The number of prescriptions for antipsychotic treatment of teenagers has increased sharply in office-based medical practice. Adolescents with psychotic symptoms frequently present for clinical evaluation, and early-onset schizophrenia spectrum disorders (onset of psychotic symptoms before the age of 18 years) represent an important consideration in the differential diagnosis in these youths
Congress substituted a 0.5% increase in Medicare fees for the first 6 months of 2008 for the 10% reduction that would otherwise have been enacted. That reduction in what is called the Medicare fee "update" was predetermined by a formula Congress itself put in place.
There have been nearly 1.5 million military deployments to the southwest Asian combat zone since the start of the Afghanistan operation and Iraq war in 2001 and 2003, respectively. There have been many casualties, some of which have been highly profiled, such as service members being killed in action, losing limbs, or suffering blast injuries to their brain.
On a hypothetical morning, you've arrived early at your office to answer e-mails and respond to prescription requests without interruptions. The following voice mail, left for you much earlier that day, awaits your attention: "Doctor, I need to discuss my mother's behavior with you. The medications she's taking might be calming her down during the days, but she's not okay at night."
Although the percentage of US adolescents who use illicit drugs or drink alcohol continued a decade-long reduction in 2006, according to the Monitoring the Future (MTF) survey,1 the use of prescription drugs, such as narcotics, tranquilizers, sedatives, and stimulants remains at relatively high levels. Concerns about marijuana and alcohol, which are easily the most prevalent substances misused by adolescents, have obscured the increasing problem of prescription drug misuse in youth. This article presents information on prescription drug misuse and diversion based on surveys of high school and college students.
Many veterans face mental illnesses on return from duty, but for how long and to what extent? Psychiatrist Charles S. Milliken and colleagues are on a mission to measure the mental health needs of returning soldiers from Iraq, including soldier assessment and use of mental health care, using 2 surveys--the Post-Deployment Health Assessment (PDHA) and the Post-Deployment Health Reassessment (PDHRA). The results of their analyses were reported in the November 2007 issue of JAMA.
Evidence for Use of Neurostimulating Techniques
Recent years have witnessed exciting developments in understanding and treating addictions. For example, it seems that almost weekly we get new insights into the neurobiology underlying vulnerability to addiction. Similarly, there have never been more medications available to treat the spectrum of addictive disorders, especially alcohol, nicotine, and opioid dependence. In addition, studies continue to underscore the crucial role of psychosocial treatments in recovery from addiction.
Almost 3 years after the FDA warned of increased mortality in elderly patients who received atypical antipsychotics off-label for neuropsychiatric syndromes of dementia, no medication has been approved as safe and effective for this increasingly challenging problem. Recent publications, however, including a white paper from the American College of Neuropsychopharmacology (ACNP), indicate that clinical investigators are wrestling with the dilemma and considering potential alternatives to antipsychotics.
The 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.
Several 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.
Public 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
There 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."
Although psychotropic medications have revolutionized the treatment of many psychiatric disorders, the benefits sometimes come at a price.
The 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.
The 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).
I 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.
In my last column I used the ancient metaphor from Homer's Odyssey of being caught between the two monsters of Scylla and Charybdis to describe the predicament of contemporary physicians treating chronic pain.
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.
Paraphilias and paraphilia-related disorders (nonparaphilic sexual compulsivity or sexual addiction) are sexual disorders that predominantly afflict men.
Since 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.
A recent analysis that found a 40-fold increase in the diagnosis of bipolar disorder in youth has highlighted diagnostic dilemmas and prompted calls for more research studies.
The 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.
Adolescence is a time of great importance during which children make extraordinary developmental strides. According to Erik Erikson, adolescents consolidate a self-concept by struggling with essential questions such as Who am I? and What is my role in life?
Widespread 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.
