ABSTRACT
The diagnosis and treatment of subclinical hypothyroidism in mood-disordered patients is complex and somewhat controversial. The psychiatrist must recognize that such subclinical states may contribute to depression, mood cycling, or delayed response to treatment if undetected. Autoimmune thyroiditis, which may ultimately lead to various grades of hypothyroidism, may also be seen in depressed populations, particularly in postpartum females. The author discusses these issues by means of a clinical vignette, then proposes an algorithm for the diagnosis and treatment of hypothyroid states in mood disordered populations.
Subject(s)
Depression, Postpartum/complications , Depression/complications , Hypothyroidism/diagnosis , Hypothyroidism/therapy , Adult , Algorithms , Case Management , Female , Humans , Hypothyroidism/complications , Hypothyroidism/prevention & control , Mass Screening/standards , Practice Guidelines as Topic , Severity of Illness Index , Thyroid Hormones/therapeutic use , Thyroiditis, Autoimmune/complicationsABSTRACT
BACKGROUND: Self-injurious behavior (SIB) is a common clinical problem that affects a diverse group of patients and populations. Little is known about the underlying pathophysiology and pharmacologic treatment of SIB. METHOD: The authors selectively reviewed the clinical literature on SIB and related aggressive/impulsive behaviors, with the aim of formulating provisional guidelines for pharmacotherapy. RESULTS: The serotonergic system is most directly implicated in the pathophysiology of SIB and related behaviors. While there is no well-established "drug of choice" for SIB, the identification of specific subgroups of SIB patients and associated symptoms such as psychosis permits the rational selection of medication. Serotonin selective reuptake inhibitors, other serotonergic agents, antipsychotics, beta-blockers, and opiate antagonists all play a role in the treatment of SIB. CONCLUSION: SIB is not a single entity and may have different pharmacologic treatments, depending on the associated symptoms and target population. Medications that act on the serotonergic system appear to be the most promising.
Subject(s)
Self-Injurious Behavior/drug therapy , Self-Injurious Behavior/physiopathology , Serotonin/physiology , Humans , Serotonin Agents/therapeutic useSubject(s)
Hallucinations/chemically induced , Hypnotics and Sedatives/adverse effects , Pyridines/adverse effects , Adult , Dose-Response Relationship, Drug , Female , Humans , Hypnotics and Sedatives/pharmacology , Memory , Pyridines/pharmacology , Sleep Initiation and Maintenance Disorders/drug therapy , Wakefulness , ZolpidemABSTRACT
Clinical medicine in general and psychiatry in particular have their roots in the Hippocratic tradition. It is this tradition that defines the "deep structure" of the medical profession. Although the field of clinical psychology has a similar "surface structure" to that of psychiatry and general medicine, it has evolved from a wholly different set of deep structural antecedents. These issues relate directly to the question of "prescribing privileges" for psychologists. The addition of course work in psychopharmacology to the psychology curriculum would not alter the deep structure of the profession nor would it equip psychologists to prescribe psychotropic medication. There are, however, ways in which the disciplines of medicine and psychology can cooperate in the education of clinicians.
Subject(s)
Clinical Medicine , Psychiatry , Psychology, Clinical , Psychotropic Drugs/administration & dosage , Cooperative Behavior , Curriculum , Hippocratic Oath , Humans , Interprofessional Relations , Mental Disorders/drug therapy , Philosophy, Medical , Psychiatry/education , Psychology, Clinical/education , Psychology, Clinical/standards , Psychopharmacology/educationSubject(s)
Dyskinesia, Drug-Induced/prevention & control , Lithium/therapeutic use , Adult , Female , Humans , Lithium Carbonate , MaleSubject(s)
Anxiety Disorders/complications , Fear , Panic , Raynaud Disease/complications , Humans , Seasons , Vasomotor System/physiopathologyABSTRACT
There is considerable disagreement about the relationship between borderline personality disorder and the affective disorders. The authors report the results of a study of the relationship between dexamethasone suppression and depressive subtype in hospitalized depressed borderline patients. Twenty-three patients met research criteria for unipolar major depressive episode without psychosis of at least moderate severity. Thirteen patients also met criteria for borderline personality disorder. Dexamethasone suppression test (DST) results showed no significant correlation with either melancholia or borderline personality disorder alone. However, of the 13 borderlines, eight failed to suppress and six of those eight were not melancholic. The authors conclude that abnormal response to dexamethasone in nonmelancholic borderlines casts some doubt on the specificity of the DST for melancholia.
Subject(s)
Borderline Personality Disorder/diagnosis , Depressive Disorder/diagnosis , Dexamethasone , Hospitalization , Personality Disorders/diagnosis , Adolescent , Adult , Aged , Borderline Personality Disorder/blood , Borderline Personality Disorder/complications , Depressive Disorder/blood , Depressive Disorder/complications , Evaluation Studies as Topic , Humans , Hydrocortisone/blood , Middle AgedABSTRACT
Hysteroid dysphoria has been described in outpatient populations and is thought to be a subtype of atypical depression involving rejection sensitivity and therapeutic response to monoamine oxidase inhibitors. The presence of hysteroid dysphoria was assessed, using a semistructured interview, in 18 depressed inpatients. The 6 patients who met the criteria for hysteroid dysphoria did not differ from other depressed patients in severity, premorbid adjustment, number of atypical features, or presence of melancholia. Implications for treatment are discussed.
