May 3rd 2024
Which is the best recommendation for the treatment of alcohol use disorder?
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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Atypical Antipsychotics for Dementia-Related Behaviors
October 1st 2007Conventional antipsychotic drugs such as haloperidol have been supplanted by newer, atypical antipsychotics (risperidone [Risperdal], olanzapine [Zyprexa], quetiapine [Seroquel], ziprasidone [Geodon], aripiprazole [Abilify]), although no medication has an FDA indication for the treatment of behavioral symptoms in patients with dementia
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Research on Psychedelics Making a Comeback
October 1st 2007In 1993, Charles Grob, MD, professor of psychiatry and pediatrics at the University of California, Los Angeles (UCLA) School of Medicine, and a research team were invited to study the physical and psychological effects of ayahuasca, a plant mixture that produces psychedelic effects.
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A New Adaptation of Integrated Psychological Treatment for Patients With Schizophrenia
September 15th 2007Integrated psychological treatment (IPT)--which was developed by a research group in Bern, Switzerland, for patients with schizophrenia--is a distinctive and practical approach to rehabilitation.
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SSRIs and Pregnancy: Putting the Risks Into Perspective
September 15th 2007Mood disorders are common in women and typically emerge during the childbearing years. While pregnancy has traditionally been considered a time of emotional well- being, recent data indicate that about 10% to 15% of women experience clinically significant depressive symptoms during pregnancy.
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Complementary Therapies for Schizophrenia: Expanding the Clinician’s Toolbox
September 9th 2007Given the burdens of living with schizophrenia, and the increasing focus on patients' quality of life, it’s no wonder clinicians are seeking other treatment options for the disorder. Here, a discussion of the most promising nonconventional therapies and how to use them.
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Sexual Offenders With Mental Illness: Special Considerations for a Special Population
September 1st 2007Whether or not sexual offending behavior-or the predisposition to such-is a mental illness, there are patients with traditional mental illnesses who also present with sexually inappropriate and even sexual offending behavior.
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Exploring OCD Subtypes and Treatment Resistance
September 1st 2007Obsessive-compulsive disorder (OCD) is a heterogeneous disorder with a variety of phenotypic expressions. Delineation of clinically distinct subtypes of the disorder may be valuable in predicting treatment response and resistance.
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Abuse of Prescription Drugs Close Behind Alcohol, Marijuana
September 1st 2007About 60% of users of illegal prescription drugs receive them free from friends or relatives, H. Westley Clark, MD, JD, director, Center for Substance Abuse Treatment (CSAT), of the federal Substance Abuse and Mental Health Services Administration (SAMHSA), told attendees at the American Society of Addiction Medicine 38th Annual Medical-Scientific Conference
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Managing MCI: Sifting Through the Unknowns
September 1st 2007In many ways, the frustration experienced bypatients struggling with mild cognitive impairment(MCI) is matched by the frustration ofclinicians facing the challenge of managing thisheterogeneous condition. The prognosis can bevariable, and no proven therapies exist.
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Antipsychotics in the Treatment of Comorbid Anxiety in Bipolar Disorder
August 1st 2007The comorbidity of anxiety disorders with bipolar disorder is a rule, not an exception, with a negative impact on both course and treatment outcome. So far, there are no guidelines or consensus for the treatment of this comorbidity.
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Options for Management of Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction
August 1st 2007Among 25 to 30 million Americans in whom depression is diagnosed annually, 18 to 25 million are treated with antidepressants, of which 90% are SSRI or non-selective serotonin reuptake inhibitor (SRI) antidepressants, the most frequently prescribed medications for all outpatients aged 18 to 65 years.
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