Psychiatry MMC

Psychiatry MMC - ISSN: 1550-5952 - Volume 4 - Issue 4 - April 2007

Brief Report:
Increased Suicidality in Mania Complicated by Alcoholism by Alexander H. Fan, MD; Mark A. Frye, MD; Susan J. Hassell, MS, MPH; Sun Hwang, MS; Lindsay Kiriakos, MD; Jim Mintz, PhD; Michael J. Gitlin, MD; Lori L. Altshuler, MD

Abstract Objective. This retrospective study was done to assess the impact of concurrent alcohol use on the illness presentation of patients hospitalized for mania. Design. Retrospective demographic and clinical data were systematically collected from the hospital records of 122 patients hospitalized for an index episode of mania between 1988 and 1995. Comorbid alcoholism was defined as alcohol abuse/dependence, based on DSM-IV criteria. Blind to alcohol use and treatment intervention, a retrospective clinical assessment of illness severity was made by the Clinical Global Impression (CGI) at the end point of hospital discharge. Demographic and clinical differences between the alcoholic and nonalcoholic manic subjects were analyzed by chi-square and independent t-tests. Survival analyses with hospital length of stay as the dependent variable were conducted on the two groups. Setting. Tertiary care university hospital. Participants. Patients with bip

Forensic Files:
Psychiatric Evaluations of Asylum Seekers: Is it Ethical Practice or Advocacy? by CA Morgan III, MD, MA

Letters to the Editor:
April 2007

Psychotherapy Rounds:
Recognizing and Managing Erotic and Eroticized Transferences by Darnell Ladson, DO; and Randon Welton, MD, LtCol, USAF

Abstract: Transference has been proposed as a critical concept in psychotherapy. The transference may be positive, negative, or sexualized. When the transference becomes sexualized, there are potentially damaging outcomes depending on the management of the transference. This paper addresses the significance of early experiences in residency training with sexualized transference and focuses on the therapeutic relationship in which the transference has become eroticized. The author will explore the potential benefits and challenges of properly managing such transference.Key Words: psychotherapy, countertransference, transference, sexualized transference, erotic transference, eroticized transference

Review:
Borderline Personality and the Pain Paradox by Randy A. Sansone, MD; and Lori A. Sansone, MD

Abstract: Clinical observations and empirical studies indicate that patients with borderline personality are both sensitive and insensitive to pain. This dichotomy may be explained by the context of the pain. For acute self-induced pain, borderline patients seem to experience attenuated pain responses. For chronic endogenous pain, borderline patients appear pain intolerant. In this paper, we explain this unusual paradox. We then discuss the psychiatric assessment of chronic pain, emphasizing the importance of initially determining the patient�s status with regard to borderline personality disorder. For those chronic pain patients who have comorbid borderline personality disorder, we recommend a specific pain-management strategy that addresses the self-regulation difficulties of these patients and minimizes the risks of treatment. Key Words: borderline personality disorder, pain, management, psychotherapy

Neuroscience and Psychoanalysis: Approaches to Consciousness and Thinking by Lawrence Greenman, MD

Abstract: There exists an enormous amount of biological and scientific data in the field of neuroscience, which are daunting and laborious to those who are not directly engaged in these specialized areas. The intricacies and complexities of the role of the central nervous system (CNS) in psychiatric disorders and human behavior are, of course, acknowledged. In this article, observations and speculations of some prominent workers in the field of neuroscience are described with focus on their conclusions, rather than specific findings as they pertain to the mind-body relationship. The mind-brain/body issue has not been resolved insofar as clarifying the connections between CNS activity and thinking is concerned. Currently, it is useful to accept the concept of parallelism between CNS activity and thought. An argument will be made for the inclusion of the psychoanalytic method as an essential component of the scientific effort to elucidate consciousness and thinking.Key Wor

Trend Watch:
Strattera: Ups, Downs, and Emerging Uses by Elisa F. Cascade; Amir H. Kalali, MD; and David Feifel, MD, PhD

Abstract: Although overall prescribing of atomoxetine hydrochloride (HCI) (Strattera) continues to decline, recent anecdotal reports suggest emerging uses of the product in combination therapy. In this article we examine trends in atomoxetine (HCI) prescribing as well as use in combination with other psychotropic classes. An expert commentary is provided on the data.key words: ADHD, attention deficit hyperactivity disorder, pharmacology, atomoxetine hydrochloride, Strattera, augmentation

Update on Cognition:
Will Improving Cognition Change Functional Outcomes in Schizophrenia? 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.

Psychiatry 2006 - ISSN: 1550-5952 - Volume 3 - Issue 5 - May 2006
Feature Article:
The Neurocognitive Mechanisms of Decision-making, Impulse Control, and Loss of Willpower to Resist Drugs
by Xavier No�l, PhD; Martial Van Der Linden, PhD; and Antoine Bechara, PhD

Many individuals with problems of substance addiction become unable to base their drug-use decisions on the long-term outcome of their choices. We present here a neural framework that explains this �myopia� for future consequences. We suggest that addiction may be the product of an imbalance between two separate, but interacting, neural systems that subserve decision-making: A reactive system for signaling pain or pleasure of immediate prospects with the amygdala as a key structure, and a reflective system for signaling pain or pleasure of future prospects involving highly the prefrontal cortex. Through development, socialization, and individuals� learning of social rules, the reflective system gains control over the reactive system via several cognitive (e.g., response inhibition, shifting) and neural mechanisms (fronto-parietal network). However, this control is not absolute; hyperactivity within the reactive system can override the reflective system and the neurotoxicity of drugs co
Ethical Issues in Diagnosing and Treating Alzheimer Disease
by Edmund G. Howe, MD, JD

abstract Many unique ethical issues arise when diagnosing and treating Alzheimer disease (AD). This article discusses several core ethical dilemmas that arise for psychiatrists during different stages of AD, focusing particularly on areas of consensus and controversy. Issues addressed include screening, genetic testing, and discussions of advance directives during early stages; telling soft and even outright lies during middle and late stages; and withholding life-preserving interventions during the last stage of AD when death is imminent. While there is overwhelming ethical consensus that psychiatrists should be fully honest and respect patient autonomy as much as possible during the early stages of disease, there is more controversy regarding the extent to which psychiatrists should do this during the later stages of disease. Possible, optimal approaches to resolving these ethical issues are presented. Key Words: Alzheimers, ethics, dementia
Vagus Nerve Stimulation (VNS) and Treatment of Depression: To the Brainstem and Beyond
by John P. O�Reardon, MD; Pilar Cristancho, MD; and Andrew D. Peshek, MD

abstract Neuromodulation appears to be emerging gradually as a new therapeutic field in psychiatric treatment. It encompasses neuropsychiatric medical devices, such as vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and electroconvulsive therapy (ECT). As a therapeutic approach to affective disorders, neuromodulation shifts the focus from the monoamine synapse to neural circuitry of the brain, which is dysregulated in depression. This neural circuitry has been elaborated on over the course of 15 years of neuroimaging research in mood disorders and is now believed to encompass disturbances in a frontolimbic network. These include reduced metabolism and blood flow in the prefrontal cortex and anterior cingulate and pathologically increased activity in the subgenual cingulate and amygdala. VNS is an implanted device that has established efficacy in pharmaco-resistant epilepsy. It was approved by the FDA for the treatment of severe, r
Effects of Paroxetine CR on Depressive and Anxiety Symptoms in a Community Sample of Adult Hispanic Women with Major Depression or Generalized Anxiety Disorder
by Paul K. Gross, MD; Rosemary Nourse, RN, CCRC; Thomas E. Wasser, PhD, MEd; and Stan Krulewicz, MA

abstract Objective: Previous research reports higher rates of depression in Hispanic women than Caucasian or African American women. The effectiveness and tolerability of paroxetine CR (controlled release) was examined in women of Hispanic heritage with depression or anxiety. Methods: Thirty-six Hispanic female patients 18 years or older meeting DSM-IV criteria for major depression or generalized anxiety disorder diagnosis with an initial Hamilton Depression Rating scale (17 item) ≥20 or Hamilton Anxiety Rating scale ≥18 measuring no less than 4 on the Clinical Global Impression Severity scale received paroxetine CR (12.5�50mg/day) for 29 weeks of open label treatment. Analysis was conducted using repeated measures methodology. Results: Significant symptom reduction was observed on all scales. Mean dose was 31.7mg. The side effect of sexual dysfunction (17%) appeared most frequently but did not cause any patients to cease study participation. Conclusions: Paroxetine CR
BRIEF REPORT New Pharmacotherapies for Treating the Neurobiology of Alcohol and Drug Addiction
by Helen M. Pettinati, PhD; and Amanda R. Rabinowitz

Forensic Files:
The Last Will and Testament and the Psychiatrist
by Seth Feuerstein, MD, JD; Vladimir Coric, MD; Charles A. Morgan, MD; Humberto Temporini, MD; Frank Fortunati, MD, JD; and Steven Southwick, MD

Letters to the Editor:
Factitious Disorders in Children and Adolescents
Marc D. Feldman, MD