Major Depressive Disorder

Response to SSRIs, the most frequently used first-line agents for major depression, tends to be slow, and full remission is obtained by fewer than half of treated patients.

Homelessness rates in both Canada and the United States have increased dramatically over the past 10 years. Among the homeless, there is a high prevalence of mental illness and substance use disorders.

Figures from the US Department of Justice indicate that more than half of prison and jail inmates have a mental health problem. Mental health courts (MHCs) were designed to divert mentally ill persons convicted of nonviolent crimes to supervised treatment instead of incarceration, but while the number of MHCs has grown substantially over the past decade, limited information has been available about outcomes and costs.

A recently published study examined the impact of publicity regarding the pediatric suicidality data on the prescribing practices of physicians in the United States. The researchers focused on the period from June 2000 to March 2005.

In what was billed as the first randomized controlled study to simultaneously evaluate antidepressant therapy and short-term psychotherapy for depressed patients with coronary artery disease (CAD), treatment with an SSRI led to significant improvement, while addition of interpersonal psychotherapy provided no added benefit.

Patients with severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to have experienced trauma in childhood, adolescence, and throughout their adult lives than the general population. This high exposure to traumatic events such as physical and sexual abuse and assault takes a heavy toll.

Traumatic experiences are linked with a continuum of mental disorders and physical complaints. In the United States, posttraumatic stress disorder (PTSD) occurs in approximately 8% of adults during their lifetime, with different trauma types associated with varying rates of illness. PTSD is commonly associated with comorbid mental conditions such as depressive disorders, other anxiety disorders, impulse control disorders, and alcohol abuse.

Rape is a crime that is defined as an unwanted sexual act that results in oral, vaginal, or anal penetration. Generally speaking, there are 2 major types of rape. Forcible rape involves unwanted sexual penetration obtained by the use of force or threat of force. Drug- or alcohol-facilitated rape occurs when the victim is passed out or highly intoxicated because of voluntary or involuntary consumption of alcohol or drugs. Rape can happen to boys and men as well as to girls and women but this article will focus primarily on women.

A major physical illness or procedure, such as a myocardial infarction (MI), a transplant operation, or a life-threatening attack of asthma, can be emotionally traumatic,1,2 but the study of posttraumatic reactions in the medically ill is relatively new. Only in the past 2 decades or so it has been recognized that, in fact, medical illness and its treatment can be traumatic, and only since the publication of DSM-IV in 1994 has medical illness been included as a potentially traumatic event that may lead to the development of posttraumatic symptoms.

In the article by Drs Kunen and Mandry, "Should Emergency Medicine Physicians Screen for Psychiatric Disorders?" (Psychiatric Times, October 2006), no mention was made of formally assessing a patient's mental status to diagnose delirium.

According to the CDC, in 2004, suicide was the 11th leading cause of death across all age groups and the 10th leading cause of death for persons aged 14 to 64 years; 32,439 people in the United States took their own lives. Women attempt suicide about 3 times more often than men, although men are 4 times as likely to complete suicide. Anderson and Smith3 reported that suicide was the eighth leading cause of death among men in 2001. Of the 24,672 completed suicides among men, 60% involved the use of a firearm (the use of a firearm was the means of suicide in 55% of all cases).

A 79-year-old woman recently died in a fire at her Washington, DC, row house when "pack rat conditions" prevented firefighters from reaching her in time. A few days later, 47 firefighters from 4 cities spent 2 hours fighting a fire in a Southern California home before they were able to bring it under control. Floor-to-ceiling clutter had made it nearly impossible for them to enter the house.

The following cases highlight some of the challenges clinicians face when treating patients in whom malingerling is suspected. One key aspect of these evaluations is not overlooking signs or symptoms that point to serious illness.

When a new patient with depression enters your practice, you face a diagnostic dilemma. If you miss bipolar disorder (BD), and prescribe an antidepressant, you can do harm. But if you call a unipolar depression "bipolar," you may also do harm, because lithium, anticonvulsants, and atypical antipsychotics carry significant risk as both short- and long-term treatments. In addition, the label of "BD" currently carries much more stigma than the term "depression."

Assessing bullying behavior and suicide attempts in victims of bullying.

Suicide is a serious public health problem that ranks as the 11th leading cause of death in the United States. Within the 15- to 24-year-old age group, it is the third leading cause of death.1 Many suicide victims have had contact with the mental health system before they died, and almost one fifth had been psychiatrically hospitalized in the year before completing suicide. A recent review found that psychiatric illness is a major contributing factor to suicide, and more than 90% of suicide victims have a DSM-IV diagnosis.

Unlike a pure psychiatric disabilityevaluation, mental and emotionaldamage claims require anassessment of causation. Today, treatingpsychiatrists are increasingly asked toprovide this assessment, since mentaland emotional damages are widelyclaimed in the United States as a remedyin legal actions.

Each year, the CDC's National Center for Health Statistics creates a report on the current health status of the US. In addition to the issues usually addressed in this report, such as information on morbidity and mortality, vaccination rates, and use of health care resources, the recently released report contained a special feature on pain.

Binge eating disorder is more common than anorexia and bulimia combined, according to a national survey, but many physicians are unaware of the problem. The guidance and evidence discussed here highlight the key issues in recognizing and managing the disorder.

Surveys of ECT use in the United Statesshow disparate applications, with theprincipal use in academic medical centers.While more than half the treatmentsare given to outpatients, wholepopulations are underserved.

Compared with schizophrenia, adherence behavior has been relatively overlooked in depression and other mood disorders. Major depression is increasingly thought of as a chronic illness. In most chronic illnesses, ideal concordance is the exception, not the rule.

Although treatment-resistant depression is defined in terms of a person's depression being resistant to medication, it usually also means that the patient has been unresponsive to whatever psychotherapy has been tried along the way. What might not be clear from the above but is known by all clinicians is that patients with TRD experience much internal suffering and misery.

Five words that are guaranteed to annoy your patientwith a diagnosis of psychogenic movementdisorder (PMD) are It's all in your head.It's the worst thing you can say, said Katie Kompoliti,MD, associate professor of neurological sciencesat Rush University Medical Center in Chicago.

Depression and cognitive impairment are common in patients with multiple sclerosis (MS) but often are overlooked. These complications affect not only general quality of life but also complicate core symptoms of the disease. Depression in MS is well documented and easily treated while cognitive impairment sometimes needs a sharper eye to detect.

The FDA finds itself straddling a data divide as it decides how to rewrite the black box warnings on the labels of SSRI antidepressants. The agency will almost certainly mandate that the existing black box warning, which addresses suicidality in children and adolescents, be expanded to include young adults up to age 25 or 30. But in what might be a pioneering move for the FDA, the agency will probably also include new verbiage in the warning related to the benefits of antidepressants to people over the age of 30 years.