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July 2009 News and Blog Posts (18)

Chronic Eating Disorders

(PSYCHIATRIC TIMES) - Eating disorders in general and anorexia nervosa in particular are complex and difficult psychiatric disorders to treat. Empirical research has established effective treatments of bulimia nervosa. However, anorexia nervosa remains without effective empirically based treatments, especially for adult patients. A significant majority of patients with bulimia nervosa will have a good outcome; however, a small minority, approximately 10%, will be refractory to… Continue

Added by psychiatryRounds Psychiatry News on July 30, 2009 at 5:00am — No Comments

Borderline Personality Disorder and Resistance to Treatment

(PSYCHIATRIC TIMES) - When the term “borderline” was first used in 1938 by the psychoanalyst Adolf Stern, he was defining a group of patients who were “extremely difficult to handle effectively by any psychotherapeutic method.”1 In the early 1950s, Robert Knight emphasized their regressive responses to unstructured treatments.2 In hospitals, borderline patients were referred to as “help-rejecting complainers.”



During that time, the term “negative therapeutic reaction” evolved as a… Continue

Added by psychiatryRounds Psychiatry News on July 30, 2009 at 4:00am — No Comments

Treatment-Resistant Depression

(PSYCHIATRIC TIMES) - Approximately 32 to 35 million adults in the United States have an episode of major depression sometime during their lifetime, and many of them do not respond to initial treatment.1 The results of an analysis undertaken by Fava and Davidson2 suggest that between 29% and 46% of depressed patients fail to respond fully to antidepressant treatment of adequate dose and duration; about 15% of patients fail to respond to multiple treatment trials.3 Fagiolini and Kupfer4 have… Continue

Added by psychiatryRounds Psychiatry News on July 27, 2009 at 9:30pm — No Comments

Treatment-Resistant Bipolar Disorder

(PSYCHIATRIC TIMES) - The concept of treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition.1 Whether the term refers to nonresponse to 1 or more standard treatments, at what dosages, and for what phases of bipolar disorder is unclear. Treatment resistance in bipolar disorder should always be based on a specific phase of treatment: mania or depression and acute or maintenance.



Treatment resistance is extremely common. Even under optimal… Continue

Added by psychiatryRounds Psychiatry News on July 27, 2009 at 4:00am — No Comments

Teenaged Brain: Part 1

(PSYCHIATRIC TIMES) - This statistic is as familiar as it is startling. According to the National Comorbidity Survey-Replication (NCS-R), the peak age of onset for any disease involving mental health is 14 years. True for bipolar disorder. True for anxiety. True for schizophrenia and substance abuse and eating disorders. The data suggest that most mental health challenges emerge during adolescence. If true, this brings to mind an important developmental question:



What is up with… Continue

Added by psychiatryRounds Psychiatry News on July 27, 2009 at 3:00am — No Comments

Treatment-Resistant Bipolar Disorder

(PSYCHIATRIC TIMES) -

The concept of treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition.1 Whether the term refers to nonresponse to 1 or more standard treatments, at what dosages, and for what phases of bipolar disorder is unclear. Treatment resistance in bipolar disorder should always be based on a specific phase of treatment: mania or depression and acute or maintenance.



Treatment resistance is extremely common. Even under optimal… Continue

Added by psychiatryRounds Psychiatry News on July 27, 2009 at 3:00am — No Comments

MRI software accurately IDs preclinical Alzheimer’s disease

Massachusetts General Hospital researchers are using automated MRI software to detect individuals in the preclinical phase of Alzheimer's disease with 95% accuracy, according to a cohort study.



The sooner physicians can diagnosis Alzheimer's disease (AD), the better. Early diagnosis means better treatment for the patient and more options for care.



Traditionally, AD has been diagnosed through a neurologic exam, detailed medical history, and written tests, with neuroimaging… Continue

Added by psychiatryRounds Psychiatry News on July 20, 2009 at 3:00am — No Comments

DSM-V: Mind Made Up?

(PSYCHIATRIC TIMES) - I read with great interest and considerable apprehension Dr. Frances’ assessment of the DSM-V developmental process ("A Warning Sign on the Road to DSM-V," Psychiatric Times, July 2009). I very much share Dr. Frances’ concerns about the premature and ill-conceived creation of new “diagnoses”; the burden on practitioners working in the real world with regard to having to learn and apply the new concepts and nomenclature; the potential abuse of the DSM by pharmaceutical… Continue

Added by psychiatryRounds Psychiatry News on July 16, 2009 at 4:30am — No Comments

Frances Responds to APA: "Important Questions Need Answering"

(PSYCHIATRIC TIMES) - I had intended not to reply to the silly suggestion made by the APA leadership that I wrote my critique of the DSM-V process out of financial motivations:



"Both Dr. Frances and Dr. Spitzer have more than a personal “pride of authorship” interest in preserving the DSM-IV and its related case book and study products. Both continue to receive royalties on DSM-IV associated products. The fact that Dr. Frances was informed at the APA Annual Meeting last month that… Continue

Added by psychiatryRounds Psychiatry News on July 15, 2009 at 4:30am — No Comments

The “We Know Better/Holier Than Thou” Crusade: A Response To Drs Frances And Spitzer’s Comments

(PSYCHIATRIC TIMES) - I appreciate Drs Spitzer and Frances’ prompt response to my article, which was published in the July issue of Psychiatric Times. I also thank them for their good wishes and thoughts about what we are doing as members of the DSM-V workgroups—membership whose rules we all knew and freely accepted.



Drs Spitzer and Frances insist that their “problem” is with the DSM-V committee leadership which, in their opinion, has imposed stringent conditions on us and has… Continue

Added by psychiatryRounds Psychiatry News on July 14, 2009 at 4:30am — No Comments

Borderline Personality Disorder and Bipolar Disorder—Distinguishing Features of Clinical Diagnosis and Treatment

(PSYCHIATRIC TIMES) - Psychiatric Times - Category 1 Credit



To earn AMA PRA Category 1 Credit(s)™:

Read the article "Borderline Personality Disorder and Bipolar Disorder" from the July 2009 issue of Psychiatric Times, complete the posttest and the evaluation. (Note: A score of at least 70% must be achieved in order to be awarded credit.)



The posttest will be scored instantly and results will be shown onscreen. Please make a copy of your test results for your… Continue

Added by psychiatryRounds Psychiatry News on July 13, 2009 at 4:00am — No Comments

Borderline Personality Disorder and Bipolar Disorder—Distinguishing Features of Clinical Diagnosis and Treatment

(PSYCHIATRIC TIMES) - Psychiatric Times - Category 1 Credit

To earn AMA PRA Category 1 Credit(s)™:

Read the article "Borderline Personality Disorder and Bipolar Disorder" from the July 2009 issue of Psychiatric Times, complete the posttest and the evaluation. (Note: A score of at least 70% must be achieved in order to be awarded credit.)



The posttest will be scored instantly and results will be shown onscreen. Please make a copy of your test results for your continuing… Continue

Added by psychiatryRounds Psychiatry News on July 13, 2009 at 3:00am — No Comments

Inflammation, Psychosis, and the Brain

(PSYCHIATRIC TIMES) - When the solution to a clinical or scientific puzzle eludes us for more than a century, as with schizophrenia, we need new methods to examine the pathology. If we want to make an impact on the disease we must shift research paradigms and focus on the early detection, early intervention, and new avenues of treatment that address different symptoms of schizophrenia. Immunological and blood-brain barrier (BBB) abnormalities in patients with psychosis have been repeatedly… Continue

Added by psychiatryRounds Psychiatry News on July 10, 2009 at 10:00pm — No Comments

Dr Frances Responds to Dr Carpenter: A Sharp Difference of Opinion

(PSYCHIATRIC TIMES) - I have the highest respect and affection for Will Carpenter, MD, who wrote a recent response ("Criticism vs Fact: A Response To A Warning Sign on the Road to DSM-V by Allen Frances, MD," Psychiatric Times, July 7, 2009) to my earlier commentary, but we do differ sharply on the following points.



1. His suggestion to include premorbid diagnoses as official categories in DSM-V is by far the most important difference in our perspectives about DSM-V. In fact, it was… Continue

Added by psychiatryRounds Psychiatry News on July 9, 2009 at 4:30am — No Comments

From Chaos to Consilience: Using the New Mind-Body Science to Improve the Diagnosis and Treatment of Major Depression

(PSYCHIATRIC TIMES) - Chaos – definition [from wordnet.princeton.edu]: a state of extreme disorder or confusion Consilience – definition [from Wikipedia]: literally a jumping together of knowledge by the linking of facts and fact-based theory across disciplines to create a common groundwork for explanation



Lecturing around the country has left us with the powerful impression that both primary care physicians and psychiatrists are hungry for new ways to think about and manage… Continue

Added by psychiatryRounds Psychiatry News on July 7, 2009 at 9:30pm — No Comments

And the Orchestra Played On: Activation of Distress Pathways—A Common Feature of Mood, Anxiety, Sleep, and Pain Disorders?

(PSYCHIATRIC TIMES) - As we begin this brief review of the neurobiology of major depressive disorder (MDD), we face these fundamental questions:



• Will the provided information be clinically relevant?



• Can current scientific research provide us with a coherent, comprehensive, and relatively accurate description of the underlying neurobiology of MDD?



Major depression, bipolar disorder (BD),1 and generalized anxiety disorder (GAD)2 are all characterized by a… Continue

Added by psychiatryRounds Psychiatry News on July 7, 2009 at 3:00am — No Comments

APA and DSM-V: Empty Promises

(PSYCHIATRIC TIMES) - The debate over DSM-V has unfortunately taken an ugly turn with the APA leadership suggesting that Dr. Frances’s and my motivation for critiquing DSM-V is financial. People familiar with this controversy might recall that it all began when I asked Darrel Regier if I could look at the minutes of DSM-V Task Force meetings so that I could keep up with the ongoing process. He explained that he could not do this because of confidentiality agreements that all DSM-V participants… Continue

Added by psychiatryRounds Psychiatry News on July 2, 2009 at 4:30am — No Comments

Setting the Record Straight: A Response to Frances Commentary on DSM-V

(PSYCHIATRIC TIMES) - The commentary “A Warning Sign on the Road to DSM-5: Beware of its Unintended Consequences” by Allen Frances, M.D., submitted to Psychiatric Times contains factual errors and assumptions about the development of DSM-V that cannot go unchallenged. Frances now joins a group of individuals, many involved in development of previous editions of DSM, including Dr. Robert Spitzer, who repeat the same accusations about DSM-V with disregard for the facts.



The facts… Continue

Added by psychiatryRounds Psychiatry News on July 1, 2009 at 4:30am — No Comments

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