Bipolar Disorder

Sensitivity and specificity of a new bipolar spectrum diagnostic scale.

Recent research has shown environmental factors may increase the risk of schizophrenia in persons who may already have a genetic predisposition toward the illness.

Obsessive-compulsive disorder is a prevalent, disabling and chronic illness. Serotonin reuptake inhibitors are the first-line of treatment; however a large proportion of patients will have either a partial or nonresponse. This review outlines the strategies for treatment-resistant OCD, including augmentation agents, alternative monotherapies, intravenous strategies and newer nonpharmacologic somatic treatments under development.

Impulsive behaviors play an important role in both bipolar and substance abuse disorders. However, results of studies investigating this link are often ambiguous, in part, due to the multidimensional nature of the impulsivity construct and the fact that many studies use a single measurement technique. We describe a model of impulsivity characterized by three components: response initiation, response inhibition and consequence sensitivity. How these components differ from one another in terms of their use, behavioral theory and biological function is discussed, along with measurement techniques.

Dr. Schwartz, founder and editor in chief of Psychiatric Times, discusses his career as a clinician and entrepreneur.

Are juveniles mature enough to receive the death penalty? No, according to a ruling by the U.S. Supreme Court. Medical, psychiatric, psychological and brain-imaging data all supported the decision to ban execution of juvenile death-row inmates.

The FDA has issued a "black box" warning about the use of all antidepressants in the pediatric population due to a 1.8-fold increase in suicidality on drug compared to placebo. Yet these medications can be an effective tool in treating depression. How should parents and patients be educated, considering this information?

Autism is a highly prevalent, highly heterogeneous disorder of unknown etiology. Studies to clearly establish the efficacy of various classes of psychoactive drugs are scarce. Nonetheless, available findings do support the efficacy of atypical antipsychotics and antidepressants in treating the core symptoms of repetitive behavior.

Bipolar disorder in children is particularly difficult to treat. A treatment algorithm combining pharmacology with psychotherapy in order to get optimal results is presented.

The discipline of psychopharmacology has expanded enormously during the last several decades. As this Special Report illustrates, while the treatment of mental illness with medication has definitely advanced, it is neither quick nor easy. Instead, it has become more complex and complicated.

On March 31, Johnson & Johnson's Ortho-McNeil Neurologics unit added a warning to its prescribing label for galantamine hydrobromide, known commercially as Reminyl, a treatment approved for individuals who have mild to moderate Alzheimer disease (AD). On April 11, the company changed the commercial name of the drug to Razadyne.

Nerve root injections can help patients with lumbar radicular pain avoid surgery for at least 5 years, according to research from Washington University in St Louis that was presented in late February at the annual meeting of the American Academy of Orthopaedic Surgeons.

Mental illness occurs more frequently among people infected with HIV. In addition, individuals with mental illnesses are at greater risk for contracting HIV. Therefore, psychiatry has a great deal to offer in the management of patients with HIV--whether through proper patient education or safe and effective psychopharmacology.

Multiple studies show that diabetes approximately doubles the risk of comorbid depression. Furthermore, major depressive disorder is a risk factor for the subsequent development of type 2 diabetes mellitus. Treatments for depression in the setting of diabetes must be evaluated for their effects on blood glucose levels, propensity for weight gain, possible concomitant use for diabetic neuropathy and potential drug interactions.

Three recently published studies uncovered some answers to the genetic underpinnings of depression. Familial vulnerability was shown to increase with each generation affected by depression. Two genetic variants pointed in opposite directions: one showed an increase risk of depression and the other predicted responsiveness to antidepressants.

"No longer a pipe dream," is the suggestive lead-in of a widely distributed press release issued last October touting the potential benefits of cannabinoid compounds in the treatment of Parkinson disease (PD), Lou Gehrig disease-or amyotrophic lateral sclerosis (ALS)-and a number of other debilitating conditions, as reported during last fall's 2004 annual meeting of the Society for Neuroscience. According to Daniele Piomelli, PhD, an expert in cannabinoid research and professor in the Department of Pharmacology at the University of California, Irvine, certain cannabinoid compounds can be harnessed to "provide select benefits to patients while avoiding some of the unwanted effects" associated with marijuana use. Compounds of greatest interest have been WIN 55212-2, delta(9)-tetrahydrocannabinol (THC), and anandamide.

The post-stroke patient is at significant risk for various psychiatric syndromes. The most commonly reported of these in the literature are post-stroke depression (PSD) and post-stroke dementia (PSDem), which may present simultaneously with overlapping mood and cognitive symptoms. In this article, we offer a review of current literature on post-stroke psychiatric syndromes and an integrated clinical approach to screening, diagnosis, and pharmacologic intervention.

Although previous findings have suggested that certain gait impairments in patients with diabetes are specifically linked to neuropathy, researchers from Loma Linda University in California also have found gait abnormalities in patients with type 2 diabetes who did not have neuropathy.

It’s a classic risk/benefit dilemma: Does preventing suicidality-assuming suicidality can predict suicide-justify scaring some doctors away from prescribing antidepressants for young patients?

Clinical Trial Enrollments

In the second part of this series, read about the special issues psychiatrists face when treating women, children and adolescents, and elderly people with bipolar disorder and dementia. What are the recommendations for care and monitoring strategies to maintain patients on effective, long-term treatment regimens?

Migraine affects approximately 12% of the population, and a high percentage of these patients have comorbid psychiatric disorders. Knowing more about the interaction between headache and psychiatric factors can assist in evaluating and treating these patients.

Despite the fact that awareness of HIV and AIDS transmission is pervasive, risky sexual behavior has been increasing in many parts of the world in recent years, with a concomitant rise in new cases of HIV and other sexually transmitted diseases.

Is sexual research still an orphan as far as recognition and funding? Yes. Yet sex and sexuality issues affect the quality of each person's life. As the articles in this Sex & Sexuality bonus issue show, sexual health remains in the physician's domain in this millennium and beyond.

The diagnosis of bipolar disorder in children remains controversial. One of the more disturbing facets of its presentation in such young patients is the presence of hypersexual behavior. How can these behaviors be differentiated from the effects of abuse and other psychiatric disorders?