Bipolar Disorder

Clinical observations have shown that patients who do not respond to antidepressants may show dramatic improvement if atypical antipsychotics are added to their regimen. How can successful patient outcomes be maximized?

Addiction-as-disease or addiction-as-choice may be better defined by delineating initial experimentation with addictive drugs from ongoing drug use. Repeated exposure to addictive substances changes the molecules and neurochemistry of the addict. Addiction-as-disease accepts the responsibility of the health care professional to treat the patient and precludes the stigmatization that addiction is a choice.

Many patients, particularly those living in colder climates, can suffer from seasonal affective disorder (SAD). What causes SAD and what are the treatment options for these patients?

College students are far less likely to kill themselves than are nonstudent peers, according to a 10-year research study examining suicide rates at 12 Midwestern campuses.

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.

Although ADHD can be effectively treated and can lead to significant dysfunction if left untreated, negative public perceptions still abound. Proper diagnosis, exploration of comorbid disorders and collaboration with other health care professionals may be the answer to ensuring positive outcomes for children afflicted with this disorder.

Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite. In some patients, an organic mental syndrome can be part of a migraine attack (Davidoff, 1995). In other patients, an acute psychotic condition is the dominating clinical feature. This presentation, with paranoid delusions, hallucinations and anxiety, has been described in families with hemiplegic migraine (Spranger et al., 1999). Migraine is, therefore, an important differential diagnosis in relation to episodic phenomena with a mixture of somatic and psychiatric symptoms. In addition, psychosocial stress is the most common precipitating factor for a migraine attack (Davidoff, 1995).

After numerous hospitalizations, electroconvulsive therapy and a battery of drug trials, a college senior remained suicidal. Looking for advice on her patient, a psychiatrist brought the case to a team meeting, only to be told by a senior colleague, "You can't save them all."

Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite.

How can psychiatrists and psychotherapists optimize their collaboration and individual skills to facilitate treatment success?

There is no question that psychotherapy and psychopharmacology can be successfully integrated. Indeed, there are still many psychiatrists left in this country who talk to patients and families, provide both psychotherapy and psychopharmacology, and care for patients in a biopsychosocial context.

As a psychiatrist working in a state hospital, this author defends the long-term commitment of sexual offenders to institutions and offers insights on factors determining prognosis.

Antidepressant use among children and adolescents is on the rise. What prescribing patterns are being formed? Researchers are suggesting that more research into psychiatric pharmacogenetics may produce better treatment outcomes. Will it one day be possible to predict treatment response?

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?

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.

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?

Treating traumatized patients requires special care so that both therapist and patient can benefit from the relationship. How can therapists facilitate this care, and what can they do to keep themselves healthy while treating such patients?

Neurofeedback, a way for patients to learn to create and maintain desirable brainwaves, may be an affective adjunct therapy for many psychiatric disorders. Which procedures are most effective, and what are the benefits and risks?

Neurofeedback, also called electroencephalogram (EEG) biofeedback or neurotherapy, is an adjunctive treatment used for psychiatric conditions such as attention-deficit/hyperactivity disorder, generalized anxiety disorder, posttraumatic stress disorder, phobic disorder, obsessive-compulsive disorder, bipolar disorder, depression and affective disorders, autism, and addictive disorders (Moore, 2000; Rosenfeld, 2000; Trudeau, 2000).

Two new reports, released by the Institute of Medicine and the World Health Organization, examine the issue of mental health care in Third World countries. In those areas that have limited medical resources, how can mentally ill patients best be served?

Although incomplete, the link between thyroid function, bipolar affective disorder, and lithium has been acknowledged for many years. This article provides an overview of the relationship and recent literature.

Source: Simons RC (1983)