Psychiatry

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Attention Deficit Hyperactivity Disorder

(PS001)

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is one of several childhood disorders that encompass behavioral difficulties. Diagnosis of this disorder requires multiple symptoms of either inattention or hyperactivity that have persisted a minimum of six months; some of these symptoms must have been present prior to age seven. It is important to realize that simple inattention or hyperactivity by itself is not sufficient for diagnosis. ADHD has been overdiagnosed in both children and adults by parents, teachers, and even by the patients themselves. Misbehavior by children or teens has been inappropriately diagnosed and treated by persons looking for a "simple" solution to personality difficulties in hopes of avoiding psychotherapy. ADHD is thought to affect 30% of school age children.

The cause of ADHD has not yet been determined. There is thought to be a neurochemical basis involving catecholamines (adrenaline-related chemicals). Studies over the past 20 years involving twins, adoptions, and more recently, molecular investigations, have provided evidence of a genetic basis for the disorder.

The standard method of treatment consists of medication. Often a combination of agents is used.

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The Medifocus Guide on Attention Deficit Disorder provides answers to the following important questions and medical issues:

What are the most common symptoms of attention deficit disorder?

Are there any recognized risk factors for developing attention deficit disorder?

What kinds of medical tests are used to establish the diagnosis of attention deficit disorder?

What is the current standard of care for the treatment of attention deficit disorder?

What treatment options are available for the management of attention deficit disorder?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in attention deficit disorder?

Where are the leading hospitals and centers of research for attention deficit disorder?

What are the most important questions to ask my doctor about attention deficit disorder?

What Your Doctor Reads:

This MediFocus Guide contains an extensive listing of citations and abstracts of recent journal articles that have been published about this condition in trustworthy medical journals. This is the same type of information that is available to physicians and other health care professionals. A partial selection of journal articles that are abstracted in this MediFocus Guide includes:

ADHD in parents.

2000

Attention deficient disorder -- part I.

Harvard Mental Health Letter. 2000

Collaborative possibilities for molecular genetic studies of attention deficit hyperactivity disorder: report from an international conference. The ADHD Molecular Genetics Network.

American Journal of Medical Genetics. 2000

Genetics of attention deficit/hyperactivity disorder: are we ready for molecular genetic studies?.

American Journal of Medical Genetics. 2000

The Texas Children's Medication Algorithm Project: Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Attention-Deficit/Hyperactivity Disorder. Part II: Tactics. Attention-Deficit/Hyperactivity Disorder.

2000

Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. American Academy of Pediatrics.

Pediatrics. 2000

Bipolar disorder and attention-deficit/hyperactivity disorder in children and adolescents.

Journal of Clinical Psychiatry. 2000

Attention-deficit/hyperactivity disorder: a neuropsychiatric disorder with childhood onset.

European Journal of Paediatric Neurology. 2000

Are stimulants overprescribed for youths with ADHD?.

Annals of Clinical Psychiatry. 2000

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Bipolar Disorder

(PS002)

Introduction

Bipolar disorder, also called manic depression, is a disorder of mood or affect that affects children and adolescents as well as adults. This disorder is characterized by two opposite extremes of mood: mania and depression.

The usual pattern of bipolar disorder is one of increasing intensity and duration of symptoms that progresses slowly over many years. However, symptoms and severity may vary significantly between individuals. Bipolar disorder can be severe and long-term, or it can be mild with infrequent episodes.

Bipolar disorder can have significant consequences on an individual's life. Impaired thinking and judgement can lead to poor decision making and impulsiveness. This can have disastrous effects on one's physical and sexual health, and financial and social wellbeing.

Treatment of Bipolar Disorder consists of a combination of medication and other forms of therapy. Several promising new treatments are currently under investigation.

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This Medifocus Guide on Bipolar Disorder provides answers to the following important questions and medical issues:

What are the most common symptoms of bipolar disorder?

Are there any recognized risk factors for developing bipolar disorder?

What kinds of medical tests are used to establish the diagnosis of bipolar disorder?

What is the current standard of care for the treatment of bipolar disorder?

What treatment options are available for the management of bipolar disorder?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in bipolar disorder?

What are the leading hospitals and centers of research for bipolar disorder?

What are the most important questions to ask my doctor about bipolar disorder?

What Your Doctor Reads:

Adjuvant therapy of melanoma with interferon-alpha-2b is associated with mania and bipolar syndromes.

Cancer. 2000

The Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder 2000.

Postgraduate Medicine. 2000

The genes for major psychosis: aberrant sequence or regulation?.

Neuropsychopharmacology. 2000

Reduced suicide risk during lithium maintenance treatment.

Journal of Clinical Psychiatry. 2000

Integration of pharmacotherapy and psychotherapy for bipolar disorder.

Journal of Clinical Psychiatry. 2000

The treatment of bipolar depression.

Journal of Clinical Psychiatry. 2000

Suicide and bipolar disorder.

Journal of Clinical Psychiatry. 2000

Efficacy of lithium in mania and maintenance therapy of bipolar disorder.

Journal of Clinical Psychiatry. 2000

Bipolar disorder and attention-deficit/hyperactivity disorder in children and adolescents.

Journal of Clinical Psychiatry. 2000

The longitudinal course of bipolar disorder.

Journal of Clinical Psychiatry. 2000

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Depression

(PS003)

Introduction

Depression, which may represent either a temporary mental state, or a chronic mental disorder, is characterized by feelings of sadness, loneliness, despair, low self-esteem, guilt and withdrawal from social contact.

Depression will affect one third of adults in the United States sometime during their lives. At any given time, 5% of adults are depressed, with women being three times likely as men to suffer depression. Although the median age of onset of depression is 25 years, the initial episode can occur at any age.

Most persons who experience depressive symptoms have a minor depression. Fortunately, almost all sufferers recover completely from a single episode of depression. Major depression is a recurrent disorder, and the risk of further episodes increases with each subsequent episode. Depression is a significant risk factor for suicide among men and women, young and old.

Depression is thought to be due to a deficiency in one or more of three chemicals (neurotransmittors) in the brain called monoamines: serotonin, norepinephrine, and dopamine.

Most cases of depression are best treated with a combination of medication and psychological counseling or psychotherapy. Pharmacological approaches attempt to correct the chemical imbalance that is causing the depression. Treatment usually consists of medications and psychotherapy. Severe cases may warrant electroconvulsive therapy.

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The Medifocus Guide on Depression provides answers to the following important questions and medical issues:

What are the most common symptoms of depression?

Are there any recognized risk factors for developing depression?

What kinds of medical tests are used to establish the diagnosis of depression?

What is the current standard of care for the treatment of depression?

What treatment options are available for the management of depression?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in depression?

Where are the leading hospitals and centers of research for depression?

What are the most important questions to ask my doctor about depression?

What Your Doctor Reads:

The mutually reinforcing triad of depressive symptoms, cardiovascular disease, and erectile dysfunction.

American Journal of Cardiology. 2000

Commentary: assessment of clinical depression in patients who request physician-assisted death.

Journal of Pain & Symptom Management. 2000

Nutrition and depression: focus on folate.

Nutrition. 2000

Adult brain neurogenesis and psychiatry: a novel theory of depression.

Molecular Psychiatry. 2000

Dysthymia: a review of pharmacological and behavioral factors.

Molecular Psychiatry. 2000

The role of depression severity in the cognitive functioning of elderly subjects with central nervous system disease.

Journal of Psychiatry & Neuroscience. 2000

Is depression a risk factor for dementia or cognitive decline? A review.

Gerontology. 2000

The effects of nicotine on neural pathways implicated in depression: a factor in nicotine addiction?.

Pharmacology, Biochemistry & Behavior. 2000

Dieting, essential fatty acid intake, and depression.

Nutrition Reviews. 2000

Cancer-related depression: Part I--Neurologic alterations and cognitive-behavioral therapy.

Oncology Nursing Forum. 2000

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Eating Disorders: Anorexia and Bulimia

(PS004)

Introduction

Eating disorders are characterized by serious disturbance in eating, such as the restriction of intake or bingeing, as well as distress or excessive concern about body shape or body weight. There are several types of eating disorders: anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder, as well as atypical eating disorders.

Eating disorders affect an estimated 5 million Americans every year. While eating disorders primarily affect young females, they can also occur in males, young children and older adults over the age of 50. Eating disorders appear to be caused by a combination of genetic, neurochemical, psychodevelopmental, and sociocultural factors.

The goals of treatment for all eating disorders include stabilization of medical and nutritional status, identification and resolution of psychological precipitants of the disorder, and reestablishment of healthful patterns of eating.

Education and modifications of behavior are the preferred methods of effecting weight gain. Enteral (tube-feeding) and parenteral (intravenous) nutrition is reserved for those with severe undernutrition. Medications such as antidepressants are commonly used.

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The Medifocus Guide on Eating Disorders provides answers to the following important questions and medical issues:

What are the most common symptoms of eating disorders?

Are there any recognized risk factors for developing eating disorders?

What kinds of medical tests are used to establish the diagnosis of eating disorders?

What is the current standard of care for the treatment of eating disorders?

What treatment options are available for the management of eating disorders?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in eating disorders?

Where are the leading hospitals and centers of research for eating disorders?

What are the most important questions to ask my doctor about eating disorders?

What Your Doctor Reads:

Stepped care treatment for eating disorders.

Journal of Consulting & Clinical Psychology. 2000

Eating disorders in adolescents and young adults.

Medical Clinics of North America. 2000

Eating disorders: diagnosis, etiology, and prevention.

Nutrition. 2000

Eating disorders: a strategic approach.

Practitioner. 2000

The female athlete triad.

American Family Physician. 2000

The reproductive endocrine consequences of anorexia nervosa.

BJOG: an International Journal of Obstetrics & Gynaecology. 2000

Eating disorders and family therapy. Why, how and when?.

Eating & Weight Disorders: EWD. 2000

Gastric perforation caused by a bulimic attack in an anorexia nervosa patient: report of a case.

Surgery Today. 2000

Research on eating disorders: current status and future prospects.

Biological Psychiatry. 2000

Eating disorders: a situation of malnutrition with peculiar changes in the immune system.

European Journal of Clinical Nutrition. 2000

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Grief and Bereavement

(PS005)

Introduction

Various definitions have been developed for the terms associated with the loss of a loved one. Bereavement is the state of having lost a significant other to death; grief is the personal response to the loss; and mourning is the public expression of that loss. The experience of grief is commonly influenced by the nature of the loss, whether sudden and unexpected, traumatic, or following a prolonged illness, which often allows for the beginning of the grief process days, weeks or months before the loss actually occurs.

Bereavement is a very individual process. No two persons experience grief in quite the same way. The meaning of the loss is different even for members of the same family. Accordingly, the emotions and significance of the loss will be different for each person as well. Grief may be strong or weak, prolonged or brief, immediate or delayed.

The goals of care for bereaved persons are to support and facilitate a normal grief process, thereby preventing or minimizing physical or mental health deterioration, and to detect bereavement complications so as to offer timely and appropriate treatment options. Medications, counseling and lifestyle interventions are often used.

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The Medifocus Guide on Grief and Bereavement provides answers to the following important questions and medical issues:

What are the most common symptoms of grief and bereavement?

Are there any recognized risk factors for developing grief and bereavement?

What kinds of medical tests are used to establish the diagnosis of grief and bereavement?

What is the current standard of care for the treatment of grief and bereavement?

What treatment options are available for the management of grief and bereavement?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in grief and bereavement?

Where are the leading hospitals and centers of research for grief and bereavement?

What are the most important questions to ask my doctor about grief and bereavement?

What Your Doctor Reads:

How can you help the bereaved patient?.

Practitioner. 2000

Chronic sorrow in parents of children with newly diagnosed diabetes: a review of the literature and discussion of the implications for nursing practice.

Journal of Advanced Nursing. 2000

Photographs and mementos. The emergency nurse's role following sudden infant death.

Emergency Nurse. 2000

The lived experience of grieving for persons living with HIV who have used injection drugs.

Journal of the Association of Nurses in AIDS Care. 2000

Support for women/families after perinatal death.

Cochrane Database of Systematic Reviews [computer file]. 2000

Acute and post-traumatic stress disorder after spontaneous abortion.

American Family Physician. 2000

On the classification and diagnosis of pathological grief.

Clinical Psychology Review. 2000

Consensus criteria for traumatic grief. A preliminary empirical test.

British Journal of Psychiatry. 1999

Bereavement and loss in childhood.

Child & Adolescent Psychiatric Clinics of North America. 1998

Loss, grief, and bereavement in family members of cancer patients.

Seminars in Oncology Nursing. 1998

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Obsessive-Compulsive Disorder

(PS007)

Introduction

Obsessive-compulsive disorder (OCD) is an illness characterized by recurrent obsessions and uncontrolled compulsions such as repetitive behavioral or mental acts ("rituals") that are performed in response to these obsessions. These ritualistic behaviors are believed to prevent or produce a future event. However, the rituals themselves have nothing to do with that event.

These obsessions and compulsions are time consuming and can significantly interfere with one's normal daily routine and ability to perform at their occupation. Symptoms may last for years or even decades and continue to progress if untreated.

OCD is thought to affect 2-3% of the general population or 4-6 million persons in the United States. OCD is the fourth most common psychiatric diagnosis in the United States, following phobias, substance abuse, and major depression. Studies have demonstrated a connection between OCD and altered levels of the neurotransmitter serotonin in the brain.

The treatment of OCD has significantly advanced in the past 10 years, and both pharmacologic and behavioral approaches are effective and important components in the management of OCD.

Treatment for OCD is usually multifaceted using both medication and counseling to control both the obsession and compulsion aspects of the disorder. Persons who do not respond well to these basic treatments may be considered candidates for other treatments.

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The Medifocus Guide on Obsessive-Compulsive Disorder (OCD) provides answers to the following important questions and medical issues:

What are the most common symptoms of OCD?

Are there any recognized risk factors for developing OCD?

What kinds of medical tests are used to establish the diagnosis of OCD?

What is the current standard of care for the treatment of OCD?

What treatment options are available for the management of OCD?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in OCD?

Where are the leading hospitals and centers of research for OCD?

What are the most important questions to ask my doctor about OCD?

What Your Doctor Reads:

The internal and external boundaries of obsessive-compulsive disorder.

Australian & New Zealand Journal of Psychiatry. 2000

On the pharmacotherapy of obsessive-compulsive disorder: is a consensus possible?.

2000

Neurobiology of the obsessive-compulsive spectrum disorders.

Biological Psychiatry. 2000

Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research.

Behaviour Research & Therapy. 1999

Obsessive-compulsive disorder: diagnosis and treatment.

Journal of Clinical Psychiatry. 1999

The assessment and coordination of treatment of children and adolescents with OCD.

Child & Adolescent Psychiatric Clinics of North America. 1999

Postinfectious and other forms of obsessive-compulsive disorder.

Child & Adolescent Psychiatric Clinics of North America. 1999

Managing aggressive behavior in patients with obsessive-compulsive disorder and borderline personality disorder.

Journal of Clinical Psychiatry. 1999

Understanding and treating obsessive-compulsive disorder.

Behaviour Research & Therapy. 1999

Posttraumatic obsessive-compulsive disorder: a three-factor model.

Psychiatry. 1999

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Panic Disorders

(PS008)

Introduction

A panic attack is a discrete period of intense fear of discomfort accompanied by a number of defined symptoms (see below). Some persons experience only one attack in their lives and never experience another. However, persons who have recurrent attacks are said to have panic disorder (PD) and can experience significant disability if untreated.

PD is defined in the Diagnostic and Statistical Manual 4th edition (DSM-IV) as recurrent panic attacks presenting in conjunction with persistent concern over additional episodes, worry over the significance or consequences of the attacks, and/or a notable change in related behavior experienced for one month (or longer) following at least one of the attacks.

PD affects between 3 and 6 million Americans. It affects women twice as commonly as men, and can occur at any age but most often begins in young adults.

During the past 2 decades, there have been significant advances in the treatment of PD, and a range of therapeutic choices is now available. Anxiety disorders are generally treated by a combination approach utilizing both medication and behavioral therapy.

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The Medifocus Guide on Panic Disorder provides answers to the following important questions and medical issues:

What are the most common symptoms of panic disorder?

Are there any recognized risk factors for developing panic disorder?

What kinds of medical tests are used to establish the diagnosis of panic disorder?

What is the current standard of care for the treatment of panic disorder?

What treatment options are available for the management of panic disorder?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in panic disorder?

Where are the leading hospitals and centers of research for panic disorder?

What are the most important questions to ask my doctor about panic disorder?

What Your Doctor Reads:

Panic: worry in the extreme.

Harvard Womens Health Watch. 2000

The impact of comorbid mood and personality disorders in the cognitive-behavioral treatment of panic disorder.

Clinical Psychology Review. 2000

Recognition and acute management of patients with panic attacks in the emergency department.

Emergency Medicine Clinics of North America. 2000

Current concepts in the treatment of panic disorder.

Journal of Clinical Psychiatry. 1999

The impact of pregnancy and puerperium on panic disorder: a review.

Journal of Psychosomatic Obstetrics & Gynecology. 1999

Blocking the cycle of panic disorder. Ways to gain control of the fear of fear.

Postgraduate Medicine. 1999

Traumatic memories, eye movements, phobia, and panic: a critical note on the proliferation of EMDR.

Journal of Anxiety Disorders. 1999

Does EMDR work? And if so, why?: a critical review of controlled outcome and dismantling research.

Journal of Anxiety Disorders. 1999

Psychological strategies for discontinuing benzodiazepine treatment.

Journal of Clinical Psychopharmacology. 1999

Subclinical symptoms of panic disorder: new insights into pathophysiology and treatment.

Psychotherapy & Psychosomatics. 1999

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Schizophrenia

(PS010)

Introduction

Schizophrenia is a chronic and disabling brain disease. People with schizophrenia often suffer terrifying episodes of hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn. Their speech and behavior can be so disorganized that they may be incomprehensible or frightening to others.

Some people have only one episode; others have many episodes during a lifetime, but lead relatively normal lives during the interim periods. However, the individual with "chronic" schizophrenia, or a continuous or recurring pattern of illness, often does not fully recover normal functioning and typically requires long-term treatment, generally including medication, to control the symptoms. Available treatments can relieve many symptoms, but most people with schizophrenia continue to suffer some symptoms throughout their lives.

Approximately 1 percent of the population develops schizophrenia during their lifetime - more than 2 million Americans suffer from the illness in a given year.

There is now significant emphasis on early diagnosis and treatment of schizophrenia. The initial episode often requires hospitalization. Medications and other treatments for schizophrenia can help reduce and control the distressing symptoms of the illness.

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The Medifocus Guide on Schizophrenia provides answers to the following important questions and medical issues:

What are the most common symptoms of schizophrenia?

Are there any recognized risk factors for developing schizophrenia?

What kinds of medical tests are used to establish the diagnosis of schizophrenia?

What is the current standard of care for the treatment of schizophrenia?

What treatment options are available for the management of schizophrenia?

Are there any promising new developments or potential breakthroughs in treatment?

Who are the most notable medical authorities who specialize in schizophrenia?

Where are the leading hospitals and centers of research for schizophrenia?

What are the most important questions to ask my doctor about schizophrenia?

What Your Doctor Reads:

Schizophrenia epigenesis?.

Theoretical Medicine & Bioethics. 2000

Depression in schizophrenia: perspective in the era of "Atypical" antipsychotic agents.

American Journal of Psychiatry. 2000

Patient education in schizophrenia: a review.

Acta Psychiatrica Scandinavica. 2000

Family interventions in schizophrenia and related disorders: a critical review of clinical trials.

Acta Psychiatrica Scandinavica. 2000

Guideline for the pharmacotherapy of treatment-resistant schizophrenia. Royal College of Psychiatrists of Thailand.

Journal of the Medical Association of Thailand. 2000

Intrinsic excitatory connections in the prefrontal cortex and the pathophysiology of schizophrenia.

Brain Research Bulletin. 2000

The imbalanced brain: from normal behavior to schizophrenia.

Biological Psychiatry. 2000

Drugs with estrogen-like potency and brain activity: potential therapeutic application for the CNS.

Current Pharmaceutical Design. 2000

Schizophrenia as a disorder of developmentally reduced synaptic connectivity.

Archives of General Psychiatry. 2000

Addiction and schizophrenia.

European Psychiatry: the Journal of the Association of European Psychiatrists. 2000

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