Alcohol Abuse

Noting the frequent unresponsiveness of posttraumatic stress disorder (PTSD) to standard drug treatments, Stein and colleagues reported results of the first double-blind, placebo-controlled trial of an adjunct to selective serotonin reuptake inhibitors for the treatment of this disorder.

Epilepsy is one of the most common chronic neurological disorders of childhood. Therapy should consist of education to reduce fears and concerns, psychotherapy to decrease triggers for seizures, and careful medication monitoring to avoid those drugs that reduce seizure threshold or have excessive interactions with antiepileptic drugs.

Catatonia is found in at least 10% of patients admitted to acute psychiatric services, so any young patient with stupor, unexplained excitement or persistent motor signs should be formally assessed for this syndrome. From among the 20 to 40 now-identified features of catatonia, its proper diagnosis must be differentiated from other mental illnesses.

In the last third of the 20th century, psychiatry boldly shook off a 120-year-long philosophical funk and rushed to catch up in the thrilling march of medicine. The biopsychosocial model that once sounded trendy now seems to be an indispensable approach. The pioneers of psychopharmacology who once labored at the margins have now been joined by thousands of bright young doctors who treat patients with depression, psychosis and impulsive aggression and realize that a troubled soul is often expressing the cries of a troubled brain. This issue of Psychiatric Times celebrates the stirring giant that is 21st-century neuropsychiatry--a discipline that derives its immense power and scope from the glad embrace of the twin Enlightenment ideals of humanism and the scientific method.

What effects will the verdict from the murder case against Andrea Yates have on the public's view of the insanity defense?

New medications for the treatment of various addictions are currently under investigation. However, there are still substantial barriers, on the part of health and social policies and the patients themselves, to patients receiving these new treatments. Many of these issues were explored at the 2001 American Society of Addiction Medicine's State of the Art in Addiction Medicine conference.

For various reasons, up to half of patients stop taking their prescribed antidepressant within three months. Side effects are often the biggest obstacle in maintaining treatment adherence. How can clinicians help patients deal with the sexual dysfunction and weight gain that often accompany psychotropic treatment?

There is a range of meaning that underlies patients' violent acts against themselves. The usefulness of so-called "safety contracts" to actually predict suicidal behavior is questioned.

Although it may be tempting to say that almost any rewarding activity can become addicting, new research appears to indicate that, at least in the case of Internet use, that may not be the case. In fact, "Internet addiction" may actually be a sign for other psychiatric disorders.

In the 1800s there was widespread concern over the increase in the number of individuals with severe mental illnesses. Evidence from the 20th and 21st centuries is building that shows a similar trend. Why, then, is this increase not being currently addressed?

Jose R. Maldonado, M.D., assistant professor of psychiatry and behavioral sciences at Stanford University, was named the 2001 recipient of the Psychiatric Times Teacher of the Year award. The award was presented to Maldonado at the 14th Annual U.S. Psychiatric & Mental Health Congress in honor of his outstanding achievements in and steadfast dedication to psychiatry. For his work with geriatric psychiatry, Dilip V. Jeste, M.D., has been appointed to the endowed Estelle and Edgar Levi Memorial Chair in Aging at University of California, San Diego (UCSD). Jeste is founder and chief of UCSD's division of geriatric psychiatry and Founding President of the International College of Geriatric Psychoneuropharmacology. He focuses his research on schizophrenia and other psychotic disorders in late life and their successful treatment with the use of safer and more effective drug and psychosocial treatments.Helping people of all ages with schizophrenia to reintegrate into society is the focus of the Eli Lilly and Company-sponsored Reintegration Awards. Recognizing both patient advocates and mental health care professionals, these awards provide grants for their recipients' respective reintegration programs. In the Honorary category, the 2001 "Public Eye Recipient" is Elizabeth Baxter, M.D., a Tennessee-based psychiatrist who, while suffering from psychosis herself, is a mental health advocate on the national level. The 2001 Reintegration Awards were also given in the categories of Advocacy (New Jersey Association for Mental Health Agencies Inc. in Manasquan, N.J.), Clinical Medicine (The Whole Person Family Medicine Clinic in Torrance, Calif.), Education (The Guidance Center Supported Education Program in New Rochelle, N.Y.), Housing (Fred Geilfuss, Scott Reithel, Jack Rosenberg in Milwaukee), Occupational (Restoration Project in Acton, Mass.) and Social Support/Rehabilitation (Fountain House in New York City).

A report released by former Surgeon General David Satcher, M.D., outlines the disparity in mental health diagnoses and treatment between majority and minority ethnic groups. The report also discusses ways of closing the gap in mental health treatment.

Many options exist for the pharmacological treatment of anxiety disorders. Are some more appropriate under certain conditions or for some patients? Mechanisms and efficacy of medicinal treatments, as well as some common herbal remedies, are reviewed.

Anxiety disorders are highly prevalent and potentially debilitating psychiatric conditions. Is heredity linked to anxiety disorders? The importance of early identification and management of children at risk for anxiety disorders is emphasized.

Compared with Caucasians, African Americans receive an excess of schizophrenia-spectrum diagnoses. Potential explanations for the ethnic differences in clinical assignment of psychiatric diagnoses are reviewed.

Social anxiety disorder, the third most common mental disorder, is often underdiagnosed and undertreated. A leading expert on SAD provides an overview, including highlights of the barriers to diagnosis, a differential diagnostic approach and treatment options for social anxiety disorder.

A recently published meta-analysis questions if efficacy data garnered from clinical trials is relevant to everyday clinical practice. The authors ponder if enough patients are being included, if they are being followed long enough afterward, and whether exclusion criteria are too broad?

As the field of addiction psychiatry continues to evolve, researchers and clinicians are looking at old problems with new vision.

Will insurance coverage for mental health care ever equal that of physical health care? Until the federal government takes a stand, many states are implementing new laws or revising old ones to help level the grounds. However, with the states' options ranging from full parity to mandated offering and the option to base coverage on type of mental illness, equal mental health care coverage is still left on shaky grounds.

Psychiatrists are being marginalized in this current era of managed care and treatment teams. What can be done to secure the psychiatrist's role in the diagnosis and treatment of patients?

While progress in identifying the specific genetic variations that help determine an individual's vulnerability to addiction has been slow, a great deal has been uncovered about delineating the role that numerous genes and their protein products play in mediating the development of addiction.

Contingency management provides tangible reinforcement to modify patients' behaviors and has been found to reduce substance abuse across a number of clinical populations and settings. What types of tangible reinforcements are most effective?

Although there are numerous media accounts of the detrimental effects of the drug Ecstasy, there may also be some clinical uses in the treatment of PTSD. The U.S. Food and Drug Administration has approved the first-ever clinical trial of MDMA since it was banned in 1988. An expert in the field discusses what psychiatrists need to know about the popular "rave" drug and the compound's use as a therapeutic tool.

Contingency management rewards good behaviors, thereby modifying behaviors of substance abusers in a positive and supportive manner.

The following are case studies discussing the impact of proper evaluation of comorbid psychiatric illness and medical disorders. To read more case studies and find out how to effectively recognize and treat patients with these disorders, please see the January 2002 issue of Psychiatric Times.

Dr. Genova offers the antidote to the complexities of manualized and proceduralized psychotherapy that have arisen in imitation of procedural, technology-driven medicine. Supportive, directive and relational types of therapy and their correlation with various power structures within the doctor-patient relationship are described.

There is currently great controversy over the issue of obsessive-compulsive behaviors in schizophrenia. Are patients who display these behaviors suffering from a separate subtype of schizophrenia?

The introduction of posttraumatic stress disorder (PTSD) into psychiatric nosology has brought about a great deal of insight as well as controversy. Have complex clinical manifestations of PTSD created a need for further clarification of the disorder?

The first magnetic resonance imaging studies in schizophrenia began to appear in the literature in 1984. These studies confirmed earlier theories and also contributed new findings such as changes in size of the hippocampus, amygdala, corpus callosum and so on in patients with schizophrenia. What other neuroimaging techniques are being used? What do recent studies show regarding the neuroanatomic abnormalities found in patients with schizophrenia?

Role Model - Poetry of the Times