also more likely to die, even when suicide is removed from the factors of consideration. Vascular depression, hyperintensities within the brain, physiological changes and late-life onset provide both insight and more questions into the nature of depression and this enigmatic paradox.

One more mouth rimmed in charcoal after an OD screams for release: to probe the night for the man who left her. No one pretends an interest: at 4 a.m. it's too late to care.

The patient, a young gay man who once lived for a time in Salt Lake City, describes his pursuers: Mormons who know where he is and are trying to kill him. As the clinic visit goes on, I see the doubt in his eyes when I explain my medication increase, and ask about it. He admits he can't be sure; his voices are saying that I'm a Mormon too. Only, with much persuasion and oversight will he comply with my prescription, because he trusts his case manager more than anyone else in the world.

September will be a difficult month for a long time.

When she asks me to massage the ache in her knuckles,

The U.S. Supreme Court's decision on Atkins v. Virginia has transformed the capital punishment landscape for the mentally retarded. This decision also marks an important step in evaluating the competency of death row inmates of any mental capacity. What could be the future outcomes of this landmark decision?

Noting the frequent unresponsiveness of posttraumatic stress disorder (PTSD) to standard drug treatments, Stein and colleagues reported results of the first double-blind, placebo-controlled trial of an adjunct to selective serotonin reuptake inhibitors for the treatment of this disorder.

Beyond the threat of malpractice suits, losing a patient to suicide can be one of the most profoundly disturbing experiences of psychiatrists' professional careers. Yet, there is sparse literature on the occurrence and scant attention given to it in residency training programs (Gitlin, 1999).

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?