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.
The setting of a fast-paced emergency department (ED) or psychiatric emergency service makes it especially difficult to sensitively elicit and address an individual patient's needs and concerns. When considering the myriad differences in culture that come into play between a patient and a psychiatrist or other mental health care clinician, optimal diagnosis and treatment can be even more challenging, as the cases described here illustrate. The important influence of culture cannot be stressed enough. Taking the time to understand "where the patient is coming from" can prevent an already stressful, highly emotionally charged situation from becoming even more convoluted.
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.
Anyone who is close to someone who abuses alcohol or drugs knows all too well that substance abusers do not typically seek treatment until they have experienced years of substance-related problems. During the first year after onset of a diagnosable substance use disorder, only 1 of 5 alcohol-dependent persons and 1 of 4 drug-dependent persons receive treatment.
The problem of treatment resistance in bipolar disorder begins with its definition. Characterizing the phases of bipolar disorder as manic, mixed, hypomanic, or depressed does not do justice to the reality for many persons with this disorder.
In 1931, Gananath Sen and Kartick Chandra Bose reported on the use of an alkaloid extract from the Rauwolfia serpentina plant in the treatment of hypertension and "insanity with violent maniacal symptoms." They noted that dosages "of 20 to 30 grains of the powder twice daily produce not only a hypnotic effect but also a reduction of blood pressure and violent symptoms
Parkinson gait is characterized by shuffling, including a decreased stride length and gait speed. The diminished stride and gait speed coupled with increased cadence puts the patient at risk for postural instability resulting in falls.
Delirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. About 15% of elderly patients admitted to the hospital have delirium as a presenting or associated symptom. Delirium will develop in another 15% of elderly patients during hospitalization.
HHD, which affects only a small percentage (4%) of patients with PD, is characterized by adverse psychomotor effects related to dopamine replacement therapy.
Typical smokers need to have brain nicotine receptors almost completely saturated throughout the day. This need creates an almost uncontrollable urge to keep smoking, commented Nora D. Volkow, MD, director of the National Institute on Drug Abuse (NIDA), addressing a study by NIDA researchers on nicotine addiction.
Hundreds of uniquely adapted venomous marine cone snail species inhabit the coral reefs of the Indian and Pacific oceans. Researchers posit that each may be a virtual neurologic pharmacopoeia with potential value for the treatment of everything from diabetic neuropathy to schizophrenia. The venoms, known as conotoxins, selectively inhibit a wide range of ion channels involved in neuromuscular signaling.
A possible link between diabetes and cognitive dysfunction, specifically Alzheimer disease (AD), is becoming increasingly apparent. Indeed, compared with AD risk in healthy persons, the risk of AD development is 65% to 100% greater in persons with diabetes.
First described more than 500 years ago, phantom limb pain (PLP) is a common disorder today; as many as 50% to 80% of patients who undergo amputation report experiencing pain in the missing appendage.
The editors of Pediatric Neuropsychiatry must have drawn on their experiences and the feedback they received on their first book, Textbook of Pediatric Neuropsychiatry (American Psychiatric Press, 1998), for this text.
Effective treatment of drug abuse and addiction in the criminal justice system saves the community money and reduces crime, the NIH's National Institute on Drug Abuse (NIDA) reported in a recently released booklet, Principles of Drug Abuse Treatment for Criminal Justice Populations.
The increase in youth violence and aggression in the past 50 years has been called an "epidemic." This epidemic has had a tremendous impact on society. From an economic and public health perspective, primary prevention of youth violence is obviously desirable.
Typically, delirium worsens at night ("sundowning"), with lucid intervals often present in the morning. It is important to realize that delirium may appear before any abnormal laboratory values are detected and may persist after the resolution of these abnormalities.
If done properly, the assessment of alcohol and substance use disorders in the emergency department (ED) or psychiatric emergency service can be the first step toward recovery.
The degree to which season changes affect mood, energy, sleep, appetite, food preference, or desire to socialize with others has been called "seasonality." Identification of a seasonal pattern can only be made if both the patient and physician actively look for it.
In a presentation given at the midyear meeting of the American Epilepsy Society, Andres Kanner, MD cited studies from the literature showing that the rates of depression, anxiety, psychosis, and attention-deficit/hyperactivity disorder (ADHD) are significantly higher among persons with epilepsy than among the general population
Most physicians make at least some use of the placebo effect to enhance treatments, whether they realize it or not. This article examines the extent of the placebo effect in patients with psychiatric illness, and reviews what is known about how placebos work.
Alcohol is the drug of choice for adolescents, with cigarettes and marijuana being second and third. Contrary to widespread belief, alcohol dependence is most common in 18- to 20-year-olds, with progressively decreasing rates of alcohol dependence in older age groups.
