Mood Disorders

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.

Compared with Caucasians, African Americans receive an excess of schizophrenia-spectrum diagnoses. Potential explanations for the ethnic differences in clinical assignment of psychiatric diagnoses are reviewed.

Diabetes doubles the likelihood of comorbid depression, which impairs functioning and quality of life. This mood disorder has a unique importance in diabetes because of its associations with treatment noncompliance, insulin resistance, hyperglycemia and an increased risk for diabetes complications.

Evidence is accumulating that untreated depression can impede comorbid medical treatment and increase mortality. The author reports on the latest research and treatment recommendations for depression that accompanies cardiovascular disease, stroke and Parkinson's disease.

Known as "the cancer of mental illness," schizophrenia can core a life, robbing a previously well-functioning person of what made the person uniquely them.

Mood-stabilizing drugs slipped into the vocabulary of psychiatrists during the last 15 years without a proper discussion of their definition. Consequently, these medications have been used in ways that have no empirical justification.

More than 430 psychiatrists, research donors and others gathered in late October for the National Alliance for Research on Schizophrenia and Depression (NARSAD)'s awards dinner in New York City. The black-tie fundraising event was held in conjunction with the organization's 10th annual scientific symposium at which 15 selected NARSAD grantees presented their ongoing research over two days of sessions devoted to basic science, schizophrenia and depression.

Although the exact etiology of premenstrual syndrome (PMS) remains unknown, it appears to be a chronic mood disorder that continues for many years in reproductive-age women. Approximately 2% to 10% of cycling women report severe symptoms resulting in a disruption of work or relationships.

Psychogenic excoriation (also called neurotic excoriation, pathologic or compulsive skin picking, and dermatotillomania) is not yet recognized as a symptom of a distinct DSM-IV disorder.

Mood disorders and their impact on women and their families was the topic of a half-day conference held at New York City's Algonquin Hotel;, former haunt of the famous-and depressed- writer Dorothy Parker, who made at least one suicide attempt there in the early 1900s.

The past decade witnessed major strides in our understanding and treatment of affective disorders in adults, children and adolescents. One of the baffling problems in child and adolescent psychiatry was the question of psychiatric illness spanning a lifetime. The existence of depressive disorders in prepubertal children has been generally recognized and acknowledged since the 1960s; however, only in the last decade did evidence become available that supports the notion that depression in different ages represents the same entity, albeit manifesting different clinical symptoms in each developmental period (Cytryn and others 1986).

Paraphilias as defined by DSM-IV, are sexual impulse disorders characterized by intensely arousing, recurrent sexual fantasies, urges and behaviors (of at least six months' duration) that are considered deviant with respect to cultural norms and that produce clinically significant distress or impairment in social, occupational or other important areas of psychosocial functioning.

At this time, both patients and professionals seem to have an unprecedented interest in circadian rhythms. We now know that the body's clock is located in the suprachiasmatic nucleus (SCN) of the hypothalamus, and that the SCN regulates the pineal gland's secretion of the hormone melatonin.