Addiction & Substance Use

It has been well established that there is a high incidence of depression in conjunction with Alzheimer's disease and other forms of dementia. What are the best assessment and diagnostic methods, and which treatments will produce the best results?

The relationship between depression and epilepsy is bidirectional as not only are patients with epilepsy at higher risk of developing depression but patients with depression have a three- to sevenfold higher risk of developing epilepsy. Several studies have found that the presence of depression in patients with intractable epilepsy was a stronger predictor of poor quality of life than the frequency and severity of seizures. The principles of managing depression in epilepsy are reviewed in this article.

Despite the fact that awareness of HIV and AIDS transmission is pervasive, risky sexual behavior has been increasing in many parts of the world in recent years, with a concomitant rise in new cases of HIV and other sexually transmitted diseases.

Is sexual research still an orphan as far as recognition and funding? Yes. Yet sex and sexuality issues affect the quality of each person's life. As the articles in this Sex & Sexuality bonus issue show, sexual health remains in the physician's domain in this millennium and beyond.

An Illinois draft plan to screen children and pregnant women for mental illness has stirred controversy and raised questions about some elements of the President's New Freedom Commission on Mental Health report. Some critics fear the Illinois case sets a worrying precedent for mental health care throughout the United States.

Whoever you are, I am writing to make contact, to get my message to someone who will understand. It is Friday, 7 p.m. and I've just finished my fifth phone call to a managed care automaton in 800-Land, my patient on a gurney in the ER with an IV in his arm, and they've finally agreed to pay for one hospital day.

The postpartum period represents a time of increased vulnerability for women, though postpartum disorders are often under-recognized and undertreated.

The diagnosis of bipolar disorder in children remains controversial. One of the more disturbing facets of its presentation in such young patients is the presence of hypersexual behavior. How can these behaviors be differentiated from the effects of abuse and other psychiatric disorders?

Geriatric psychotherapy has begun to receive consistent and supportive attention in the psychiatric literature. Despite this growing interest in psychotherapy for older adults, studies of efficacy of either psychotherapy alone or of combined treatments for older patients are still limited in number, and more attention to the issue is needed.

A greater understanding of how the brain works, including the effect of environment on it development, has led to advances in diagnosing and treating psychopathology. The latest findings will be presented at an international meeting, along with a discussion of how much work is to be done and the great need for qualified child psychiatrists, especially in developing countries.

Although light therapy is an old treatment, new therapeutic uses are being researched. What is the optimal time and strength of light treatment to best help patients with depressive disorders?

As society and the definition of family in the West changes, fathers in the 21st century face emotional and psychological obstacles to a healthy parent-child relationship. This article examines professional interventions and other resources that can help prepare fathers to be effective parents.

A cross-cultural comparison of suicide in old age, including a discussion of recent epidemiological trends in suicide rates. The authors also discuss the impact of social and cultural variables on the detection of depression and the formulation of suicide prevention strategies.

Beginning a therapeutic relationship with an adolescent patient requires an understanding of the family dynamics and the patient's experience of their unique stage of life. In this rapidly evolving population, a thoughtful approach is essential to prevent many of the pitfalls in treating adolescents.

What are the current policy barriers to effective addiction treatment, and how can they be overcome? Attendees at the American Society of Addiction Medicine's Annual Meeting heard about new and innovative ways of helping patients suffering from substance abuse.

There appears to be a subgroup of children and adolescents who, despite repeated brief hospitalizations, do not improve, but along the way, these patients accumulate medications. During long-term residential treatment, however, these patients do improve and their medications are reduced.

Cognitive-behavioral therapy can be tailored for use with children who have experienced sexual abuse in order to relieve symptoms of PTSD.

Evidence is growing that trauma-focused cognitive-behavioral therapy (TF-CBT) is an effective treatment for sexually abused children, including those who have experienced multiple other traumatic events. This article reviews the research that has examined treatments for sexually abused children and suggests future research priorities in this regard.

The past two decades have ushered in a new era of methodological advances in tools for noninvasive imaging of the living brain. The information gleaned from advances in neuroimaging have been used to provide insights into ADHD's etiology, diagnosis and treatment.

Patients with anorexia nervosa often attempt to deceive health care professionals because they do not want treatment for their disorder. Thus, physicians must maintain a high index of suspicion for signs and symptoms of AN due to its potentially fatal complications.

Although eating disorders have been considered to be largely sociocultural in origin, findings from family, twin and molecular genetic studies conducted during the last decade are refuting that perspective. Recent studies have had significant success in isolating specific chromosome regions that may harbor susceptibility loci for anorexia and bulimia nervosa and are helping to shed light on the degree of heritability of eating disorders.

Transcranial magnetic stimulation has been applied in a growing number of psychiatric disorders as a putative treatment. As a focal intervention that may exert lasting effects, TMS offers the hope of targeting underlying circuitry and ameliorating the effects of psychiatric disorders. The ultimate success of such an approach depends upon our knowledge of the neural circuitry involved, on how TMS exerts its effects and on how to control its application to achieve the desired effects. Current challenges in the field include determining how to enhance the efficacy of TMS in these disorders and how to identify patients for whom TMS may be efficacious.

In the United States, approximately 2% to 6% of school-age children are diagnosed with attention-deficit/hyperactivity disorder. Despite more than 50 years of clinical and neuroscientific research, appropriate diagnostic and therapeutic interventions for ADHD are still an issue for many people, and although reports summarize the current knowledge, they use parameters that are still based on the same descriptive determinations that have plagued the field for years.

The field of neuropsychiatry has undergone tremendous growth over the past few decades.

Our evolving understanding of borderline personality disorder and its treatment includes the surprising evidence that this disorder has more significant genetic determinants and many patients have a far better prognosis than had previously been thought. Treatment approaches have also become less intensive and more diverse and specific. This is a disorder that, despite the considerable gains, remains one of psychiatry's most vexsome problems and one of society's major health care priorities.