August 5th 2023
From overutilization of emergency departments to reversible clomiphene-associated manic episodes, here are highlights from the week in Psychiatric Times.
August 2nd 2023
What risk does clomiphene use present to patients?
March 8th 2023
Lithium: what’s its history and where do we still need more information?
January 23rd 2023
Catatonia: learn more about how to best diagnose early.
August 23rd 2022
In this CME article, examine how current DSM nosology defines the proper method of assessing a mixed-episode patient and which diagnostic labels to give them based on their presenting symptomatology.
Prodromal Mania and Psychosis
Predicting mania versus psychosis: Researchers performed a retrospective study of prodromal symptoms, risk factors, and vulnerability markers in first-episode mania and psychosis.
Can This Cancer Treatment Cause Manic Episodes?
A case report and literature review of intrathecal methotrexate-induced mania.
Co-Occurring Mania and ADHD in Youths
Evidence suggests that co-occurrence with ADHD is a marker of preadolescent-onset mania. This slideshow provides some evidence for you to decide whether this form of very early-onset mania represents a developmental subtype of the disorder.
Natural Products Used to Treat Depressed Mood as Monotherapies and Adjuvants to Antidepressants
Most persons who use CAM modalities to self-treat a mental health problem take prescription antidepressants concurrently. Combined use can result in serious supplement-drug interactions.
The Role of Biological Tests in Psychiatric Diagnosis
"Psychiatric diagnosis is certainly imperfect -- but so is much of diagnosis throughout medicine. And whatever the current limitations, psychiatric diagnosis is useful and essential. There are no 'paradigm shifts possible til we learn a lot more. To imply otherwise is misleading and confusing to patients."
Will Your Clinical Records Support You in Court?
A clinician’s notes and clinical records should document and defend treatment decisions, and are the best defense in court. Here: 3 key things every patient record should include.
DSM-5 Won’t Solve the Overdiagnosis Problem-But Clinicians Can
With DSM-5, one more examination of bipolar diagnosis is warranted. After all, if a diagnosis is inaccurate, treatment efforts, however well-intentioned, may misfire.
Lamotrigine for Major Depressive Disorder Is Inappropriate
Lamotrigine is an important option in bipolar disorders. However, many clinicians also use it in patients with a (unipolar) depressive disorder who have not responded adequately to conventional antidepressants.
Update on Adolescent Mood Disorders
In line with adolescents' interest in interactive video games, a computerized cognitive-behavioral therapy intervention that is an interactive fantasy game for depressed adolescents has been developed.
Context Does Not Determine “Disorderness” or Normality
The issue of context and its relationship to disorderness extends well beyond panic attacks: it arises in nearly all psychiatric diagnoses not explicitly defined contextually.
Treatment Issues for Bipolar Disorder in Women
Treating bipolar disorder in women has unique concerns. For example, contraceptive use can decrease the level of mood stabilizers and alter their effectiveness.
Traumatic Brain Injury in Children and Adolescents
Traumatic brain injury (TBI) in children and adolescents is a major public health problem. Psychiatrists have a crucial role in the management of young persons who have a TBI.
Coming Along With the DSM-5: Hybrid Models of Psychiatric Diagnosis
Do not be surprised if you hear more about hybrid models of psychiatric diagnoses included in DSM-5. The categorical and dimensional model approaches are 2 sides of the same coin as you look at the same patient from 2 different angles.
Dr Marcia Angell and the Illusions of Anti-Psychiatry
Anti-psychiatry proponents forget it is widely recognized that the DSM is a provisional diagnostic system pending progress in better understanding uniquely human disorders of our most complex organ.
Effective Personalized Strategies for Treating Bipolar Disorder
Effective personalized treatment recognizes bipolar disorder as a biopsychosocial disorder, but mood-stabilizing medications are the backbone of treatment. These medications fall into 3 categories: lithium, antikindling/antiepileptic agents, and second-generation antipsychotics.
Confounding Factors in TRD (Part 1): The Role of Subtyping and Bipolarity
The current system of payment for mental health care in the US can lead, or even incentivize, clinicians to focus on and code for Axis I disorders and their more readily reimbursed psychopharmacological treatment approaches.
Psychism: Defining Discrimination of Psychiatry
The mental health toll of any form of discrimination is great.
On the Efficacy of Psychiatric Drugs
In a recent interview on 60 Minutes, Harvard psychologist Irving Kirsch, PhD, commented, “the difference between the effect of a placebo and the effect of an antidepressant is minimal for most people.”
Determination and Documentation of Insight in Psychiatric Inpatients
Insight can be assessed in the course of a typical evaluation or follow-up interview with augmentation by questions borrowed from any of the validated insight rating scales.
Psychopharmacological Treatment to Reduce Suicide Risk
Adequate treatment of the underlying psychiatric illness consistently appears to be the most effective use of medication in suicidal patients.
Lasting Ties in Just 8 Days: Mental Health in a World Without Psychiatrists
During their time in Ayacucho, these visiting psychiatrists learned that American psychiatric training has wide-reaching cultural value.
Severe Temper Outbursts in a 10-Year-Old Girl
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.
Educating Patients About Bipolar Disorders
Patients with bipolar disorder need a great deal of information about the illness. Without this education, adherence to your recommendations is uncertain; with it, outcomes will likely be better (and your job easier).
How We Age: A Doctor’s Journey Into the Heart of Growing Old
In his book, How We Age: A Doctor’s Journey Into the Heart of Growing Old, Dr Marc Agronin helps reduce the stigma of ageism and provides clinical guidance for seasoned geriatric psychiatrists, primary care clinicians, and medical students alike.
Mixed States in Their Manifold Forms: Part 3
In Part 3 of this 3-part series, Dr Dilsaver discusses dichotomization versus a continuum model and concerns that bipolar disorders are over-diagnosed.
Available Compounds Tried in Bipolar Disorder
Several available agents in addition to methylene blue are being investigated for bipolar disorder and were in a in a recent review.
Methylene Blue Studied for Bipolar as FDA Issues Warning
A study presented by Canadian investigators at the 24th Congress of the European College of Neuropsychopharmacology (ECNP) in Paris, September 5 evaluated whether methylene blue can reduce residual symptoms of depression and mania in bipolar disorder.
Antidepressants: Lifesavers-or Active Placebos?
Are antidepressants active placebos or lifesavers? Are they overprescribed? Are clinical trials of these drugs insufficient?
Doctor, Is My Mood Disorder Due to a Chemical Imbalance?
Dear Mrs. -- You have asked me about the cause of your mood disorder, and whether it is due to a "chemical imbalance."
Treatment-Resistant Bipolar Disorder
Treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition. Numerous evidence-based treatments exist for all phases of bipolar disorder, and these should be optimized and fully explored.
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