NEJM â Collection Updates for Psychiatry

CLINICAL PRACTICE: Jet Lag

Robert L. Sack, M.D. — Thu, 04Â FebÂ 2010 00:00:00 -05:00

A 55-year-old physician is planning a trip from Los Angeles to London to attend a scientific conference. His previous trip to Europe was complicated by sleepiness during meetings and difficulty...

EDITORIAL: Prevention of Psychiatric Problems among Military Personnel and Their Spouses

Matthew J. Friedman, M.D., Ph.D. — Thu, 14Â JanÂ 2010 00:00:00 -05:00

It is always important to capture information generated from clinical databases to advance theory and practice. This is certainly the case with two articles in this issue of the Journal....

ORIGINAL ARTICLE: Morphine Use after Combat Injury in Iraq and Post-Traumatic Stress Disorder

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Background: Post-traumatic stress disorder (PTSD) is a common adverse mental health outcome among seriously injured civilians and military personnel who are survivors of trauma. Pharmacotherapy in the aftermath of serious...

ORIGINAL ARTICLE: Deployment and the Use of Mental Health Services among U.S. Army Wives

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Background: Military operations in Iraq and Afghanistan have involved the frequent and extended deployment of military personnel, many of whom are married. The effect of deployment on mental health in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 41-2009 â A 16-Year-Old Boy with Hypothermia and Frostbite

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Dr. Benjamin Sandefur (Emergency Medicine): A 16-year-old boy was admitted to the hospital after being found unconscious in a snow bank at 6 a.m. on New Year's Day. He had...

PERSPECTIVE: A Difficult Balance â Pain Management, Drug Safety, and the FDA

Thu, 26Â NovÂ 2009 00:00:00 -05:00

Pain is a common medical problem, and relief of pain is an important therapeutic goal. Although nonpharmacologic approaches to treating pain (e.g., behavioral techniques) show promise for certain conditions, pain...

EDITORIAL: Dying from Dementia

Greg A. Sachs, M.D. — Thu, 15Â OctÂ 2009 00:00:00 -05:00

As a teenager, I had the unfortunate but ultimately career-shaping experience of watching my maternal grandmother decline from Alzheimer's disease. She resided in a nursing home, where her final months...

ORIGINAL ARTICLE: The Clinical Course of Advanced Dementia

Thu, 15Â OctÂ 2009 00:00:00 -05:00

Background: Dementia is a leading cause of death in the United States but is underrecognized as a terminal illness. The clinical course of nursing home residents with advanced dementia has...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2009 â A 26-Year-Old Man with Abdominal Distention and Shock

Thu, 08Â OctÂ 2009 00:00:00 -05:00

Dr. Jeffrey S. Ustin (Trauma, Emergency Surgery, and Surgical Critical Care): A 26-year-old man was admitted to this hospital because of abdominal distention and shock.

The patient had been well until...

EDITORIAL: Heroin Prescription and History

Virginia Berridge, Ph.D. — Thu, 20Â AugÂ 2009 00:00:00 -05:00

In this issue of the Journal, Oviedo-Joekes et al.1 report on the results of the North American Opiate Medication Initiative (NAOMI) trial comparing methadone with injectable diacetylmorphine (the active ingredient...

ORIGINAL ARTICLE: Diacetylmorphine versus Methadone for the Treatment of Opioid Addiction

Thu, 20Â AugÂ 2009 00:00:00 -05:00

Background: Studies in Europe have suggested that injectable diacetylmorphine, the active ingredient in heroin, can be an effective adjunctive treatment for chronic, relapsing opioid dependence.

Methods: In an open-label, phase 3,...

BOOK REVIEW:

Thu, 13Â AugÂ 2009 00:00:00 -05:00

The drama of chronic disease has many actors, but the single most important one â and far too often, the silent one â is the patient. Chronic illness changes the...

BOOK REVIEW:

Thu, 30Â JulÂ 2009 00:00:00 -05:00

Medicating Children is an account of the past 100 years of the diagnosis and treatment of attention deficitâhyperactivity disorder (ADHD). The three authors come from different fields: Rick Mayes is...

PERSPECTIVE: What Would Osler Do? Learning from âDifficultâ Patients

Thu, 30Â JulÂ 2009 00:00:00 -05:00

âMy intern can't stand Ms. Andrews and refuses to meet with her. He says I'll do all the communicating for the team and that I shouldn't be too nice to...

EDITORIAL: Effect of Genetic Testing for Risk of Alzheimer's Disease

Rosalie A. Kane, Ph.D., and Robert L. Kane, M.D. — Thu, 16Â JulÂ 2009 00:00:00 -05:00

Genetic testing can be considered a complex variant of diagnostic testing. If the results are not actionable, the findings may lead to anxiety or even life-disrupting actions with little offsetting...

ORIGINAL ARTICLE: Longitudinal Modeling of Age-Related Memory Decline and the Îµ4 Effect

Thu, 16Â JulÂ 2009 00:00:00 -05:00

Background: The APOE Îµ4 allele is associated with the risk of late-onset Alzheimer's disease. The age at which memory decline diverges among persons who are homozygous for the APOE Îµ4...

ORIGINAL ARTICLE: Disclosure of Genotype for Risk of Alzheimer's Disease

Thu, 16Â JulÂ 2009 00:00:00 -05:00

Background: The apolipoprotein E (APOE) genotype provides information on the risk of Alzheimer's disease, but the genotyping of patients and their family members has been discouraged. We examined the effect...

PERSPECTIVE: Who Has Capacity?

Thu, 16Â JulÂ 2009 00:00:00 -05:00

âSomeone else should get the liver,â the patient told me, âsomebody with kids or a family.â Mr. D. was lying in his hospital bed with his hands folded atop his...

BOOK REVIEW:

Thu, 09Â JulÂ 2009 00:00:00 -05:00

According to the model that was developed in the 1960s by George Engel, behavioral medicine attempts to integrate social, psychological, and biologic sciences into the prevention, diagnosis, and treatment of...

BOOK REVIEW:

Thu, 25Â JunÂ 2009 00:00:00 -05:00

This is the second edition of a book that was well received when it was first published. It has been updated substantially and now has a focus on problems of...

BOOK REVIEW:

Thu, 25Â JunÂ 2009 00:00:00 -05:00

The title and subtitle of this book promise a comprehensive examination of an important public health problem. However, the editors immediately disabuse readers of this notion by stating that the...

CORRESPONDENCE: Developing Unbiased Diagnostic and Treatment Guidelines in Psychiatry

Lisa Cosgrove, Ph.D., Harold J. Bursztajn, M.D., and Sheldon Krimsky, Ph.D. — Thu, 07Â MayÂ 2009 00:00:00 -05:00

To the Editor: In 1984, the Journal was one of the first medical journals to establish a policy requiring disclosure of financial interests for all authors of research articles. During...

BOOK REVIEW:

Thu, 16Â AprÂ 2009 00:00:00 -05:00

More than 50 years ago, John Money and colleagues proposed that gender identity was shaped by rearing and social influence. They also argued that sexual reassignment was possible during the...

BOOK REVIEW:

Thu, 09Â AprÂ 2009 00:00:00 -05:00

Placebo Effects is a comprehensive monograph on placebo that appears at an auspicious time, after we have had a chance to digest recent research using brain imaging to determine possible...

BOOK REVIEW:

Thu, 02Â AprÂ 2009 00:00:00 -05:00

This book is an account of author Paul McHugh's involvement in scientific and legal battles regarding false memory syndrome and multiple personality disorder. A final chapter is devoted to McHugh's...

REVIEW ARTICLE: Medical Evaluation of Patients Undergoing Electroconvulsive Therapy

Anjala V. Tess, M.D., and Gerald W. Smetana, M.D. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

After a period of declining use, electroconvulsive therapy (ECT) is now used more widely as a treatment for major depression and other psychiatric disorders.1 Many patients undergoing ECT are elderly...

BOOK REVIEW:

Thu, 26Â FebÂ 2009 00:00:00 -05:00

Joel Paris, an academic psychiatrist with a special interest in personality disorders, was chair of the McGill University department of psychiatry from 1997 through 2007 and is editor-in-chief of the...

BOOK REVIEW:

Thu, 19Â FebÂ 2009 00:00:00 -05:00

Psychotropic drugs are sometimes used to treat particular diseases such as obsessiveâcompulsive disorder, schizophrenia, and panic attacks. More often, however, they are used to alleviate the stresses of everyday life...

BOOK REVIEW:

Thu, 05Â FebÂ 2009 00:00:00 -05:00

Richard Kradin, as he explains in the acknowledgements section of his book, sets out to develop âan explanatory model for the placebo response,â with a particular interest in mindâbody physiology...

CLINICAL THERAPEUTICS: Behavioral Management for Anorexia Nervosa

Evelyn Attia, M.D., and B. Timothy Walsh, M.D. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

A 23-year-old woman with anorexia nervosa visits her internist. Her height is 5 ft 6 in. (168 cm), and her weight is 104 lb (47 kg), with a body-mass index...

CORRESPONDENCE: Long-QT Syndrome Induced by the Antiaddiction Drug Ibogaine

Thu, 15Â JanÂ 2009 00:00:00 -05:00

To the Editor: Anecdotal evidence suggests that ibogaine alleviates drug craving and relapse of drug use in humans, as has been confirmed for animals.1 Ibogaine is currently used as an...

EDITORIAL: Antipsychotic Agents and Sudden Cardiac Death â How Should We Manage the Risk?

Sebastian Schneeweiss, M.D., Sc.D., and Jerry Avorn, M.D. — Thu, 15Â JanÂ 2009 00:00:00 -05:00

Antipsychotic medications are commonly used across the entire age spectrum, both within and outside their labeled (and evidence-based) indications.12 Three atypical antipsychotic medications, olanzapine (Zyprexa, Eli Lilly), risperidone (Risperdal, Janssen),...

ORIGINAL ARTICLE: Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death

Thu, 15Â JanÂ 2009 00:00:00 -05:00

Background: Users of typical antipsychotic drugs have an increased risk of serious ventricular arrhythmias and sudden cardiac death. However, less is known regarding the cardiac safety of the atypical antipsychotic...

BOOK REVIEW:

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Asperger's Disorder is a fascinating compilation of scientific papers that concern a condition about which few people know anything. The book is a page turner â I could hardly put...

EDITORIAL: Pediatric Anxiety â Underrecognized and Undertreated

Graham J. Emslie, M.D. — Thu, 25Â DecÂ 2008 00:00:00 -05:00

Generalized anxiety disorder, separation anxiety disorder, and social phobia are relatively prevalent disorders that affect 6 to 20% of children and adolescents.1 However, these disorders frequently go unrecognized by medical...

ORIGINAL ARTICLE: Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety

Thu, 25Â DecÂ 2008 00:00:00 -05:00

Background: Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about...

BOOK REVIEW:

Thu, 11Â DecÂ 2008 00:00:00 -05:00

The focus of this book is not limited to sleep difficulties in children and adolescents with psychiatric disorders. About half of the 28 chapters deal with such problems as autism,...

BOOK REVIEW:

Thu, 27Â NovÂ 2008 00:00:00 -05:00

Once, physician Thomas Graboys had it all â devoted patients, the best and brightest colleagues, a loving family, and a terrific physique. For the past decade, however, he has faced...

BOOK REVIEW:

Thu, 27Â NovÂ 2008 00:00:00 -05:00

Paul Lombardo's book is an authoritative history of the U.S. Supreme Court's infamous decision, Buck v. Bell (1927), which held that Virginia's mandatory sterilization law did not violate Carrie Buck's...

BOOK REVIEW:

Thu, 27Â NovÂ 2008 00:00:00 -05:00

Hardly a week goes by without a person who is alleged to be mentally ill committing some act of violence â and it is always covered by the media. What...

BOOK REVIEW:

Thu, 20Â NovÂ 2008 00:00:00 -05:00

This book is about heads of state â presidents, shahs, prime ministers. Author David Owen seeks to examine the relationship between the health of leaders and the quality and integrity...

BOOK REVIEW:

Thu, 13Â NovÂ 2008 00:00:00 -05:00

In this book, Nicolas Rasmussen tackles a topic that is important to the readership of the Journal. Unfortunately, he appears to be biased from the start, and his bias leads...

ORIGINAL ARTICLE: Subthalamic Nucleus Stimulation in Severe ObsessiveâCompulsive Disorder

Thu, 13Â NovÂ 2008 00:00:00 -05:00

Background: Severe, refractory obsessiveâcompulsive disorder (OCD) is a disabling condition. Stimulation of the subthalamic nucleus, a procedure that is already validated for the treatment of movement disorders, has been proposed...

BOOK REVIEW:

Thu, 06Â NovÂ 2008 00:00:00 -05:00

Psychotherapists endeavor to help people bear the burdens of their lives and become more fulfilled in their relationships and societal roles. Modern approaches to psychotherapy take many forms and use...

CLINICAL THERAPEUTICS: Varenicline for Tobacco Dependence

J. Taylor Hays, M.D., and Jon O. Ebbert, M.D. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

A 57-year-old man with a 60-pack-year history visits his primary care provider because he wants to quit smoking. He has a history of stable coronary artery disease, peripheral vascular disease,...

BOOK REVIEW:

Thu, 16Â OctÂ 2008 00:00:00 -05:00

Headache, one of the most common disorders, is a considerable burden to the individual and to society. The word âcomprehensiveâ in the title of this book may put off some...

BOOK REVIEW:

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Anyone who has had even one poor night of sleep will immediately recognize the substantial impact of sleep disturbance on quality of life. Sleep and Quality of Life in Clinical...

BOOK REVIEW:

Thu, 25Â SepÂ 2008 00:00:00 -05:00

Joseph A. Califano, Jr., has had a distinguished career as a civil servant and was the secretary of Health, Education, and Welfare under President Jimmy Carter. In his latest book,...

BOOK REVIEW:

Thu, 25Â SepÂ 2008 00:00:00 -05:00

In an interesting coincidence, these two books on insomnia were written not by experts in the field but by two professors in the humanities. You might then expect the books...

BOOK REVIEW:

Thu, 18Â SepÂ 2008 00:00:00 -05:00

The earliest symptoms of autism spectrum disorders often appear before a child's second birthday, but most children with autism are not diagnosed until they are in preschool or elementary school....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2008 â A 19-Year-Old Man with Weight Loss and Abdominal Pain

Thu, 18Â SepÂ 2008 00:00:00 -05:00

Dr. Jennifer Broder (Pediatrics): A 19-year-old man was admitted to this hospital because of acute abdominal pain.

He had been in his usual state of health until the evening before admission,...

PERSPECTIVE: The Ethics of Interrogation â The U.S. Military's Ongoing Use of Psychiatrists

Thu, 11Â SepÂ 2008 00:00:00 -05:00

In May 2006, the American Psychiatric Association (APA) adopted a position statement prohibiting psychiatrists from âdirect participationâ in the interrogation of any person in military or civilian detention â including...

PERSPECTIVE: Guns and Suicide in the United States

Thu, 04Â SepÂ 2008 00:00:00 -05:00

This past June, in a 5-to-4 decision in District of Columbia v. Heller, the Supreme Court struck down a ban on handgun ownership in the nation's capital and ruled that...

BOOK REVIEW:

Thu, 21Â AugÂ 2008 00:00:00 -05:00

When the Willard Psychiatric Center, overlooking Seneca Lake in upstate New York, closed in 1995, a curator from the New York State Museum in Albany roamed the grounds, looking from...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2008 â A 26-Year-Old Woman with Headache and Behavioral Changes

Thomas D. Sabin, M.D., Jeffrey A. Jednacz, M.D., and Paul N. Staats, M.D. — Thu, 21Â AugÂ 2008 00:00:00 -05:00

Dr. Thomas J. Cummings, Jr. (Psychiatry): A 26-year-old woman was admitted to this hospital because of headache, behavioral changes, abnormal movements, and inability to communicate. The patient had been well,...

CLINICAL THERAPEUTICS: Naltrexone for the Management of Alcohol Dependence

Raymond F. Anton, M.D. — Thu, 14Â AugÂ 2008 00:00:00 -05:00

A 44-year-old businessman with a history of hypertension presents for evaluation with a report of being under stress at work and home, which has led to âunsatisfactoryâ sleep. Although there...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2008 â A 35-Year-Old Woman with Postpartum Confusion, Agitation, and Delusions

Adele C. Viguera, M.D., Anne D. Emmerich, M.D., and Lee S. Cohen, M.D. — Thu, 31Â JulÂ 2008 00:00:00 -05:00

Dr. Alexia E. Koukopoulos (Psychiatry): A 35-year-old woman was admitted to the inpatient psychiatry service of this hospital 5 days after the birth of her first child because of confusion,...

BOOK REVIEW:

Thu, 24Â JulÂ 2008 00:00:00 -05:00

Thirty years of practice have finally convinced me that the mind and body are indeed connected. As this fascinating book explains, the idea of these connections goes back a long...

BOOK REVIEW:

Thu, 24Â JulÂ 2008 00:00:00 -05:00

In Gaetano Donizetti's opera L'Elisir d'Amore (The Elixir of Love), the itinerant Dr. Dulcamara peddles a âmarvelous elixir that awakens love,â and in a vocally demanding patter song proclaims that...

BOOK REVIEW:

Thu, 10Â JulÂ 2008 00:00:00 -05:00

Aristotle famously asked, âWhy is it that all men who have become outstanding in philosophy, statesmanship, poetry, and the arts are melancholic?â The question persists today, as investigators in the...

PERSPECTIVE: Shuffling toward Parity â Bringing Mental Health Care under the Umbrella

Thu, 10Â JulÂ 2008 00:00:00 -05:00

For half a century, advocates and reformers have sought to ensure that mental illnesses are addressed in the same way as all other illnesses. Considerable progress has been made, and...

IMAGES IN CLINICAL MEDICINE: Bladder Foreign Body

William E. Corcoran, M.D. and Nancy Phifer, M.D. — Thu, 19Â JunÂ 2008 00:00:00 -05:00

A 35-year-old woman with bipolar disorder was found wandering on a highway screaming and crying, with disorganized speech. She was evaluated in the emergency department, and computed tomography of the...

SPECIAL ARTICLE: The Collective Dynamics of Smoking in a Large Social Network

Nicholas A. Christakis, M.D., Ph.D., M.P.H., and James H. Fowler, Ph.D. — Thu, 22Â MayÂ 2008 00:00:00 -05:00

Background: The prevalence of smoking has decreased substantially in the United States over the past 30 years. We examined the extent of the person-to-person spread of smoking behavior and the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2008 â A 78-Year-Old Man with Anergia and Anhedonia Associated with Cardiovascular Surgery

Thu, 08Â MayÂ 2008 00:00:00 -05:00

Dr. David T. Plante (Psychiatry): A 78-year-old man was admitted to the inpatient psychiatry service of this hospital because of anergia and anhedonia.

Thirty-three months before admission, the patient was told...

EDITORIAL: Depth-of-Anesthesia Monitor and the Frequency of Intraoperative Awareness

Beverley A. Orser, M.D., Ph.D., F.R.C.P.C. — Thu, 13Â MarÂ 2008 00:00:00 -05:00

More than 21 million patients in North America alone receive general anesthesia each year,1 and thanks to increasing knowledge, skill, and sophisticated technology, the vast majority of anesthetic procedures are...

ORIGINAL ARTICLE: Anesthesia Awareness and the Bispectral Index

Thu, 13Â MarÂ 2008 00:00:00 -05:00

Background: Awareness during anesthesia is a serious complication with potential long-term psychological consequences. Use of the bispectral index (BIS), developed from a processed electroencephalogram, has been reported to decrease the...

EDITORIAL: Disentangling Mild Traumatic Brain Injury and Stress Reactions

Richard A. Bryant, Ph.D. — Thu, 31Â JanÂ 2008 00:00:00 -05:00

The study by Hoge and colleagues in this issue of the Journal provides an important profile of the sequelae of mild traumatic brain injury in military personnel after combat.1 The...

ORIGINAL ARTICLE: Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq

Thu, 31Â JanÂ 2008 00:00:00 -05:00

Background: An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related...

SPECIAL ARTICLE: Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy

Thu, 17Â JanÂ 2008 00:00:00 -05:00

Background: Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials â and the outcomes within those trials â can...

REVIEW ARTICLE: Major Depressive Disorder

R.H. Belmaker, M.D., and Galila Agam, Ph.D. — Thu, 03Â JanÂ 2008 00:00:00 -05:00

Depression is related to the normal emotions of sadness and bereavement, but it does not remit when the external cause of these emotions dissipates, and it is disproportionate to their...

PERSPECTIVE: The Good Patient

Thu, 20Â DecÂ 2007 00:00:00 -05:00

The visit to my doctor was not terribly out of the ordinary. I had waited several months, hoping the pain would remit, but the throbbing in my shoulders, initially episodic...

PERSPECTIVE: The View from the Other Side â Patients, Doctors, and the Power of a Camera

Thu, 20Â DecÂ 2007 00:00:00 -05:00

By the time Galen Buckwalter's physician knocked on the exam-room door, Buckwalter's video camera had been recording for nearly 40 minutes. He had booked the appointment because his shoulders were...

CLINICAL PRACTICE: Erectile Dysfunction

Kevin T. McVary, M.D. — Thu, 13Â DecÂ 2007 00:00:00 -05:00

A 65-year-old man presents to an outpatient clinic, reporting that he can no longer maintain an erection sufficient for intercourse. His medical history includes well-controlled hypertension and stable coronary artery...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Molecules That Mediate Mood

Michael E. Thase, M.D. — Thu, 06Â DecÂ 2007 00:00:00 -05:00

Major depressive disorder is now recognized as one of the world's greatest public health problems: it is common, typically follows a relapsing or recurrent course, disrupts the performance of social...

IMAGES IN CLINICAL MEDICINE: Trichobezoar

Ronald M. Levy, M.D. and Srinadh Komanduri, M.D. — Thu, 22Â NovÂ 2007 00:00:00 -05:00

A previously healthy 18-year-old woman presented with a 5-month history of pain in the left upper quadrant of the abdomen, abdominal distention, postprandial emesis, and weight loss of 18 kg....

CLINICAL THERAPEUTICS: Electroconvulsive Therapy for Depression

Sarah H. Lisanby, M.D. — Thu, 08Â NovÂ 2007 00:00:00 -05:00

An 82-year-old widowed woman with a history of recurrent unipolar major depression is referred to the electroconvulsive therapy (ECT) service of an academic medical center. During her illness, she has...

CLINICAL PRACTICE: Assessment of Patients' Competence to Consent to Treatment

Paul S. Appelbaum, M.D. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

A 75-year-old woman with type 2 diabetes mellitus and peripheral vascular disease is admitted with a gangrenous ulcer of the plantar aspect of her left foot. A surgical consultation results...

ORIGINAL ARTICLE: Visualizing Out-of-Body Experience in the Brain

Thu, 01Â NovÂ 2007 00:00:00 -05:00

An out-of-body experience was repeatedly elicited during stimulation of the posterior part of the superior temporal gyrus on the right side in a patient in whom electrodes had been implanted...

EDITORIAL: Treatment of Neuropsychiatric Symptoms in Patients with Dementia

Kristine Yaffe, M.D. — Thu, 04Â OctÂ 2007 00:00:00 -05:00

Although cognitive deficits are the clinical hallmark of dementia syndromes, noncognitive symptoms are common and can dominate the disease course. These include a range of neuropsychiatric symptoms, such as agitation,...

ORIGINAL ARTICLE: Donepezil for the Treatment of Agitation in Alzheimer's Disease

Thu, 04Â OctÂ 2007 00:00:00 -05:00

Background: Agitation is a common and distressing symptom in patients with Alzheimer's disease. Cholinesterase inhibitors improve cognitive outcomes in such patients, but the benefits of these drugs for behavioral disturbances...

EDITORIAL: Sex and Aging

John H.J. Bancroft, M.D. — Thu, 23Â AugÂ 2007 00:00:00 -05:00

Human beings are living longer, women more so than men. Among people 85 years of age and older, there are 4 men for every 10 women.1 What happens to sexuality...

ORIGINAL ARTICLE: A Study of Sexuality and Health among Older Adults in the United States

Thu, 23Â AugÂ 2007 00:00:00 -05:00

Background: Despite the aging of the population, little is known about the sexual behaviors and sexual function of older people.

Methods: We report the prevalence of sexual activity, behaviors, and problems...

PERSPECTIVE: When Doctors Become Terrorists

Thu, 16Â AugÂ 2007 00:00:00 -05:00

We were lucky in London in June. A large car bomb was left just outside a crowded nightclub near Piccadilly Circus, and a second car bomb was parked nearby to...

PERSPECTIVE: Falling through the Cracks â Virginia Tech and the Restructuring of College Mental Health Services

Thu, 12Â JulÂ 2007 00:00:00 -05:00

Since April 16, when Virginia Tech student Seung-Hui Cho gunned down 27 fellow students and 5 faculty members and injured 24 other people before taking his own life, some disturbing...

EDITORIAL: Teratogenicity of SSRIs â Serious Concern or Much Ado about Little?

Michael F. Greene, M.D. — Thu, 28Â JunÂ 2007 00:00:00 -05:00

In the fall of 2005, GlaxoSmithKline called attention to recently collected safety data indicating an increased risk of major congenital malformations among infants exposed during organogenesis to GlaxoSmithKline's selective serotonin...

ORIGINAL ARTICLE: Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects

Thu, 28Â JunÂ 2007 00:00:00 -05:00

Background: Information regarding the safety of selective serotonin-reuptake inhibitors (SSRIs) in human pregnancy is sparse. Concern has been raised about the risk of congenital heart defects associated with the use...

ORIGINAL ARTICLE: First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects

Thu, 28Â JunÂ 2007 00:00:00 -05:00

Background: The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial.

Methods: We assessed associations between first-trimester maternal use of SSRIs and the risk of birth...

PERSPECTIVE: Expanding the Black Box â Depression, Antidepressants, and the Risk of Suicide

Thu, 07Â JunÂ 2007 00:00:00 -05:00

On May 2, 2007, the Food and Drug Administration (FDA) ordered that all antidepressant medications carry an expanded black-box warning incorporating information about an increased risk of suicidal symptoms in...

EDITORIAL: Treatment of Bipolar Depression

R.H. Belmaker, M.D. — Thu, 26Â AprÂ 2007 00:00:00 -05:00

Bipolar disorder consists of depressive episodes of low mood, difficulty in concentration and work, poor sleep, and poor appetite, as well as distinct manic episodes of expansive mood, pressured speech,...

ORIGINAL ARTICLE: Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression

Thu, 26Â AprÂ 2007 00:00:00 -05:00

Background: Episodes of depression are the most frequent cause of disability among patients with bipolar disorder. The effectiveness and safety of standard antidepressant agents for depressive episodes associated with bipolar...

PERSPECTIVE: Approving the Vagus-Nerve Stimulator for Depression

Thu, 19Â AprÂ 2007 00:00:00 -05:00

The vagus-nerve stimulator (VNS), a device that is implanted by a neurosurgeon and sends intermittent electrical pulses to the brain, has been marketed in the United States since 1997 as...

PERSPECTIVE: The Antidepressant Quandary â Considering Suicide Risk When Treating Adolescent Depression

Thu, 28Â DecÂ 2006 00:00:00 -05:00

In March 2004, the Food and Drug Administration (FDA) issued a public health advisory regarding worsening depression and suicidal thoughts and behavior in patients treated with the newer antidepressant drugs...

PERSPECTIVE: Familial Pathways to Suicidal Behavior â Understanding and Preventing Suicide among Adolescents

Thu, 28Â DecÂ 2006 00:00:00 -05:00

A 16-year-old boy whose brother recently committed suicide is seen in the emergency room after slashing his wrists. He reports having felt severely depressed and hopeless since his brother died...

PERSPECTIVE: Uncovering an Epidemic â Screening for Mental Illness in Teens

Thu, 28Â DecÂ 2006 00:00:00 -05:00

Courtney, a 15-year-old from Portland, Oregon, always knew she was different from the other kids. âI had a sense that something was going on, but I was afraid to say...

ORIGINAL ARTICLE: PET of Brain Amyloid and Tau in Mild Cognitive Impairment

Thu, 21Â DecÂ 2006 00:00:00 -05:00

Background: Amyloid senile plaques and tau neurofibrillary tangles are neuropathological hallmarks of Alzheimer's disease that accumulate in the cortical regions of the brain in persons with mild cognitive impairment who...

PERSPECTIVE: Reconstructing Lives â A Tale of Two Soldiers

Thu, 21Â DecÂ 2006 00:00:00 -05:00

Jason Pepper can't see the deer and wild turkeys that feed in the pasture in front of his new home, an hour's drive from Nashville. But when he sits and...

PERSPECTIVE: Violence and Mental Illness â How Strong is the Link?

Thu, 16Â NovÂ 2006 00:00:00 -05:00

On Sunday afternoon, September 3, 2006, Wayne Fenton, a prominent schizophrenia expert and an associate director at the National Institute of Mental Health (NIMH), was found dead in his office....

EDITORIAL: Alzheimer's Disease â Clinical Trials and the Logic of Clinical Purpose

Jason Karlawish, M.D. — Thu, 12Â OctÂ 2006 00:00:00 -05:00

Agitation, aggression, delusions, and hallucinations are among the most common and disabling symptoms of Alzheimer's disease. These problems diminish the quality of life for both the patient and caregiver.1 They...

ORIGINAL ARTICLE: Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer's Disease

Thu, 12Â OctÂ 2006 00:00:00 -05:00

Background: Second-generation (atypical) antipsychotic drugs are widely used to treat psychosis, aggression, and agitation in patients with Alzheimer's disease, but their benefits are uncertain and concerns about safety have emerged....

CLINICAL PRACTICE: Social Anxiety Disorder

Franklin R. Schneier, M.D. — Thu, 07Â SepÂ 2006 00:00:00 -05:00

A 28-year-old man reports feeling anxious and self-conscious around people in school, work, and social situations since his early teens. He appears shy and, on questioning, describes avoidance of speaking...

ORIGINAL ARTICLE: Counseling plus BuprenorphineâNaloxone Maintenance Therapy for Opioid Dependence

Thu, 27Â JulÂ 2006 00:00:00 -05:00

Background: The optimal level of counseling and frequency of attendance for medication distribution has not been established for the primary care, office-based buprenorphineânaloxone treatment of opioid dependence.

Methods: We conducted a...

ORIGINAL ARTICLE: A Controlled Trial of Homocysteine Lowering and Cognitive Performance

Thu, 29Â JunÂ 2006 00:00:00 -05:00

Background: The results of observational studies suggest that plasma homocysteine concentrations are inversely related to cognitive function in older people. Our objective was to test the hypothesis that lowering the...

PERSPECTIVE: ADHD in Adults

Thu, 22Â JunÂ 2006 00:00:00 -05:00

As a child, Dr. Y often confounded her parents and teachers. She regularly brought home straight-A report cards, but the grades were accompanied by comments like âShe is a very...

CLINICAL PRACTICE: Panic Disorder

Wayne J. Katon, M.D. — Thu, 01Â JunÂ 2006 00:00:00 -05:00

A 30-year-old woman, recently divorced, presents with daily episodes of chest pain, shortness of breath, sweating, and palpitations. She feels very anxious when these episodes occur and worries that she...

CLINICAL PRACTICE: Sexual Desire and Arousal Disorders in Women

Rosemary Basson, M.D. — Thu, 06Â AprÂ 2006 00:00:00 -05:00

A 46-year-old woman, married for 16 years, reports having had a low level of sexual desire and minimal sexual arousal during sexual activity for the past 10 years. Sexual thoughts,...

PERSPECTIVE: The Changing Face of Teenage Drug Abuse â The Trend toward Prescription Drugs

Thu, 06Â AprÂ 2006 00:00:00 -05:00

When Eric, an 18-year-old who lives in San Francisco, wants to get some Vicodin (hydrocodoneâacetaminophen), it's a simple matter. âI can get prescription drugs from different places and don't ever...

PERSPECTIVE: ADHD Drugs and Cardiovascular Risk

Thu, 06Â AprÂ 2006 00:00:00 -05:00

On February 9, 2006, the Drug Safety and Risk Management Advisory Committee of the Food and Drug Administration (FDA) voted by a narrow margin â eight to seven â to...

EDITORIAL: Better Behavioral Health Care Coverage for Everyone

Sherry Glied, Ph.D., and Alison Cuellar, Ph.D. — Thu, 30Â MarÂ 2006 00:00:00 -05:00

People with private health insurance who seek care for mental health conditions generally face higher coinsurance and more limits to coverage â including limits on the numbers of outpatient visits...

SPECIAL ARTICLE: Behavioral Health Insurance Parity for Federal Employees

Thu, 30Â MarÂ 2006 00:00:00 -05:00

Background: To improve insurance coverage of mental health and substance-abuse services, the Federal Employees Health Benefits (FEHB) Program offered mental health and substance-abuse benefits on a par with general medical...

EDITORIAL: Treatment Strategies after SSRI Failure â Good News and Bad News

David R. Rubinow, M.D. — Thu, 23Â MarÂ 2006 00:00:00 -05:00

My recent use of that august medical search engine, Google, revealed a publication that identified sin as the cause of depression. Initial amusement quickly gave way to the sobering recognition...

ORIGINAL ARTICLE: Medication Augmentation after the Failure of SSRIs for Depression

Thu, 23Â MarÂ 2006 00:00:00 -05:00

Background: Although clinicians frequently add a second medication to an initial, ineffective antidepressant drug, no randomized controlled trial has compared the efficacy of this approach.

Methods: We randomly assigned 565 adult...

ORIGINAL ARTICLE: Bupropion-SR, Sertraline, or Venlafaxine-XR after Failure of SSRIs for Depression

Thu, 23Â MarÂ 2006 00:00:00 -05:00

Background: After unsuccessful treatment for depression with a selective serotonin-reuptake inhibitor (SSRI), it is not known whether switching to one antidepressant is more effective than switching to another.

Methods: We randomly...

EDITORIAL: Play It Again, Sam â Depression Is Recurring

Burton V. Reifler, M.D., M.P.H. — Thu, 16Â MarÂ 2006 00:00:00 -05:00

Many years ago I read an editorial, author and journal now forgotten, that included in its title the phrase, âPlay it again, Samâ â words attributed to, but never actually...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2006 â A 71-Year-Old Woman with Crohn's Disease and Altered Mental Status

Thu, 16Â MarÂ 2006 00:00:00 -05:00

A 71-year-old woman was admitted to the hospital because of left-sided weakness and a mass in the brain. She had had Crohn's disease for many years but was in her...

REVIEW ARTICLE: Delirium in Older Persons

Sharon K. Inouye, M.D., M.P.H. — Thu, 16Â MarÂ 2006 00:00:00 -05:00

Delirium, an acute decline in attention and cognition, is a common, life-threatening, and potentially preventable clinical syndrome among persons who are 65 years of age or older. The development of...

ORIGINAL ARTICLE: Maintenance Treatment of Major Depression in Old Age

Thu, 16Â MarÂ 2006 00:00:00 -05:00

Background: Elderly patients with major depression, including those having a first episode, are at high risk for recurrence of depression, disability, and death.

Methods: We tested the efficacy of maintenance paroxetine...

LEGAL ISSUES IN MEDICINE: Congress, Controlled Substances, and Physician-Assisted Suicide â Elephants in Mouseholes

George J. Annas, J.D., M.P.H. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

The U.S. Supreme Court's decision in Gonzales v. Oregon to reject the U.S. attorney general's authority to prohibit physicians in Oregon from prescribing Schedule II drugs for their terminally ill...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2006 â A 47-Year-Old Man with Altered Mental Status and Acute Renal Failure

J. Kimo Takayesu, M.D., M.Sc., Hasan Bazari, M.D., and Michael Linshaw, M.D. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

A 47-year-old man was transferred to the emergency department of this hospital at 10 a.m. on a day in early June because of altered mental status and acute renal failure....

PERSPECTIVE: Improving Health Care for the Lesbian and Gay Communities

Thu, 02Â MarÂ 2006 00:00:00 -05:00

On my 40th birthday, I made two important decisions regarding my health: I would finally see a physician on a routine basis, and I would be frank with my newly...

PERSPECTIVE: Brave New Face

Thu, 02Â MarÂ 2006 00:00:00 -05:00

In her office at the Cleveland Clinic, plastic surgeon Maria Siemionow has been studying the photographs and perusing the medical records of severely disfigured people, looking for the ideal candidate...

SPECIAL ARTICLE: Mortality after the Hospitalization of a Spouse

Nicholas A. Christakis, M.D., Ph.D., M.P.H., and Paul D. Allison, Ph.D. — Thu, 16Â FebÂ 2006 00:00:00 -05:00

Background: The illness of a spouse can affect the health of a caregiving partner. We examined the association between the hospitalization of a spouse and a partner's risk of death...

EDITORIAL: Depressing Observations on the Use of Selective Serotonin-Reuptake Inhibitors during Pregnancy

James L. Mills, M.D. — Thu, 09Â FebÂ 2006 00:00:00 -05:00

Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition that typically occurs in full-term or near-term infants. Before birth, the fetus receives oxygenated blood from the placenta; a...

ORIGINAL ARTICLE: Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn

Thu, 09Â FebÂ 2006 00:00:00 -05:00

Background: Persistent pulmonary hypertension of the newborn (PPHN) is associated with substantial infant mortality and morbidity. A previous cohort study suggested a possible association between maternal use of the selective...

EDITORIAL: The Choice of Drugs for Schizophrenia

John M. Davis, M.D. — Thu, 02Â FebÂ 2006 00:00:00 -05:00

Schizophrenia is a serious chronic illness that requires lifelong medication. In some patients, the illness is refractory to even highly effective medications such as clozapine, and these patients desperately need...

ORIGINAL ARTICLE: Clozapine Alone versus Clozapine and Risperidone with Refractory Schizophrenia

Thu, 02Â FebÂ 2006 00:00:00 -05:00

Background: The treatment of schizophrenia with multiple antipsychotic drugs is common, but the benefits and risks are not known.

Methods: In a randomized, double-blind study, we evaluated patients with schizophrenia and...

ORIGINAL ARTICLE: Risk of Death in Elderly Users of Conventional vs. Atypical Antipsychotic Medications

Thu, 01Â DecÂ 2005 00:00:00 -05:00

Background: Recently, the Food and Drug Administration (FDA) issued an advisory stating that atypical antipsychotic medications increase mortality among elderly patients. However, the advisory did not apply to conventional antipsychotic...

PERSPECTIVE: Beyond Red Lake â The Persistent Crisis in American Indian Health Care

Yvette Roubideaux, M.D., M.P.H. — Thu, 03Â NovÂ 2005 00:00:00 -05:00

On March 21, 2005, at the high school on the Red Lake Indian reservation in Minnesota, a troubled American Indian teenager went on a shooting rampage, killing nine people before...

REVIEW ARTICLE: The Medical Management of Depression

J. John Mann, M.D. — Thu, 27Â OctÂ 2005 00:00:00 -05:00

Recurrent episodes of major depression, which is a common and serious illness, are called major depressive disorder; depressive episodes that occur in conjunction with manic episodes are called bipolar disorder....

PERSPECTIVE: Aftershocks

Edward D. Frohlich, M.D., Ochsner Clinic Foundation, New Orleans — Thu, 13Â OctÂ 2005 00:00:00 -05:00

When Hurricane Katrina hit, my wife and I responded in a fashion common to many New Orleans residents: we âvertically evacuatedâ to the lower floors of one of the city's...

CLINICAL PRACTICE: Anorexia Nervosa

Joel Yager, M.D., and Arnold E. Andersen, M.D. — Thu, 06Â OctÂ 2005 00:00:00 -05:00

A 17-year-old girl is taken to her physician by worried parents. Never overweight, in the past six months she became determined to reduce from her baseline weight of 59.1 kg...

EDITORIAL: The Choice of Antipsychotic Drugs for Schizophrenia

Robert Freedman, M.D. — Thu, 22Â SepÂ 2005 00:00:00 -05:00

Since the discovery of the effects of chlorpromazine in the 1950s, treatment of schizophrenia has relied on antipsychotic drugs that target dopamine D2 receptors. The effectiveness of these agents in...

ORIGINAL ARTICLE: Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia

Thu, 22Â SepÂ 2005 00:00:00 -05:00

Background: The relative effectiveness of second-generation (atypical) antipsychotic drugs as compared with that of older agents has been incompletely addressed, though newer agents are currently used far more commonly. We...

PERSPECTIVE: Getting an Edge â Use of Stimulants and Antidepressants in College

Richard Kadison, M.D. — Thu, 15Â SepÂ 2005 00:00:00 -05:00

A college student sought help at our health center because he was having social anxiety and difficulty participating in class discussion. He said he had used an antidepressant drug to...

PERSPECTIVE: White Coat, Mood Indigo â Depression in Medical School

Julie M. Rosenthal and Susan Okie, M.D. — Thu, 15Â SepÂ 2005 00:00:00 -05:00

As the head of student government at Duke University School of Medicine in Durham, North Carolina, Sujay Kansagra had witnessed several of his fellow students dealing with depression. âI knew...

CLINICAL PRACTICE: Chronic Insomnia

Michael H. Silber, M.B., Ch.B. — Thu, 25Â AugÂ 2005 00:00:00 -05:00

A 46-year-old woman has difficulty in falling asleep and staying asleep. The problem started after the birth of her second child 15 years earlier in association with mild postpartum depression....

PERSPECTIVE: Curing Stigma â The Limits of Antiretroviral Access

Oni Blackstock, M.D. — Thu, 25Â AugÂ 2005 00:00:00 -05:00

Once physically incapacitated by their disease, many people with human immunodeficiency virus (HIV) infection or AIDS have found new life, thanks to the increasing availability of antiretroviral drugs. But for...

PERSPECTIVE: Victimhood and Resilience

Simon Wessely, M.D. — Thu, 11Â AugÂ 2005 00:00:00 -05:00

At least until the failed attacks of July 21, the gut-wrenching shock of the July 7 suicide bombings in London had been starting to dissipate, and the nonstop news coverage...

ORIGINAL ARTICLE: Modafinil for Excessive Sleepiness Associated with Shift-Work Sleep Disorder

Thu, 04Â AugÂ 2005 00:00:00 -05:00

Background: Patients with shift-work sleep disorder chronically have excessive sleepiness during night work and insomnia when attempting to sleep during the day. We evaluated the use of modafinil for treating...

PERSPECTIVE: Last-Ditch Medical Therapy â Revisiting Lobotomy

Barron H. Lerner, M.D., Ph.D. — Thu, 14Â JulÂ 2005 00:00:00 -05:00

Desperate times call for desperate measures. So thought Walter J. Freeman, a neurologist who became the United States's staunchest advocate of the lobotomy between the 1930s and the 1970s. A...

PERSPECTIVE: Doctors and Interrogators at Guantanamo Bay

M. Gregg Bloche, M.D., J.D., and Jonathan H. Marks, M.A., B.C.L. — Thu, 07Â JulÂ 2005 00:00:00 -05:00

Mounting evidence from many sources, including Pentagon documents, indicates that military interrogators at Guantanamo Bay have used aggressive counter-resistance measures in systematic fashion to pressure detainees to cooperate. These measures...

REVIEW ARTICLE: Î³-Hydroxybutyric Acid

O. Carter Snead III, M.D., and K. Michael Gibson, Ph.D. — Thu, 30Â JunÂ 2005 00:00:00 -05:00

The short-chain fatty acid Î³-hydroxybutyric acid (GHB) was synthesized in 1960 in an attempt to create an analogue of the ubiquitous inhibitory brain neurotransmitter Î³-aminobutyric acid (GABA) that would cross...

SPECIAL ARTICLE: Prevalence and Treatment of Mental Disorders, 1990 to 2003

Thu, 16Â JunÂ 2005 00:00:00 -05:00

Background: Although the 1990s saw enormous change in the mental health care system in the United States, little is known about changes in the prevalence or rate of treatment of...

PERSPECTIVE: Taking Their Own Lives â The High Rate of Physician Suicide

Eva Schernhammer, M.D., Dr.P.H. — Thu, 16Â JunÂ 2005 00:00:00 -05:00

When I was an oncology fellow in Vienna, a colleague who had attended rounds with me on the ward went home afterward and strangled herself. Only later was it learned...

PERSPECTIVE: Americans as Survivors

Robert Jay Lifton, M.D. — Thu, 02Â JunÂ 2005 00:00:00 -05:00

Physicians have always been concerned with how people survive trauma. There has been much interest in the psychology of the survivors of such massive trauma as that inflicted by the...

PERSPECTIVE: Traumatic Brain Injury in the War Zone

Susan Okie, M.D. — Thu, 19Â MayÂ 2005 00:00:00 -05:00

Sergeant David Emme, a supply officer with a U.S. Army Stryker Brigade, was stationed at a submachine gun on a truck rolling through northern Iraq last November, in a convoy...

IMAGES IN CLINICAL MEDICINE: Wernicke's Encephalopathy

Brian Kaineg, M.D. and Patricia A. Hudgins, M.D. — Thu, 12Â MayÂ 2005 00:00:00 -05:00

A 21-year-old woman with schizoaffective disorder and a four-month history of diffuse abdominal pain, nausea, vomiting, and weight loss of more than 13 kg was admitted to the hospital because...

PERSPECTIVE: Physician as Serial Killer â The Shipman Case

Aneez Esmail, M.D., Ph.D. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

Harold Fredrick Shipman, a British general practitioner, was convicted on January 31, 2000, of murdering 15 of his patients (and of forging a will of one of them) while he...

PERSPECTIVE: Mental Health Care Needs among Recent War Veterans

Han K. Kang, Dr.P.H., and Kenneth C. Hyams, M.D., M.P.H. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

Fifteen percent or more of some populations of veterans of the Vietnam War and the 1991 Gulf War have received diagnoses of post-traumatic stress disorder (PTSD).12 Given this history and...

PERSPECTIVE: Veterans' Mental Health in the Wake of War

Matthew J. Friedman, M.D., Ph.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

Some aspects of the psychological experiences of war bind veterans together across temporal and national boundaries. Consider Hotspur's traumatic nightmares in Shakespeare's King Henry IV, Part I, the challenges confronting...

ORIGINAL ARTICLE: Hospitalization for Mental Illness among Parents after the Death of a Child

Thu, 24Â MarÂ 2005 00:00:00 -05:00

Background: The loss of a child is considered one of the most stressful events in the life of a parent. We hypothesized that parental bereavement increases the risk of hospital...

REVIEW ARTICLE: The Serotonin Syndrome

Edward W. Boyer, M.D., Ph.D., and Michael Shannon, M.D., M.P.H. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

The serotonin syndrome is a potentially life-threatening adverse drug reaction that results from therapeutic drug use, intentional self-poisoning, or inadvertent interactions between drugs. Three features of the serotonin syndrome are...

PERSPECTIVE: The Accidental Addict

Howard Markel, M.D., Ph.D. — Thu, 10Â MarÂ 2005 00:00:00 -05:00

All stories of addiction are tragic. Some addictions are so well concealed that, when discovered, they initially appear to be inconceivable. One of the most remarkable tales of a concealed...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2005 â A 53-Year-Old Man with Depression and Sudden Shortness of Breath

Thu, 17Â FebÂ 2005 00:00:00 -05:00

Dr. Daniel Egan (Emergency Medicine, Massachusetts General Hospital and Brigham and Women's Hospital): A 53-year-old man came to the emergency department because of symptoms of depression.

The patient had been in...

CLINICAL PRACTICE: Unhealthy Alcohol Use

Richard Saitz, M.D., M.P.H. — Thu, 10Â FebÂ 2005 00:00:00 -05:00

A 32-year-old man has a three-month history of difficulty sleeping. On questioning, he mentions that he drinks four to six glasses of wine three to four times per week. How...

ORIGINAL ARTICLE: Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress

Thu, 10Â FebÂ 2005 00:00:00 -05:00

Background: Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown.

Methods: We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional...

CLINICAL PRACTICE: Attention DeficitâHyperactivity Disorder

Marsha D. Rappley, M.D. — Thu, 13Â JanÂ 2005 00:00:00 -05:00

A mother brings in her eight-year-old son for evaluation after he is suspended from riding the school bus for jumping out of his seat, teasing other children, and not following...

IMAGES IN CLINICAL MEDICINE: The Tale of Phineas Gage, Digitally Remastered

Peter Ratiu, M.D. and Ion-Florin Talos, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

On September 13, 1848, while using a tamping iron to pack explosive into a rock, Phineas Gage, a 25-year-old construction foreman, triggered an uncontrolled explosion that propelled the tool (which...

PERSPECTIVE: America's Gulag Archipelago

Norman Fost, M.D., M.P.H. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

If you were to meet Fred Boyce today, you might think he was a normal person, aside from the fact that he is better looking and more charming than most...

PERSPECTIVE: Antidepressants and Pediatric Depression â The Risk of Doing Nothing

David A. Brent, M.D. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

There is great concern that antidepressants used in children and adolescents may paradoxically increase their risk of suicidal thoughts and behavior. Is this concern valid, and if so, how should...

PERSPECTIVE: A Black-Box Warning for Antidepressants in Children?

Thomas B. Newman, M.D., M.P.H. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

On September 14, 2004, a Food and Drug Administration (FDA) joint advisory committee voted 15 to 8 to recommend that a âblack-boxâ warning label be required for antidepressant drugs, indicating...

IMAGES IN CLINICAL MEDICINE: Communicating Hydrocephalus

J.P. Newman, Ph.D. and Ricardo Segal, M.D. — Thu, 30Â SepÂ 2004 00:00:00 -05:00

A 56-year-old woman, who was a pediatric surgeon, presented with a five-year history of memory deficits, loss of professional self-confidence, and dysphoric mood that was unresponsive to antidepressant medication; her...

IMAGES IN CLINICAL MEDICINE: MarchiafavaâBignami Disease

Philippe Demaerel, M.D., Ph.D. and Wim Van Paesschen, M.D., Ph.D. — Thu, 09Â SepÂ 2004 00:00:00 -05:00

A 45-year-old man with chronic alcoholism was found at home with altered consciousness. On admission, neurologic examination showed disorientation, perseveration, dysarthria, dyspraxia, peripheral sensory neuropathy, and coarse rigidity of all...

PERSPECTIVE: Culture and Depression

Arthur Kleinman, M.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

In many parts of Chinese society, the experience of depression is physical rather than psychological. Many depressed Chinese people do not report feeling sad, but rather express boredom, discomfort, feelings...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2004 â A 79-Year-Old Woman with Disturbances in Gait, Cognition, and Autonomic Function

Thu, 26Â AugÂ 2004 00:00:00 -05:00

A 79-year-old woman was evaluated in a neurology clinic because of difficulty walking and cognitive changes.

The patient had been well until 18 months earlier, when she began to fall occasionally....

CLINICAL PRACTICE: Generalized Anxiety Disorder

Gregory Fricchione, M.D. — Thu, 12Â AugÂ 2004 00:00:00 -05:00

During a routine visit, a 59-year-old woman, who describes herself as a lifetime âworrierâ and has a family history of depression, reports having restless sleep, muscle tension, and fatigue. Recently,...

REVIEW ARTICLE: Bipolar Disorder

R.H. Belmaker, M.D. — Thu, 29Â JulÂ 2004 00:00:00 -05:00

Bipolar disorder is one of the most distinct syndromes in psychiatry and has been described in numerous cultures over the course of history.1 The unique hallmark of the illness is...

PERSPECTIVE: Mind Reading

Elissa Ely, M.D. — Thu, 29Â JulÂ 2004 00:00:00 -05:00

I was called in to see a man I did not know. No one knew him. His usual doctor was on vacation, and the social worker who paged me was...

PERSPECTIVE: Doctors and Torture

Robert Jay Lifton, M.D. — Thu, 29Â JulÂ 2004 00:00:00 -05:00

There is increasing evidence that U.S. doctors, nurses, and medics have been complicit in torture and other illegal procedures in Iraq, Afghanistan, and Guantanamo Bay. Such medical complicity suggests still...

EDITORIAL: Acknowledging the Psychiatric Cost of War

Matthew J. Friedman, M.D., Ph.D. — Thu, 01Â JulÂ 2004 00:00:00 -05:00

The data presented by Hoge and associates in this issue of the Journal1 about members of the Army and the Marine Corps returning from Operation Iraqi Freedom or Operation Enduring...

PERSPECTIVE: Surviving Torture

Richard F. Mollica, M.D. — Thu, 01Â JulÂ 2004 00:00:00 -05:00

The shocking, unfiltered images from the Abu Ghraib prison in Iraq have focused the world's attention on the plight of torture survivors. Physicians in the United States are confronted as...

PERSPECTIVE: Semper Fi

Pamela Grim, M.D. — Thu, 01Â JulÂ 2004 00:00:00 -05:00

A while ago, before more recent geopolitical disasters, I saw on the news that a ârapid response teamâ of Marines had landed in Port-au-Prince, Haiti, and I wondered whether any...

ORIGINAL ARTICLE: Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care

Thu, 01Â JulÂ 2004 00:00:00 -05:00

Background: The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental...

LEGAL ISSUES IN MEDICINE: Forcible Medication for Courtroom Competence â The Case of Charles Sell

George J. Annas, J.D., M.P.H. — Thu, 27Â MayÂ 2004 00:00:00 -05:00

The right to refuse treatment is firmly recognized in U.S. law.1 Competent persons have the legal right to refuse treatment, even life-sustaining treatment, and incompetent patients can also refuse treatment...

PERSPECTIVE: Torment

Danielle Ofri, M.D., Ph.D. — Thu, 27Â MayÂ 2004 00:00:00 -05:00

I groan when I catch sight of her name on the patient roster. Nazma Uddin. Not again! She is in my clinic office almost every month. I dread her visits,...

PERSPECTIVE: Antidepressant Medications in Children

Benedetto Vitiello, M.D., and Susan Swedo, M.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

In June 2003, the Medicine and Healthcare Products Regulatory Agency of the British Department of Health warned physicians to avoid the off-label use of paroxetine, a selective serotonin-reuptake inhibitor (SSRI)...

ORIGINAL ARTICLE: Outcomes at School Age after Postnatal Dexamethasone Therapy for Lung Disease of Prematurity

Thu, 25Â MarÂ 2004 00:00:00 -05:00

Background: We studied the outcomes at school age in children who had participated in a double-blind, placebo-controlled trial of early postnatal dexamethasone therapy (initiated within 12 hours after birth) for...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Psychotomimetic Effects of Drugs â A Common Pathway to Schizophrenia?

David J. Gerber, Ph.D., and Susumu Tonegawa, Ph.D. — Thu, 04Â MarÂ 2004 00:00:00 -05:00

Researchers have long been interested in identifying a final, common pathway for psychosis. The existence of such a pathway is implied by the fact that various drug intoxications, schizophrenia and...

PERSPECTIVE: Narrative and Medicine

Rita Charon, M.D., Ph.D. — Thu, 26Â FebÂ 2004 00:00:00 -05:00

A 36-year-old Dominican man with a chief symptom of back pain comes to see me for the first time. As his new internist, I tell him, I have to learn...

HEALTH POLICY REPORT: The Mental Health Maze and the Call for Transformation

John K. Iglehart — Thu, 29Â JanÂ 2004 00:00:00 -05:00

In an early effort to establish his credentials as a âcompassionate conservativeâ during the 2000 presidential campaign, George W. Bush pledged that if he were elected, he would create a...

ORIGINAL ARTICLE: Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth

William G. Reiner, M.D., and John P. Gearhart, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

Background: Cloacal exstrophy is a rare, complex defect of the entire pelvis and its contents that occurs during embryogenesis and is associated with severe phallic inadequacy or phallic absence in...

PERSPECTIVE: Three Facets of Sexual Differentiation

Daniel D. Federman, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

Sexual reproduction requires three types of differentiation: gonadal for the production of gametes, genital for the conveyance of gametes to a point of fertilization, and behavioral for the urge to...

CLINICAL PRACTICE: ObsessiveâCompulsive Disorder

Michael A. Jenike, M.D. — Thu, 15Â JanÂ 2004 00:00:00 -05:00

A 33-year-old woman presents with a seven-year history of hand washing for two to six hours a day, as well as urges to check doors and stoves extensively before leaving...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Bruno FranÃ§ois, M.D. and Olivier Brenet, M.D. — Thu, 01Â JanÂ 2004 00:00:00 -05:00

A 62-year-old man presented with an ileus, marked abdominal distention, hypotension, and oliguria. He had a 15-year history of chronic psychosis. Laboratory findings included renal dysfunction, abnormal liver-function values, and...

SPECIAL ARTICLE: End-of-Life Care and the Effects of Bereavement on Family Caregivers of Persons with Dementia

Thu, 13Â NovÂ 2003 00:00:00 -05:00

Background: Although family caregiving has been intensively studied in the past decade, little attention has been paid to the impact of end-of-life care on caregivers who are family members of...

PERSPECTIVE: Costs to Society of Family Caregiving for Patients with End-Stage Alzheimer's Disease

Holly G. Prigerson, Ph.D. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

Recent estimates indicate that the prevalence of Alzheimer's disease is increasing at an alarming rate, and with that increase comes a dramatic upsurge in the cost of this disease to...

REVIEW ARTICLE: Schizophrenia

Robert Freedman, M.D. — Thu, 30Â OctÂ 2003 00:00:00 -05:00

Schizophrenia is a chronic, debilitating psychotic mental disorder that affects about 1 percent of people. A new generation of medications and recent developments in neuropathology, brain imaging, and molecular genetics...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2003 â A 37-Year-Old Man with a History of Alcohol and Drug Abuse and Sudden Onset of Leg Weakness

Oscar Soto, M.D, and E. Tessa Hedley-Whyte, M.D. — Thu, 23Â OctÂ 2003 00:00:00 -05:00

A 37-year-old man was admitted to the hospital because of collapse.

The patient was unmarried and unemployed and was a former smoker. He had abused alcohol since the age of 13...

REVIEW ARTICLE: Drug Addiction

Jordi CamÃ, M.D., Ph.D., and MagÃ FarrÃ©, M.D., Ph.D. — Thu, 04Â SepÂ 2003 00:00:00 -05:00

Drug addiction is a chronic, relapsing disorder in which compulsive drug-seeking and drug-taking behavior persists despite serious negative consequences. Addictive substances induce pleasant states (euphoria in the initiation phase) or...

ORIGINAL ARTICLE: Office-Based Treatment of Opiate Addiction with a Sublingual-Tablet Formulation of Buprenorphine and Naloxone

Thu, 04Â SepÂ 2003 00:00:00 -05:00

Background: Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone has been proposed, but its efficacy and safety have not been well studied.

Methods: We conducted a...

CLINICAL PRACTICE: Bulimia Nervosa

Philip S. Mehler, M.D. — Thu, 28Â AugÂ 2003 00:00:00 -05:00

A 20-year-old woman presents with fatigue; laboratory tests reveal a serum potassium level of 2.3 mmol per liter and a serum bicarbonate level of 36 mmol per liter. She is...

ORIGINAL ARTICLE: Psychiatric Hospitalizations among Survivors of Cancer in Childhood or Adolescence

Thu, 14Â AugÂ 2003 00:00:00 -05:00

Background: We investigated whether children and adolescents who survive cancer are at increased risk for psychiatric hospitalization.

Methods: In a nationwide, population-based, retrospective cohort study, 3710 persons who survived at least...

ORIGINAL ARTICLE: Leisure Activities and the Risk of Dementia in the Elderly

Thu, 19Â JunÂ 2003 00:00:00 -05:00

Background: Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation...

PERSPECTIVE: Use It or Lose It â Do Effortful Mental Activities Protect against Dementia?

Joseph T. Coyle, M.D. — Thu, 19Â JunÂ 2003 00:00:00 -05:00

The past 15 years, since the cloning of the gene for amyloid precursor protein, have witnessed breathtaking advances in our understanding of the pathophysiology of Alzheimer's disease, the most common...

ORIGINAL ARTICLE: Pernicious Anemia with Neuropsychiatric Dysfunction in a Patient with Sickle Cell Anemia Treated with Folate Supplementation

Meekoo Dhar, M.D., Rita Bellevue, M.D., and Ralph Carmel, M.D. — Thu, 29Â MayÂ 2003 00:00:00 -05:00

03052932.xml The administration of folic acid can mask the megaloblastic anemia caused by cobalamin deficiency.12345 More critically, this masking, although neither complete nor permanent,234 can permit neurologic dysfunction to...

EDITORIAL: Managing Behavioral Health in Medicaid

David Mechanic, Ph.D. — Thu, 08Â MayÂ 2003 00:00:00 -05:00

Mental health and substance abuse services, commonly referred to as behavioral health services, have been more aggressively managed than most other medical and surgical services.1 Managed behavioral health organizations came...

SPECIAL ARTICLE: Effect of a Mental Health âCarve-Outâ Program on the Continuity of Antipsychotic Therapy

Wayne A. Ray, Ph.D., James R. Daugherty, M.S., and Keith G. Meador, M.D., M.P.H. — Thu, 08Â MayÂ 2003 00:00:00 -05:00

Background: On July 1, 1996, as a cost-containment strategy, Tennessee's expanded Medicaid program, TennCare, rapidly shifted the provision of mental health services to a fully capitated, specialty âcarve-outâ program, TennCare...

REVIEW ARTICLE: Management of Drug and Alcohol Withdrawal

Thomas R. Kosten, M.D., and Patrick G. O'Connor, M.D., M.P.H. — Thu, 01Â MayÂ 2003 00:00:00 -05:00

Each year in the United States, approximately 8.2 million persons are dependent on alcohol and 3.5 million are dependent on illicit drugs, including stimulants (1 million) and heroin (750,000).1 In...

CLINICAL PRACTICE: Care after Coronary-Artery Bypass Surgery

Mary E. Charlson, M.D., and O. Wayne Isom, M.D. — Thu, 10Â AprÂ 2003 00:00:00 -05:00

A 71-year-old woman who had a myocardial infarction five years previously and underwent coronary-artery bypass surgery six months ago visits a primary care physician. She had no complications after surgery,...

EDITORIAL: Opioids and Chronic Neuropathic Pain

Kathleen M. Foley, M.D. — Thu, 27Â MarÂ 2003 00:00:00 -05:00

Chronic neuropathic pain is a serious problem resulting from injury to the central or peripheral nervous system; it affects more than 2 million Americans. Despite advances in our understanding of...

ORIGINAL ARTICLE: Oral Opioid Therapy for Chronic Peripheral and Central Neuropathic Pain

Thu, 27Â MarÂ 2003 00:00:00 -05:00

Background: Although opioids are commonly used to treat chronic neuropathic pain, there are limited data to guide their use. Few controlled trials have been performed, and many types of neuropathic...

CLINICAL PRACTICE: Premenstrual Dysphoric Disorder

Tana A. Grady-Weliky, M.D. — Thu, 30Â JanÂ 2003 00:00:00 -05:00

A 33-year-old woman without a history of psychiatric illness presents with marked irritability, periods of crying, mood swings, severe fatigue, and increased appetite associated with a craving for carbohydrates. These...

ORIGINAL ARTICLE: A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism

Thu, 07Â NovÂ 2002 00:00:00 -05:00

Background: It has been suggested that vaccination against measles, mumps, and rubella (MMR) is a cause of autism.

Methods: We conducted a retrospective cohort study of all children born in Denmark...

PERSPECTIVE: Suspicions about the Safety of Vaccines

Thu, 07Â NovÂ 2002 00:00:00 -05:00

Vaccines represent one of the most effective interventions in medicine. They can protect whole populations from potentially dangerous diseases. Because vaccines are usually given to healthy people, especially children, any...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Restoring the Addicted Brain

Thu, 12Â SepÂ 2002 00:00:00 -05:00

Addictions are relapsing, remitting lifelong illnesses that are notoriously difficult to treat. One year after they have stopped drinking, approximately one third of patients with alcoholism remain abstinent, one third...

CLINICAL PRACTICE: Office-Based Treatment of Opioid-Dependent Patients

David A. Fiellin, M.D., and Patrick G. O'Connor, M.D., M.P.H. — Thu, 12Â SepÂ 2002 00:00:00 -05:00

A 30-year-old man reports a two-year history of heroin use. For the past year, he has been using intranasal heroin every day. He has undergone detoxification twice at a local...

IMAGES IN CLINICAL MEDICINE: Severe Abdominal Pain in a Girl

Carrie A. Czarnecki, M.D. and D. Fergus O'Coclain, M.D. — Thu, 05Â SepÂ 2002 00:00:00 -05:00

Figure 1. A 17-year-old girl with a history of bulimia and binge eating presented to the emergency room with severe, diffuse abdominal pain six hours after ingesting massive amounts of...

CLINICAL PRACTICE: Adolescent Depression

David A. Brent, M.D., and Boris Birmaher, M.D. — Thu, 29Â AugÂ 2002 00:00:00 -05:00

A 16-year-old boy is brought by his parents to his primary care physician because of a decline in school performance, which began at least three years earlier and has become...

ORIGINAL ARTICLE: Voriconazole versus Amphotericin B for Primary Therapy of Invasive Aspergillosis

Thu, 08Â AugÂ 2002 00:00:00 -05:00

Background: Voriconazole is a broad-spectrum triazole that is active against aspergillus species. 02080826.xml We conducted a randomized trial to compare voriconazole with amphotericin B for primary therapy of invasive aspergillosis.

Methods:...

ORIGINAL ARTICLE: Risperidone in Children with Autism and Serious Behavioral Problems

Thu, 01Â AugÂ 2002 00:00:00 -05:00

Background: Atypical antipsychotic agents, which block postsynaptic dopamine and serotonin receptors, have advantages over traditional antipsychotic medications in the treatment of adults with schizophrenia and may be beneficial in children...

PERSPECTIVE: The Autistic-Spectrum Disorders

Thu, 01Â AugÂ 2002 00:00:00 -05:00

Any person, talented or handicapped, whose social skills have been severely deficient since very early childhood, who started to talk late or whose communicative use of language is inadequate, and...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Long-Term Effects of Early Genetic Influences on Behavior

Thu, 18Â JulÂ 2002 00:00:00 -05:00

The symptoms of anxiety disorders frequently begin in childhood. However, the full importance of childhood shyness and inhibited behavior as predictors of dysfunction during adulthood and as indicators of the...

CLINICAL PRACTICE: Postpartum Depression

Thu, 18Â JulÂ 2002 00:00:00 -05:00

A woman visits the doctor for her six-week postpartum evaluation. She reports that she cannot sleep even if her baby sleeps. She cries daily and worries constantly. She does not...

PERSPECTIVE: Physicians and Addiction

Thu, 16Â MayÂ 2002 00:00:00 -05:00

A report in this issue of the Journal (see pages 1529â1537), describes an outbreak of bloodstream infections in an intensive care unit that was traced to an employee who was...

SPECIAL ARTICLE: Psychological Sequelae of the September 11 Terrorist Attacks in New York City

Thu, 28Â MarÂ 2002 00:00:00 -05:00

Background: The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and...

EDITORIAL: Post-Traumatic Stress Disorder

Thu, 10Â JanÂ 2002 00:00:00 -05:00

Terrorist attacks require our health care system to prepare for the unspeakable. The primary goal of terrorism is to erode the security of a nation, to disrupt the continuity of...

REVIEW ARTICLE: Post-Traumatic Stress Disorder

Rachel Yehuda, Ph.D. — Thu, 10Â JanÂ 2002 00:00:00 -05:00

The terrorist attacks on the World Trade Center and the Pentagon on September 11, 2001, represented an amalgam of interpersonal violence, loss, and disaster. Tens of thousands of people ran...

EDITORIAL: Prevention of Relapse in Schizophrenia

Thu, 03Â JanÂ 2002 00:00:00 -05:00

Schizophrenia is a devastating mental disorder and a leading cause of disability.1 It affects between 0.4 and 1.4 percent of people during their lives,2 usually beginning in adolescence or early...

ORIGINAL ARTICLE: A Comparison of Risperidone and Haloperidol for the Prevention of Relapse in Patients with Schizophrenia

Thu, 03Â JanÂ 2002 00:00:00 -05:00

Background: Prevention of relapse is a major goal of maintenance treatment in patients with psychotic disorders. We performed a long-term comparison of a newer, atypical antipsychotic drug, risperidone, and an...

EDITORIAL: Tragedy and Insomnia

Thu, 20Â DecÂ 2001 00:00:00 -05:00

In this issue of the Journal, Lavie points out the high frequency of sleep disturbances, primarily insomnia and nightmares, that occur after local or distant disasters.1 This observation is supported...

REVIEW ARTICLE: Sleep Disturbances in the Wake of Traumatic Events

Peretz Lavie, Ph.D. — Thu, 20Â DecÂ 2001 00:00:00 -05:00

The terrorist attacks on the United States of September 11, 2001, are without precedent in modern history. On the basis of the incidence of psychiatric illness in the aftermath of...

EDITORIAL: Naltrexone Treatment for Alcohol Dependence

Thu, 13Â DecÂ 2001 00:00:00 -05:00

Treatment for alcohol dependence has been limited almost entirely to various types of counseling. An exception has been the use of the medication disulfiram, which acts indirectly by making a...

EDITORIAL: Mind Matters â Group Therapy and Survival in Breast Cancer

Thu, 13Â DecÂ 2001 00:00:00 -05:00

How much does mind matter in the outcome of cancer? The extent to which treatment of the emotional aspects of cancer affects disease progression is ultimately an empirical question. There...

ORIGINAL ARTICLE: Naltrexone in the Treatment of Alcohol Dependence

Thu, 13Â DecÂ 2001 00:00:00 -05:00

Background: Although naltrexone, an opiate-receptor antagonist, has been approved by the Food and Drug Administration for the treatment of alcohol dependence, its efficacy is uncertain.

Methods: We conducted a multicenter, double-blind,...

ORIGINAL ARTICLE: The Effect of Group Psychosocial Support on Survival in Metastatic Breast Cancer

Thu, 13Â DecÂ 2001 00:00:00 -05:00

Background: Supportiveâexpressive group therapy has been reported to prolong survival among women with metastatic breast cancer. However, in recent studies, various psychosocial interventions have not prolonged survival.

Methods: In a multicenter...

SOUNDING BOARD: Will Parity in Coverage Result in Better Mental Health Care?

Thu, 06Â DecÂ 2001 00:00:00 -05:00

âEquality between mental health coverage and other health coverage is an affordable and effective objective,â according to a 1999 report by the Surgeon General.1 On the basis of this conclusion...

SPECIAL REPORT: A National Survey of Stress Reactions after the September 11, 2001, Terrorist Attacks

Thu, 15Â NovÂ 2001 00:00:00 -05:00

Background: People who are not present at a traumatic event may experience stress reactions. We assessed the immediate mental health effects of the terrorist attacks on September 11, 2001.

Methods: Using...

CLINICAL PRACTICE: The Patient with Hypochondriasis

Arthur J. Barsky, M.D. — Thu, 08Â NovÂ 2001 00:00:00 -05:00

A 39-year-old single woman returns to her internist for the sixth time in nine months with the same symptoms â intermittent paresthesias and âswelling" of her hands and feet and...

EDITORIAL: Drug Treatment of Anxiety Disorders in Children

Thu, 26Â AprÂ 2001 00:00:00 -05:00

Anxiety disorders represent the most common group of serious psychiatric conditions affecting children and adolescents. In a community-based study, approximately 3 percent of 9-to-17-year-olds had a diagnosable anxiety disorder that...

ORIGINAL ARTICLE: Fluvoxamine for the Treatment of Anxiety Disorders in Children and Adolescents

Thu, 26Â AprÂ 2001 00:00:00 -05:00

Background: Drugs that selectively inhibit serotonin reuptake are effective treatments for adults with mood and anxiety disorders, but limited data are available on the safety and efficacy of serotonin-reuptake inhibitors...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Anxiety at the Frontier of Molecular Medicine

Thu, 19Â AprÂ 2001 00:00:00 -05:00

Anxiety is a ubiquitous and unavoidable experience of life. It can be adaptive but also debilitating. Anxiety involves subjective feelings (e.g., worry and a sense of threat), physiological responses (e.g.,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2001 â A 16-Year-Old Boy with an Altered Mental Status and Muscle Rigidity

Mark H. Libenson, Jane M. Yang — Thu, 19Â AprÂ 2001 00:00:00 -05:00

A 16-year-old boy was admitted to the hospital because of an altered mental and emotional status.

At an uncertain interval before admission, the patient began to have diarrhea. One week before...

ORIGINAL ARTICLE: Paroxetine for the Prevention of Depression Induced by High-Dose Interferon Alfa

Thu, 29Â MarÂ 2001 00:00:00 -05:00

Background: Depression commonly complicates treatment with the cytokine interferon alfa-2b. Laboratory animals pretreated with antidepressants have less severe depression-like symptoms after the administration of a cytokine. We sought to determine...

REVIEW ARTICLE: Managing Depression in Medical Outpatients

Mary A. Whooley, M.D., and Gregory E. Simon, M.D., M.P.H. — Thu, 28Â DecÂ 2000 00:00:00 -05:00

Depression is second only to hypertension as the most common chronic condition encountered in general medical practice.1 At least 1 in 10 outpatients has major depression, but most cases are...

EDITORIAL: Treating Opioid Dependence â New Data and New Opportunities

Thu, 02Â NovÂ 2000 00:00:00 -05:00

Heroin use in the United States has grown considerably over the past decade. Approximately 3 million Americans have used heroin,1 a fact that has led to increasing concern about heroin-related...

ORIGINAL ARTICLE: Lack of Correlation between Psychological Factors and Subclinical Coronary Artery Disease

Thu, 02Â NovÂ 2000 00:00:00 -05:00

Background: The relation between psychological variables and clinically evident coronary artery disease has been studied extensively, although the potential mechanisms of such a relation remain speculative. We studied the relation...

ORIGINAL ARTICLE: A Comparison of Levomethadyl Acetate, Buprenorphine, and Methadone for Opioid Dependence

Thu, 02Â NovÂ 2000 00:00:00 -05:00

Background: Opioid dependence is a chronic, relapsing disorder with important public health implications.

Methods: In a 17-week randomized study of 220 patients, we compared levomethadyl acetate (75 to 115 mg), buprenorphine...

ORIGINAL ARTICLE: Transdermal Testosterone Treatment in Women with Impaired Sexual Function after Oophorectomy

Thu, 07Â SepÂ 2000 00:00:00 -05:00

Background: The ovaries provide approximately half the circulating testosterone in premenopausal women. After bilateral oophorectomy, many women report impaired sexual functioning despite estrogen replacement. We evaluated the effects of transdermal...

EDITORIAL: Detection of Preclinical Alzheimer's Disease

Thu, 17Â AugÂ 2000 00:00:00 -05:00

Alzheimer's disease is a chronic disorder with a gradual onset and slowly progressive course that is characterized by an inevitable deterioration in cognitive function. To develop new methods to prevent...

ORIGINAL ARTICLE: Patterns of Brain Activation in People at Risk for Alzheimer's Disease

Thu, 17Â AugÂ 2000 00:00:00 -05:00

Background: The Îµ4 allele of the apolipoprotein E gene (APOE) is the chief known genetic risk factor for Alzheimer's disease, the most common cause of dementia late in life. To...

REVIEW ARTICLE: Erectile Dysfunction

Tom F. Lue, M.D. — Thu, 15Â JunÂ 2000 00:00:00 -05:00

Erectile dysfunction is defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse.1 It has been estimated to affect 20 million to 30 million...

EDITORIAL: Treatment of Chronic Depression

Thu, 18Â MayÂ 2000 00:00:00 -05:00

The majority of persons who have an acute episode of a major depressive disorder will have a response to the first or second treatment tried.1 In patients with mild or...

ORIGINAL ARTICLE: A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression

Thu, 18Â MayÂ 2000 00:00:00 -05:00

Background: Patients with chronic forms of major depression are difficult to treat, and the relative efficacy of medications and psychotherapy is uncertain.

Methods: We randomly assigned 681 adults with a chronic...

SPECIAL ARTICLE: Symptoms and Suffering at the End of Life in Children with Cancer

Thu, 03Â FebÂ 2000 00:00:00 -05:00

Background: Cancer is the second leading cause of death in children, after accidents. Little is known, however, about the symptoms and suffering at the end of life in children with...

SPECIAL ARTICLE: Mass Psychogenic Illness Attributed to Toxic Exposure at a High School

Thu, 13Â JanÂ 2000 00:00:00 -05:00

Background: Mass psychogenic illness may be difficult to differentiate from illness caused by bioterrorism, rapidly spreading infection, or toxic substances. We investigated symptoms attributed to exposure to toxic gas at...

EDITORIAL: Responding to Mass Psychogenic Illness

Thu, 13Â JanÂ 2000 00:00:00 -05:00

In this issue of the Journal, Jones and colleagues report on an episode of mass psychogenic illness that had a devastating impact on a high school in McMinnville, Tennessee.1 They...

EDITORIAL: Lessons from Secretin

Thu, 09Â DecÂ 1999 00:00:00 -05:00

In this issue of the Journal, Sandler and colleagues report the negative results of a double-blind, placebo-controlled trial of a single intravenous dose of synthetic human secretin in children with...

EDITORIAL: Lessons from Secretin

Thu, 09Â DecÂ 1999 00:00:00 -05:00

ORIGINAL ARTICLE: Lack of Benefit of a Single Dose of Synthetic Human Secretin in the Treatment of Autism and Pervasive Developmental Disorder

Thu, 09Â DecÂ 1999 00:00:00 -05:00

Background: Secretin is a peptide hormone that stimulates pancreatic secretion. After recent publicity about a child with autism whose condition markedly improved after a single dose of secretin, thousands of...

ORIGINAL ARTICLE: Lack of Benefit of a Single Dose of Synthetic Human Secretin in the Treatment of Autism and Pervasive Developmental Disorder

Thu, 09Â DecÂ 1999 00:00:00 -05:00

EDITORIAL: Firearms and Suicide

Thu, 18Â NovÂ 1999 00:00:00 -05:00

The article by Wintemute et al.1 in this issue of the Journal adds to the growing literature that connects firearms with increased risks of suicide and homicide.23456 Some of these...

SPECIAL ARTICLE: Mortality among Recent Purchasers of Handguns

Thu, 18Â NovÂ 1999 00:00:00 -05:00

Background: There continues to be considerable controversy over whether ownership of a handgun increases or decreases the risk of violent death.

Methods: We conducted a population-based cohort study to compare mortality...

ORIGINAL ARTICLE: An International Study of the Relation between Somatic Symptoms and Depression

Thu, 28Â OctÂ 1999 00:00:00 -05:00

Background: Patients with depression, particularly those seen by primary care physicians, may report somatic symptoms, such as headache, constipation, weakness, or back pain. Some previous studies have suggested that patients...

REVIEW ARTICLE: Domestic Violence

Stephanie A. Eisenstat, M.D., and Lundy Bancroft, B.A. — Thu, 16Â SepÂ 1999 00:00:00 -05:00

Domestic abuse, or battering, is a pattern of psychological, economic, and sexual coercion of one partner in a relationship by the other that is punctuated by physical assaults or credible...

SPECIAL ARTICLE: An Increase in the Number of Deaths in the United States in the First Week of the Month â An Association with Substance Abuse and Other Causes of Death

Thu, 08Â JulÂ 1999 00:00:00 -05:00

Background: and Methods: There are regular changes in mortality rates, such as increased rates of death from influenza in the winter and from motor vehicle accidents on long holiday weekends....

EDITORIAL: Use of Alternative Medicine â A Marker for Distress?

Thu, 03Â JunÂ 1999 00:00:00 -05:00

In this issue of the Journal, Burstein and colleagues give us surprising new information about women who begin to use alternative medicine after receiving a diagnosis of breast cancer.1 The...

SPECIAL ARTICLE: Use of Alternative Medicine by Women with Early-Stage Breast Cancer

Thu, 03Â JunÂ 1999 00:00:00 -05:00

Background: We analyzed the use of alternative medicine by women who had received standard therapy for early-stage breast cancer diagnosed between September 1993 and September 1995.

Methods: A cohort of 480...

SOUNDING BOARD: The Loneliness of the Long-Term Care Giver

Thu, 20Â MayÂ 1999 00:00:00 -05:00

I am standing at a bank of phones, desperately punching in codes and numbers. Each time, the line goes dead. âWhy can't I get through to anyone?â I think. âI...

EDITORIAL: Parkinson's Disease, Depression, and Electrical Stimulation of the Brain

Thu, 13Â MayÂ 1999 00:00:00 -05:00

On November 6, 1780, the Italian anatomist Luigi Galvani made an entry in his diary that recorded his observation of electrically stimulated muscle contractions in the legs of a freshly...

REVIEW ARTICLE: Drug Therapy for Alcohol Dependence

Robert M. Swift, M.D., Ph.D. — Thu, 13Â MayÂ 1999 00:00:00 -05:00

Alcohol dependence is a chronic disorder that results from a variety of genetic, psychosocial, and environmental factors.1 As defined by the American Psychiatric Association in the Diagnostic and Statistical Manual...

ORIGINAL ARTICLE: Transient Acute Depression Induced by High-Frequency Deep-Brain Stimulation

Thu, 13Â MayÂ 1999 00:00:00 -05:00

Continuous high-frequency stimulation of the basal ganglia was recently introduced for the treatment of patients with advanced Parkinson's disease.1 This treatment seems to be most effective when the electrodes are...

SOUNDING BOARD: Ethical and Human-Rights Issues in Research on Mental Disorders That May Affect Decision-Making Capacity

Thu, 06Â MayÂ 1999 00:00:00 -05:00

For research with human subjects, the more things change, the more they remain the same. In the 50-odd years since the 10 principles of the Nuremberg Code were set forth...

SOUNDING BOARD: Are Research Ethics Bad for Our Mental Health?

Thu, 06Â MayÂ 1999 00:00:00 -05:00

Patients with mental illness are much better off now than they were only a few decades ago. Diagnostic methods are more reliable, and treatments are more effective. Only a minority...

REVIEW ARTICLE: Eating Disorders

Thu, 08Â AprÂ 1999 00:00:00 -05:00

Eating disorders affect an estimated 5 million Americans every year. These illnesses â anorexia nervosa, bulimia nervosa, binge-eating disorder, and their variants â are characterized by a serious disturbance in...

EDITORIAL: Managing Psychosis in Patients with Parkinson's Disease

Thu, 11Â MarÂ 1999 00:00:00 -05:00

Managing psychosis is one of the most difficult challenges in the care of patients with Parkinson's disease. This complication occurs in 10 to 15 percent of such patients and consists...

REVIEW ARTICLE: Treatment of Attention-DeficitâHyperactivity Disorder

Josephine Elia, M.D., Paul J. Ambrosini, M.D., and Judith L. Rapoport, M.D. — Thu, 11Â MarÂ 1999 00:00:00 -05:00

Attention-deficitâhyperactivity disorder (ADHD) is a common but controversial syndrome characterized by developmentally inappropriate hyperactivity, impulsivity, and inattention.1 The disorder, which continues throughout life,234567 usually begins in childhood and is characterized...

ORIGINAL ARTICLE: Low-Dose Clozapine for the Treatment of Drug-Induced Psychosis in Parkinson's Disease

The Parkinson Study Group — Thu, 11Â MarÂ 1999 00:00:00 -05:00

Background: Drug-induced psychosis is a difficult problem to manage in patients with Parkinson's disease. Multiple open-label studies have reported that treatment with clozapine at low doses ameliorates psychosis without worsening...

ORIGINAL ARTICLE: A Controlled Trial of Sustained-Release Bupropion, a Nicotine Patch, or Both for Smoking Cessation

Thu, 04Â MarÂ 1999 00:00:00 -05:00

Background: and Methods: Use of nicotine-replacement therapies and the antidepressant bupropion helps people stop smoking. We conducted a double-blind, placebo-controlled comparison of sustained-release bupropion (244 subjects), a nicotine patch (244...

EDITORIAL: Understanding the Causes of Schizophrenia

Thu, 25Â FebÂ 1999 00:00:00 -05:00

Schizophrenia is one of our most important public health problems. It is a common, tragic, and devastating mental illness that typically strikes young people just when they are maturing into...

ORIGINAL ARTICLE: Effects of Family History and Place and Season of Birth on the Risk of Schizophrenia

Thu, 25Â FebÂ 1999 00:00:00 -05:00

Background: Although a family history of schizophrenia is the best-established risk factor for schizophrenia, environmental factors such as the place and season of birth may also be important.

Methods: Using data...

EDITORIAL: Cocaine, Smoking, and Spontaneous Abortion

Thu, 04Â FebÂ 1999 00:00:00 -05:00

In 1991 the Senate Committee on Appropriations approached the National Institute of Child Health and Human Development with a request and an offer. The request was to design a definitive...

ORIGINAL ARTICLE: Cocaine and Tobacco Use and the Risk of Spontaneous Abortion

Thu, 04Â FebÂ 1999 00:00:00 -05:00

Background: Cigarette smoking and cocaine use may be risk factors for spontaneous abortion, but data supporting such a link are limited.

Methods: We studied the associations between cocaine and tobacco use...

REVIEW ARTICLE: Problems in the Management of Attention-DeficitâHyperactivity Disorder

Alan J. Zametkin, M.D., and Monique Ernst, M.D., Ph.D. — Thu, 07Â JanÂ 1999 00:00:00 -05:00

Despite several name changes over the past 50 years, the current diagnosis of attention-deficitâhyperactivity disorder (ADHD) shares the core group of symptoms â impulsivity, inattention, and motor restlessness â with...

EDITORIAL: Infanticide

Thu, 22Â OctÂ 1998 00:00:00 -05:00

Accounts of parents who kill their infants date to the beginning of recorded history.1 As recently as the early 1800s in Europe, up to a third of live-born infants were...

SPECIAL ARTICLE: Attitudes of Patients with Amyotrophic Lateral Sclerosis and Their Care Givers toward Assisted Suicide

Thu, 01Â OctÂ 1998 00:00:00 -05:00

Background: and Methods: Amyotrophic lateral sclerosis (ALS) is a neuromuscular disease that causes gradual paralysis, respiratory failure, and death, usually within three to five years after it has been diagnosed....

EDITORIAL: Depression in the Elderly â Falls and Pitfalls

Thu, 24Â SepÂ 1998 00:00:00 -05:00

Committing a patient to a course of drug therapy, particularly a long-term one, often represents a delicate balancing act in which the physician must juggle estimates of benefit and risk...

ORIGINAL ARTICLE: Antidepressants and the Risk of Falls among Nursing Home Residents

Thu, 24Â SepÂ 1998 00:00:00 -05:00

Background: In nursing home residents, the use of tricyclic and other heterocyclic antidepressants is associated with an increased risk of falls. The newer selective serotonin-reuptakeâinhibitor antidepressants are largely free of...

EDITORIAL: Regulation of Firearms

Thu, 17Â SepÂ 1998 00:00:00 -05:00

In the United States, the rates of injury and death due to firearms and the rate of crimes committed with firearms are far higher than those in any other industrialized...

SPECIAL ARTICLE: Use and Cost Effectiveness of Smoking-Cessation Services under Four Insurance Plans in a Health Maintenance Organization

Thu, 03Â SepÂ 1998 00:00:00 -05:00

Background: Lack of information about the effect of insurance coverage on the demand for and use of smoking-cessation services has prevented widescale adoption of coverage for such services.

Methods: In a...

SPECIAL ARTICLE: Hospitalization Costs Associated with Homelessness in New York City

Thu, 11Â JunÂ 1998 00:00:00 -05:00

Background: Homelessness is believed to be a cause of health problems and high medical costs, but data supporting this association have been difficult to obtain. We compared lengths of stay...

EDITORIAL: A Pill for Impotence

Thu, 14Â MayÂ 1998 00:00:00 -05:00

Impotence â the preferred term is now erectile dysfunction â is a common problem, especially among older men,1 and if it is not caused by psychological problems it certainly can...

EDITORIAL: Private Arsenals and Public Peril

Thu, 07Â MayÂ 1998 00:00:00 -05:00

In the aftermath of the shootings at the Westside Middle School in Jonesboro, Arkansas, Karen Curtner, the principal of the school, said, âThe issue here is not the weapon or...

REVIEW ARTICLE: Patients with Alcohol Problems

Patrick G. O'Connor, M.D., M.P.H., and Richard S. Schottenfeld, M.D. — Thu, 26Â FebÂ 1998 00:00:00 -05:00

Alcohol use is associated with many health problems,12 along with 100,000 deaths and an annual economic cost of $100 billion in the United States.1 From the perspective of generalist physicians,...

EDITORIAL: Treatment of Men with Paraphilia

Thu, 12Â FebÂ 1998 00:00:00 -05:00

People convicted of sexually abusing children are usually incarcerated, a strategy that has not been successful but for which the costs have been staggering ($2,055,528,000 in the United States in...

ORIGINAL ARTICLE: Treatment of Men with Paraphilia with a Long-Acting Analogue of Gonadotropin-Releasing Hormone

Ariel RÃ¶sler, M.D., and Eliezer Witztum, M.D. — Thu, 12Â FebÂ 1998 00:00:00 -05:00

Background: Men with deviant sexual behavior, or paraphilia, are usually treated with psychotherapy, antidepressant drugs, progestins, and antiandrogens, but these treatments are often ineffective. Selective inhibition of pituitaryâgonadal function with...

SPECIAL ARTICLE: Suicide after Natural Disasters

Thu, 05Â FebÂ 1998 00:00:00 -05:00

Background: Among the victims of floods, earthquakes, and hurricanes, there is an increased prevalence of post-traumatic stress disorder and depression, which are risk factors for suicidal thinking. We conducted this...

REVIEW ARTICLE: Dyslexia

Sally E. Shaywitz, M.D. — Thu, 29Â JanÂ 1998 00:00:00 -05:00

Developmental dyslexia is characterized by an unexpected difficulty in reading in children and adults who otherwise possess the intelligence, motivation, and schooling considered necessary for accurate and fluent reading. Dyslexia...

EDITORIAL: Premenstrual Syndrome â Pathophysiologic Considerations

Thu, 22Â JanÂ 1998 00:00:00 -05:00

During the past decade premenstrual syndrome has become a well-defined entity.1 The hallmark of the syndrome is the repeated occurrence of behavioral and somatic symptoms severe enough to impair a...

ORIGINAL ARTICLE: Differential Behavioral Effects of Gonadal Steroids in Women with and in Those without Premenstrual Syndrome

Thu, 22Â JanÂ 1998 00:00:00 -05:00

Background: The symptoms of women with premenstrual syndrome improve in response to suppression of ovarian function, although these women have no evidence of ovarian dysfunction. We undertook a study to...

REVIEW ARTICLE: Assessment and Treatment of Suicidal Patients

Robert M.A. Hirschfeld, M.D., and James M. Russell, M.D. — Thu, 25Â SepÂ 1997 00:00:00 -05:00

The assessment of suicidal thoughts or behavior and its management are topics relevant to all clinicians, not just mental health professionals. Up to two thirds of patients who commit suicide...

EDITORIAL: Pharmacologic Advances in the Treatment of Schizophrenia

Thu, 18Â SepÂ 1997 00:00:00 -05:00

Although medications have dramatically improved the lives of many people with schizophrenia, treatment resistance remains a serious problem. Three quarters of patients with schizophrenia become ill before the age of...

ORIGINAL ARTICLE: A Comparison of Clozapine and Haloperidol in Hospitalized Patients with Refractory Schizophrenia

Thu, 18Â SepÂ 1997 00:00:00 -05:00

Background: Clozapine, a relatively expensive antipsychotic drug, is widely used to treat patients with refractory schizophrenia. It has a low incidence of extrapyramidal side effects but may cause agranulocytosis. There...

SPECIAL ARTICLE: The Sleep of Long-Haul Truck Drivers

Thu, 11Â SepÂ 1997 00:00:00 -05:00

Background: Fatigue and sleep deprivation are important safety issues for long-haul truck drivers.

Methods: We conducted round-the-clock electrophysiologic and performance monitoring of four groups of 20 male truck drivers who were...

REVIEW ARTICLE: Autism

Isabelle Rapin, M.D. — Thu, 10Â JulÂ 1997 00:00:00 -05:00

Few disorders seem more confusing than autism. Common stereotypes â of a severely withdrawn, mute child with ceaselessly repetitive activities and an averted gaze or a freakish-looking, inept, mathematical prodigy...

EDITORIAL: Psychiatry and Assisted Suicide in the United States

Thu, 19Â JunÂ 1997 00:00:00 -05:00

After years of debate over the ethical and legal issues in physician-assisted suicide, empirical research is beginning to infuse a realistic clinical perspective into this previously theoretical controversy. Studies reveal...

EDITORIAL: Improving Outpatient Psychiatric Care

Thu, 20Â FebÂ 1997 00:00:00 -05:00

Medical care can be managed so as to ensure quality, distribute resources rationally, and control costs. The specific market-based variant of managed care that has flourished in the United States...

SPECIAL ARTICLE: Differences in the Use of Psychiatric Outpatient Services between the United States and Ontario

Thu, 20Â FebÂ 1997 00:00:00 -05:00

Background: The relation between health insurance and the use of mental health services is unclear. We compared the use of outpatient services for psychiatric problems in the United States and...

REVIEW ARTICLE: Management of Insomnia

David J. Kupfer, M.D., and Charles F. Reynolds III, M.D. — Thu, 30Â JanÂ 1997 00:00:00 -05:00

Insomnia is a common symptom, and clinicians need a diagnostic approach that allows them to choose from among many different types of therapy. This review focuses on the practical management...

ORIGINAL ARTICLE: Neurodevelopment of Children Exposed in Utero to Antidepressant Drugs

Thu, 23Â JanÂ 1997 00:00:00 -05:00

Background: Many women of reproductive age have depression, necessitating therapy with either a tricyclic antidepressant drug or a drug, such as fluoxetine, that inhibits the reuptake of serotonin. Whether these...

ORIGINAL ARTICLE: The Safety of Transdermal Nicotine as an Aid to Smoking Cessation in Patients with Cardiac Disease

Thu, 12Â DecÂ 1996 00:00:00 -05:00

Background: Transdermal nicotine therapy is widely used to aid smoking cessation, but there is uncertainty about its safety in patients with cardiac disease.

Methods: In a randomized, double-blind, placebo-controlled trial at...

ORIGINAL ARTICLE: Bone Mineral Density in Women with Depression

Thu, 17Â OctÂ 1996 00:00:00 -05:00

Background: Depression is associated with alterations in behavior and neuroendocrine systems that are risk factors for decreased bone mineral density. This study was undertaken to determine whether women with past...

EDITORIAL: Treating Depression in Pregnancy

Thu, 03Â OctÂ 1996 00:00:00 -05:00

Pregnancy is frequently thought of as a time of emotional well-being for women, but it does not protect them from mood instability. In fact, it is a risk factor for...

ORIGINAL ARTICLE: Birth Outcomes in Pregnant Women Taking Fluoxetine

Thu, 03Â OctÂ 1996 00:00:00 -05:00

Background: Although fluoxetine is the most frequently prescribed antidepressant drug in the United States, its safety in pregnant women has not been established.

Methods: From 1989 through 1995, we prospectively identified...

REVIEW ARTICLE: Evaluation of Dementia

David S. Geldmacher, M.D., and Peter J. Whitehouse, M.D., Ph.D. — Thu, 01Â AugÂ 1996 00:00:00 -05:00

Dementia is the clinical syndrome characterized by acquired losses of cognitive and emotional abilities severe enough to interfere with daily functioning and the quality of life. The term does not...

REVIEW ARTICLE: Evaluation of Dementia

David S. Geldmacher, M.D., and Peter J. Whitehouse, M.D., Ph.D. — Thu, 01Â AugÂ 1996 00:00:00 -05:00

Dementia is the clinical syndrome characterized by acquired losses of cognitive and emotional abilities severe enough to interfere with daily functioning and the quality of life. The term does not...

SOUNDING BOARD: Physical and Emotional Problems of Elite Female Gymnasts

Thu, 25Â JulÂ 1996 00:00:00 -05:00

Within the past five years, two U.S. female gymnasts at the Olympic level, Christy Henrich and Julissa Gomez, died from medical problems related to their sport. Christy died from complications...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Molecular Mechanisms of Cocaine Addiction

Thu, 11Â JulÂ 1996 00:00:00 -05:00

Effective medication for the treatment of cocaine overdose and addiction is a major unmet need of worldwide importance. In contrast to heroin, for which there are effective medications to treat...

REVIEW ARTICLE: The Psychological Care of Patients with Insulin-Dependent Diabetes Mellitus

Alan M. Jacobson, M.D. — Thu, 09Â MayÂ 1996 00:00:00 -05:00

Patients with insulin-dependent diabetes mellitus (IDDM) face major changes in lifestyle and the possibility of debilitating and life-threatening complications. Treatment requires a knowledgeable health care team that includes a physician,...

REVIEW ARTICLE: Management of Cocaine Abuse and Dependence

Jack H. Mendelson, M.D., and Nancy K. Mello, Ph.D. — Thu, 11Â AprÂ 1996 00:00:00 -05:00

During the 20th century, there have been recurrent episodes of cocaine abuse in the United States that have achieved epidemic proportions.1 Although the total number of people using the drug...

EDITORIAL: Injection Therapy for Erectile Dysfunction

Thu, 04Â AprÂ 1996 00:00:00 -05:00

In this issue of the Journal, Linet and Ogrinc report that intracavernous-injection therapy with alprostadil (a synthetic prostaglandin E1) can produce good results in men with erectile dysfunction (impotence).1 It...

SOUNDING BOARD: The Challenges Posed by Managed Behavioral Health Care

Thu, 11Â JanÂ 1996 00:00:00 -05:00

Someone reportedly once teased H.L. Mencken, a proudly self-proclaimed atheist, by asking him if he believed in infant baptism. âBelieve in it?â Mencken replied. âHell, I've seen it with my...

REVIEW ARTICLE: Schizophrenia

John Michael Kane, M.D. — Thu, 04Â JanÂ 1996 00:00:00 -05:00

Schizophrenia is an often severe and disabling disorder that usually begins in late adolescence or early adulthood. The essential features of this illness are a variable array of symptoms, such...

NEJM â Collection Updates for Psychiatry

CLINICAL PRACTICE: Jet Lag

EDITORIAL: Prevention of Psychiatric Problems among Military Personnel and Their Spouses

ORIGINAL ARTICLE: Morphine Use after Combat Injury in Iraq and Post-Traumatic Stress Disorder

ORIGINAL ARTICLE: Deployment and the Use of Mental Health Services among U.S. Army Wives

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 41-2009 â A 16-Year-Old Boy with Hypothermia and Frostbite

PERSPECTIVE: A Difficult Balance â Pain Management, Drug Safety, and the FDA

EDITORIAL: Dying from Dementia

ORIGINAL ARTICLE: The Clinical Course of Advanced Dementia

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2009 â A 26-Year-Old Man with Abdominal Distention and Shock

EDITORIAL: Heroin Prescription and History

ORIGINAL ARTICLE: Diacetylmorphine versus Methadone for the Treatment of Opioid Addiction

BOOK REVIEW:

BOOK REVIEW:

PERSPECTIVE: What Would Osler Do? Learning from âDifficultâ Patients

EDITORIAL: Effect of Genetic Testing for Risk of Alzheimer's Disease

ORIGINAL ARTICLE: Longitudinal Modeling of Age-Related Memory Decline and the Îµ4 Effect

ORIGINAL ARTICLE: Disclosure of Genotype for Risk of Alzheimer's Disease

PERSPECTIVE: Who Has Capacity?

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

CORRESPONDENCE: Developing Unbiased Diagnostic and Treatment Guidelines in Psychiatry

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

REVIEW ARTICLE: Medical Evaluation of Patients Undergoing Electroconvulsive Therapy

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

CLINICAL THERAPEUTICS: Behavioral Management for Anorexia Nervosa

CORRESPONDENCE: Long-QT Syndrome Induced by the Antiaddiction Drug Ibogaine

EDITORIAL: Antipsychotic Agents and Sudden Cardiac Death â How Should We Manage the Risk?

ORIGINAL ARTICLE: Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death

BOOK REVIEW:

EDITORIAL: Pediatric Anxiety â Underrecognized and Undertreated

ORIGINAL ARTICLE: Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

ORIGINAL ARTICLE: Subthalamic Nucleus Stimulation in Severe ObsessiveâCompulsive Disorder

BOOK REVIEW:

CLINICAL THERAPEUTICS: Varenicline for Tobacco Dependence

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2008 â A 19-Year-Old Man with Weight Loss and Abdominal Pain

PERSPECTIVE: The Ethics of Interrogation â The U.S. Military's Ongoing Use of Psychiatrists

PERSPECTIVE: Guns and Suicide in the United States

BOOK REVIEW:

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2008 â A 26-Year-Old Woman with Headache and Behavioral Changes

CLINICAL THERAPEUTICS: Naltrexone for the Management of Alcohol Dependence

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2008 â A 35-Year-Old Woman with Postpartum Confusion, Agitation, and Delusions

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

PERSPECTIVE: Shuffling toward Parity â Bringing Mental Health Care under the Umbrella

IMAGES IN CLINICAL MEDICINE: Bladder Foreign Body

SPECIAL ARTICLE: The Collective Dynamics of Smoking in a Large Social Network

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2008 â A 78-Year-Old Man with Anergia and Anhedonia Associated with Cardiovascular Surgery

EDITORIAL: Depth-of-Anesthesia Monitor and the Frequency of Intraoperative Awareness

ORIGINAL ARTICLE: Anesthesia Awareness and the Bispectral Index

EDITORIAL: Disentangling Mild Traumatic Brain Injury and Stress Reactions

ORIGINAL ARTICLE: Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq

SPECIAL ARTICLE: Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy

REVIEW ARTICLE: Major Depressive Disorder

PERSPECTIVE: The Good Patient

PERSPECTIVE: The View from the Other Side â Patients, Doctors, and the Power of a Camera

CLINICAL PRACTICE: Erectile Dysfunction

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Molecules That Mediate Mood

IMAGES IN CLINICAL MEDICINE: Trichobezoar

CLINICAL THERAPEUTICS: Electroconvulsive Therapy for Depression

CLINICAL PRACTICE: Assessment of Patients' Competence to Consent to Treatment

ORIGINAL ARTICLE: Visualizing Out-of-Body Experience in the Brain

EDITORIAL: Treatment of Neuropsychiatric Symptoms in Patients with Dementia

NEJM â Collection Updates for Psychiatry

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 41-2009 â A 16-Year-Old Boy with Hypothermia and Frostbite

PERSPECTIVE: A Difficult Balance â Pain Management, Drug Safety, and the FDA

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2009 â A 26-Year-Old Man with Abdominal Distention and Shock

PERSPECTIVE: What Would Osler Do? Learning from âDifficultâ Patients

EDITORIAL: Antipsychotic Agents and Sudden Cardiac Death â How Should We Manage the Risk?

EDITORIAL: Pediatric Anxiety â Underrecognized and Undertreated

ORIGINAL ARTICLE: Subthalamic Nucleus Stimulation in Severe ObsessiveâCompulsive Disorder

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2008 â A 19-Year-Old Man with Weight Loss and Abdominal Pain

PERSPECTIVE: The Ethics of Interrogation â The U.S. Military's Ongoing Use of Psychiatrists

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2008 â A 26-Year-Old Woman with Headache and Behavioral Changes

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2008 â A 35-Year-Old Woman with Postpartum Confusion, Agitation, and Delusions

PERSPECTIVE: Shuffling toward Parity â Bringing Mental Health Care under the Umbrella

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2008 â A 78-Year-Old Man with Anergia and Anhedonia Associated with Cardiovascular Surgery

PERSPECTIVE: The View from the Other Side â Patients, Doctors, and the Power of a Camera

PERSPECTIVE: Falling through the Cracks â Virginia Tech and the Restructuring of College Mental Health Services

EDITORIAL: Teratogenicity of SSRIs â Serious Concern or Much Ado about Little?

PERSPECTIVE: Expanding the Black Box â Depression, Antidepressants, and the Risk of Suicide

PERSPECTIVE: The Antidepressant Quandary â Considering Suicide Risk When Treating Adolescent Depression

PERSPECTIVE: Familial Pathways to Suicidal Behavior â Understanding and Preventing Suicide among Adolescents

PERSPECTIVE: Uncovering an Epidemic â Screening for Mental Illness in Teens

PERSPECTIVE: Reconstructing Lives â A Tale of Two Soldiers

PERSPECTIVE: Violence and Mental Illness â How Strong is the Link?

EDITORIAL: Alzheimer's Disease â Clinical Trials and the Logic of Clinical Purpose

ORIGINAL ARTICLE: Counseling plus BuprenorphineâNaloxone Maintenance Therapy for Opioid Dependence

PERSPECTIVE: The Changing Face of Teenage Drug Abuse â The Trend toward Prescription Drugs

EDITORIAL: Treatment Strategies after SSRI Failure â Good News and Bad News

EDITORIAL: Play It Again, Sam â Depression Is Recurring

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2006 â A 71-Year-Old Woman with Crohn's Disease and Altered Mental Status

LEGAL ISSUES IN MEDICINE: Congress, Controlled Substances, and Physician-Assisted Suicide â Elephants in Mouseholes

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2006 â A 47-Year-Old Man with Altered Mental Status and Acute Renal Failure

PERSPECTIVE: Beyond Red Lake â The Persistent Crisis in American Indian Health Care

PERSPECTIVE: Getting an Edge â Use of Stimulants and Antidepressants in College

PERSPECTIVE: White Coat, Mood Indigo â Depression in Medical School

PERSPECTIVE: Curing Stigma â The Limits of Antiretroviral Access

PERSPECTIVE: Last-Ditch Medical Therapy â Revisiting Lobotomy

PERSPECTIVE: Taking Their Own Lives â The High Rate of Physician Suicide

PERSPECTIVE: Physician as Serial Killer â The Shipman Case