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PsychiatryRounds Psychiatry News's Blog – March 2007 Archive (40)

Treatment-Resistant Depression: Figure Clarification

(PSYCHIATRIC TIMES) - I was disappointed to see the Figure titled "Olanzapine and fluoxetine in the treatment of TRD" in the article "Treatment-Resistant Depression: Strategies for Management" (Psychiatric Times, page 34) in the October 2006 special bonus edition.



The Figure in this article is misleading and out-of-date. It shows strikingly positive results in treatment-resistant depression (TRD) with the combination of olanzapine (Zyprexa) and fluoxetine (Prozac), which were derived… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 11:00pm — No Comments

Major Depression on the Rise in the United States

(PSYCHIATRIC TIMES) - Rates of major depression and of major depression with comorbid substance use disorders are on the rise. A recent review that was conducted by Dr Wilson M. Compton and associates from the National Institutes of Health showed that the prevalence rates of major depression increased in patients with and without a substance use disorder from 3.33% in 1991-1992 to 7.06% in 2001-2002. The results of the survey were published in the December 2006 issue of The American Journal of… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 11:00pm — No Comments

Atypical Antipsychotic Augmentation in the Treatment of Depression

(PSYCHIATRIC TIMES) - Despite the clinician's goal of treating the depressed patient to the point of remission, this state is generally achieved in only 15% to 30% of patients.1 Another 10% to 30% of patients respond poorly to antidepressant treatment, while 30% to 40% have a remitting and relapsing course.1 Patients without a major depressive disorder are likely to be treated successfully by primary care physicians and/or other mental health professionals, which leaves psychiatrists to treat… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 11:00pm — No Comments

WHIPLASHED: A Mnemonic for Recognizing Bipolar Depression

(PSYCHIATRIC TIMES) - CASE VIGNETTE

Ms T, a 22-year-old, presents to you with her third episode of major depression. Her referring doctor—a very competent family physician—tells you that Ms T "has been tried on everything, and nothing seems to help her." Indeed, the patient has taken 5 different antidepressants in the past 4 years and in each case she "felt like crawling out of her skin." Although the referring physician described the patient as having developed a "tolerance" to various… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 11:00pm — No Comments

PET shows link between endorphins, depression

(PSYCHIATRIC TIMES) - Researchers have found more evidence that depression has its roots in specific alterations within the brain, particularly in the endorphin system that is a central part of the brain's natural pain and stress reduction capability.



Susan Kennedy, Ph.D., and colleagues at the University of Michigan Molecular and Behavioral Neuroscience Institute evaluated 28 women, 14 with major depression, and 14 healthy controls. Subjects were asked to recall a sad life event… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 11:00pm — No Comments

Nondrug Treatments for Neuropsychiatric Symptoms in Dementia

(PSYCHIATRIC TIMES) - Given the lack of a good evidence base for pharmacological treatment of neuropsychiatric symptoms of dementia, are there any effective treatments for such problems as agitation, aggression, delusions, hallucinations, repetitive vocalizations, and wandering? A recent review suggests that nondrug interventions that address behavioral issues and unmet needs may be helpful, as may caregiving interventions and the use of bright light therapy.



Dr Liat Ayalon and… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 10:30pm — No Comments

Increased Plasma Cortisol Levels Associated With Alzheimer Progression

(PSYCHIATRIC TIMES) - Increased plasma cortisol levels (correlated with increased hypothalamic-pituitary-adrenal axis activity) may be associated with more rapid disease progression in Alzheimer-type dementia (AD). In a study conducted at the Washington University School of Medicine in St Louis, Dr John Csernansky and colleagues assessed 33 patients with very mild or mild AD and 21 persons without AD annually for up to 4 years, using the Clinical Dementia Rating Scale and various… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 10:30pm — No Comments

SCREENING FOR AT-RISK DRINKING Barry KL. Screening psychiatric emergency department patients with major mental illnesses for at-risk drinking. Psychiatr Serv. 2006;57:1039-1042.

(PSYCHIATRIC TIMES) - Summary



This study determined the prevalence of at-risk drinking in a psychiatric emergency service (PES) and compared the characteristics and functioning of at-risk drinkers with schizophrenia or bipolar disorder with those of at-risk drinkers with depression or anxiety disorders. Of the adult patients who entered the PES and met study criteria, 148 had schizophrenia or bipolar disorder and 242 had depression or anxiety.



Twenty-three percent of… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 10:30pm — No Comments

Serial MRI cracks mystery of schizophrenia's origins

(PSYCHIATRIC TIMES) - Scottish researchers have opened a way to an accurate predictive test that might help prevent the onset of schizophrenia.



For 10 years, Dr. Dominic E. Job and colleagues at the University of Edinburgh followed 200 young people who were at high risk of developing schizophrenia because two or more family members had already been diagnosed with the illness (BMC Med 2006;4:29).



The investigators analyzed MR scans from 65 of them taken over an interval of… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 10:30pm — No Comments

Don't overlook the impact of these comorbidities COPD and mood disorders, part 1: Anxiety and depression

(PSYCHIATRIC TIMES) - Chronic obstructive pulmonary disease (COPD) is a health problem worldwide, and the impact is expected to increase in the next several decades.1 In the United States, COPD has been diagnosed in more than 10 million persons, and an additional 14 million show signs of the disease, although they have not yet received the diagnosis.2



The COPD death rate for women has more than doubled in the past 20 years--from 20.1 to 56.7 per 100,000--and the financial burden of… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 8:00pm — No Comments

Treatment of Somatic Symptoms in Generalized Anxiety Disorder

(PSYCHIATRIC TIMES) - Generalized 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.… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 5:30am — No Comments

Anxiety in the Medical Patient

(PSYCHIATRIC TIMES) - Anxiety is a ubiquitous, natural affective state that is essential for evolutionary survival. Nearly as common, however, are experiences of anxiety that exceed social, psychological, or physiological needs, leading to functional impairment. Indeed, primary anxiety disorders, including panic disorder, social phobia, and generalized anxiety disorder (GAD), represent the most common category of mental illness in the United States. Secondary, or reactive, anxiety is also… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 5:30am — No Comments

Comorbidity of Bipolar and Panic Disorders and Its Consequences

(PSYCHIATRIC TIMES) - 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… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 5:30am — No Comments

A Mother's Touch Can Reduce Exam Anxiety

(PSYCHIATRIC TIMES) - Because we see many sexually abused children in our practice, we invite the mother to help with superficial labial/vaginal examinations in young girls. We tell the mother exactly what we are going to do, then ask whether she would feel comfortable retracting the labia and touching the patient. Both the involvement of the mother and the fact that the examiner never actually touches the patient help alleviate any anxiety the patient may have



For full article,… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 5:30am — No Comments

Panic Disorder: Telemedicine Gives Encouraging Results

Treatment interventions via telephone, Internet, and through other telemedical services are gaining popularity, especially in rural areas where licensed clinicians might not be available. Dr Per Carlbring and colleagues recently evaluated a 10-week, Internet-based, self-help program with weekly telephone calls for patients who had panic disorder with or without agoraphobia. The results were published in the December 2006 issue of the American Journal of Psychiatry.



A total of 60… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 5:30am — No Comments

Bipolar II

(PSYCHIATRIC TIMES) - by Ronald R. Fieve

New York: Rodale Press, 2006

275 pages • $22.95 (hardcover)



Ronald Fieve and his colleagues were among the first to document milder versions of manic symptoms—hypomania—in the 1970s, observations that did not make it into DSM until 1994. Perhaps the reason for this delay is that hypomania is possibly the only DSM axis I condition that does not involve marked functional impairment and, in fact, requires the absence of such impairment.… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 4:00am — No Comments

Clinical Assessment and Management of Pathological Gambling

(PSYCHIATRIC TIMES) - Pathological gambling (PG) is characterized by persistent and recurrent maladaptive patterns of gambling behavior (eg, a preoccupation with gambling, the inability to control gambling behavior, lying to loved ones, illegal acts, and impaired social and occupational functioning).1 With past-year prevalence rates similar to those of schizophrenia and bipolar disorder,2 it is apparent that PG has become a significant public health issue. The aim of this article, therefore, is… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 4:00am — No Comments

WHIPLASHED: A Mnemonic for Recognizing Bipolar Depression

(PSYCHIATRIC TIMES) - CASE VIGNETTE

Ms T, a 22-year-old, presents to you with her third episode of major depression. Her referring doctor—a very competent family physician—tells you that Ms T "has been tried on everything, and nothing seems to help her." Indeed, the patient has taken 5 different antidepressants in the past 4 years and in each case she "felt like crawling out of her skin." Although the referring physician described the patient as having developed a "tolerance" to various… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 4:00am — No Comments

Comorbidity of Bipolar and Panic Disorders and Its Consequences

(PSYCHIATRIC TIMES) - 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… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 4:00am — No Comments

Methylphenidate Treatment of ADHD in Preschoolers

(PSYCHIATRIC TIMES) - Despite the increased use of methylphenidate in preschoolers with attention deficit/hyperactivity disorder (ADHD), few data are available regarding the efficacy and safety of methylphenidate in this population. Methylphenidate has been approved by the FDA for the treatment of ADHD in children aged 6 years or older. A recent large-scale, controlled trial of methylphenidate for the treatment of preschoolers with ADHD provides clinically relevant and greatly needed… Continue

Added by psychiatryRounds Psychiatry News on March 1, 2007 at 3:00am — No Comments

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