Addiction & Substance Use

How do we help patients manage pain without exacerbating or reactivating an addictive disorder?

There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.

Bipolar disorder is often seen as a perplexing illness by patients and clinicians alike. In recent years, there has been a growing appreciation in psychiatric circles of the disorder's prevalence. This increased attention has filtered its way down to the general public, which, in turn, has produced sometimes sensationalistic media portrayals of manic depression, a number of speculative books about historic figures and noted artists who purportedly had the illness, and an array of self-help books marketed to individuals (and their families) afflicted with the disorder.

Predicting extent of neurologic recovery is crucial. The most accurate and standardized method is clinical neurologic examination using the International Standards for Neurological Classification of Spinal Cord Injury.

More than 1 in 20 adults nationwide suffer from compulsive buying, according to a telephone survey of 2500 adults. And contrary to popular opinion, “compulsive buying appears to be almost as common in men as in women,” according to Lorrin M. Koran, MD, first author of a recently published prevalence study of compulsive buying behavior in the United States. Six percent of women and 5.5% of men in the study reported symptoms considered to be consistent with compulsive buying disorder.

Debates surrounding the psychological implications of human reproductive cloning (HRC) escalated in 1997, following the 1996 birth of Dolly, the cloned Scottish lamb. Aside from the physical risks to which cloned persons might be subjected, there was concern over psychological implications associated with family structure and relationships. Would cloned persons be deprived of autonomy and independence? Would parents impose unfair expectations on children who were their genetic replicas?

Many abusers of methamphetamine in rural areas manufacture the drug for their personal use. These "mom-and-pop cooks" produce methamphetamine in and around homes where children are also living. This article provides an overview of the mental health of children whose parents abuse methamphetamine.

One of the major concerns of health professionals working in the area of psychiatry is understanding the conditions under which patients adhere to prescribed treatments. While adherence is linked to some extent to the patients' comprehension of their illness, it is also a function of their social and demographic characteristics, such as age, social milieu, or sex. Another attribute also merits our attention, however: the patient's cultural affiliation and in particular, his or her religious background.

Compared with the many recent articles addressing medications' multiple meanings for the patients who take them and the psychiatrist-therapists who prescribe them, there has persisted in the literature and in clinical practice a curious literal conception of the prescription itself. This article challenges the idea that the only medication that can be prescribed comes in the form of pills or tablets; on the contrary, ideas constitute some of the most potent "medication" known.

In this essay, I approach the question about the BPSM from the perspective of a teacher of psychiatry, medical school dean responsible for (among other matters) student career advising, and clinician. In those capacities, my duties include fostering an understanding of psychiatric disorders among medical students and residents, instilling confidence in and respect for the discipline of psychiatry among students as well as nonpsychiatric colleagues, and explaining psychiatric diagnosis and treatment to patients and their families.

Recently, 3 reports that shed further light on the short- and long-term mental health consequences for children of depressed parents were published.

Traditional physical therapy for neurologic conditions can be boring for the patient and tiring for the physical therapist, making it difficult to put in the required number of training hours. That is why researchers are developing a new generation of physical therapy tools that use video games, robotics, and virtual reality.

Investigational drugs and novel applications of established agents for psychiatric illness were described in a number of reports at the 46th annual NIMH-sponsored New Clinical Drug Evaluation Unit (NCDEU) meeting in Boca Raton, Fla, June 12-15, 2006.

According to the National Institute on Drug Abuse (NIDA), gender differences can influence the causes, effects, consequences, and treatment of substance abuse disorders. A recent NIDA News Scan focused on several investigations supported by the NIDA.

Epilepsy affects about 2% of the US population and is a disability fraught with unique psychosocial and health care challenges. Authors of a study appearing in the journal Epilepsy and Behavior note that the ongoing quest of persons with epilepsy is to find informed physicians, effective therapies, and resources to help them achieve an adequate level of normalcy.

Huntington disease (HD) is a devastating hereditary, degenerative brain disorder for which there is, at present, no effective treatment or cure. More than a quarter of a million Americans have HD or are at risk for the disease because of potential genetic transmission. The disease slowly diminishes the affected person's ability to walk, think, talk, and reason. As it progresses, concentration and short-term memory diminish and involuntary movements of the head, trunk, and limbs increase.

It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with convulsive, clonic movements may, in fact, be experiencing psychogenic events.

Addictive disorders are among the leading causes of disability worldwide; however, misuse of and addiction to alcohol and illicit substances is often not appreciated as relevant to the care of older adults.

Borderline personality disorder (BPD) is a serious illness involving multiple symptoms and mal adaptive behaviors. According to DSM-IV, “the essential feature of borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects” (p. 650). This pervasive pattern of instability also applies to behaviors that are impulsive and potentially damaging, including excessive spending, sexual promiscuity, reckless driving, binge eating, and substance misuse.

Older adults have higher rates of suicide than younger adults in many industrialized nations.

The emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).

Many physicians, including psychiatrists, may shy away from seeing elderly patients with symptoms of dementia because they imagine that there are a large number of alternative diagnoses and that differential diagnosis is complicated. In fact, however, the number of possible diagnoses in most situations is relatively small and the diagnosis of dementia in older patients is certainly feasible in primary care psychiatry.

Office management of attention-deficit/hyperactivity disorder (ADHD) differs in many important ways from ADHD management conducted in a research environment. In clinical trials, treatments and eligible patients are selected in advance by committees, patients are randomized to different management strategies, and both clinicians and pa tients are blinded to the treatments.

For patients with psychiatric illnesses, the treatment team today often consists of a psychotherapist, psychiatrist, and/or primary care physician-all of whom are motivated to achieve the same goals. These include full remission of symptoms; improvement and restoration of function, quality of life, and relationships; and the delay and preferably prevention of recurrence of symptoms.

Anxiety disorders are the most prevalent psychiatric disorders in the United States. Although effective treatments are available, such as the SSRIs and cognitive-behavioral therapy (CBT), it is estimated that in about 40% of patients, anxiety disorders are partially or completely resistant to first-line treatment.