Patients with severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to have experienced trauma in childhood, adolescence, and throughout their adult lives than the general population. This high exposure to traumatic events such as physical and sexual abuse and assault takes a heavy toll.
The traumatic events surrounding the recent school shootings at Virginia Tech remind us that a disturbing aspect of our current culture is the rate at which America's youth are exposed to violence. Whether it is graphic episodes of violence on television, violent music, aggressive video games, hearing about or witnessing violence in the home or neighborhood, or being the direct victim of violence--violence is a pervasive part of society that disproportionately affects youth.
The addition of an antidepressant to a mood stabilizer did not add any benefit for patients with bipolar depression, according to an NIMH-sponsored research project reported in April in the New England Journal of Medicine. In the multicenter study, adding an antidepressant to the regimen also did not increase affective switching to mania.
children, Psychotherapy
Successfully weaving together the long and complex history of melancholic depression as a severe mood disorder with strong biological underpinnings and a distinctive clinical profile.
Childhood bipolar disorder is a devastating illness that affects emotional, social, and cognitive development. In recent years, increased attention devoted to the study of bipolar disorder in childhood has resulted in greater information regarding the cause, phenomenology, and treatment of the disorder.
In the article by Drs Kunen and Mandry, "Should Emergency Medicine Physicians Screen for Psychiatric Disorders?" (Psychiatric Times, October 2006), no mention was made of formally assessing a patient's mental status to diagnose delirium.
Psychiatrists know that it takes longer to interview children and adolescents than adults. Child and adolescent psychiatrists are universally struck by how comparatively easy it is to interview an adult patient, whereas general psychiatrists face the evaluation of a child or adolescent with apprehension.
A complex and heterogeneous condition characterized by a variety of symptoms and marked variability in disease course, bipolar disorder is marked by episodes of depression, hypomania, mania, or psychosis and,patients can experience a mixture of emotional states.
Making the Connection: A Parent's Guide to Medication in AD/HD is a concise, user-friendly book intended for parents of children with attention-deficit/hyperactivity disorder (ADHD).
According to the CDC, in 2004, suicide was the 11th leading cause of death across all age groups and the 10th leading cause of death for persons aged 14 to 64 years; 32,439 people in the United States took their own lives. Women attempt suicide about 3 times more often than men, although men are 4 times as likely to complete suicide. Anderson and Smith3 reported that suicide was the eighth leading cause of death among men in 2001. Of the 24,672 completed suicides among men, 60% involved the use of a firearm (the use of a firearm was the means of suicide in 55% of all cases).
A 79-year-old woman recently died in a fire at her Washington, DC, row house when "pack rat conditions" prevented firefighters from reaching her in time. A few days later, 47 firefighters from 4 cities spent 2 hours fighting a fire in a Southern California home before they were able to bring it under control. Floor-to-ceiling clutter had made it nearly impossible for them to enter the house.
In The Perfect Storm, Sebastian Junger describes the desperate plight of sailors and fisherman who, in the fall of 1991, were caught out in the Atlantic Ocean as 2 powerful storms converged into 1.1 Like those mariners, emergency department (ED) clinicians find themselves at the confluence of 2 powerful trends in modern society.
The following cases highlight some of the challenges clinicians face when treating patients in whom malingerling is suspected. One key aspect of these evaluations is not overlooking signs or symptoms that point to serious illness.
When a new patient with depression enters your practice, you face a diagnostic dilemma. If you miss bipolar disorder (BD), and prescribe an antidepressant, you can do harm. But if you call a unipolar depression "bipolar," you may also do harm, because lithium, anticonvulsants, and atypical antipsychotics carry significant risk as both short- and long-term treatments. In addition, the label of "BD" currently carries much more stigma than the term "depression."
Bipolar disorder is often accompanied by a host of other medical and psychiatric comorbidities. Recent evidence suggests that the illness is not as benign as originally considered . . .
There is growing evidence that individuals with bipolar affective disorder have cognitive impairments, even during periods of symptom remission.
Suicide is a serious public health problem that ranks as the 11th leading cause of death in the United States. Within the 15- to 24-year-old age group, it is the third leading cause of death.1 Many suicide victims have had contact with the mental health system before they died, and almost one fifth had been psychiatrically hospitalized in the year before completing suicide. A recent review found that psychiatric illness is a major contributing factor to suicide, and more than 90% of suicide victims have a DSM-IV diagnosis.
Unlike a pure psychiatric disabilityevaluation, mental and emotionaldamage claims require anassessment of causation. Today, treatingpsychiatrists are increasingly asked toprovide this assessment, since mentaland emotional damages are widelyclaimed in the United States as a remedyin legal actions.
Paraphilias are defined by DSM-IV-TR as sexual disorders characterized by "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving (1) nonhuman objects, (2) the suffering or humiliation of oneself or one's partner, or (3) children or other nonconsenting persons that occur over a period of 6 months" (Criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (Criterion B). DSM-IV-TR describes 8 specific disorders of this type (exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism) along with a ninth residual category, paraphilia not otherwise specified (NOS).
Recent issues of Psychiatric Timeshad articles focusing on psychiatricpractice guidelines and algorithms. Dr Michael Fauman examinedthe extent to which they are used,how they are used, and studies that havevalidated their usefulness comparedwith usual care.
Although treatment-resistant depression is defined in terms of a person's depression being resistant to medication, it usually also means that the patient has been unresponsive to whatever psychotherapy has been tried along the way. What might not be clear from the above but is known by all clinicians is that patients with TRD experience much internal suffering and misery.
Over the past 50 years, psychiatry has increasingly become psychiatric medicine coincident with the enormous developments in our understanding of and ability to effectively use clinical psychopharmacology to treat patients with psychiatric illnesses. There have been both increased understanding of the molecular mechanisms underlying the effects of psychiatric medications and increased numbers of psychiatric medications. The latter has occurred in tandem with a similar explosion in the availability of medications to treat a host of other medical conditions. In fact, the repertoire of available medications expands virtually every few weeks.
As I approach retirement, I have been looking back over the patients I have seen. Although I was trained as a psychoanalyst, most of the therapeutic procedures I have engaged in have, of necessity, been adaptations of my analytic skills in order to meet the needs of particular patients.
A great deal of data exists about the dangers of polypharmacy. Persons with psychiatric disorders experience increased risk for adverse drug interactions because of the great frequency with which multiple medications are used.
