Mood Disorders

The relationship between bipolar disorder and ADHD remains unclear; however, this combined condition may represent an important genetic and clinical subtype with distinct psychopathology, familiality, and treatment response.

Mood switching is not uncommon and it is much more prevalent in depressed juveniles than in depressed adults, and there is a large apparent excess of antidepressant-associated switching over reported spontaneous diagnostic changes to bipolar disorder. Details here.

In a PsychCongress presentation on perinatal mood disorders, Marlene Freeman, MD, stressed that treatment is essential for women with mood disorders-but whether to treat becomes complicated during a women’s reproductive years.

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.

Nonpharmacological interventions-such as mind-body interventions-can improve a partial response to antidepressants via stress reduction, improved physical functioning, increased socialization, and reduced risks of polypharmacy.

A recent meta-analysis supports evidence of the effectiveness of the fixed olanzapine/fluoxetine combination (Symbyax) in treating the depressive phase of bipolar disorder. Response was ranked higher, but with no more adverse effects, than with treatment with olanzapine alone.

Hypothyroidism is a common clinical disorder that psychiatrists frequently encounter. However, symptoms of thyroid dysfunction are often vague and nonspecific, which can lead to delayed or missed diagnosis.

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.

Borderline Personality Disorder - Psychogenic Movement Disorders - Myalgic Encephalomyelitis - Migraine

According to the CDC's latest published report, there were 38,364 suicides in the US in 2010-an average of 105 each day. Globally, an estimated 1 million suicides occur annually.

These articles illustrate the variety and complexity of problems associated with comorbidity in psychiatric disorder.

Borderline personality disorder typically coexists with depression, anxiety, and substance abuse. Symptoms of these conditions may lead the clinician to miss the diagnosis of personality disorder entirely. Careful diagnosis of BPD and comorbid disorders is the first step.

Identification of atypical features is important in the treatment of depression for both treatment selection and prognosis, especially when initial measures prove ineffective. The concept of atypical depression has evolved over many years, and now it appears timely for a further revision.

A plethora of studies support the hypothesis that inflammation plays a role in the pathophysiology of major psychiatric disorders.

Given the likelihood that insufficient numbers of patients will be available for a randomized controlled trial of MAOIs in refractory depression or atypical depression, we must still rely on consensus guidelines and expert opinion.

DSM-5 presents psychiatry with a potential “reset button” for diagnostic reliability.

Four studies sprang from the TORDIA trial on treatment-resistant depression in children and adolescents and showed that several factors influence treatment efficacy following treatment resistance.

The role of subtyping and bipolarity in TRD was discussed in Part 1 of this 2-part article. Here we review a number of the most common confounding factors of TRD but limit our scope to comorbidities that can be directly addressed and treated by psychiatrists.

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.

Melatonin has a role in psychiatric illness and the treatment of circadian rhythm sleep disorders, insomnia, and comorbid depressive disorders.

Research is needed to define clinical biomarkers and genetic screens that could be used to identify early stages of dementia and to link clinical syndromes with the later development of dementia.

The New York Times ran a front-page story regarding numerous controversies surrounding the DSM-5, most notably, the issue of eliminating the so-called bereavement exclusion in diagnosing a major depressive episode. Here, Dr Pies responds to Dr John Grohol, Psychologist and Editor of the Psychcentral Web site.

The designer of the DSM-5 Field Trials has just written a telling commentary in the American Journal of Psychiatry. She makes what I consider to be 2 basic errors that reveal the fundamental worthlessness of these Field Trials and their inability to provide any information that will be useful for DSM-5 decision making.

This essay is a brief update on an earlier Psychiatric Times article by Dr James Phelps. Several major studies have appeared since the publication of the original article, which shed further light on this issue.

Understanding pediatric psychopharmacology in the context of medical illness.