Comorbidity

Although valiant efforts have been made to reduce access to the chemical precursors of methamphetamine, it is likely that methamphetamine will remain accessible and inexpensive, and costs associated with increased use will continue to rise.

A Public Health Approach to Intervening With Youth in Schools

The November death of an Israeli fashion model whose weight had dropped below 60 lb was chilling even in a world that prizes rail-thin models as an ideal of feminine chic. Social critics have long blamed the fashion industry's use of such models for inspiring teenagers and young women to engage in extreme dieting. But at the recent Annual Meeting of the California Psychiatric Association, in Huntington Beach, eating disorders expert Walter Kaye, MD, reminded attendees that the causes of anorexia nervosa (AN) relate more to genetics and neurobiology than to size-zero models on catwalks.1

The revolution inherent in the move from DSM-II to DSM-III primarily involved a growing emphasis on comorbidity. For several decades before DSM-III, the emphasis had been on diagnostic economy: fewer diagnoses were considered more elegant, more accurate, and more useful in guiding care.

Patients with chronic pain and head injury frequently have comorbid anxiety and depressive disorders, with depressive disorders appearing to be more predominant. A number of studies show that depressive spectrum illness develops in 40% to 80% of patients with chronic pain; in a majority of these cases, the mood disorder is caused by chronic pain.

I was taken ill with the flu. They gave me up. The paper had my obit set in type. . . . My hair turned white and then it fell out. The first time I tried to rise to a sitting position I fell and broke an arm. I had phlebitis in one leg and they said I'd never walk again.

Comorbidity of psychiatric syndromes is quite common-in a 12-month period, almost 50% of adults in the United States with any psychiatric disorder had 2 or more disorders.

Most estimates suggest that there are just over a million persons living with HIV/AIDS in the United States. According to CDC data, between 2001 and 2005, an average of 37,127 new cases of HIV infection, HIV infection and later AIDS, and concurrent HIV infection and AIDS were diagnosed each year.

Since the revision of DSM-III, high rates of co-occurring psychiatric disorders have been observed, particularly in cases of moderate and severe psychiatric illness. The reason lies in the design of the diagnostic system itself: DSM-IV is a descriptive, categorical system that splits psychiatric behaviors and symptoms into numerous distinct disorders, and uses few exclusionary hierarchies to eliminate multiple diagnoses.

A recent analysis that found a 40-fold increase in the diagnosis of bipolar disorder in youth has highlighted diagnostic dilemmas and prompted calls for more research studies.

Among clinicians and researchers in geriatric psychiatry, interest in late-life bipolar disorder is growing, fueled not only by the increasing size of this clinical population but also by the recent discovery that mood stabilizers such as lithium may influence the pathogenesis of Alzheimer disease.

Bipolar disorder (BD) in later life is a complex and confounding neuropsychiatric syndrome with diagnostic and therapeutic challenges.

Many recall the phrase "To know syphilis is to know medicine." Now Lyme disease (Lyme borreliosis), the new "great imitator," is the ultimate challenge to the breadth and depth of our knowledge. In psychiatry, we generally treat mental symptoms or syndromes rather than the underlying cause of a disorder.

Marijuana is the most commonly used illicit drug in the United States and worldwide. Initiation of use typically occurs during adolescence. The most recent epidemiological data indicate that in the United States, 42% of high school seniors have tried marijuana, 18% have used it in the past 30 days, and 5% use it daily.

Voluntary informed consent is, with rare exceptions, a necessary, albeit not sufficient, defining precondition of ethical clinical treatment, and it is essential for enrollment in clinical research trials.

The clinical management of patients with psychopathy and other psychopathic disorders presents a vexing challenge for mental health professionals. The issues of hospital treatment and civil commitment can be especially confusing.

It is not known what makes children vulnerable to the development of psychogenic nonepileptic seizures. To date, there are no research studies available on the epidemiological, medical, or genetic risk factors for childhood PNES.

Since its introduction in DSM-III in 1980, attention-deficit/ hyperactivity disorder (ADHD) has proved to be a developmental disorder with many causes and complex behavioral, cognitive, and emotional manifestations that can impair academic functioning, occupational achievement, social relationships, and self-esteem.

Bone mineral density (BMD) was reduced at a greater rate in older women when they had symptoms of depression, according to one recent report from the Study of Osteoporotic Fractures Research Group, while another report implicated treatment with SSRI antidepressants.

The American Academy of Child and Adolescent Psychiatry recently published a practice parameter with evidence-based guidelines for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Recommendations for the best treatment practices were made based on empirical evidence and clinical consensus, and the strength of these recommendations was based on the extent and degree of these variables. This column will provide a summary of the parameter.

Mood disorders are among the most prevalent forms of mental illness. Serious depression is especially common; based on a face-to-face survey conducted from December 2001 to December 2002, the past-year prevalence rate of clinically significant major depressive disorder (MDD) was estimated to be 6.6%, affecting at least 13.1 to 14.2 million Americans.

Obsessive-compulsive disorder (OCD) is a heterogeneous disorder with a variety of phenotypic expressions. Delineation of clinically distinct subtypes of the disorder may be valuable in predicting treatment response and resistance.

The comorbidity of anxiety disorders with bipolar disorder is a rule, not an exception, with a negative impact on both course and treatment outcome. So far, there are no guidelines or consensus for the treatment of this comorbidity.

A new set of guidelines confirms the value of psychotherapy, medications-including SSRIs-and combinations of therapy in managing anxiety disorders in children.

In this article, we examine the relationship between anxiety disorders and SDs, using DSM-IV-TR categories, although we are conscious of the limits of this approach. In doing so, we will consider not only the dichotomy between normal and pathological functioning but also the issue of sexual satisfaction as part of wellness.