Alcohol Abuse

Nonconventional and Integrative Treatments of Alcohol and Substance Abuse (Part 1)

Psychological Therapies for Schizophrenia: Family and Cognitive Interventions

Biological Markers and the Future of Early Diagnosis and Treatment in Schizophrenia

Up to 30% of patients for whom opioids are prescribed for chronic pain show an escalating pattern of opioid abuse characterized by taking more opioids than prescribed, seeking early refills, and finding additional sources of opioids. Although many of these drug-seeking patients are addicted to opioids, some are suffering not from addiction but from inadequate pain management, according to Martha Wunsch, MD, chair of Addiction Medicine and associate professor of pediatrics at Edward Via Virginia College of Osteopathic Medicine (VCOM) in Blacksburg.

The ideal medication for Parkinson disease (PD) would reduce disability and halt or slow disease progression without intolerable adverse effects. Although such an agent is not yet available, current treatments offer significant symptom control for most patients. The decision about when to start therapy is highly individual; however, delaying treatment because of fear of adverse effects may not be in the patient's best interest.

The reason a person has a stroke is no mystery. Results of a Danish study, reported at the 10th Congress of the European Federation of Neurological Societies in Glasgow, Scotland, held September 2 to 5, confirmed that risk factors could be identified in 98.5% of acute ischemic stroke patients.

Persons who have anxiety disorders commonly self-medicate with alcohol and other drugs, a recent survey confirmed. The results were published in the November 2006 issue of The Journal of Nervous and Mental Disease.

Clinical depression is an increasingly well-recognized sequela of epilepsy (see "Optimizing Treatment of Seizures by Addressing Psychiatric Comorbidities," Applied Neurology, August 2006, pages 41-42). Questions are therefore surfacing as to whether patients with epilepsy are being adequately identified and treated.

Psychotic disorders are a group of syndromes characterized by positive symptoms, including hallucinations, delusions, and thought disorder; and negative symptoms, including mood symptoms, social withdrawal, and reduced motivation. Cognitive deficits also appear with psychotic disorders. Psychotic disorders rank 22nd in the World Health Organization's list of worldwide causes of disability. This ranking is adjusted for the relatively low lifetime prevalence rate for psychosis; the perceived burden of the disease on those affected with psychotic disorders, as well as their relatives and caregivers, is much higher.

Beyond demographic characteristics, risk and protective factors for suicide in older adults have been much more clearly defined in recent years by a series of methodologically rigorous, case-controlled psychological autopsy studies.

Substance use disorder (SUD) plays a prominent role in the epidemiology, cause, and course of mental illness. Of the more than 5 million Americans with comorbid mental illness and SUD, fewer than half received treatment at either a specialty mental health or substance abuse treatment facility.

The prevalence of substance use disorders in patients with schizophrenia is greater than the rate observed in the general population, with a dramatic increase since the 1970s. Several theories exist to explain the high rate of comorbidity. The "self-medication" hypothesis suggests that persons may abuse substances to treat underlying psychotic symptoms or adverse effects of medications commonly used to treat schizophrenia.

Once his colleagues began to recover from the shock, the death of Dr Wayne S. Fenton triggered a discussion in the professional and lay press about the risks of violence to mental health professionals posed by mentally ill patients. Fenton was found unconscious and bleeding in his office in Bethesda, Md, on Sunday, September 3, 2006. He had been beaten severely around the head and died at the scene.

Psychiatrists certainly do not know all the answers when it comes to the recent spate of school shootings, but we do know some of the most pressing questions. For example, is there a difference in the psychological makeup of adult shooters versus student, or juvenile, shooters? To what degree does untreated psychosis or depression play a part in the shooter's seemingly inexplicable behavior? How important is bullying in motivating some students to seek revenge on their peers? What are the earliest warning signs of an impending attack by an assailant of any age?

Borderline personality disorder (BPD) and substance use disorder (SUD) often co-occur. Comorbid BPD and SUD is related to a variety of severe adverse outcomes.

How do we help patients manage pain without exacerbating or reactivating an addictive disorder?

There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.

The National Institutes of Health has awarded the Alzheimer's Disease Cooperative Study (ADCS) $52 million to test the effectiveness of therapies to slow the progression and treat symptoms of Alzheimer disease (AD). New initiatives will include 3 studies to explore the effects of therapies on amyloid-β peptide and the tau protein, as well as an initiative to identify new methods for conducting dementia research.

Antipsychotic medications for the treatment of agitation, aggression, psychosis, and other symptoms of Alzheimer disease (AD) are no better than placebo and may even be harmful, according to a highly publicized study by a team from the University of Southern California Keck School of Medicine. In a statement to the press, the lead author of the study Lon Schneider, MD, professor of psychiatry, neurology, and gerontology at Keck, commented that after 12 weeks participation in a double-blind placebo-controlled trial, no significant differences were seen in symptom improvement in patients taking an antipsychotic drug compared with patients taking placebo

Despite the accepted validity of Hispanic as a distinct demographic and cultural category, we have only fragmentary evidence and scarce guidelines regarding the treatment of mentally ill Hispanic Americans. This article provides a brief review of the topics with the most clinical relevance to diagnosis and treatment of mental disorders in Hispanic Americans.

Many abusers of methamphetamine in rural areas manufacture the drug for their personal use. These "mom-and-pop cooks" produce methamphetamine in and around homes where children are also living. This article provides an overview of the mental health of children whose parents abuse methamphetamine.

Several readers have responded with comments and concerns regarding my column, "Do Physicians Use Practice Guidelines?" Since the issues these readers raised are important and concern many psychiatrists, they merit some discussion.

A discussion of the intellectual, social, and historical similarities and differences between sacred texts and the DSM would require a full-length book, but we will concentrate here on 5 main aspects: controversy, communication, interpretation, change, and power.

Analyzing data gathered in a 10-nation study of psychoses by the World Health Organization (WHO), Susser and Wanderling1 found that the incidence of nonaffective psychoses with acute onset and full recovery was about 10 times higher in premodern cultures than in modern cultures. Transient psychoses with full recovery were comparatively rare in modern cultures. Such a dramatic difference begs for explanation.

In a recent article on genetic counseling in psychiatry, Christine Finn, MD, and Jordan W. Smoller, MD, ScD, noted that family and twin studies have documented the familiality and heritability of schizophrenia, bipolar disorder, major depression, anxiety disorders, autism, attention-deficit/hyper- activity disorder (ADHD), and Tourette syndrome, among others, and that molecular genetic studies have begun to identify possible susceptibility loci for several of these disorders, most notably schizophrenia.