Addiction & Substance Use

Pavuluri MN, Birmaher B, Naylor MW. Pediatric bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 2005; 44:846-871.

Schizophrenia poses a challenge for diagnosis and treatment at least in part because it remains a syndromal diagnosis without clearly understood neuropathological bases or treatments with clearly understood mechanisms of action. Neuroimaging research promises to advance understanding of the unique pathological processes that contribute to this syndrome, and to foster both better appreciation of how current treatments work, and how future treatments should be developed.

Although several clinical studies suggest that cognitive impairments in schizophrenia are associated with reduced stimulation of dopamine receptors in the prefrontal cortex, mounting evidence suggests that other monoaminergic neurotransmitter systems may also be involved. We provide an overview of neurotransmitters that hold promise as therapeutic interventions for the cognitive deficit in schizophrenia.

It was not too long ago that the management of schizophrenia focused primarily on symptom relief in inpatient and outpatient settings. Over the past two decades, there has been a paradigm shift in our approach in the overall management of schizophrenia, toward preventive and early interventions. What are some of these management techniques, and how well do they work?

Alcohol and substance use disorders take a tremendous toll on society as a whole and also require significant emergency department (ED) resources. Alcohol use and abuse in the United States accounts for over 100,000 deaths each year1 and costs more than $185 billion annually.2 A study of the effects of alcohol-related disease and injuries found that the number of patients who presented with these conditions increased by 18% from 1992 to 2000.3

The use of benzodiazepines in psychiatry and general medicine is fraught with controversy because of the potential for abuse and dependence. In daily practice, clinicians vary widely in their comfort level with prescribing this class of medications, whether for short-term relief of panic or for long-term prophylaxis of generalized anxiety. The use of benzodiazepines in acutely traumatized persons is particularly controversial.

Assessment and management of dual diagnosis--that is, the comorbidity of substance use disorder in persons with mental illness--is a major challenge for clinicians, especially in the emergency department (ED). It is widely accepted, but perhaps less well appreciated in the clinical realm, that substance abuse comorbidity is more the rule than the exception in persons with serious mental illness.

Proper evaluation of patients for alcohol and substance use disorders is usually time-consuming. When done in a busy emergency department (ED), assessment is often rushed, increasing the likelihood of misdiagnosis and, therefore, mismanagement. Because the evaluation is a patient's first step to effective therapy, it should be conducted as efficiently and effectively as possible.

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. A proper assessment, however, can be extremely taxing for both the clinician and the patient. This article offers a paradigm for performing a rapid and comprehensive evaluation in the ED of medically stable adults with alcohol and substance use disorders.

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With its focus on both behavior modification and mindfulness training, dialectical behavior therapy has proven quite effective in treating patients with borderline personality disorder. This article provides a primer on a modified version of this outpatient treatment for borderline patients with substance use disorders, a comorbid condition that may affect as many as two-thirds of patients with BPD.

The U.S. Departments of Defense and Veterans Affairs have developed protocols for assessing soldiers returning from combat operations in Iraq and Afghanistan. With data showing that many veterans do not show psychiatric symptoms until three to six months after returning home, a new post-deployment assessment was created and is ready to roll out. In the meantime, a jump in PTSD cases led to an internal review at the VA.

Smokers with co-morbid psychiatric and substance use disorders smoke at a much higher rate and seem to have more difficulty quitting than those in the general population. Tobacco treatment that is integrated into mental health settings may lead to greater success than non-integrated treatment. As a result, mental health care providers can play a critical role by careful assessments of smoking, employment of motivational techniques and increasing access to pharmacological and behavioral treatments.

The most common club drugs or party drugs are MDMA, ketamine and GHB. How dangerous is continued use of these substances? Can they cause real damage to the brain?

Intimate partner violence is a common problem and a significant public health concern. Substance use is involved in 40% to 60% of IPV incidents. Several lines of evidence suggest that when substance use and IPV co-occur, substance use may play a facilitative role in IPV by precipitating or exacerbating violence. This article will review epidemiological, clinical and treatment research relevant to substance-abusing men with co-occurring domestic violence.

Treatment compliance is a crucial determinant of the outcome of any disease. Poor treatment compliance can worsen the prognosis and significantly increase health care costs. Effective methods to improve treatment compliance for individuals with comorbid mental illness and SUDs will translate in better outcome for the patients and significant health care cost savings.

Social anxiety disorder and drug addiction commonly co-occur in the same individual, complicating the presentation, course and treatment of both disorders. Using drugs or alcohol may be a coping mechanism for social anxiety; however, many treatments for addiction are group-based approaches, which would be especially challenging for people with social anxiety disorder. This article provides a brief overview of what is known about the co-occurrence of these disorders, as well as possible treatment interventions for this population.

There has been increasing interest in the overlap between attention-deficit/hyperactivity disorder and substance use disorders. Pharmacotherapeutic treatment of ADHD in children reduces the risk for later SUD in adolescence and adulthood. In contrast, medication treatment of substance-abusing adolescents with ADHD does not reduce the SUD. Diagnostic and treatment strategies for adults with ADHD plus SUDs are discussed.

cultural training

Huntington disease, neurogenetics, George Sumner Huntington, Systematic Evaluation of Treatments for Huntington's Disease, Alzheimer disease, Parkinson disease, amyotrophic lateral sclerosis

Pediatric neurology, influenza, immunization, light therapy, depression, sleep, multiple sclerosis

traumatic brain injury, memory impairment, depression, neurobehavioral disorders

Anesthesia-assisted rapid opioid detoxification has been touted as a painless way to kick an addiction. In a randomized trial comparing it to two other rapid detox methods, it was found to be similar on several methods, but resulted in greater risks for life-threatening adverse events. Opioid dependency is a chronic, remitting disorder and the greatest need is not a fast painless method of getting detoxed, but a reliable method of maintaining abstinence.

Are all treatments for schizophrenia created equal? With Phase I of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study completed, five pharmacological options have been compared in an attempt to answer this question. Results from this portion of the trial have been released and are discussed.

Forensic examinations involving children and adolescents are particularly difficult, due to the vulnerability of this patient population. What ethical guidelines should be followed and what sorts of pitfalls should clinicians attempt to avoid?