Major Depressive Disorder

Emotional maltreatment is of two major types: emotional abuse and emotional neglect. While emotional abuse is easier to identify, emotional neglect is subtler, possibly more damaging, and poses even more challenging barriers to definition and study.

An appreciation of melancholia as the principal definable mood disorderoffers a better guide to diagnosis and treatment than does DSM-identified major depression.

Half of patients with nonpsychotic major depressive disorder can achieve symptomatic remission with no more than two treatments.

Caregivers may face years of continuous exposure to physical and psychosocial demands with burdens that can include physical, psychological, social, and financial problems; embarrassment; overload; and resentment.

The shift toward biologic preeminence has led to psychiatric residency programs de-emphasizing psychotherapy education. How does psychotherapy fit into the “age of the brain”?

Increased demand for accountability is requiring more clinicians to supplement their judgments of patient outcome with standardized and objective protocols. The protocol outlined here is a model or jumping-off point for outcome evaluation.

Childhood adversities associated with suicide risk include childhood maltreatment, problematic family relationships, socioeconomic hardship, and difficult relationships with peers. Acute suicide prevention strategies should focus on the treatment of contributory psychiatric disorders and on the crises that may precipitate suicidal behavior.

The use of psychiatric medications in children, including antidepressants (such as selective serotonin reuptake inhibitors) and drugs used to manage attention-deficit/hyperactivity disorder, are continuing to be reviewed by the FDA.

The search in identifying risk factors affecting cognitive health and longevity, including Alzheimer disease and other dementias, has broadened to include genes and lifestyle factors.

Pediatric psychosomatic research shows that emotional, behavioral, and psychiatric symptoms are found more often in children and adolescents with chronic illnesses than in healthy children.

Evidence showing the effectiveness of psychopharmacologic and psychotherapeutic management of functional gastrointestinal disorders over standard medical treatment is increasing.

The perinatal period is a high-risk time for some women to experience a new onset or exacerbation of a mood disorder that may require emergency psychiatric care.

A discussion of the evidence that the pharmaceutical industry influences how physicians evaluate drugs in ways that encourage sales of their products and that are not always in the best interests of the patient.

This study examined national patterns in emergency department (ED) treatment of patients aged 7 to 22 years who were seen after episodes of deliberate self-harm. Data were from the 1997-2002 National Hospital Ambulatory Medical Care Survey. Population data from the 2000 US Census Bureau were used to estimate population visit rates for the age group studied.

All physicians need to be aware of the medicolegal aspects of practicing medicine, but because emergency psychiatrists must sometimes treat patients against their will or act as consultants to determine capacity, they must be especially vigilant when dealing with the overlap between law and medicine.

Psychiatric advance directives (PADs) allow persons to authorize proxy decision makers and document advance instructions or preferences about future mental health treatment in the event of a crisis. The intent of PAD legislation is to enhance treatment autonomy for persons with severe mental illnesses (such as schizophrenia, bipolar disorder, and major depression) who anticipate periods of decisional incapacity associated with illness relapse.

What does the new set of U.S. Public Health Service guidelines for treating tobacco dependence say? Should everyone, regardless of mental health status, receive treatment?

Selective serotonin reuptake inhibitors, SSRIs, Suicidality, Depression, Major depressive disorder, Neonatal abstinence syndrome

The renaming of consultation-liaison psychiatry as psychosomaticmedicine, a new formal subspecialtyof psychiatry, may require someadjustment in our understanding ofthese terms. Both consultation-liaisonpsychiatry and psychosomatic medicinehave focused on treatment and researchof illnesses with mind-body interactions.Despite considerable overlap,consultation-liaison psychiatry hastraditionally been associated with treatmentand clinical research of comorbidmental disorders of the medicallyill, while psychosomatic medicine hasbeen associated with research into thephysiologic mechanisms underlyingmind-body interactions and classicalpsychosomatic diseases such as hypertension,asthma, and ulcerative colitis.

Physicians who use electroconvulsivetherapy (ECT) need tobe vigilant for unstable medicalconditions before and during the courseof treatment. This brief review is intendedto highlight some basic principlesand specific concerns that maybe encountered in the use of ECT inpatients who have comorbid medicalillness.

Practitioners understand the wholeness and unity of their patients. Instead of being considered isolated organ systems or enzyme cycles, patients are understood as coherent entities composed of coordinated and interrelated processes and systems. This fundamental understanding guidesinvestigative and clinical care approaches in psychosomatic medicine.

While teen drug use continues to decline, it is the baby boomers who are suffering the greatest losses from substance abuse, and whose plight is largely overlooked by policy makers.

A black box warning about increased suicidality in pediatric patients is now required for all antidepressant medications. This column reviews a number of studies on this topic that were published after the FDA advisory was issued.

In the late 18th century, a French surgeon named Pouteau performed 120 successive lithotomies with an extraordinarily low mortality rate. His secret was the use of innovations used widely today. Why weren't his methods more widely adopted by other physicians in his time?

Each year, more than 2 million individuals in the United States sustain a traumatic brain injury. Increased vigilance for previously undiagnosed or incidental TBIs in general mental health populations may lead to more effective clinical management.

The FDA advisories warning of increased suicide risk among children and adolescents beginning antidepressant therapy have alarmed the health care community--but it may actually be a disservice to withhold these medications from those who need them.

Aware that mental illness generally begins early in life and that four teenagers commit suicide every day, several organizations and agencies are stepping up efforts to expand voluntary mental health screening and suicide prevention initiatives for youth--but they are doing so in the face of stigma and vocal opposition.

Well into the 1970s, we psychiatrists believed that depression came from anger turned inward-and we acted on this notion. Psychiatrists spent countless hours trying to get depressed patients to talk about their anger. Enterprising psychologists and psychiatrists devised schemes to make such patients angry.

Research Review: Treating Major Depressive Disorder With MAOIs: Effect of Delivery System on Cardiovascular Events

Funded by the National Institute of Mental Health, the STAR*D project is one of the largest depression treatment studies ever conducted, with more than 4,000 participants. Results from the second phase of the study will be published over the next year. In this issue PT readers will find a preliminary review of data drawn from the first 1,500 enrollees.