ADHD

Houston, we have a problem. There is a critical shortage of psychiatrists.

The recently posted criteria sets for DSM5 are a mess. The writing is unclear, inconsistent, and imprecise. Unless they are edited and drastically improved, any field testing based on them will be a waste of time, effort, and money- and DSM5 may not be usable.

Sometimes you spot a serious problem and figure out a very well-intended solution, only to discover eventually that your solution created as much trouble as the original problem. The workers on DSM5 have spotted an enormously worrying problem-the wild overdiagnosis of childhood bipolar disorder (BD) which has led to a massive increase in the use of antipsychotic and mood stabilizing medications in children and teenagers.

Avoid Surprises and Unintended Consequences

Epidemiological studies show that, 4% to 5% of the general population have severe ADHD. Of this number, half have a comorbid substance use disorder. The aim of this article is to help physicians understand and manage this challenging combination of comorbidities.

Oregon’s legislature has passed the bill: should the governor sign it? Most opinions on this issue are strong, and many have reached the point of invective. Even such a cool mind as Ronald Pies' has weighed in with an emotionally charged editorial.1 To speak in favor when so many are opposed seems only to invite more affective discharge. On the other hand, editorial views thus far may be moving us toward extremes on an issue that is highly complex. Perhaps a dialectic approach -– what value can we find in an opposing view? -- would be wise at this point. In that spirit, here are 4 considerations that I hope will be useful.

I have been closely following the discussions of the proposed DSM5 in Psychiatric Times. Your publication of this discourse is a significant contribution to our field. As a research psychiatrist who has published over 150 peer-reviewed papers, I strongly support Allen Frances’ emphasis on the importance of continuity in diagnostic criteria for DSM5.

New Insights Into Diagnosis, Comorbidities, and Treatment Approaches

Treating Child and Adolescent Mental Illness: A Practical, All-in-One Guide is just what its title promises: a clinically relevant, encompassing yet concise guide to child and adolescent mental health care. Dr Shatkin’s book serves as a useful primer for medical and mental health clinicians who do not specialize in the treatment of children and adolescents but who find themselves faced with the growing demand to provide mental health services to this sector. It is also a handy refresher for child and adolescent clinicians called on to treat disorders seen less often in their practices, as well as a reference for nonphysicians less familiar with psychopharmacological interventions.

It is generally held that the offspring of parents with bipolar disorder (BD) are at risk for BD. The degree of risk is an important question for both clinicians and parents. A recent study of bipolar offspring by Birmaher and colleagues1 sheds light on this issue.

“The proper use of these criteria requires specialized clinical training that provides both a body of knowledge and clinical skills.” How many of us psychiatrists recognize this statement? Or, is it like the fine print that we often gloss over in our everyday contracts and hope it doesn’t cause us trouble at some later time?

The young adult years (18 to 29) are a critical time of transition, and they present unique challenges in regard to mental health issues and development. Until recently, most research has focused either on children and adolescents or adults. Grant and Potenza’s Young Adult Mental Health is a comprehensive text for clinicians and researchers who work with persons in the transitional period of young adulthood.

Of particular utility in the position statement is a checklist for identifying children who are at risk for sudden death, independent of ADHD or stimulant drug treatments.

The onset of psychiatric illness in a child is a life-changing event for families. Families from immigrant and ethnocultural communities often must come to an understanding of their child’s psychiatric difficulties while simultaneously interacting with an unfamiliar health care system and its practitioners.

The CASE Approach is built to uncover pieces of a puzzle that enhance the likelihood of an accurate clinical formulation of risk.

Descartes’ Error1 can be read in 2 ways. To start, it works as an engagingly written, accurate piece of science journalism (which is something that we need more of; it’s hard to imagine running a democracy without it).

Obesity has emerged as a significant threat to public health throughout the developed world. The World Health Organization defines overweight as a body mass index of 25.0 to 29.9 kg/m2 and obesity as a BMI of 30.0 kg/m2 or greater.1 Nearly two-thirds of Americans are overweight or obese according to these criteria.2 Numerous health problems, including diabetes, cardiovascular disease, arthritis, and cancer, are associated with obesity. In addition, overweight and obese persons are more likely than their normal-weight peers to have a variety of psychiatric disorders.

New compounds and novel applications for established products were evaluated in many of the clinical trials reported at the recent 49th annual NIMH-sponsored New Clinical Drugs Evaluation Unit meeting.

Pediatric bipolar disorder (PBD) is a serious psychiatric illness that impairs children’s emotional, cognitive, and social development. PBD causes severe mood instability that manifests in chronic irritability, episodes of rage, tearfulness, distractibility, grandiosity or inflated self-esteem, hypersexual behavior, a decreased need for sleep, and behavioral activation coupled with poor judgment. While research in this area has accelerated during the past 15 years, there are still significant gaps in knowledge concerning the prevalence, etiology, phenomenology, assessment, and treatment for PBD.

In 2007, cancer was diagnosed in 10,400 children and adolescents under the age of 15 years.1 While cancer remains the second leading cause of death in children, increasing numbers of children with cancer are surviving into adulthood.2 Over the past 30 years, 5-year survival rates for children with cancer have significantly improved, from 59% in 1975 to 1977 to 80% in 1996 to 2004.3 Pediatric cancer, increasingly considered a chronic rather than an acute condition, is an intense emotional and physical experience for patients and their families.4

A 24-year-old veteran of Operation Iraqi Freedom (OIF) presents to the ED mid-morning on a weekday. While the veteran is waiting to be triaged, other patients alert staff that he appears to be talking to himself and pacing around the waiting room. A nurse tries to escort the veteran to an ED examination room. Multiple attempts by the ED staff and hospital police-several of whom are themselves OIF veterans-are unsuccessful in calming the patient or persuading him to enter a room.

In our last installment, we discussed a familiar finding from the National Comorbidity Survey Replication (NCS-R): the peak age of onset for any mental health disorder is about 14 years. In an attempt to explain these data, we are exploring some of the known developmental changes in the teenaged brain at the level of gene, cell, and behavior.

Self-administration of drugs of abuse often causes changes in the brain that potentiate the development or intensification of addiction. However, an addictive disorder does not develop in every person who uses alcohol or abuses an illicit drug. Whether exposure to a substance of abuse leads to addiction depends on the antecedent properties of the brain.

There is no magic moment when it becomes clear that the world needs a new edition of the DSM. With just one exception, the publication dates of all previous DSM’s were determined by the appearance of new revisions of the International Classification of Diseases (ICD). Thus, DSM-I appeared in conjunction with ICD-6 in 1952; DSM-II with ICD-8 in 1968; DSM-III with ICD-9 in 1980; and DSM-IV with ICD-10 in 1994. The lone exception was DSM-IIII-R, which appeared in 1987-out of cycle only because it was originally meant to be no more than a minor revision. The official publication date for DSM-V is May 2012. That date was picked to be consistent with an earlier, no longer correct, expectation that ICD-11 would be published in that same year.

What the New Mind-Body Science Tells Us About the Pathophysiology of Major Depression-Focus on Treatment