Comorbidity

Psychotic disorders are a group of syndromes characterized by positive symptoms, including hallucinations, delusions, and thought disorder; and negative symptoms, including mood symptoms, social withdrawal, and reduced motivation. Cognitive deficits also appear with psychotic disorders. Psychotic disorders rank 22nd in the World Health Organization's list of worldwide causes of disability. This ranking is adjusted for the relatively low lifetime prevalence rate for psychosis; the perceived burden of the disease on those affected with psychotic disorders, as well as their relatives and caregivers, is much higher.

Intermittent explosive disorder (IED) is not yet on the radar screens of many psychiatrists, but it is more prevalent than panic disorder and warrants extensive research and attention, 2 experts on IED said recently.

The prevalence of substance use disorders in patients with schizophrenia is greater than the rate observed in the general population, with a dramatic increase since the 1970s. Several theories exist to explain the high rate of comorbidity. The "self-medication" hypothesis suggests that persons may abuse substances to treat underlying psychotic symptoms or adverse effects of medications commonly used to treat schizophrenia.

Borderline personality disorder (BPD) and substance use disorder (SUD) often co-occur. Comorbid BPD and SUD is related to a variety of severe adverse outcomes.

There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.

More than 1 in 20 adults nationwide suffer from compulsive buying, according to a telephone survey of 2500 adults. And contrary to popular opinion, “compulsive buying appears to be almost as common in men as in women,” according to Lorrin M. Koran, MD, first author of a recently published prevalence study of compulsive buying behavior in the United States. Six percent of women and 5.5% of men in the study reported symptoms considered to be consistent with compulsive buying disorder.

Despite the accepted validity of Hispanic as a distinct demographic and cultural category, we have only fragmentary evidence and scarce guidelines regarding the treatment of mentally ill Hispanic Americans. This article provides a brief review of the topics with the most clinical relevance to diagnosis and treatment of mental disorders in Hispanic Americans.

The skin is the largest organ of the body and functions as a social, psychological, and metabolically active biologic interface between the individual and the environment.

Certainly, with the advent of the atypicals, it has become almost too easy to forget about doing an Abnormal Involuntary Movement Scale (AIMS) checklist. Given the time and reimbursement constraints of current psychiatric practice, however, it is close to impossible to find time for clinical rating scales.

That depression, anxiety, sleep disorders, and other neuropsychological conditions are often associated with chronic pain isn't news to most neurologists. But physicians who do not specialize in pain management are largely unaware of a growing body of research suggesting that the race (a genetic classification) or ethnicity (a cultural classification) of a patient with chronic pain may determine the patient's risk of neuropsychological symptoms.

Office management of attention-deficit/hyperactivity disorder (ADHD) differs in many important ways from ADHD management conducted in a research environment. In clinical trials, treatments and eligible patients are selected in advance by committees, patients are randomized to different management strategies, and both clinicians and pa tients are blinded to the treatments.

Anxiety disorders are the most prevalent psychiatric disorders in the United States. Although effective treatments are available, such as the SSRIs and cognitive-behavioral therapy (CBT), it is estimated that in about 40% of patients, anxiety disorders are partially or completely resistant to first-line treatment.

Although studies now suggest that some psychotropic medication regimens have a somewhat higher success rate than the one-third rule would have predicted, psychiatrists are still left with the problem of why it is that only one third to one half of patients who are treated get better, and why fewer still sustain that improvement over time

In the era of Google and PubMed, a medical reference book finds itself in a precarious position. Is there a role for a bundled, unchangeable hard copy of data that may become outdated in the near (and more easily accessed) future?

Despite the progressive increase in the number of available antidepressants, many patients with depression continue to be symptomatic.

If done properly, the assessment of alcohol and substance use disorders in the emergency department (ED) or psychiatric emergency service can be the first step toward recovery.

In a presentation given at the midyear meeting of the American Epilepsy Society, Andres Kanner, MD cited studies from the literature showing that the rates of depression, anxiety, psychosis, and attention-deficit/hyperactivity disorder (ADHD) are significantly higher among persons with epilepsy than among the general population

Alcohol is the drug of choice for adolescents, with cigarettes and marijuana being second and third. Contrary to widespread belief, alcohol dependence is most common in 18- to 20-year-olds, with progressively decreasing rates of alcohol dependence in older age groups.

The longitudinal course of bipolar disorder (BD) is characterized by a low rate of recovery, a high rate of recurrence, and poor interepisodic functioning. There is a need to invoke a chronic disease management model (CDMM) when treating individuals with BD.

The continuation of the epidemic of childhood obesity and overweight has major implications and consequences for future research in psychopathology.

New findings in epidemiology, developmental psychiatry, and neuroscience offer the opportunity for a new perspective on the problems of juvenile delinquency and bring to bear the insights of modern psychiatry in the treatment and successful rehabilitation of juvenile offenders.

DSM-IV-TR emphasizes that patients with borderline personality disorder (BPD) show a "instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts," and any five out of nine listed criteria must be present for the diagnosis to be made.

Paraphilias as defined by DSM-IV, are sexual impulse disorders characterized by intensely arousing, recurrent sexual fantasies, urges and behaviors (of at least six months' duration) that are considered deviant with respect to cultural norms and that produce clinically significant distress or impairment in social, occupational or other important areas of psychosocial functioning. The common paraphilias described include exhibitionism (exposure of genitals to a stranger), pedophilia (sexual activity with a prepubescent child, generally 13 years of age or younger), voyeurism (observing others' sexual activities), fetishism (use of inert objects, such as female undergarments), transvestic fetishism (cross-dressing), sexual sadism (inflicting suffering or humiliation), sexual masochism (being humiliated, beaten, bound or made to suffer) and frotteurism (touching, rubbing against a nonconsenting person).

Although psychosis is rare in adolescent patients with anorexia nervosa restricting type, the possibility should be explored because it may be the underlying cause of the eating disorder.

The past few years have seen substantial progress in recognizing and treating several of the subtypes of bipolar disorder. This Special Report addresses the diagnostic challenges and the different strategies for managing these subtypes.