April 27th 2024
The experts weighed in on a wide variety of psychiatric issues for the April issue of Psychiatric Times.
The Expanding Role of Fluid Biomarkers in the Diagnosis and Management of Patients With Alzheimer Disease
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Clinical Consultations™: Considerations for Customizing Care Plans for Patients with Parkinson Disease Psychosis
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Expert Illustrations & Commentaries™: Visualizing New Therapeutic Targets in Schizophrenia
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Advances In™ Schizophrenia: Expanding the Therapeutic Landscape
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Southern California Psychiatry Conference
September 13-14, 2024
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Updates on New and Emerging Therapies to Improve Outcomes for Patients With Major Depressive Disorder
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5th Annual International Congress on the Future of Neurology®
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2023 Annual Psychiatric Times™ World CME Conference
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Clinical Consultations™: Managing Depressive Episodes in Patients with Bipolar Disorder Type II
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Patient, Provider, and Caregiver Connection™: Exploring Unmet Needs In Postpartum Depression – Making the Case for Early Detection and Novel Treatments
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Medical Crossfire®: Understanding the Advances in Bipolar Disease Treatment—A Comprehensive Look at Treatment Selection Strategies
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'REEL’ Time Patient Counseling: The Diagnostic and Treatment Journey for Patients With Bipolar Disorder Type II – From Primary to Specialty Care
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More Than ‘Blue’ After Birth: Managing Diagnosis and Treatment of Post-Partum Depression
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Patient, Provider & Caregiver Connection™: Reducing the Burden of Parkinson Disease Psychosis with Personalized Management Plans
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Fibromyalgia Syndrome: A Guide for the Perplexed
February 1st 2009Fibromyalgia syndrome is a chronic condition that consists of a pervasive set of unexplained physical symptoms with widespread pain (involving at least 3 of 4 body quadrants and axials) of at least 3 months duration and point tenderness at 9 bilateral locations (Figure) as the cardinal features.1 Patients with FM report a set of symptoms, functional limitations, and psychological dysfunctions, including persistent fatigue (78.2%), sleep disturbance (75.6%), feelings of stiffness (76.2%), headaches (54.3%), depression and anxiety (44.9%), and irritable bowel disorders (35.7%).1 Patients also report cognitive impairment and general malaise, “fibro fog.” This pattern of symptoms has been reported under various names (such as tension myalgia, psychogenic rheumatism, and fibromyositis) since the early 19th century.
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Sleep Disturbances Associated With Posttraumatic Stress Disorder
November 1st 2008The National Comorbidity Survey estimates that approximately 50% of the population in the United States is exposed to traumatic events and that the lifetime prevalence of posttraumatic stress disorder (PTSD) is approximately 7.8%.
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Behavioral Comorbidities in Rheumatoid Arthritis
August 1st 2008While tremendous therapeutic advancements have been made, patients with rheumatoid arthritis (RA) have a myriad of comorbidities, including fatigue, depression, and sleep disturbances. Data on the comorbidity of psychiatric disorders with arthritis are also striking: according to the NIMH Catchment Area program, the lifetime prevalence of psychiatric disorders among patients with RA is 63%.
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Nonmotor PD Symptoms Are Many and Deserve Attention
August 1st 2007Nonmotor symptoms of Parkinson disease [PD] are diverse and include sleep disorders, depression, and pain," reported Carlo Colosimo, MD, assistant professor of neurology at La Sapienza University in Rome. He noted that a screening tool is needed.
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Treatment of Comorbid Sleep Disorders Improves Seizure Control
June 1st 2007It is a widely known fact that Fyodor Dostoevsky, the famous 19th-century Russian novelist, suffered from epilepsy for most of his life. However, not too many persons are aware that Dostoevsky also had a sleep disorder called delayed sleep phase syndrome, which may have contributed to his seizures.1 Although no one knows for certain, it is quite conceivable that Dostoevsky's sleep disorder worsened his epilepsy, according to Carl Bazil, MD, PhD, director of Clinical Anticonvulsant Drug Trials and director of the Neurology Division, Columbia Comprehensive Sleep Center, Columbia University, New York.
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The Science of Sleep. A quirky Indy motion picture by that title was in theaters last year. The plot concerned an odd but wildly creative and endearing fellow who ran into problems in his interpersonal relationships, in part, because he often couldn't distinguish between being awake and asleep. Wake and dream episodes mirrored each other, creating a penchant for the surreal and a personal narrative for the protagonist that wasn't quite in sync with that of the characters around him.
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Patients who experience seizure 24 hours after stroke onset may be at increased risk for death, according to Angela Rackley, MD, a clinical neurophysiology fellow in epilepsy, and coresearchers at the University of Cincinnati. Rackley presented an abstract on the incidence of seizures within 24 hours after acute stroke at the annual meeting of the American Epilepsy Society in San Diego this past December. She and colleagues found a higher 30- day mortality rate among patients who had a seizure within hours of stroke compared with patients who did not experience poststroke seizure.
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Recognition of Dopamine in Sleep-Wake Function May Improve PD Care
May 1st 2007aytime sleepiness is common in patients with parkinsonism but has little to do with the amount of sleep these patients get and everything to do with dopaminergic dysfunction, according to David B. Rye, MD, PhD, associate professor of neurology at Emory University in Atlanta. "The idea is that if I sleep a lot, I shouldn't be so sleepy the next day, and if I sleep little, I should be very sleepy. This is doesn't hold true for patients with Parkinson disease [PD]. The loss of dopamine disrupts that banking system, or the sleep-wake homeostat," he said during a presentation at the 9th annual meeting of the American Society for Experimental Therapeutics, which met March 8 to 10 in Washington, DC. Addressing dopa- minergic tone during sleep might help ameliorate daytime symptoms of parkinsonism in general.
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Broken Sleep May Be Natural Sleep
March 1st 2007Once again your patient, an accountant and tax specialist, is complaining about his sleep. More nights than not he awakens at about 2 am. An hour goes by, sometimes 2, before he returns to sleep. You've prescribed 4 different hypnotics. Each gave the same unsatisfactory result. For 2 weeks, your patient got the 8 hours of uninterrupted sleep he-and you-seek, but then the old pattern returned. Following your instructions, he avoids caffeine, doesn't exercise after 6 pm, and confines his activities in bed to sleep, but to no avail. You refer him to a sleep laboratory, and the results there are entirely consistent with what he's been telling you. In the sleep lab he falls asleep at 11 pm, awakens at 2:30 am, returns to sleep at 4 am, and awakens for good at 7:30 am. He does not have sleep apnea, restless legs syndrome, or depression.
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Treatment of Somatic Symptoms in Generalized Anxiety Disorder
March 1st 2007Generalized anxiety disorder (GAD) is characterized by excessive or unrealistic anxiety and worries about life circumstances. In the general population, the prevalence of GAD is 2% to 5%. It is the most frequent anxiety disorder seen in primary care, where 22% of patients complain of anxiety problems.1 DSM-IV lists 6 somatic symptoms associated with GAD: restlessness, increased fatigability, difficulty in concentrating, irritability, muscle tension, and sleep disturbance. These symptoms may present with hyperarousal, hypervigilance, and heightened muscle tension; autonomic symptoms are milder than in other anxiety disorders and can be absent.
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Racial, Ethnic Variables Shape the Experience of Chronic Pain
November 1st 2006That depression, anxiety, sleep disorders, and other neuropsychological conditions are often associated with chronic pain isn't news to most neurologists. But physicians who do not specialize in pain management are largely unaware of a growing body of research suggesting that the race (a genetic classification) or ethnicity (a cultural classification) of a patient with chronic pain may determine the patient's risk of neuropsychological symptoms.
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ChEIs Beneficially Affect REM Sleep in AD. Cholinesterase inhibitors (ChEIs) do not modify disturbances of sleep-wake rhythm or sleep continuity in patients with either Alzheimer disease (AD) or frontotemporal dementia (FTD), but they may have a beneficial effect on REM sleep, according to investigators from the University of Marburg in Germany.
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Cortisol and Seasonal Changes in Mood and Behavior
October 1st 2006The degree to which season changes affect mood, energy, sleep, appetite, food preference, or desire to socialize with others has been called "seasonality." Identification of a seasonal pattern can only be made if both the patient and physician actively look for it.
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Assessing and Treating Sleep Disturbances in Patients With Alzheimer's Disease
November 2nd 2005Patients with Alzheimer's disease may suffer the same age- and disease-related changes to sleep as their age-matched peers. However, as the dementia progresses, even more severe disturbances develop, with impairments in both nighttime sleep continuity and daytime alertness. This article focuses on long-term, holistic approaches to treatment, including environmental and behavioral interventions to augment sleep medications.
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The Light-er Side of Treating Seasonal Affective Disorder
October 1st 2005Seasonal affective disorder affects 1% to 3% of the North American population. Evidence exists for the efficacy of high-intensity bright, fluorescent light. Pharmacological management with SSRIs has shown equivalent efficacy to light therapy. How can these two therapies be combined? What other therapies are available?
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Treating Insomnia in Patients With Substance Use/Abuse Disorders
February 1st 2004espite the fact that about 30% of our life is spent sleeping and decades of research have been spent on sleep, we still do not know its real function. What we do know is lack of sleep can have serious implications, such as increased risk of depressive disorders, impaired breathing and heart disease. On the other hand, nighttime sleep disturbance is usually followed by excessive daytime sleepiness that is associated with delayed problems like memory deficits and impaired social and occupational function, and immediate consequences such as car accidents (Kupfer and Reynolds, 1997; Roehrs and Roth, 1995).
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Neurobehavioral Consequences of Sleep Dysfunction
October 1st 1999As chief of the division of sleep and chronobiology in the department of psychiatry at the University of Pennsylvania School of Medicine, David F. Dinges, Ph.D., focuses on ways sleep and the endogenous circadian pacemaker interact to control wakefulness and waking neurobehavioral functions such as physiological alertness, attention, cognitive performance, fatigue, mood, neuroendocrine profiles, immune responses and health. In an interview with Psychiatric Times, Dinges discussed neurobehavioral consequences of sleep loss, factors that impair sleeping, the pervasiveness of sleepiness and new ways to manage sleepiness.
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Melatonin and Sleep Disturbances
March 1st 1999In recent years, melatonin has been touted in the media as a "hot sleeping pill, natural and cheap" and as the drug that "may help ease insomnia, combat jet lag...and extend life." Trials are finally being conducted. Across the United States, some 30 medical centers are studying melatonin as a potential treatment for sleep disturbances.
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