Addiction & Substance Use

From a research perspective, it is always a joy when molecular mechanisms that were first characterized in petri dishes are confirmed inside a living animal. As molecular techniques have become more sophisticated, such dual results are increasingly commonplace. This month's column is about just such an achievement and takes its cue from a topic I considered in last month's article.

Book review

Sexual dysfunctions as distinct syndromes were first identified in DSM-III in 1980. At that time, sets of criteria were specified for inhibited sexual desire, inhibited sexual excitement, inhibited female orgasm, inhibited male orgasm, premature ejaculation, dyspareunia, and functional vaginismus.

The comorbidity of anxiety disorders with bipolar disorder is a rule, not an exception, with a negative impact on both course and treatment outcome. So far, there are no guidelines or consensus for the treatment of this comorbidity.

There are occasions in which one's best psychotherapeutic efforts are not effective or help only modestly. If the effort has taken place for a relatively long period, the therapist has several options. One is to ask a colleague for consultation. A second is to reexamine one's understanding of the patient's dilemma.

In our presentation at the 2006 annual meeting of the American Academy of Child and Adolescent Psychiatry, we suggested that child psychiatrists who come across a child with the profile of the following hypothetical case should consider whether the child may have deficits that are not currently covered by DSM-IV nosology: either a nonverbal learning disability (NVLD) or a sensory processing disorder (SPD).

An item in the Boston Globe recently caught my eye. Apparently, a man who was fired by a large corporation for visiting an adult "chat room" while at work is suing the company. The man is claiming he is an "Internet addict" who "deserves treatment and sympathy rather than dismissal." Another item reported recently concerned a lawyer who argued that her client was not responsible for a rampage that he had committed because he "had been obsessed with comic book superheroes as a kid."

In this article we discuss psychoneuroendocrine influences on sexual orientation and the psychodynamics of internalized homophobia. Because of space limitations, we focus on homosexual orientation, although research in this area sheds light on heterosexual and bisexual orientation as well.

Any sexual behavior--normal or abnormal, masturbatory or partnered--ultimately rests on biological elements, psychological elements, interpersonal elements, and cultural concepts of normality and morality.

Epidemiological studies report a lifetime prevalence rate of 24.9% for (any) anxiety disorder. Feelings of anxiety can also be related to normal fear of pain, loneliness, ridicule, illness, injury, grief, or death. In both these types of situations, anxiety can be difficult to deal with. Consequently, benzodiazepines, which offer almost immediate symptomatic relief for anxiety, can be quite appealing to many persons.

This May, the FDA called for a black box warning on antidepressants to indicate that patients aged 18 to 24 years are at heightened risk for treatment-emergent suicidality. But a member of the FDA advisory committee that recommended that warning has issued his own warning, saying that the "real killer in this story is untreated depression and the possible risk from antidepressant treatment is dwarfed by that from the disease."

Involuntary Emotional Expression Disorder Often Misdiagnosed and Untreated

Alejandro Gonzales's Babel is a meditation on the barriers to communication in a world divided by class, culture, and language. Although his vision is dark, he never surrenders to cynicism. His Babel, unlike the Bible story, holds out the promise of a universal language of the human heart. Psychiatrists know this language as empathy--the wordless connection that is the art form of every caring profession.

From our Readers

From our Readers

Homelessness rates in both Canada and the United States have increased dramatically over the past 10 years. Among the homeless, there is a high prevalence of mental illness and substance use disorders.

This commentary arises from my concern about the superficiality that characterizes the process of diagnosing attention-deficit/hyperactivity disorder (ADHD) in children--usually followed by the prescription of one of the most powerful drugs on earth, methylphenidate.

Psychiatric emergencies usually involve some combination of agitation, aggression, impulsivity, psychosis, and risk of destructive behavior, including suicide and homicide. The psychiatrist must ensure the safety of the patient and others while identi- fying and treating immediate medical and psychiatric problems and developing and initiating a strategy for continuing the management of less immediate problems. In the diagnosis of acute behavioral disturbances, it is necessary to determine the role of the patient's primary psychiatric illnesses and any complications or treatments of those primary psychiatric illnesses, as well as the role of other medical or toxic disturbances that may be interacting with the patient's psychiatric illnesses or treatments.

Figures from the US Department of Justice indicate that more than half of prison and jail inmates have a mental health problem. Mental health courts (MHCs) were designed to divert mentally ill persons convicted of nonviolent crimes to supervised treatment instead of incarceration, but while the number of MHCs has grown substantially over the past decade, limited information has been available about outcomes and costs.

This article examines the risks involved in prescribing psychotropic medication and offers suggestions for managing those risks to ensure the best possibility for a favorable outcome.

Psychiatrists who work in inpatient units are faced with daily decisions about predicting which patients will be violent, both in the hospital and after discharge. These decisions are often made using unstructured clinical judgment based on the clinician's experience and knowledge of the literature. How long such judgment stays the standard of care remains to be seen, because psychiatric researchers have produced a number of assessment and management tools to improve the accuracy and use of violence risk assessment. This article briefly outlines 3 tools: the Brøset Violence Checklist (BVC), the Classification of Violence Risk (COVR), and the Historical Clinical Risk-20 (HCR-20).

While many of the claims at improving cognition are dubious (eg, the "Mozart effect"), there is now ample reason to suspect that parental involvement in children's brain development occurs much earlier than the first 3 years. Data now suggests that maternal cues are critical to proper brain development long before birth.

The role of no-suicide contracts is but a small tactical piece of the larger strategic approach to the assessment and prevention of suicide. Its many obvious limitations-to some degree in assessment, but primarily in suicide prevention-should have driven serious discussion of no-suicide contracts out of consideration as a practical measure in clinical practice and a legal talking point in the courtroom.

This article briefly reviews the federal standards regarding S/R and methods of reducing the risk associated with their use. CMS standards that went into effect February 6, 2007, will be emphasized; however, some of these standards vary from JCAHO standards.

An imbalance in blood levels of oxytocin may be associated with certain forms of autism spectrum disorders (ASDs).

Although there are many treatments and interventions available for drug abuse and dependence, few persons with substance use disorders actually use them, a new survey reports. The National Epidemiologic Survey on Alcohol and Related Conditions, conducted by scientists from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, was published in the May 2007 issue of the Archives of General Psychiatry. The survey used face-to-face interviews with over 43,000 US adults aged 18 years or older.

The FDA has ordered the addition of a "black box" warning to antidepressant labeling of increased suicide risk in adults aged 18 to 24 years. The labeling will also note that no increased risk has been seen in older adults and that, in fact, the incidence of suicidal thoughts and behavior has been found to decrease during antidepressant therapy in patients 65 years and older.

I grew up with a neighborhood kid who was a nice guy but burst into tears at even the tiniest of scrapes--heck, even if he fell down--so we always called him a crybaby. He seemed to be very tuned to his sensory environment--in our gang's perspective, overly tuned--hence the epithet for his behavior. The many unjust cruelties of childhood notwithstanding, was that really a fair accusation? There is growing evidence that may supply a solid molecular answer to this question. It may reveal the accusation to be not only emotionally unkind but also biologically unsound.

There are important distortions in the article "Substance Abuse in Women: Does Gender Matter?" (Psychiatric Times, January 2007, page 48). My concerns regard the political assumptions made (rather than those based on science) that put a spin on data rather than letting the data stand alone.

Intensive Melodic Intonation Therapy (MIT) results in significant gains in speech production, and functional improvements are matched by longlasting neural changes, according to research by a team led by Gottfried Schlaug, MD, PhD, associate professor of neurology at Harvard Medical School and director of neuroimaging at Beth Israel Deaconess Medical Center in Boston.