Psychosomatics

Migraine, particularly chronic migraine, as well as other chronic headaches, have high rates of comorbidity with mood and anxiety disorders.

The primary difference between malingering and factitious disorder is the question of motivation.

Of the 3 informative articles included in this special geriatric collection, 1 offers a perspective on the treatment of depression that does not focus on somatotherapy. The others remind us of 2 additional geriatric Ds of importance: drugs and driving.

Sybil Exposed makes the case that the 1973 book Sybil misrepresents the facts of Shirley Mason’s life, diagnosis, and treatment. It also points to concerns that extend beyond a single case, to the diagnostic concept of multiple personalities. Still, perhaps the books suggests the need for a more systematic look at not just the case of Sybil, but also the diagnosis of dissociative identity disorder (DID).

Dr Roger McIntyre answers a reader's question. How would you answer? Take the quiz.

Understanding pediatric psychopharmacology in the context of medical illness.

Depression, anxiety, and delirium are 3 examples of common but frequently challenging areas of distress in pediatric palliative care patients.

Sadly, type 2 diabetes mellitus is increasing in children and adolescents at a rapid rate associated with rising rates of obesity.

I teach doctors and nurses how to assess, treat, and prevent delirium-an acute confusional disorder caused by multiple medical problems that mimics mental illness-but is actually a medical emergency.

The treatment of incest victims is often painful and difficult. With patience, the vast majority of those who have experienced incest can experience considerable improvement and enjoy an enhanced quality of life without succumbing to repeated victimization.

Many psychiatrists, residents, and other mental health professionals believe that psychodynamic therapy lacks empirical support or that other psychotherapies are more effective.

Although acute pain typically resolves on its own with little need for intervention, for some persons pain persists past the point where it is considered an adaptive reaction to injury.

Dramatology approaches human encounters, events, and scenes as dramatic enactments of characters in conflict and crisis.

In addition to their use in the management of epilepsy, anticonvulsants are indicated for management of bipolar disorder, mania, neuralgia, migraine, and neuropathic pain.

A new study sheds some light on the pathogenesis of body dysmorphic disorder (BDD). Feusner and colleagues from UCLA, whose study was recently published in Archives of General Psychiatry, used functional MRI to determine whether patients with BDD have abnormal patterns of brain activation when visually processing their own face. The severity of symptoms of this disorder were found to correlate with activity in frontostriatal systems and the visual cortex. http://archpsyc.ama-assn.org/cgi/content/abstract/67/2/197

Unless you have been living on a desert island for the past 2 years, you are well aware that the development of DSM-V is well under way.

Patients who exaggerate, feign, or induce physical illness are a great challenge to their physicians. Trained to trust their patients’ self-reports, even competent and conscientious physicians can fall victim to these deceptions.

Restless legs syndrome (RLS) is a neurosensory disorder first described by Sir Thomas Willis in 1672. As early as the 19th century, Theodor Wittmaack observed the comorbidity of RLS with depression and anxiety. He termed this condition “anxietas tibiarum” and believed it to be a form of hysteria.

Delirium has been recognized and described since antiquity. It is a brain disturbance manifested by a syndrome of diverse neuro­­psychiatric symptoms. Various terms have been used for delirium, such as acute brain disorder, metabolic enceph­alopathy, organic brain syndrome, and ICU psychosis.

Research emerging from the field of emotion science suggests that individuals who have anxiety and mood disorders tend to experience negative affect more frequently and more intensely than do healthy individuals, and they tend to view these experiences as more aversive, representing a common diathesis across anxiety and mood disorders.1-5 Deficits in the ability to regulate emotional experiences, resulting from unsuccessful efforts to avoid or dampen the intensity of uncomfortable emotions, have also been found across the emotional disorders and are a key target for therapeutic change.

The epidemiology and management of psychiatric disability have gained increased attention for a variety of reasons in the past 3 decades. There are issues of empowerment, advocacy, and reduction of stigma. There are also concerns about cost containment as well as reliability, validity, and efficacy of the determination process.

DSM-IV-TR, our current diagnostic classification system of psychiatric disorders, follows the diagnostic paradigm first established by DSM-III in 1980.

Recent research has raised concerns about the adequacy of psychiatric diagnostic evaluations conducted in routine clinical practice, particularly the detection of disorders that are comorbid to the principal diagnosis.

A 52-year-old female college professor was referred to a psychiatrist by a nurse practitioner at the college health clinic. The referring diagnosis was “adjustment disorder with depressed mood versus atypical depression with somatization; rule out fibromyalgia.”