Not all that moves is tardive dyskinesia.

OBJECTIVE: Because tardive dyskinesia and spontaneous dyskinesia appear the same, it is difficult to determine whether an individual patient's abnormal movements are induced by medication or have developed spontaneously. Therefore, estimates of the prevalence of tardive dyskinesia that are based on observations not adjusted for spontaneous dyskinesia are inflated. In addition, age is thought to be an important risk factor in the development of both tardive and spontaneous dyskinesias. The authors estimate the prevalence of both disorders for specific age groups. METHOD: The authors reviewed nine reports on dyskinesia prevalence that included history of neuroleptic treatment and related prevalence to age. A rating of 2 or more on the Abnormal Involuntary Movement Scale or an equivalent score on another scale was considered an indication of dyskinesia. If the subject had taken neuroleptics for more than 3 months, the movement disorder was classified as neuroleptic-associated dyskinesia; other dyskinesias were considered spontaneous. The prevalence of tardive dyskinesia was defined as the rate of neuroleptic-associated dyskinesia minus the rate of spontaneous dyskinesia. RESULTS: The true rate of tardive dyskinesia was below 20% for all age groups except 70-79 years. The correlation between the rate of neuroleptic-associated dyskinesia and the rate of spontaneous dyskinesia was low. CONCLUSIONS: After age 40 the prevalence of spontaneous dyskinesia is sufficiently high to conclude that many patients with diagnoses of tardive dyskinesia have abnormal movements attributable to causes other than neuroleptics.     

Psychosomatic Medicine is a Comprehensive Field,Not a Synonym for Consultation Liaison Psychiatry

There is controversy surrounding the term psychosomatic. If it is used as an equivalent of consultation liaison psychiatry, there is little justification for retaining it. Psychosomatic medicine, however, may be defined as a comprehensive interdisciplinary framework for the assessment of psychosocial factors affecting individual vulnerability, course, and outcome of any type of disease; holistic consideration of patient care in clinical practice; and integration of psychological therapies in the prevention, treatment, and rehabilitation of medical disease. Psychosomatic medicine has developed several clinimetric tools for assessing psychosocial variables in the setting of medical disease and has raised the need for specific evaluations in medical assessment. The term psychosomatic medicine today seems to be more timely than ever and provides a home for innovative and integrative thinking at the interface of behavioral and medical sciences.     

Screening of Autism Spectrum Disorders in Geriatric Psychiatry

Autism spectrum disorders (ASD) are difficult to detect in old age. This study examined if ASD symptoms in older adults (age?>?60) can be detected with the Dutch informant personality questionnaire, (Hetero-Anamnestische Persoonlijkheidsvragenlijst, HAP) in a mental health setting. Patients with ASD (N?=?40) were compared to patients with a different psychiatric diagnosis (N?=?43; personality disorders excluded). The ASD group had significant higher scores on the scales ‘Socially avoidant behavior’, ‘Rigid behavior’ and ‘Unpredictable and impulsive behavior’. These scales were able to discriminate between individuals with or without ASD. The HAP can thus be used as a screening instrument for ASD symptoms in elderly patients. Further research is needed to clarify what items have the best predictive validity for ASD symptoms.     

A Randomized Controlled Trial of a Tailored Interactive Computer-Delivered Intervention to Promote Colorectal Cancer Screening: Sometimes More is Just the Same

Background

There have been few studies of tailored interventions to promote colorectal cancer (CRC) screening.

Purpose

We conducted a randomized trial of a tailored, interactive intervention to increase CRC screening.

Methods

Patients 50–70 years completed a baseline survey, were randomized to one of three groups, and attended a wellness exam after being exposed to a tailored intervention about CRC screening (tailored group), a public web site about CRC screening (web site group), or no intervention (survey-only group). The primary outcome was completion of any recommended CRC screening by 6 months.

Results

There was no statistically significant difference in screening by 6 months: 30%, 31%, and 28% of the survey-only, web site, and tailored groups were screened. Exposure to the tailored intervention was associated with increased knowledge and CRC screening self-efficacy at 2 weeks and 6 months. Family history, prior screening, stage of change, and physician recommendation moderated the intervention effects.

Conclusions

A tailored intervention was not more effective at increasing screening than a public web site or only being surveyed.     

The Mood Disorder Questionnaire: A Simple, Patient-Rated Screening Instrument for Bipolar Disorder

Bipolar disorder is frequently encountered in primary care settings, often in the form of poor response to treatment for depression. Although lifetime prevalence of bipolar I disorder is 1%, the prevalence of bipolar spectrum disorders (e.g., bipolar I, bipolar II, and cyclothymia) is much higher, especially among patients with depression. The consequences of misdiagnosis can be devastating. One way to improve recognition of bipolar spectrum disorders is to screen for them. The Mood Disorder Questionnaire is a brief, self-report screening instrument that can be used to identify patients most likely to have bipolar disorder. Once identified, and subsequently appropriately diagnosed, the lives of those with bipolar disorder may be considerably improved.     

NMDAR LTP and LTD induction: 2B or Not 2B...is that the question?

NMDA receptor (NMDAR) dependent forms of synaptic plasticity are thought to play critical roles in many aspects of CNS function and dysfunction, from learning and memory to addiction. NMDARs are heteromeric tetramers principally comprised of two NR1 subunits and two of four varieties of NR2 subunits (NR2A-2D). Recently, it has been proposed that specific NR2 subtypes subserve distinct roles in NMDAR-dependent long-term potentiation (LTP) and long-term depression (LTD). Here, we will review this literature, and describe an existing countervailing hypothesis, the charge-transfer hypothesis, which postulates that the total charge transfer through NMDARs, rather than specific subunits, dictates the polarity of synaptic plasticity. We will propose that a modification of the charge-transfer hypothesis, to include the possible involvement of protein-protein interactions imparted by distinct NR2 subunits, best fits the existing data.     

The Study of Psychiatry

This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.     

Stereoisomers in Psychiatry: The Case of Escitalopram

Many medications in common clinical use consist of "mirror image" isomers that differ only in the direction in which they rotate plane-polarized light. These stereoisomers exist as mixtures of "right" and "left" handed molecules that are the product of chemical syntheses. However, the biochemical milieu of the human body is a highly stereospecific environment where the fit of medication and receptor may depend on the shape of the molecule in 3-dimensional space. Recent advances in chemistry have allowed the more ready preparation of single isomers of various drugs that were previously available only as racemic mixtures. For those compounds in which the isomers differ in stereospecificity, this separation into single isomers can result in significant changes in potency, tolerability, and efficacy. This article reviews some basic information about stereochemistry and describes the development of a new single isomer antidepressant, escitalopram, which is one of the components of the widely used selective serotonin uptake inhibitor citalopram.