The methodology of clinical trials was as much of interest as the trial results for investigators gathered at the 39th annual NCDEU (New Clinical Drug Evaluation Unit) Program meeting. This meeting was conducted in June by the National Institute of Mental Health in Boca Raton, Fla.
As chief of the division of sleep and chronobiology in the department of psychiatry at the University of Pennsylvania School of Medicine, David F. Dinges, Ph.D., focuses on ways sleep and the endogenous circadian pacemaker interact to control wakefulness and waking neurobehavioral functions such as physiological alertness, attention, cognitive performance, fatigue, mood, neuroendocrine profiles, immune responses and health. In an interview with Psychiatric Times, Dinges discussed neurobehavioral consequences of sleep loss, factors that impair sleeping, the pervasiveness of sleepiness and new ways to manage sleepiness.
The most common psychiatric sequelae following trauma include major depressive disorder, somatoform pain disorder, adjustment disorder and posttraumatic stress disorder (PTSD). In law, trauma that precipitates PTSD is viewed as a tort, which stems from the root word "torquere" (to twist), as does the word torture. In a sense, plaintiffs do allege torture in personal injury cases. A tort constitutes a civil or private wrong, as opposed to a criminal wrong, and rests on the general principle that every act of a person causing damage to a legally protected interest of another obliges that person, if at fault, to repair the damage (Slovenko, 1973).
Only one month after the American Medical Association unveiled a major reorganization of its science and technology departments-one that included the dismantling of its department of mental health-the former director, psychiatrist Larry Goldman, M.D., was fired after he criticized the changes.
Recent advances in the treatment of mental and addictive disorders, along with research findings in basic neuroscience, molecular genetics and molecular biology that contribute to the understanding of such disorders, were discussed at the American College of Neuropsychopharmacology's 37th annual meeting in Puerto Rico. The following are brief reports from selected presentations.
More than 80 medications are in development to treat mental illnesses, including 18 for depression, 15 for schizophrenia and 16 for anxiety disorders, according to the Pharmaceutical Researchers and Manufacturers of America (1998). Which ones will most likely come to market in the United States?
Daniel F. Kripke, M.D. has studied the relationship between biological rhythms and depression since the early 1970s. He states that seasonal responses in many mammals are controlled by the photoperiod. Therefore, it seemed that depression might be analogous to winter responses and that light might be an effective treatment.
Faced with the trend toward shorter length of stay in inpatient psychiatric units, practitioners and patients in need of care face dramatic changes in treatment.
Although evidence shows that selective serotonin reuptake inhibitor (SSRI) antidepressants cause less orthostasis and interfere less with psychomotor function than do tricyclic antidepressants (TCAs), a recent pharmacoepidemiologic study found them comparable in increasing elderly patients' risk for falling.
When treating agitation in the elderly, the optimization of certain behavioral techniques may enhance medication therapies or sometimes eliminate the need for them. Clinicians should look more closely at the behavioral causes behind a demented older person's problem behavior.
In Western psychiatry, depression is considered a major cause of suicide. But research from China calls that assumption into question. More than 300,000 suicides occur annually in China, nearly 10 times the number of suicides in the United States.
Consider the following scenario: You are contacted by the major health plan with which you contract and are told that your average length of inpatient stay is longer than their standard. You believe this is because your patients are more severely ill than average. How do you respond?
This is the second of two articles regarding herbal medicines as discussed at the American Psychiatric Association's annual meeting in Toronto. Potential benefits and risks of kava, St. John's wort and hoasca were considered at the recent American Psychiatric Association's symposium on herbal medicine.
This month establishes a milestone for CME LLC Not only is it the company's 11th annual U.S. Psychiatric & Mental Health Congress, it also marks the 20th anniversary of the company's first conference. CME LLC grew out of a desire to reach and educate more people regarding psychiatric issues. One way to do this was by developing high-quality continuing education opportunities.
The Health Care Financing Administration (HCFA), the agency responsible for administering the burgeoning Medicare program for the elderly, announced a nationwide crackdown on community mental health care centers (CMHCs) in September, signaling increased efforts to curtail fraud, error and abuse.
The 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.
Women and their special needs regarding addiction was the topic of a recent two-day conference held at New York University (NYU).
This is the fourth in a series of five articles regarding obsessive-compulsive spectrum disorders. The first three articles ran in the March 1997, June 1997 and January 1998 issues of Psychiatric Times. The first article gave an overview of spectrum disorders, the second discussed obsessive-compulsive disorder and the third examined body dysmorphic disorder.
Just as the first scattered incidents of homicide involving urban children in the early 1980s were not isolated episodes precipitated by "criminally ill" children, the recent episodes of school homicide in nonurban middle-class America, including the massacre in Littleton, Colo., are not isolated incidents of violence involving seriously "mentally ill" children.
The Office for Protection from Research Risks (OPRR), an agency operating under the aegis of the U.S. Department of Health and Human Services, launched an investigation in April aimed at determining whether young boys were endangered during the course of experiments involving the drug fenfluramine (Pondimin).
For over 50 years we clinicians have administered electroconvulsive therapy with little to guide us in deciding whether or not a particular induced seizure is an effective treatment. At first we thought that piloerection or pupillary dilatation predicted the efficacy of a seizure, but these signs were difficult to assess and were never subjected to controlled experiments.
The increasing complexity and specificity of clinical trials, widely publicized research scandals and major advances in psychopharmacology have created a dilemma for academic institutions and private research organizations alike--how to find appropriate volunteers to participate in clinical drug trials. A major obstacle to patient recruitment is finding patients who are protocol-appropriate, said Nancy Hashim, affiliated with the Feighner Research Institute in San Diego.
Today, average young adults report sleeping about seven to seven and one-half hours each night. Compare this to sleep patterns in 1910, before the electric lightbulb, the average person slept nine hours each night. This means that today's population sleeps one to two hours less than people did early in the century.
For elders confronted with the necessity of living in a nursing home, the choice of facility is a decision with profound consequences-for their health, their quality of life and their family finances. Nursing home care may cost $50,000 a year or even more, and more than half of all elders begin their nursing home stays by paying the costs out of pocket. That imposing sum can purchase excellent care, or can pay the rent for a place that is literally "worse than death" for the unfortunates who live there.
A lawsuit brought on behalf of the 600,000-member United Seniors Association (USA) and four individual Medicare recipients last December may turn the Washington, D.C., federal court where it was filed into the latest health care battleground. The issue: Does a patient's right to choose a physician outweigh the federal government's efforts to regulate health care provided to the elderly?
