Mania

The Emerging Role of GABAergic Mechanisms in Mood Disorders by Po W. Wang, M.D., and Terence A. Ketter, M.D. Gamma-aminobutyric acid is a major inhibitory neurotransmitter widely distributed in the mammalian central nervous system. Animal models of depression have pointed toward the importance of the GABA system in the pathophysiology of mood disorders. Thus, elucidating the GABAergic effects of benzodiazepines, mood stabilizers, antidepressants, and new anticonvulsants and antipsychotics may expand our understanding of mood disorder pathophysiology and potentially generate new targets for treatment.

Although lithium is still a first-line treatment for bipolar disorder, many psychiatrists are reluctant to use it due to blood monitoring requirements. The FDA has approved an in-office blood test that allows lithium blood levels to be obtained in minutes. The test is similar to glucose monitoring devices used for diabetes, and experts on BD are hoping it will increase the use of lithium, which has also been shown to lower the suicide rate among patients with this disorder.

Restraints and seclusion have been used for many years in emergency departments (EDs) and psychiatric emergency services (PESs), but anecdotal case reports and newspaper investigations as well as clinical advances have led to restrictions in their use.

The FDA has issued a "black box" warning about the use of all antidepressants in the pediatric population due to a 1.8-fold increase in suicidality on drug compared to placebo. Yet these medications can be an effective tool in treating depression. How should parents and patients be educated, considering this information?

More than 100 neurologic diseases, injuries, and intoxications are known to prominently or exclusively involve the white matter of the brain.

Nerve root injections can help patients with lumbar radicular pain avoid surgery for at least 5 years, according to research from Washington University in St Louis that was presented in late February at the annual meeting of the American Academy of Orthopaedic Surgeons.

Mental illness occurs more frequently among people infected with HIV. In addition, individuals with mental illnesses are at greater risk for contracting HIV. Therefore, psychiatry has a great deal to offer in the management of patients with HIV--whether through proper patient education or safe and effective psychopharmacology.

The post-stroke patient is at significant risk for various psychiatric syndromes. The most commonly reported of these in the literature are post-stroke depression (PSD) and post-stroke dementia (PSDem), which may present simultaneously with overlapping mood and cognitive symptoms. In this article, we offer a review of current literature on post-stroke psychiatric syndromes and an integrated clinical approach to screening, diagnosis, and pharmacologic intervention.

In the second part of this series, read about the special issues psychiatrists face when treating women, children and adolescents, and elderly people with bipolar disorder and dementia. What are the recommendations for care and monitoring strategies to maintain patients on effective, long-term treatment regimens?

Despite the fact that awareness of HIV and AIDS transmission is pervasive, risky sexual behavior has been increasing in many parts of the world in recent years, with a concomitant rise in new cases of HIV and other sexually transmitted diseases.

Is sexual research still an orphan as far as recognition and funding? Yes. Yet sex and sexuality issues affect the quality of each person's life. As the articles in this Sex & Sexuality bonus issue show, sexual health remains in the physician's domain in this millennium and beyond.

The diagnosis of bipolar disorder in children remains controversial. One of the more disturbing facets of its presentation in such young patients is the presence of hypersexual behavior. How can these behaviors be differentiated from the effects of abuse and other psychiatric disorders?

Given that a substantial minority of patients don't respond to monotherapy, clinicians may have to consider combined or augmentation therapy. According to the research, which drugs are most effective, and in which combinations?

Although light therapy is an old treatment, new therapeutic uses are being researched. What is the optimal time and strength of light treatment to best help patients with depressive disorders?

The number of magnetic resonance spectroscopy studies that assess the levels of different neurochemicals in bipolar disorder has increased considerably in recent years. Abnormalities were reported mainly in the brain regions implicated in the pathophysiology of BD: the dorsolateral prefrontal cortex, cingulated gyrus, hippocampus and basal ganglia. Although these findings are not diagnostic, future research in this area may help to elucidate the pathophysiology of BD and monitor treatment effects.

Transcranial magnetic stimulation has been applied in a growing number of psychiatric disorders as a putative treatment. As a focal intervention that may exert lasting effects, TMS offers the hope of targeting underlying circuitry and ameliorating the effects of psychiatric disorders. The ultimate success of such an approach depends upon our knowledge of the neural circuitry involved, on how TMS exerts its effects and on how to control its application to achieve the desired effects. Current challenges in the field include determining how to enhance the efficacy of TMS in these disorders and how to identify patients for whom TMS may be efficacious.

According to a large international study, BD-II mixed depression can easily be misdiagnosed as major depressive disorder. Proper assessment and treatment of mixed depression in BD-II could have a positive impact on outcomes in bipolar disorder.

While the symptoms of somatoform and dissociative disorders are influenced by the patient's culture, these syndromes are heterogeneous and may have overlapping features. Although more frequently reported in non-Western cultures and thought of as exotic and culture-bound, multiple personality disorder may be a North American example of one such disorder.

Research presented at an international meeting in Australia found that lamotrigine may be beneficial against depressive relapse for patients either currently or recently in a manic phase.

Will the most effective treatments be available for your patients? Atypical antipsychotics and antidepressants that are being marketed or developed worldwide are reviewed.

Although there are many social impediments to the use of ECT, it appears to meet the four ethical principles of health care.

In looking at the history of ECT, it appeared to have been quite successful in treating a variety of psychiatric disorders. If that is the case, then why did it disappear from the "psychiatric map" for a number of years? What obstacles need to be overcome to return ECT to its place as a viable treatment option?

This year marks the 70th anniversary of the first use of induced seizures to treat mental disorders. Read about the career of Ladislas Meduna, M.D., the Hungarian neuropathologist who pioneered this treatment method. Although his theory that convulsive therapy is effective because it increases glial cell function was disproved, it remains one of the

Results from three statewide studies of the clinical practices for assessing and treating children and adolescents with a primary diagnosis of conduct disorder, ADHD or bipolar I disorder demonstrate gender and ethnic differences only for those diagnosed with conduct disorder. The implications of these findings and their similarities to the literature on adults with psychiatric disorders are discussed.

An increasing amount of systemic research has galvanized opinions regarding pediatric-onset bipolar disorder (BD). Although originally thought to be a rare condition, the number of pediatric-onset BD diagnoses is rising. This article summarizes current thinking regarding pediatric BD, including work focusing on presentation, psychiatric comorbidity and recent treatment data