Major Depressive Disorder

College students are far less likely to kill themselves than are nonstudent peers, according to a 10-year research study examining suicide rates at 12 Midwestern campuses.

What does the term “polypharmacy” actually mean? Dr Pies likens polypharmacy to fire: just as the latter may either heat your house or burn it down, polypharmacy may either help or harm the patient.

A discussion of the pharmacologic management of bipolar depression, including emerging treatments and expert recommendations.

A look at how to use the spectrum concept to promote understanding and acceptance of bipolar II and soft bipolar diagnoses. In this article, you will find 5 tools for fostering what has been called “concordance” or, more simply, “buy-in.”

Can sociodemographic and clinical variables predict outcome in cases of schizophrenia? Results from studies related to prognostic variables for schizophrenia have yielded interesting yet inconsistent results.

There are still many questions about how to develop useful guidelines, introduce them into clinical practice, and measure their effectiveness. What does it mean to use a guideline in practice?

A discussion of the many difficulties in treating patients with the rapid-cycling subtype of bipolar disorder, along with a history of the condition and the author’s treatment approach.

Three issues of current concern in bipolar II disorder include: diagnostic criteria for hypomania, diagnosis of mixed depression, and management of mixed depression.

Bipolar disorder I and II have the highest association with substance use disorder, compared with any other major psychiatric disorder. Treatment requires an integrated approach that includes specific psychotherapy as well as the use of medication.

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.

Using Antidepressants During Pregnancy: An Update

There are dozens of books on the market aimed at helping the general public recognize depression; there are far fewer that focus specifically on the more subtle forms of bipolar disorder. This disparity has its clinical parallel in the over-diagnosis of unipolar depression among patients who ultimately prove to have a bipolar disorder. Indeed, survey data suggest that there is typically a 7-year delay in the correct diagnosis of bipolar spectrum disorder.

Deep brain stimulation (DBS) may hold promise for patients with treatment-resistant and severe major depression and obsessive-compulsive disorder (OCD). However, it may not be the best choice for patients with Parkinson (PD) disease who display certain compulsive behaviors, reported researchers from the Cleveland Clinic and from Brown Medical School (Providence, Rhode Island) at the annual meeting of the American Academy of Neurological Surgeons, which took place April 22-27 in San Francisco.

A discussion of the epidemiology, assessment, diagnostic dilemmas, and treatment of avoidant personality disorder.

The prevalence and debilitating nature of some of the personality disorders has impeded the study of psychopharmacology in these conditions. However, important advances have been made in the last several years.

Suicidality in patients with borderline personality disorder is chronic. It is important to distinguish these patients from those with classic mood disorders, who are suicidal only when acutely depressed.

The evidence showing a relationship between mental disorders in childhood and adulthood has increased in the last several decades.

An examination of recent research on psychosocial treatments for personality disorders, including randomized controlled trials and empirically supported therapies as well as dialectical behavior therapy.

When assessing a sleep-related problem in a psychiatric patient, investigating all possible causes may be more helpful than assuming the complaint is a result of medication or the underlying condition.

Dr Ronald Pies questions the statements in regards to antidepressant response time from an October 2005 article in Psychiatric Times.

How does the difference between objective evidence and subjective evidence relate to the practice of psychiatry?

With expansion of the concept of bipolar disorder (BD), there has been concern about the potential for overdiagnosis. However, diagnostic errors in bipolar disorder are currently skewed towards underdiagnosis.

The psychiatric community has a need for diagnostic and predictive tests. Some recent techniques have just become available for clinical care.

Dr Muller describes a case of a patient with a paranoid psychosis who clearly needs help, yet refuses treatment.

Should physicians be allowed to assist in their patients' dying, and how can physician-assisted suicide be reconciled with the physician’s role as a healer?