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Many of the advantages of the MAOIs are seen with selective serotonin reuptake inhibitors, which have become the drugs of choice in the treatment of panic disorder.

As psychiatry is swept along by the evolutionary winds of change, will you be poised and trained for success? This question was posed to psychiatrists by Joel Yager, M.D., at the recent annual meeting of the American Psychiatric Association, at which he received the Seymour D. Vestermark Award.

Rural psychiatry is on the threshold of an immense transformation. Across the country, each state, faced with mandates to cut budgets and conserve health care spending, is in the complex process of negotiating the changing world of health care reimbursement and the redistribution of ever-shrinking funds. Since the majority of rural psychiatric care is delivered at community mental health centers, which rely heavily on state and federal government funding and initiatives, rural psychiatrists are likely to find themselves battling bureaucratic waves that challenge their resourcefulness and ardor.

Attention-deficit/hyperactivity disorder (ADHD) has received an extraordinary amount of attention in the popular media over the past eight months. Stories concerning the disorder, and especially its treatment with stimulant medication, have appeared in many major newspapers, news magazines and television news, entertainment and talk show programs.

Historically, cult refers to a system of worship and more specifically to an innovative religious system, as opposed to a sect, which is a breakaway group from an established religion. During the past 30 years, however, cult has taken on a pejorative connotation arising from disasters such as Jonestown and Waco, and hundreds of media reports of individuals and families devastated by involvement in cults.

Attention-deficit/hyperactivity disorder (ADHD) in adults is a common-and, frequently undiagnosed-psychiatric disorder. This article will focus on the symptoms, associated features, diagnosis, differential diagnosis, prevalence, etiology and treatment of this illness.

Paraphilias as defined by DSM-IV, are sexual impulse disorders characterized by intensely arousing, recurrent sexual fantasies, urges and behaviors (of at least six months' duration) that are considered deviant with respect to cultural norms and that produce clinically significant distress or impairment in social, occupational or other important areas of psychosocial functioning.

Since 1980, criteria for diagnosing bipolar disorder in adults have also been used to diagnose mania in children, with some modifications to adjust for age.

At this time, both patients and professionals seem to have an unprecedented interest in circadian rhythms. We now know that the body's clock is located in the suprachiasmatic nucleus (SCN) of the hypothalamus, and that the SCN regulates the pineal gland's secretion of the hormone melatonin.

For clinicians, the assiduous and sustained resistance to change common in patients with narcissistic personality disorder (NPD) has been especially noticeable and trying. However, until recently the natural course of NPD has not received much attention in the clinical and empirical literature, and there is very little documented knowledge about the factors that might contribute to changes.

Personality disorders are characterized by the presence of inflexible and maladaptive patterns of perceiving oneself and relating to the environment that result in psychosocial impairment or subjective distress. The enduring nature of the behaviors, their impact on social functioning, the lack of clear boundaries between normality and illness, and the patient's perception of the symptoms as not being foreign make this group of conditions more difficult to conceptualize than the more typical, episodic mental disorders.

Psychopathy (renamed antisocial personality disorder) is marked by persistent violations of social norms, including lying, stealing, truancy, inconsistent work behavior and traffic arrests.

Significant research developments in the etiopathogenesis of schizophrenia have occurred during the past several years. One such advance is the "neurodevelopmental" hypothesis that events during early brain development, especially the prenatal and perinatal periods, may play an important causal role in at least some, and perhaps many, cases of schizophrenia.

Temporal lobe epilepsy (TLE), now more commonly called complexpartial seizure disorder so as to include seizures that originatein the frontal foci, straddles the borderland between psychiatryand neurology.

Brain serotonin levels as a predictor of suicide has been the subject of intense research scrutiny over the past several years, with scientists trying to find easily accessible markers so that the neurotransmitter's levels might someday be readily measured in clinical settings.

Late last year, Oregon voters approved a law that would permit doctors to prescribe lethal drugs to patients judged to be in the last six months of life. Oregonians are setting out on a path that the Dutch have traveled for the past 20 years.

Venlafaxine (Effexor) is a novel antidepressant recently released to the American market. Its entry into the antidepressant market has been much heralded. The lay press has described the drug as "Prozac with a punch," and many patients were asking for it long before it was available. As the hoopla settles down, we are learning that venlafaxine is a potentially important drug with both advantages and disadvantages over other available antidepressants, including the selective serotonin reuptake inhibitors (SSRIs).

Sleep disorders and substance abuse disorders are widespread acrossthe United States, researchers have found. According to the NationalCommission on Sleep Disorders Research, more than 80 million Americanscomplain of sleep difficulties, while Schuckit and Irwin reportedthe lifetime prevalence of alcohol abuse or dependence to be 13percent and nonalcohol drug abuse, 5.9 percent.

Insomnia, the subjective sense of having inadequate quantity orquality of sleep, may result from a variety of causes. In itschronic form, such etiologies may include psychiatric disorderssuch as depression or anxiety, medical illnesses, medications,substance abuse, circadian dysrhythmias and pathophysiologiesintrinsic to sleep such as sleep apnea or periodic movement disorder.When these conditions have been ruled out, however, there remaintwo very interesting groups that at this time are best understoodin psychophysiological terms.

Sleep apnea, a medical disorder with significant health and behavioraleffects, is of particular interest to psychiatrists for its capacityto mimic or exacerbate symptoms of psychiatric disturbances suchas depression, anxiety and panic disorder.

Dopamine plays an important role in controlling movement, emotion and cognition. Dopaminergic dysfunction has been implicated in the pathophysiology of schizophrenia, mood disorders, attention-deficit disorder, Tourette's syndrome, substance dependency, tardive dyskinesia, Parkinson's disease and other disorders.

The gloom of winter, more often a literary theme than a medical topic, is a biological reality for an estimated 10 million Americans who suffer from seasonal affective disorder (SAD). For some, however, the depression ushered in by the dark days of winter can be treated simply and with rapid results with 30 minutes to two hours of bright-light therapy per day for a few weeks.