Psychiatry MMC

Psychiatry 2007 - ISSN: 1550-5952 - Volume 4 - Issue 1 - January 2007
Feature Article:
Managing Depressive Disorders in Patients with Epilepsy
by Madhukar H. Trivedi, MD; and Ben T. Kurian, MD, MPH

Abstract: Patients with epilepsy are more likely to suffer from psychiatric illnesses, and more specifically depressive disorders (9% to 22%), than the general population. Depression in epilepsy is often described by the temporal correlation to a seizure, with interictal depression being the most commonly described. Furthermore, epileptic patients with depression often report a poorer quality of life on global assessments and are at an increased risk of suicide as compared to the general population, 11.5 percent versus 1.2 percent, respectively. Despite the clinical significance of depression, it often goes unrecognized and hence untreated in this population. Recently, more efforts at screening epilepsy patients for coexisting depression have been undertaken, yielding fair results. However, some epilepsy patients express a certain constellation of symptoms, including an explosive or irritable mood, somatic pains, anxiety and fear, and periods of brief euphoria, which are not cap
Why Psychiatrists Are Reluctant to Diagnose Borderline Personality Disorder
by Joel Paris, MD

Abstract: Clinicians can be reluctant to make a diagnosis of borderline personality disorder (BPD). One reason is that BPD is a complex syndrome with symptoms that overlap many Axis I disorders. This paper will examine interfaces between BPD and depression, between BPD and bipolar disorder, and between BPD and psychoses. It will suggest that making a BPD diagnosis does more justice to patients than avoiding it.

Key Words: borderline personality disorder, psychiatric diagnosis
A Description of the Use of Music Therapy in Consultation-Liaison Psychiatry
by Roia Rafieyan, MA, MT-BC; and Rose Ries, MD

Abstract: Music therapy is gaining increasing recognition for its benefit in medical settings both for its salutary effects on physiological parameters and on psychological states associated with medical illness. This article discusses the role of a music therapist in consultation-liaison psychiatry, a specialty that provides intervention for medical and surgical patients with concomitant mental health issues. We describe the ways in which music therapy has been integrated into the consultation-liaison psychiatry service at Hahnemann University Hospital, a tertiary care facility and major trauma center in Philadelphia. The referral process and some of the techniques used in music therapy are explained. Anecdotal observations illustrate how a music therapist incorporates the various elements of music as well as the experiences of engaging in music-making to bring about changes in mood and facilitate expression of feelings and social interactions in patients who are having diffi

Letters to the Editor:
Risperidone-induced enuresis in an adult
by Tanvir Singh, MD; Theodor Rais, MD;and Alina Rais, MD

Point/Counterpoint:
Point�Our psychiatric diagnoses are still unreliable
by Ahmed Aboraya, MD, DrPh
Counterpoint�There isn�t enough evidence available to speculate on the reliability of diagnoses in clinical settings
by Michael B. First, MD

Psychotherapy Rounds:
More than Medication�Achieving Goals through Psychotherapy in Patients with Obsessive Compulsive Disorder
by J. Scott Wilson, MD; and Brenda JB Roman, MD; Series Editor: Paulette Marie Gillig, MD, PhD

Abstract: There are numerous variables to consider when planning treatment for a psychiatric disorder as complex as obsessive compulive disorder (OCD). Beyond the efficacy of the medications, one must take into account patient preferences and beliefs, as well as the impact of the disease and treatment on social and occupational functioning. Psychotherapy, specifically cognitive behavioral therapy (CBT), can serve as an addition to pharmacotherapy or as an alternative treatment, if necessary, for OCD. However, psychotherapy remains under-utilized. In this article, the authors review the available evidence supporting various treatment options for OCD and describe how psychotherapy (specifically CBT) can be used as monotherapy for OCD or as an adjunct to medication. Effective strategies for delivering CBT via its two modalities (exposure-response prevention and cognitive therapy) are described and illustrated by a composite case.

Editor�s Note: All cases presented in the

Trend Watch:
Prescribing for Buprenorphine in the Treatment of Opioid Addiction
by Elisa F. Cascade; Penny Randall, MD, MBA; and Amir H. Kalali, MD
Expert Commentary� Prescribing for Buprenorphine in the Treatment of Opioid Addiction
by Susan Stine, MD, PhD

Update on Cognition:
Cognitive Impairments in Major Depression and Bipolar Disorders
by Philip D. Harvey, PhD

This regular column is written to provide readers with the latest updates on the measurement and treatment of cognitive and functional deficits in psychiatric disorders.