Abstract: Skilled clinical decision making in the diagnosis and treatment of chronic pain can create unique clinical and ethical challenges, particularly when opioid medications are involved. This report presents the case of a pregnant woman who sought treatment for an illicit opioid dependence, initiated by opioid analgesic treatment of chronic pain. While recognizing opioids’ high level of effectiveness for pain relief, the case demonstrates the potential harms of opioid medications for particular patients

Source: General Hospital Psychiatry


Bupropion: 5 tips

By Flavio Guzman, MD
Editor, Psychopharmacology Institute

 

In this psychopharmacology refresher series, from the Psychopharmacology Institute, we discuss key aspects of commonly used medications. Today we start with 5 important concepts about bupropion.

1. Non-serotonergic. It does not influence serotonergic neurotransmission: it is a norepinephrine dopamine reuptake inhibitor without activity on the serotonin reuptake transporter.

 

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When I recruit scientists to NIMH, I usually have the three-legged stool conversation. I explain that career decisions can be based on three factors: salary, lifestyle, and impact. For most scientists, coming to NIMH means sacrificing salary and working very long hours for the opportunity to have enormous impact.

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Donated organs have saved the lives of many; most of us would gratefully receive a heart or kidney, and many of us willingly identify ourselves as potential donors for organs that can be used to restore health and life. It does not seem to be widely known, however, that there is a pressing need for donated postmortem brains—not for transplantation, which exists only in the realm of science fiction, but for research. Even assuming an awareness of the need for human brain tissue, the notion of donating the brain after death gives many pause

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Importance Despite evidence of the increasing use of psychotropic medications, little is known about the broader changes in the delivery of outpatient mental health treatment to children, adolescents, and adults. Objective To assess national trends and patterns in the mental health care of children, adolescents, and adults in office-based medical practice. Design, Setting, and Participants Outpatient visits to physicians in office-based practice from the 1995-2010 National Ambulatory Medical Care Surveys (N = 446 542).

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In this issue of JAMA Psychiatry , Bebko et al present an innovative multisite study that uses both categorical and dimensional approaches to test associations between brain activity and symptoms in youth with severe emotional and behavioral dysregulation. Using functional magnetic resonance imaging (fMRI) and a reward-guessing task in 105 youth, the authors examined associations between brain activation and DSM-IV categories and between brain activation and dimensional measures of mania, depression, anxiety, and risk for bipolar spectrum disorder (BPSD, measured by the Parent General Behavior Inventory 10-Item Mania Scale [PGBI-10M]). During reward trials, Bebko et al found associations between frontal activation and both dimensional and categorical clinical measures.

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Importance Posttraumatic stress disorder (PTSD) indicates a chronic stress reaction in response to trauma. This prevalent condition has been identified as a possible risk factor for obesity. Whether PTSD symptoms alter the trajectory of weight gain or constitute a comorbid condition has not been established.

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Importance An increased risk of depressive symptoms has been associated with the transition to menopause, but the risk of depressive symptoms in the early postmenopausal years has not been well characterized. Objectives To identify within-woman changes in depressive symptoms during a 14-year period around menopause, determine associations of a history of depression with the pattern of depressive symptoms, and evaluate the rate of change in reproductive hormones as predictors of depressive symptoms following menopause.

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Of late, the word “government” has been frequently followed by dispiriting nouns like “shutdown,” “gridlock,” and “dysfunction.” By contrast, government-funded science has recently produced some high profile discoveries, although most news coverage of the work did not link the discoveries to government funding. One game changing finding worth highlighting from last week changes the way we think about genetics, the brain, and individual differences.

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Benzodiazepines have been used for more than half a century for their anxiolytic, hypnotic, anticonvulsant, and muscle relaxant properties. Benzodiazepines act as positive allosteric modulators of the γ-aminobutyric acid (GABA) type A receptor (GABA A R), amplifying inhibitory neurotransmission. While benzodiazepines provide rapid and effective symptom relief, their use has declined over the years owing to their unfavorable adverse effect profile (eg, sedation when used for daytime anxiolysis, falls related to muscle relaxation and ataxia, development of tolerance, and sometimes dependence after long-term use)

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