Cover Article
What Are the Long-Term Effects of Rapid-Cycling Bipolar Disorder?
Long-term follow-up of patients with rapid-cycling bipolar I or bipolar II disorder has yielded a clearer picture of rapid cyclers. “In the large majority of cases, rapid cycling does not persist more than several years beyond its onset, though it is associated with an increased level of long-term morbidity,” said William Coryell, MD. Regarding treatment, he commented that “currently used antidepressants do not seem to trigger manic episodes nor promote rapid cycling.”

Selected Articles

• Are Antidepressants Beneficial for All Patients Who Have a Stroke?
• The Genetics of Schizophrenia—Recent Findings

Cover Article
Some Autistic Children Benefit From Behavioral Intervention
The lifetime outlook for autistic children may be improving. A recent study showed that early extensive behavioral intervention can increase most autistic children’s IQ—some considerably enough to allow for mainstream schooling.

Selected Articles

• Stimulants May Limit Neurospasticity
• Disturbed Sleep and Psychiatric Disorders in Children—Is There a Link?

Cover Article
Common Misperceptions of Bipolar Disorder May Lead to Misdiagnosis in Children
Results of a nationwide survey indicate that common misperceptions about bipolar disorder could lead to misdiagnosis in children and could also delay appropriate treatment.

• Does Living at Home Enhance a College Freshman’s Mental Health?
• Is Gambling a Risk for Patients With Parkinson’s Disease?

Cover Article
Atypical Antipsychotics and Metabolic Disorders—Are Physicians Aware of the Risks?
While weight gain and diabetes are risks widely associated with many atypical antipsychotics, other metabolic disorders may be unique to one or perhaps a few atypical antipsychotics. A recent survey assessed psychiatrists’ knowledge of the adverse effects of the drugs they prescribe and the role that metabolic disorders play in prescribing decisions.

Selected Articles

• Physicians and Patients Don’t See Eye to Eye When Selecting Antidepressants
• Defining the Core Catatonic Syndrome—A New Look at Presentation and Diagnosis

Cover Article
Managing Dementia and Aggression in Schizophrenia and Alzheimer’s Disease
In her address at the American Association for Geriatric Psychiatry’s annual meeting, Sue Borson, MD, examined the relationship between the cognitive impairments typical of schizophrenia, Alzheimer’s disease, and other primary neurodegenerative dementias in order to consider informative commonalities.

Selected Articles

• Antipsychotic Therapy—Is There a Link to Diabetes?
• Herbal Options for Antidepressant-Induced Sexual Dysfunction

Cover Article
Sudden Emergence of Visual Creativity in Patients With Frontotemporal Dementia
Bruce L. Miller, MD, discusses several unusual cases in which patients with a variant of frontotemporal dementia have suddenly exhibited artistic abilities when none existed before or have displayed a dramatic resurgence of visual creativity at a time when their progressive cognitive decline should have rendered them artistically impotent.

Selected Articles

• Can a Treatment for Parkinson’s Disease Help Alleviate OCD?
• Is Diabetes a Risk Factor for Cognitive Impairment?

Cover Article
What Contributes to Good Vocational Outcomes in Some Schizophrenia Patients?
While life-long functional disability is common in patients with schizophrenia, there is a small percentage of patients who are able to work. Two studies presented at the annual meeting of the International Neuropsychological Society focused on predictors of good vocational outcome in patients with schizophrenia.

Selected Articles

• Depression and Huntington’s Disease—Different Symptoms for Different Stages
• Neurocognitive Deficits in Relatives May Predict Schizophrenia But Not ADHD

Cover Article
Behavioral Neurogenetics—A Complementary Strategy to Understanding Neuropsychiatric Disorders
Behavioral neurogenetics is “first and foremost an opportunity to improve our understanding of how genetic factors influence brain development,” said Allan L. Reiss, MD, at the 14th Annual Meeting of the American Neuropsychiatric Association. He elaborated on the concept by discussing how it has yielded insights into Fragile X syndrome and Williams syndrome.

Selected Articles

• The Effects of War—Posttraumatic Stress Disorder After Traumatic Brain Injury
• Serotonin Transporter Defect May Underlie Suicidal Behavior

Cover Article
The Brain on Drugs—Key Finding May Pave the Way For Universal Treatment of Drug Addiction
According to researchers at Stanford University, all addictive drugs, regardless of their molecular mechanisms, affect neurons in the same area of the brain. This finding suggests that it may be possible to someday contrive a universal approach to treating addiction.

Selected Articles

• Combination Therapy Enhances Schizophrenia Treatment
• Can Neurocognition Predict Future Quality of Life in Patients With Mental Illness?

Cover Article
Functional Imaging Provides Insight Into the Neural Substrate of Anosognosia
Several studies have indicated that patients with Alzheimer’s disease and anosognosia have significantly more deficits on frontal lobe-related neuropsychological tests. Recent neuroimaging findings now demonstrate that decreased glucose uptake in the anterior cingulate cortex correlates with anosognosia severity.

Selected Articles

• Does Drinking Wine Help Keep Dementia Away?
• Dopamine Agonists for Smoking Cessation?

Cover Article
Is Bipolar Disorder More Prevalent Than Believed?
The prevalence of bipolar disorders in the United States is almost three times greater than previously reported, according to new data presented at the 2002 Annual Meeting of the American Psychiatric Association. “These findings suggest that bipolar disorders are under-recognized, under-diagnosed, and potentially misdiagnosed,” said Robert Hirschfeld, MD, the study’s lead author.

Selected Articles

• Should Children With Psychiatric Conditions Undergo EEGs?
• Why Doesn’t the Mental Health System Work?

Cover Article
Bright Light Treatment Inconsistent, Study Suggests
At first glance, bright light treatment seems promising for a range of neuropsychiatric conditions, but in the practical sense, most therapy scenarios suffer from an inability to rigorously control how much light is actually delivered. Too often, the result is inconsistent and questionably effective treatment.

Selected Articles

• Brain Volumetric Changes in Bipolar I Disorder—A Gray Matter
• A Neural Theory of Consciousness

Cover Article
Delirium Is Under-Recognized and Under-Treated
One of the barriers to intervention is the lack of recognition of the distress experienced by medically ill patients with delirium, as well as by their caregivers and the nursing staff. Two presentations at the 2002 Annual Meeting of the American Psychiatric Association addressed the problem of delirium in medically ill patients.

Selected Articles

• Is There a Bidirectional Link Between Migraine and Major Depression?
• Brain Music Therapy for the Treatment of Insomnia and Anxiety

Cover Article
Pregnant and Postpartum Women With Psychiatric Illness Are Often Under-Treated
Although there is almost no evidence that maternal use of most psychiatric drugs harms either the fetus or the breast-fed infant, most psychiatrists are hesitant to prescribe psychoactive drugs for patients during pregnancy or the postpartum period. At the American Psychiatric Association’s 2002 Annual Meeting, Zachary Stowe, MD, admonished clinicians to weigh the risk of treatment against the risk that untreated maternal illness poses for mother and child. Further, he advised that physicians should generally continue the treatment regimen that has worked in the past.

Selected Articles

• Interim Olanzapine Report—Prodromals Happier but Heavier
• Beyond Benzodiazepines

Cover Article
Rotten in Denmark—The Case for Psychotherapeutics
Using Shakespeare’s Hamlet as an example of a conflicted soul and a model for the depressed patient, Elio Frattaroli, MD, posits that in the age of the brain, many psychiatrists have lost all sense of psychiatry as the art and science of healing the psyche. Instead of healing, psychiatrists increasingly focus on adjusting brain chemistry. Dr. Frattaroli views depression not as a disease but as a symptom of an underlying emotional conflict and he believes that this symptom embodies an unconscious impulse toward healing.

Selected Articles

• The Mind’s Eye—Neuroscience, Synesthesia, and Art
• Novel Targets, Novel Mechanisms for Antidepressants

Cover Article
Posttraumatic Stress Disorder in the Age of Terrorism
Carol S. North, MD, MPE, details the psychiatric fallout in the aftermath of the Oklahoma City bombing as a real-world example of how individuals respond to disasters or terrorist attack. She identifies the two symptoms that virtually define posttraumatic stress disorder and discusses what to expect in the wake of the September 11 attack.

Selected Articles

• Subsyndromal Depression—Undefined and Misdiagnosed?
• “Unaware” May Equal “Unwilling” in Patients With Psychotic Disorders

Cover Article
Provisional Diagnostic Criteria for Depression of Alzheimer’s Disease
Twenty experts have proposed consensus criteria for diagnosing depression of Alzheimer’s disease. These criteria, they posit, should provide a target for treatment studies.

Selected Articles

• Driving With Dementia—What Is the Physician’s Role?
• Consensus Report Defends Ethics, Utility of Placebo in Clinical Trials of Mood Disorders

Cover Article
How to Recognize Frontotemporal Dementia
The various frontotemporal dementia syndromes are characterized by a wide range of behavioral and cognitive manifestations. Dr. Tiffany Chow offers tips on how to recognize FTD and treat the resulting symptoms.

Selected Article

• Putting the "Fun" in Functional Neuroanatomy

Cover Article
Pediatric Depression: Treatment Tips and Tatics
Despite recent evidence that childhood-onset depression is greatly under-diagnosed and under-treated, there have only been a handful of large clinical trials focusing on this population. Here is what we know so far.

Selected Article

• ADHD: What to Do When Stimulant Treatment Fails
• Can Beta Blockers Prevent PTSD? A First Look

Cover Article
Beyond Psychosis
Use of atypical antipsychotics for pediatric patients has expanded well beyond the treatment of psychosis itself. Yet the data supporting these off–label indications if often tenous. This article reviews the published and unpublished data from–blind trials of atypical agents in the treatment of conduct disorder (for patients with subnormal IQs) and Tourette's syndrome.

Selected Article

• Why Isn’t Methylphenidate More Addictive?

Cover Article
Treating Aggression
Aggression is associated with numerous neuropsychiatric disorders, including dementia, mental retardation, and stroke. Fortunately, a wide range of medications have been shown to decrease the frequency and intensity of aggressive acts. Which agent should the clinician try first?

Selected Article

• Schizophrenia: A "Wave" of Cortical Changes

Cover Article
Which Is More Toxic to a Fetus—Antidepressants or Maternal Depression?
Ten years ago, many clinicians considered prescribing antidepressants to a pregnant woman to be foolhardy. But recent data increasingly suggest otherwise. Most studies indicate that antidepressants do not increase the risk of obstetrical complications or birth defects (though more long-term behavioral studies are needed). Conversely, evidence now suggests that untreated maternal depression can have deleterious effects on offspring, both by altering their neurobiology during fetal development and by compromising care after birth.

Selected Articles

• Are Patients With Real Head Injuries Better Malingerers?
• Geriatric Depression: New Avenues of Research

Cover Article
Are Today's Mood Stabilizers Tomorrow's Neurotrophic Agents?
New evidence suggests that lithium and other mood stabilizers may actually promote neuronal growth and survival. It is not yet clear, however, whether these neurotrophic and neuroprotective effects contribute to clinical response.

Selected Articles

• Poststroke Anxiety Disorder: Try a Tricyclic?
• Atypical Antipsychotics: New Evidence of Diabetes Risk

Cover Article
Searching for the Essence of Delirium
Delirium is associated with a wide range of symptoms, including disorientation, memory problems, delusions, and numerous others. But which of these symptoms represent the essential features of the syndrome?

Selected Articles

• Why is Psychopathology So Common in Cerebellar Degeneration?
• Management of Comorbid ADHD and Tics

Cover Article
Treating Pediatric Depression: What We Know—and What Lies Ahead
Although clinicians and researchers have begun to recognize the high prevalence and substantial impact of childhood depression, only two large placebo-controlled antidepressant trials have been conducted in pediatric patients. Fortunately, additional multicenter trials are currently underway and should yield a wealth of clinically valuable data during the next three to five years.

Selected Articles

• OCD: Will Immunotherapy Succeed Where Other Approaches Have Failed?
• Recognizing Psychopathology in Early Childhood

Cover Article
Why Don't Psychiatrists Look at the Brain? The Case for Greater Use of SPECT Imaging in Neuropsychiatry
In this intriguing article, Dr. Daniel Amen argues that psychiatrists have vastly underutilized SPECT imaging in their clinical work and that the technique can play a valuable role in diagnosis and treatment.

Selected Articles

• The MTA Trial: How Long Do the Benefits Last?
• ADHD in Adults: Definition and Diagnosis

Cover Article
Can Schizophrenia Be Prevented?
Several teams of investigators are working to achieve one of the key goals of schizophrenia research: halting the development of the disease while patients are still in the prodromal phase. Their initial findings, while necessarily sketchy and preliminary, nonetheless suggest that this approach holds great promise.

Selected Articles

• Is rTMS as Effective as ECT?
• Psychiatric Disorders in Epilepsy: An Interview With Dietrich Blumer, MD

Cover Article
Brain Injury and Alzheimer's Disease: What Is the Link?
Recent studies have yielded new insights into the controversial connection between traumatic brain injury and Alzheimer's disease. Some investigators even believe that brain injury may provide a route for understanding the pathogenic mechanisms behind Alzheimer's.

Selected Articles

• The OCD Spectrum: From Autism to Problem Gambling
• Treating Behavioral Disturbances in Alzheimer's Disease: What Works?

Cover Article
Which Depressed Patients Will Get Better? New findings on predicting treatment response
Electrophysiologic measures may offer insights regarding which depressed patients are likely to respond to antidepressant medication, researchers reported at the annual meeting of the American Psychiatric Association.

Selected Articles

• DLB + Alzheimer's = Lewy Body Proliferation
• Apathy in Depression: A Result of Cholinergic Dysregulation?

Cover Article
Better, Stronger, Faster: Accelerating Antidepressant Response in Elderly Patients
Combination therapy and electroconvulsive therapy are the most promising approaches for reducing response time in elderly patients with depression, according to a symposium at the annual meeting of the American Association for Geriatric Psychiatry.

Selected Articles

• Childhood-Onset Bipolar Disorder: The Danger of Misdiagnosis:
  An interview with Demitri Papolos, MD
• "N of 1" Trials: An Underused Approach in Clinical Psychiatry?

Cover Article
Can Antidepressants Prevent Poststroke Dementia?
Treating depression in stroke patients may delay or even prevent the occurrence of poststroke dementia, according to a series of recent studies. The findings may help resolve the question of whether cognitive impairment leads to depression in stroke survivors, or whether depression causes the cognitive impairment.

Selected Articles

• Is It AD or DLB? Tau May Tell, Plus Other Dementia News From ANPA
• Parkinson's Disease: Do Mood and Motor Fluctuations Match?

Cover Article
ADHD in Adults: Are the Current Diagnostic Criteria Adequate?
Diagnosing attention-deficit/hyperactivity disorder in adults is anything but straightforward. Several of the criteria specified in DSM-IVdo not apply to postadolescents, and there is growing evidence that the manifestations of ADHD change with age. Moreover, comorbid disorders and above-normal intelligence can mask ADHD symptoms and hinder diagnosis.

Selected Articles

• VNS: An Epilepsy Treatment Shows Promise for Depression
• Can Dementia "Awaken" Dormant PTSD?