Mood Disorders

A psychiatrist in private practice gives guidelines when faced with the prospect of treating multiple members of the same family.

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.

Memory, Perimenopause

Published a decade ago, the original National Comorbidity Survey focused largely on anxiety and depression. In an exclusive interview, the survey's designer, Ronald C. Kessler, Ph.D., talks with Psychiatric Times about the just-published replication study, which found that the combined lifetime prevalence of impulse control disorders is higher than that for either mood or substance use disorders.

Over the past decade, there has been increasing attention to the identification and management of mood and anxiety disorders related to childbearing. Emergen- cy physicians, including psychiatrists, primary care providers, obstetricians, gynecologists, and pediatricians, encounter women who are struggling with mental health issues in the context of reproductive events, such as pregnancy, pregnancy loss, and the postpartum adjustment period. In some cases, the reproductive event may precipitate a mental health crisis. In others, it may exacerbate an underlying mental health condition that, in turn, may need to be managed differently because of issues related to pregnancy or breast-feeding.

Recent evidence suggests that reorganization of neuronal connectivity might play an important role in the pathophysiology of mood disorders and in both pharmacological and psychological treatments of depression. This evidence suggests a new framework for the etiology of mood disorders that focuses more on the problems in neuronal connectivity, plasticity and information processing in the brain than on abnormalities in chemical neurotransmission. Although this framework is still controversial and far from being complete, improved familiarity with the concepts of neuronal development and activity-dependent plasticity among mental health professionals would be useful.

Comorbidity of Dysthymic Disorders in Children and Adolescents by Atilla Turgay, M.D. Many patients with dysthymic disorders also have associated comorbid disorders. A detailed history will provide insight into the comorbidity profile, cross-sectionally and developmentally. Dysthymic disorder should be addressed clinically, as it may cause long-term chronic unhappiness and poor quality of life for the patient.

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.

Suicidal behavior is a complex and multi-factorial phenomenon for which epidemiological genetics suggests a genetic basis that may be specific and independent from those implicated in the vulnerability to the psychiatric disorders associated with SB. Recently, new molecular biology tools have been designed to identify predisposition factors to complex disorders. One of the main goals of current studies is to specify the suicidal phenotype, as well as the intermediate phenotypes associated with these genes.

Sensitivity and specificity of a new bipolar spectrum diagnostic scale.

Three recently published studies uncovered some answers to the genetic underpinnings of depression. Familial vulnerability was shown to increase with each generation affected by depression. Two genetic variants pointed in opposite directions: one showed an increase risk of depression and the other predicted responsiveness to antidepressants.

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.

Patients with anorexia nervosa often attempt to deceive health care professionals because they do not want treatment for their disorder. Thus, physicians must maintain a high index of suspicion for signs and symptoms of AN due to its potentially fatal complications.

Borderline personality disorder is a complex, disabling disorder. The chairperson for the American Psychiatric Association workgroup for the evidence-based practice guideline on its treatment gives an overview of this disorder's etiologies, neurobiology, longitudinal course and recommended treatments. Future directions for both treatments and research are also discussed.

Although the term borderline has been in clinical use since the late 1930s, it only became an official Axis II diagnosis in 1980 with the publication of DSM-III.

Since the introduction of the SSRIs in the early 1990s, the rate of antidepressant prescribing has increased dramatically. This look at five national data sets concludes that greater recognition of depression and greater rates of treatment with medication and psychosocial interventions has made a significant contribution to reducing suicide rates.

One of the spin-offs of the consensus statement is a study of the risk for metabolic disorders with antipsychotic use in children and adolescents. Here, the lead researcher discusses some of the group's initial findings.

Unlike other forms of self-injury, suicidal self-injury has special meaning, particularly in the context of borderline personality disorder. How is suicidal self-injury differentiated from non-suicidal self-injury in these patients, and how can their behavior be properly assessed and treated?

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

The DSM may be flawed, but it is the best available system for organizing and diagnosing mental disorders, and it remains a model for other medical specialties.

Decades of labor have been poured into the formulation of the DSM and its descendants. Is this system of classification still useful and relevant to clinical practice? Should psychiatrists continue to revise it or get rid of it altogether?

Although late-onset psychosis is not as common as the early-onset variety, it can still pose difficulties in diagnosing and treating patients. How are patients with late-onset psychosis different from those who have early-onset, and what sorts of issues should clinicians be aware of?

Treatment successes can be hampered by treatment-refractory mood disorders. Nine key concepts are outlined to help guide the treatment of these patients.

Catatonia is found in at least 10% of patients admitted to acute psychiatric services, so any young patient with stupor, unexplained excitement or persistent motor signs should be formally assessed for this syndrome. From among the 20 to 40 now-identified features of catatonia, its proper diagnosis must be differentiated from other mental illnesses.

Although ADHD can be effectively treated and can lead to significant dysfunction if left untreated, negative public perceptions still abound. Proper diagnosis, exploration of comorbid disorders and collaboration with other health care professionals may be the answer to ensuring positive outcomes for children afflicted with this disorder.