September 23rd 2024
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September 20th 2024
Healing Addiction: An Integrated Pharmacopsychosocial Approach to Treatment
January 1st 2008The goal of this well-intentioned and mostly well-written, small book is to present an "integrated pharmacopsychosocial approach to treatment" of substance addictions and behavioral addictions, such as pathological gambling, eating disorders, and compulsive sexuality. A unified framework for the treatment of addictive disorders has great clinical appeal, given that most people seeking treatment will have multiple addictions as well as co-occurring psychiatric symptoms and disorders. The authors offer valuable advice on principles that increase the likelihood of successful treatment, such as "Less is more--simplification of pharmacotherapy" and "Importance of accurate diagnosis as the basis for treatment." They also correctly emphasize that addiction is a chronic disorder requiring a long-term approach to treatment.
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New Compounds, Novel Applications Described
January 1st 2008Several new substances and new uses for available products were evaluated in research projects reported at the 47th annual NIMH-sponsored New Clinical Drug Evaluation Unit, held this past June in Boca Raton, Fla. The agonists included a melatonergic compound for depression, 2 new agents for schizophrenia, some g-aminobutyric acid (GABA)-ergic antipsychotics, and several drugs being evaluated for non-approved indications.
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Anabolic Androgenic Steroid Use Pharmacology, Prevalence, and Psychiatric Aspects Check Points
January 1st 2008Public concern about the use of anabolic androgenic steroids by athletes and others has led to enhanced testing for these drugs as well as an improved understanding of their medical and psychiatric effects. This article reviews the pharmacology of these compounds, the prevalence and effects of their use among athletes, and the basics of steroid testing, and it concludes with treatment recommendations. Even though athletes may use other illicit substances, such as stimulants, human growth hormone, and erythropoietin, this article focuses only on anabolic androgenic steroids. Review articles on the psychiatric effects of the other performance-enhancing substances are available elsewhere.1,2
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Culture and Substance Abuse: Impact of Culture Affects Approach to Treatment
January 1st 2008There have been numerous definitions of culture. Dwight Heath1 offers a simple definition: "It [culture] is a system of patterns of belief and behavior that shape the worldview of the member of a society. As such, it serves as a guide for action, a cognitive map, and a grammar for behavior."
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Comorbidity and Psychiatric Disorders: Support or Hindrance for Psychiatric Care?
December 1st 2007The revolution inherent in the move from DSM-II to DSM-III primarily involved a growing emphasis on comorbidity. For several decades before DSM-III, the emphasis had been on diagnostic economy: fewer diagnoses were considered more elegant, more accurate, and more useful in guiding care.
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Vets' Mental Health Bill Becomes Law
December 1st 2007The Senate on September 27 passed what may be the first ever veterans' mental health bill. The Joshua Omvig Veterans' Suicide Prevention Act is named after a young man who came home from Operation Iraqi Freedom with posttraumatic stress disorder (PTSD) and was unable to get mental health care from the Department of Veterans Affairs (VA).
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Psychiatric Aspects of the Impending Avian Flu Pandemic
December 1st 2007I was taken ill with the flu. They gave me up. The paper had my obit set in type. . . . My hair turned white and then it fell out. The first time I tried to rise to a sitting position I fell and broke an arm. I had phlebitis in one leg and they said I'd never walk again.
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Most estimates suggest that there are just over a million persons living with HIV/AIDS in the United States. According to CDC data, between 2001 and 2005, an average of 37,127 new cases of HIV infection, HIV infection and later AIDS, and concurrent HIV infection and AIDS were diagnosed each year.
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The Conundrum of Psychiatric Comorbidity
December 1st 2007Since the revision of DSM-III, high rates of co-occurring psychiatric disorders have been observed, particularly in cases of moderate and severe psychiatric illness. The reason lies in the design of the diagnostic system itself: DSM-IV is a descriptive, categorical system that splits psychiatric behaviors and symptoms into numerous distinct disorders, and uses few exclusionary hierarchies to eliminate multiple diagnoses.
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Psychedelic Medicine: New Evidence for Hallucinogenic Substances as Treatments (2 volumes)
November 1st 2007The use of psychedelic plants and drugs in psychiatric medicine has been a promise for more than half a century, suppressed by a draconian legal response to the epidemic of drug abuse in the 1960s. This 2-volume work seeks to reverse the suppression of scientific inquiry in this field by bringing together a comprehensive airing of the topic.
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Strategies Against Methamphetamine and Cocaine Described at ASAM Meeting
November 1st 2007Widespread media reports and billboard campaigns decrying a methamphetamine epidemic are drawing attention away from the greater and more entrenched use of cocaine, according to a National Institute of Drug Abuse (NIDA) scientist speaking at the American Society of Addiction Medicine's (ASAM) 38th Annual Medical-Scientific Conference, held in Miami, April 26 to 29.
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Computer Gaming--When Virtual Violence Becomes Real
November 1st 2007Virtual games, such as World of Warcraft, The Sims, and Second Life, are played by thousands every day, allowing people, worldwide, to connect and share information. In fact, the virtual "worlds" that can be created in these games are now being used to make money (through buying and selling virtual objects), to form partnerships and friendships, and even to conduct business; it is easy to see how many become engrossed in this alternative life.
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Psychiatric Emergencies in Bipolar and Related Disorders
November 1st 2007Part 1 of this article, discussed a general approach to treating psychiatric emergencies in patients with bipolar and related disorders, as well as the assessment and management of agitation and impulsive aggression. Part 2 focuses on psychosis, suicidality, and specific treatments relevant to patients in emergency settings who are agitated or have bipolar disorder.
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Marijuana Use, Withdrawal, and Craving in Adolescents
November 1st 2007Marijuana is the most commonly used illicit drug in the United States and worldwide. Initiation of use typically occurs during adolescence. The most recent epidemiological data indicate that in the United States, 42% of high school seniors have tried marijuana, 18% have used it in the past 30 days, and 5% use it daily.
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Managing Late-Life Depression With Combined Medication and Psychotherapy
November 1st 2007There are hundreds of studies that show that pharmacotherapy is used to treat depression in adult and geriatric populations. There are far fewer studies that test the efficacy of psychotherapies and even fewer studies that focus on combined treatment for older patients.
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The Intersection of Mental Health and Successful Aging
November 1st 2007One consequence of the "graying" of the world's population is that psychiatrists, along with all health care professionals, will increasingly be providing services to older adults. In the United States, the first set of people belonging to the baby boom generation turned 60 in 2005, and the number of people older than 60 will soonoutnumber children for the first time in recorded history.
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The Collapse of Psychiatry in Tajikistan
November 1st 2007Since April 2006, I have traveled 3 times to the Central Asian Republic of Tajikistan to work with migrants on the risk of HIV/AIDS. According to the United States Agency for International Development, Central Asia has the fastest growth rate of HIV/ AIDS in the world.
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Shooting for What I Want, Part 2
October 1st 2007How time flies! It has been more than a year since my last column, when I staked my claim in psychiatry. I planned to eschew the medical rat race and find my own little piece of medicine as it used to be, when doctors were doctors, nurses were nurses, and insurance salespeople were . . . salespeople. Should one read anything into the long delay between that column and this one? Absolutely! But I'll get to that.
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All of us have heard the phrase "between a rock and a hard place," and many of us have been in the situation that the idiom describes. However, few of us (other than English professors) likely know the origin of the saying and even fewer of us know how it applies to clinical psychiatry. Delving into these seemingly unrelated queries will be the subject of this month's column.
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Major Studies on ECT for Depression: What Have We Learned?
October 1st 2007Early relapse is a limiting defect in electroconvulsive therapy (ECT). Although more than 80% of patients with a severe depressive illness who complete an acute course of ECT are relieved within three weeks, up to 60% relapse within six months, despite continuation treatments with antidepressant medications.1,2 In a large, government-supported, collaborative study led by the Columbia University Consortium (CUC), patients with unipolar major depression that had failed to respond to multiple trials of medications were treated with ECT to clinical remission and then randomly assigned to one of three continuation treatments--placebo, nortriptyline (Aventyl, Pamelor) alone, or the combination of nortriptyline and lithium (Eskalith, Lithobid). The patients were monitored for adequacy of blood levels.1 Within the six-month follow-up period, 84% of patients treated with placebo, 60% of patients treated with nortriptyline, and 39% of patients treated with the combination medications had relapsed.
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Treatment Resistance in Youths With ADHD and Comorbid Conditions
October 1st 2007Since its introduction in DSM-III in 1980, attention-deficit/ hyperactivity disorder (ADHD) has proved to be a developmental disorder with many causes and complex behavioral, cognitive, and emotional manifestations that can impair academic functioning, occupational achievement, social relationships, and self-esteem.
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Psychiatric Naturalism and the Dimensions of Freedom: Implications for Psychiatry and the Law
October 1st 2007In part 1 of this essay, I argued that individual freedom is not only compatible with determinism but dependent on it. I also argued that freedom is not an "either/or" condition. Rather, actions may be more or less free, and therefore, more or less "responsible," depending on a number of contingent factors, yielding various degrees of freedom. Psychiatrists, I suggested, can be most helpful in so far as we can describe, study, and categorize these degrees of freedom and the psychopathological conditions that undermine them. In part 2, I elaborate on the "naturalistic" model of freedom and autonomy and suggest how it may be applied to psychiatric disorders and medico-legal determinations of culpability.
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Recognition of Apathy as Marker for Dementia Growing
October 1st 2007A recent 4-year study linked apathy to a hastened decline in persons with Alzheimer disease (AD). Another recent study found that persons with mild cognitive impairment (MCI) were more likely to convert to AD a year later if they also had apathy.
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