Psychiatry (Edgmont (Pa. : Township))最新文献

There are close functional and anatomical relationships between cranial nerves V and VII in both their sensory and motor divisions. Sensation on the face is innervated by the trigeminal nerves (V) as are the muscles of mastication, but the muscles of facial expression are innervated mainly by the facial nerve (VII) as is the sensation of taste. This article briefly reviews the anatomy of these cranial nerves, disorders of these nerves that are of particular importance to psychiatry, and some considerations for differential diagnosis.

A 21-year-old man presented in a state of delirium with compulsive, pathologic laughter and no focal neurologic findings. Brain imaging revealed a lenticulostriate artery infarct of the caudate nucleus. The absence of neurological signs made the diagnosis difficult, but the presence of delirium was a clue to the existence of structural brain disease.

Bipolar disorder is a chronic mental illness with a profound personal and public health costs attached to it. The majority of patients suffering from bipolar disorder have an onset prior to the fifth decade of their lives. However, a significant number of patients have onset of illness after age 50, commonly referred to as late-onset bipolar disorder. Age of onset can have a significant impact on the nature and course of bipolar illness. We present an interesting case of late-onset bipolar disorder while evaluating secondary mania. The patient was a 76-year-old African American woman who presented with religious and sexual preoccupations, reduced requirement of sleep, and auditory hallucinations. Magnetic resonance imaging scans of the brain revealed diffuse atrophy and two localized lesions on T2 weighted images. Diagnosing late-onset bipolar disorder requires a meticulous assessment for all the potential secondary causes. This might be challenging given the number of confounding agents and the attached cost. Nevertheless, thorough work-up to rule out secondary causes remains the centerpiece of correctly diagnosing and effectively treating late-onset bipolar disorder.

Sensory processing problems in children with attention deficit hyperactivity disorder have been the focus of many studies in recent years. It is obvious that different aspects of sensory problems such as with tactile sensory are involved in attention deficit hyperactivity disorder. However, whether the sensory information process problems can be factors in decision making regarding pharmacological management of children with attention deficit hyperactivity disorder has not been researched. This case report presents two children with attention deficit hyperactivity disorder. The mother of the first patient reported that her child's ability for detecting, identifying, and discriminating smells was very high and more than the other children at this age. As she reported, the child also liked to touch everything and everybody. He experienced nail biting after taking 20mg methylphenidate in single dosage. By decreasing of the dosage, nail biting disappeared in the three trials. The other patient started lip biting about half an hour after taking the first dosage of the medication. It continued for four hours. This report suggests that there is an association between methylphenidate and tactile sensory problems in children with attention deficit hyperactivity disorder. It is possible that methylphenidate induces or exacerbates tactile hyposensitivity. If this assumption is supported in controlled clinical trials, then tactile sensory assessment might help to make decisions for the pharmacological management of children with attention deficit hyperactivity disorder. Further studies should investigate whether attention deficit hyperactivity disorder with sensory processing problems is a phenotype with an overlap between autistic disorders and attention deficit hyperactivity disorder in which stimulants may exacerbate some sensory processing problems. Also, if this is the case, the diagnosis of attention deficit hyperactivity disorder as an exclusionary criterion for pervasive developmental disorder needs to be revised.

Clinicians have a number of treatment options for dealing with the emotional ills of patients, including psychoeducation, psychotherapy, and pharmacotherapy. However, after years of experience in the clinical field, we have recognized that these treatment options may not be sufficient to adequately address the problems of some patients. We have found that adding a metaphysical/spiritual component may be helpful, particularly for those patients with histories of childhood trauma. In this edition of The Interface, we discuss four metaphysical techniques for facilitating patient healing-1) refocusing on the present, 2) reframing adversity, 3) practicing surrender, and 4) meditation. These approaches can be mutually integrated and compliment a psychological treatment in either the psychiatric or primary care setting, regardless of whether or not the patient has formal religious beliefs.

This is Part 2 of a two-part series on the ethical issues surrounding the use of placebo arms in clinical trials for psychiatric drugs. Part 1 discussed the ethical argument from a statistical, population-based perspective. Part 2 explores the ethical issues of placebo-controlled studies as they relate to individual psychiatric patients who may participate in them. Many patients who are candidates for psychiatric clinical trials would receive poor treatment for their mental illness under standard treatment conditions. Industry-sponsored clinical trials often provide treatment resources otherwise not available to patients at a more intense level of care than the local standard. Moreover, study design features, such as those developed at University of California, San Diego (presented herein), can mitigate the risks of placebo arms. With this in mind, clinical trials represent an ethical option for many patients with chronic mental illness.