April 27th 2024
The experts weighed in on a wide variety of psychiatric issues for the April issue of Psychiatric Times.
Issues and Challenges in the Diagnosis and Treatment of Mentally Ill Hispanic Patients
December 1st 2006Despite 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.
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Culture and Urban Mental Health
December 1st 2006Mostly because of increased speed and decreased costs of communication and transportation, cities are growing increasingly diverse in their population. Consequently, cultural factors have taken center stage in the understanding of urban mental health. This article will focus on the main approaches to urban mental health and briefly summarize the 3 lines of research in this area. It will then discuss the main themes of a vast body of literature on the cultural aspects of urban mental health.
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Senate Hearings: Suicide in Seniors
November 1st 2006Concerns about senior suicide and the lack of geriatric mental health services took center stage at hearings in the Senate Special Committee on Aging on September 14. Geriatric psychiatrists reviewed unfavorable trends such as faltering numbers of medical school graduates going into primary care and already small numbers of geriatric psychiatrists getting even smaller.
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The Impact of Abnormal Insulin Levels on Cognitive Function in Older Adults
November 1st 2006By now, many clinical researchers and practitioners recognize the strong association between cognitive impairment and type 2 diabetes, which, in its early stages, is characterized by hyperinsulinemia and insulin resistance. Although this relationship has not been observed uniformly, more than 20 large-scale epidemiologic studies have reported a link between type 2 diabetes and in creased risk of cognitive impairment and dementia, including Alzheimer disease (AD), the most common type of dementia.
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Vision Loss and Depression in the Elderly
November 1st 2006The emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).
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Depression in Patients With Alzheimer Dementia
November 1st 2006Alzheimer dementia (AD) represents a profound global health concern. By the year 2050, the prevalence of AD in the United States is expected to reach 15 million. At present, there are 4.5 million cases in the United States, which equals an estimated cost of $100 billion each year in medical and family expenses.
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Pinpointing the Cause of Non-Alzheimer Dementia
November 1st 2006Many physicians, including psychiatrists, may shy away from seeing elderly patients with symptoms of dementia because they imagine that there are a large number of alternative diagnoses and that differential diagnosis is complicated. In fact, however, the number of possible diagnoses in most situations is relatively small and the diagnosis of dementia in older patients is certainly feasible in primary care psychiatry.
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Treatment-Resistant Anxiety Disorders: Neurotrophic Perspectives
October 31st 2006Anxiety 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.
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Treating Delirium: When the Brain Goes Off Track
October 1st 2006Typically, delirium worsens at night ("sundowning"), with lucid intervals often present in the morning. It is important to realize that delirium may appear before any abnormal laboratory values are detected and may persist after the resolution of these abnormalities.
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Should Emergency Medicine Physicians Screen for Psychiatric Disorders?
October 1st 2006Emergency department (ED) visits have increased from 89 million in 1992 to more than 110 million in 2002, while the number of EDs decreased by about 15% during the same period. One suspected consequence of ED overcrowding is an increased tendency to disregard a psychiatric problem, especially if it is not the chief complaint.
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Nonconventional Treatments of Cognitive Impairment
September 1st 2006The numbers of patients with Alzheimer disease (AD), as well as those with severe cognitive impairment caused by traumatic brain injury and stroke, are continuing to increase. This article includes some nonconventional treatment approaches for which the evidence is limited.
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10-Point Clock Test Screens for Cognitive Impairment in Clinic and Hospital Settings
August 25th 2006The obvious sometimes bears repeating: Sick people have trouble thinking. They may be suffering from a delirium, a dementia or a more subtle disturbance of cognition caused by fever, drugs, infection, inflammation, trauma, hypoxemia, metabolic derangement, hypotension, tumor, intracranial pathology, pain and so forth.
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Since its initial description by Kahlbaum (1828-1899) over a century ago, catatonia has been associated with psychiatric, neurologic, and medical disorders. Contemporary authors view catatonia as a syndrome of motor signs in association with disorders of mood, behavior, or thought. Some motor features are classic but infrequent (eg, echopraxia, waxy flexibility) while others are common in psychiatric patients (eg, agitation, withdrawal), becoming significant because of their duration and severity.
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The Perils of Compulsive Hoarding and How to Intervene
June 1st 2006Because hoarding occurs in a substantial portion of patients with neurodegenerative disorders, neurologists are likely to encounter patients with this problem. Until recently, they had little to offer their patients or the patients' caregivers. Compulsive hoarding can cause severe impairment and presents intriguing psychopathology, yet it has received little systematic study, and no effective treatment is currently on the market.
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