Bipolar Disorder

The development of new, more effective antipsychotics with fewer adverse effects (eg, extrapyramidal symptoms, tardive dyskin­esia, metabolic syndrome) is paramount.

Youths aged 6 to 16 years with any subtype of ADHD participated in the study. Comorbid bipolar disorder, pervasive developmental disorder, psychotic illness, anxiety disorders, and tic disorders were exclusionary criteria. Patients with other comorbid psychiatric disorders, including major depressive disorder, were allowed to participate if ADHD was the primary diagnosis.

Studies of antipsychotics in child prenpresented at the 48th Annual New Clinical Drugs Evaluation Unit (NCDEU) Meeting, conducted by the NIMH in Phoenix, May 27-30, provide some data where there have been relatively little on the increasing use of these agents.

Major depressive disorder has become psychiatry’s signature diagnosis. Depression is diagnosed in about 40% of patients who see a psychiatrist. This percentage is double that of just 20 years ago.

Participants from around the globe recently came together to create an international consensus statement on bipolar disorder that was presented at the 21st Congress of the European College of Neuropsychopharmacology (ECNP).

Although several studies indicate that psychotherapy (alone or in combination with medications) can help psychiatric patients reach recovery faster and stay well longer, a declining number of office-based psychiatrists are providing psychotherapy to their patients.

DSM-IV-TR, our current diagnostic classification system of psychiatric disorders, follows the diagnostic paradigm first established by DSM-III in 1980.

Diagnostic assessment of psychiatric disorders and their comorbidities is a challenge for many clinicians. In emergency settings, there is no time to conduct lengthy interviews, and collateralinformation is often unavailable.

Neuroimaging is often used in clinical psychiatry to rule out medical and neurological conditions that can mimic psychiatric disease rather than for the diagnosis of specific psychiatric disorders.

A 52-year-old female college professor was referred to a psychiatrist by a nurse practitioner at the college health clinic. The referring diagnosis was “adjustment disorder with depressed mood versus atypical depression with somatization; rule out fibromyalgia.”

ADHD, the most common diagnosis in child psychiatry, appears to be more challenging to diagnose and treat when there is a comorbid depressive disorder.

In his review of my book, Doing Psychiatry Wrong: A Critical and Prescriptive Look at a Faltering Profession (Psychiatric Times, June 2008, page 57), S.N. Ghaemi, MD, MPH, citing George Orwell, writes that I “seek to justify an opinion” rather than “seek the truth.” He claims that my “errors are numerous and fundamental.”

In this column, I will discuss new progress on this Internet-boosted line of inquiry. I will begin with a few basics about differential gene expression and microarrays and will then move on to something that researchers are calling “convergent functional genomics.” As you shall see, the clever use of online databases both confirmed and extended the work done at the bench.

This article focuses on recent innovations in diagnostic issues, tactics, and strategy, and takes a brief look at the future.

In our own time, many so-called conflicts of interest (COI) boil down to temptation, as James DuBois,3 professor and department chair of health care ethics at Saint Louis University, notes in his excellent chapter on this subject. A physician-researcher is tempted to slant the results of his or her study in order to maintain funding from a medical technology company.

Universal prevention has been a focus of psychiatric research for the past 4 decades. Using a public health approach, research has shown that mitigating major risk factors, such as poverty and early life stress, and promoting protective factors can improve behavioral outcomes.

Debates over conflicts of interest (COIs) in medical research and practice are intensifying with recent proposals to ban industry funding of medical education, to better “manage” industry-physician relationships, and to mandate public disclosure of industry payments to physicians and medical institutions. Caught in the cross fire are prominent psychiatrists accused of underreporting payments received from pharmaceutical companies.

Polypharmacy is used increasingly in the treatment of depression.1 Although it can be beneficial-and at times may even be unavoidable-it can also be overused, resulting in drug-drug interactions, accumulation of adverse effects, reduced treatment adherence, and unnecessary increases in the cost of health care.2 This article describes current trends in psychiatric polypharmacy in the treatment of depression along with ways to use polypharmacy to optimize treatment outcomes.

This review provides an overview of the efficacy, safety, and mechanisms of action in the treatment of depression.

We are growing older. In ancient Greece, the expected life span was 20 years. In Medieval Europe, it went up to 30 years. In 1900, people reasonably could expect to live to the ripe old age of 47 years, and 39% of those born at that time survived to age 65 years in the United States. Currently, the average life span in the United States is 78 years, and 86% of those born will survive to age 65 years. The very old-people older than 85 years-are the fastest-growing population group in the country, and there are 120,000 Americans over the age of 100 years. And the trend continues.

Education is a cornerstone for the effective treatment of bipolar disorder. The Bipolar Disorder Answer Book is a recent addition to the resources available for patients and their families. Each of the newly emerging self-help books offers different perspectives and emphasis. This book sets out to cover a broad range of relevant topics. Although it begins with the usual discussion of diagnosis and treatment, it quickly moves on to specific issues, such as securing care (both outpatient and inpatient), relapse prevention, comorbid illnesses, “survival tips” for friends and family, insurance coverage, and disability resources.

A review of targeted treatment strategies for symptom domains when impulsivity and compulsivity become dysfunctional.

The rising prevalence and dispersion of obesity in North America in the past decade is analogous to a communicable disease epidemic. Longitudinal and cross-sectional associations between major depressive disorder, schizophrenia, and obesity have been established. Existing evidence also indicates that there is an association between bipolar disorder and obesity.

The loss of a loved one is one of the most traumatic events in a person’s life. In spite of this, most people cope with the loss with minimal morbidity. Approximately 2.5 million people die in the United States every year, and each leaves behind about 5 bereaved people.

Business groups are pressing the Department of Labor (DOL) to eliminate "serious mental illness resulting from stress" from the "serious health conditions" an employee can cite when requesting unpaid leave under the Family and Medical Leave Act (FMLA) of 1993. The effort is being orchestrated by the Society for Human Resource Management (SHRM) and is being backed by personnel executives at companies such as Wal-Mart.