Major Depressive Disorder

According to this week’s Time Magazine, the American Psychiatric Association has just recruited a new public relations spokesman who previously worked at the Department of Defense.

Of all the misconceived DSM-5 suggestions, the one touching the rawest public nerve is the proposed medicalization of normal grief into a mental disorder.

The responsibility for improvement was placed on psychiatrists: diagnostic skills had to be improved and patients and their families and caregivers as well as the general public needed to be better educated about the disorder and treatment options.

Three twin studies published between 1977 and 1995, which provided the main body of knowledge on heritability of autism, showed a concordance rate of 72% for a total of 36 monozygotic pairs and a concordance rate of 0% for 30 dizygotic pairs.

While SSRIs and SNRIs are valuable in the treatment of major depression, partial response or nonresponse occurs in many patients. Research has found that bupropion was the most frequently chosen agent for addition to an SSRI after inadequate response.

Effective, early intervention and appropriate support for and treatment of the caregivers of these vulnerable children will improve short-term outcomes and also may provide positive lifelong benefits.

Charles Dickens might well say of American psychiatry, “These are the best of times and the worst of times.”

Research is needed to define clinical biomarkers and genetic screens that could be used to identify early stages of dementia and to link clinical syndromes with the later development of dementia.

Dr Angell and others may be right to claim that we should be concerned about the current practice of psychiatry. But the simple fact that mental illnesses seem to be common is not one of them.

The New York Times ran a front-page story regarding numerous controversies surrounding the DSM-5, most notably, the issue of eliminating the so-called bereavement exclusion in diagnosing a major depressive episode. Here, Dr Pies responds to Dr John Grohol, Psychologist and Editor of the Psychcentral Web site.

In this podcast, Dr Helen Lavretsky discusses the topic of appropriate diagnosis of mild cognitive impairment. It will be increasingly important to strengthen the definitions of what is “normal” to avoid the “pathologizing” of aging or of any individuals who experience temporary or continuous cognitive impairment.

How often do insomnia and anxiety disorders coexist? And how best to treat patients with comorbid insomnia and anxiety? Answers here..

This essay is a brief update on an earlier Psychiatric Times article by Dr James Phelps. Several major studies have appeared since the publication of the original article, which shed further light on this issue.

The response of psychiatrists to Medicare’s continued inhospitability to psychiatrists in 2012 is cautious.

Have you heard the news that citalopram should no longer be used at doses greater than 40 mg? Steven Moffic, MD, explores the issues surrounding this recent recommendation.

Critics of DSM-5 argue that the expansion of diagnostic criteria may increase the number of “mentally ill” individuals and/or pathologize “normal” behavior, and lead to the possibility that thousands-if not millions-of new patients will be exposed to medications which may cause more harm than good.

Some say that study subjects who are not severely depressed may respond better to placebo than subjects who are severely depressed. Is the data thus unreliable?

More and more research is being conducted in the US and abroad on the role of psychiatric pharmacogenomics in identifying new gene variants and in predicting treatment response to specific medications.

Medicare announced in October that it would pay for depression screening in primary care settings that have “staff-assisted depression care supports” in place to ensure accurate diagnosis, effective treatment, and follow-up.

Understanding pediatric psychopharmacology in the context of medical illness.

The purpose of suicide risk assessment is to identify treatable and modifiable risks and protective factors that inform the patient’s treatment and safety management requirements.

On November 21, 2011, John Oldham, MD, president of the American Psychiatric Association (APA), wrote a response letter to Don W. Locke, EdD, president of the American Counseling Association, who had some concerns with proposed revisions for DSM-5.

Some months ago, I received a stern admonition from my family doctor. My fasting blood sugar of 99 mg/dL was “right on the border”, he said, and I had better work on bringing it down. “But,” I protested, “when I was in medical school (in the 70s), the normal FBS range went up to 110 mg/dL!” "Well,” he replied a bit huffily, “they changed the criteria!”

The articles by Arline Kaplan and Hagop Akiskal, MD, in the November 2011 issue of Psychiatric Times highlight the race to patent bio-tests for schizophrenia and depression.

This article provides background information on the FGIDs for psychiatrists and a review of recent research on the biopsychosocial mechanisms that contribute to the illness experience.