Personality Disorders

According to the National Institute on Drug Abuse, of all the illicit substances, marijuana is the most commonly abused among adolescents and young adults, and abuse during adolescence increases the likelihood of dependency in adulthood.

Attachment may be defined as a composite of behaviors in an infant, toddler, or young child that is designed to achieve physical and emotional closeness to a mother or preferred caregiver when the child seeks comfort, support, nurturance, or protection.

Of the 7 "deadly" sins that are committed by humans, envy is primarily directed toward the destruction of an external object. Over the centuries, this unfortunate emotion has been the subject of inquiry by many disciplines (philosophy, religion, sociology, fiction, and so on).

One day in 1946 while I was making neurology rounds, a crumpled piece of humanity was wheeled into the ward. When "Ora" came to the hospital for her annual epilepsy checkup, she had not been able to walk for more than a year.

Whether or not sexual offending behavior-or the predisposition to such-is a mental illness, there are patients with traditional mental illnesses who also present with sexually inappropriate and even sexual offending behavior.

In this article we discuss psychoneuroendocrine influences on sexual orientation and the psychodynamics of internalized homophobia. Because of space limitations, we focus on homosexual orientation, although research in this area sheds light on heterosexual and bisexual orientation as well.

Epidemiological studies report a lifetime prevalence rate of 24.9% for (any) anxiety disorder. Feelings of anxiety can also be related to normal fear of pain, loneliness, ridicule, illness, injury, grief, or death. In both these types of situations, anxiety can be difficult to deal with. Consequently, benzodiazepines, which offer almost immediate symptomatic relief for anxiety, can be quite appealing to many persons.

Psychiatric emergencies usually involve some combination of agitation, aggression, impulsivity, psychosis, and risk of destructive behavior, including suicide and homicide. The psychiatrist must ensure the safety of the patient and others while identi- fying and treating immediate medical and psychiatric problems and developing and initiating a strategy for continuing the management of less immediate problems. In the diagnosis of acute behavioral disturbances, it is necessary to determine the role of the patient's primary psychiatric illnesses and any complications or treatments of those primary psychiatric illnesses, as well as the role of other medical or toxic disturbances that may be interacting with the patient's psychiatric illnesses or treatments.

There are important distortions in the article "Substance Abuse in Women: Does Gender Matter?" (Psychiatric Times, January 2007, page 48). My concerns regard the political assumptions made (rather than those based on science) that put a spin on data rather than letting the data stand alone.

He was young, schizoid, and had experienced brief periods of psychotic-like disorganization. We worked together in psychotherapy for many years. None of the then available psychotropic agents were helpful. He believed, however, that marijuana was helpful, and, if he smoked a joint in the hours preceding a session, his way of relating to me was different. He was less "there," more deeply into himself. His descriptions of the marijuana experience never varied. "I am," he would say, "at peace. I feel connected to everything. I am part of the universe, part of nature, part of God." He was, I thought, a person with significant ego boundary problems who, for the most part, maintained his basic sense of self by distancing himself from both the world and inner turmoil. Marijuana appeared to lead to the internal experience of greater connectedness and peace, although I felt he was less available to me after using it.

After wading through the initial shock and horror of the murder of 32 students and faculty at Virginia Tech on April 16 by student Seung-Hui Cho, there is a natural impulse to rush to enact laws to prevent this type of tragic event from ever happening again in our schools. As professionals, as parents, as concerned members of a community, we have a felt need for an immediate response to ensure that schools are safe and secure places to learn and grow. Action is demanded. Not only must this opportunity/obligation not be squandered, but we must make sure that by our actions we do not make things worse.

Proper suicide assessment is probably the most important part of a clinician's job; appropriately, heavy emphasis is placed on this in our education. Unfortunately, psychiatrists receive comparatively little practical guidance in documenting the history and physical examination (H&P) of a suicidal patient.

There were only 3 Jewish students in my high school, and I was one of them. In the small, western New York town where I grew up, most people were tolerant. But a small clique of anti-Semites made life tough for us Jewish kids. Most of the time, we just shrugged off the jokes and insults or came right back at these louts with a snappy retort. Sometimes, the bigotry grew more menacing.

"There must be some way out of here," said the joker to the thief."There's too much confusion, I can't get no relief. . . .""No reason to get excited," the thief, he kindly spoke,"There are many here among us who feel that life is but a joke.But you and I, we've been through that, and this is not our fate,So let us not talk falsely now, the hour is getting late."From "All Along the Watchtower," Bob Dylan

The following cases highlight some of the challenges clinicians face when treating patients in whom malingerling is suspected. One key aspect of these evaluations is not overlooking signs or symptoms that point to serious illness.

SAN FRANCISCO -- Given the high prevalence of substance abuse in patients with attention deficit hyperactivity disorder (ADHD), psychiatrists need to consider comorbidity in assessment of both conditions.

Suicide is a serious public health problem that ranks as the 11th leading cause of death in the United States. Within the 15- to 24-year-old age group, it is the third leading cause of death.1 Many suicide victims have had contact with the mental health system before they died, and almost one fifth had been psychiatrically hospitalized in the year before completing suicide. A recent review found that psychiatric illness is a major contributing factor to suicide, and more than 90% of suicide victims have a DSM-IV diagnosis.

Physicians are often conflicted regarding prescription medications for pain, especially pain complicated by insomnia and anxiety. Concerns that patients may become addicted to medications, exacerbated by limited time available to get to know patients, can lead to underprescribing of needed medications, patient suffering, and needless surgery. At the other extreme, pressure to alleviate patients' distress can lead to overprescribing, needless side effects, and even addiction.

Few phenomena in medicine aremore confounding than the diagnosesinvolving deception:malingering, Munchausen syndrome,Munchausen by proxy (MBP), and factitiousdisorder.

Paraphilias are defined by DSM-IV-TR as sexual disorders characterized by "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving (1) nonhuman objects, (2) the suffering or humiliation of oneself or one's partner, or (3) children or other nonconsenting persons that occur over a period of 6 months" (Criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (Criterion B). DSM-IV-TR describes 8 specific disorders of this type (exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism) along with a ninth residual category, paraphilia not otherwise specified (NOS).

Attention-deficit/hyperactivity disorder (ADHD) is often underappreciated and inadequately treated in adults. Long thought to be a disorder of childhood, ADHD is now believed to persist into adulthood in approximately half of all cases.

Panic disorder occurs in about 1 in 5 individuals who have bipolar disorder. Anxiety amplifies the distress caused by depression and mania, but pharmacological approaches are tricky and under-studied. Frequent comorbidity and evidence of a possible genetic relationship of bipolar and panic disorders are suggestive of a causal relationship between the 2. Thus, it may be fruitful to look more closely at evidence for common biological abnormalities in both disorders to find a pathophysiological mechanism that links mania, depression, and panic attacks. Mood episodes and panic attacks can both be modeled as the result of deficits in amygdala-mediated emotional conditioning. From this model, some insight may be gained for potentially helpful treatment strategies for the 2 disorders when they occur together.

DVD Aims to Educate Clinicians, Patients on Borderline Personality Disorder

Depression and Diet in Elderly Community-Dwelling Mexican and European Americans

Nonconventional and Integrative Treatments of Alcohol and Substance Abuse (Part 1)