e-mail: ns@mblcommunications.com


Dr. Sussman is editor of Primary Psychiatry and professor of psychiatry at the New York University School of Medicine in New York City.

Dr. Sussman reports no affiliation with or financial interest in any organization that may pose a conflict of interest.



There is no theme to this issue of Primary Psychiatry. Instead, This issue features a series of articles that help fill some gaps involving common clinical situations that confront clinicians who treat psychiatric patients. A self-authored article provides a brief overview of medical complications that may arise in the course of treatment with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. Unlike common side effects, such as sexual dysfunction or weight gain, less common adverse reactions may have serious consequences for the patient. Among the possible side effects discussed are bleeding abnormalities, hyponatremia, bone loss, and serotonin toxicity. Because most of our readers are non-psychiatrists and might encounter patients exhibiting these problems, it is useful to increase awareness of these events. In this way, patients might be spared unncessary work-ups and prolonged suffering due to non-recognition of the side effects discussed.

Suicide is difficult to predict and prevent. Knowledge of any risk factors relevant to the patient evaluation could prove crucial to making the correct decision in terms of intervention and degree of special precautions used with a person who is potentially suicidal. M. Mercedes Perez-Rodriguez, MD, and colleagues, address this issue. Suicide is one of the leading causes of death, and suicidal ideation and attempts are a major public health problem. In the United States, suicide is the eleventh cause of death for all ages, the third cause of death in individuals between 10 and 24 years of age, and the second in those 25–34 years of age. However, little is known about the relationship between ethnicity and suicidal behaviors. The goal of this article is to provide an update on the relationship between ethnicity and suicidal ideation and attempts. The authors review the rates of suicide ideation attempts across ethnic groups in the US, and the risk factors associated with suicide attempts in each ethnic group. They also argue that mental health professionals should focus on factors consistently found to be strongly associated with suicide attempts across different populations, including major depressive disorder and other psychiatric disorders, female gender, and young age. The authors provide an update on the relationship between race and ethnicity and suicidal ideation and attempts.

At one time, restraints were commonly used to manage aggressive or agitated patients. Although the advent of medications and behavioral interventions have reduced both the frequency and duration of restraints in the acute care setting, restraints are still utilized. A study by Leslie S. Zun, MD, MBA, and LaVonne Downey, PhD, discusses the level of agitation associated with the use of restraints, reviews the methods to measure the level of agitation that patients exhibit, and suggests ways of determining the effect of the addition of chemical modulation to patients’ level of agitation.

There were 62 physically restrained patients and 41 physically and chemically restrained patients seen in the emergency department during the study. Zun and Downey report that the findings demonstrated physically and chemically restrained patients become more agitated when restraints are first applied and have less agitation by 120 minutes. The addition of chemical restraint reduced the level of agitation more than physical restraints alone. It had not been expected that patients would become more agitated when the restraints were first applied. The authors comment on this finding and ask whether there are better means to reduce a patient’s level of agitation. The authors note that “[i]f the mantra of medicine is to ‘first, do no harm,’ then we need to find better and more humane means to reduce a patient’s level of agitation instead of the use of restraints.”

Jeffrey Cummings, MD, contributes the first of two concise educational reviews on the diagnosis and treatment of Alzheimer’s disease and other dementias. This first part discusses epidemiology, genetics, neuropathology, and pathophysiology of Alzheimer’s disease and other dementias. It also discusses the assessment of cognitive impairment, clinical scales and inventories, and warning signs of Alzheimer’s disease, and provides contact information for caregiver and professional resources. The second part will appear in next month’s Primary Psychiatry and will discuss diagnosis and management of Alzheimer’s disease and dementia.

Dr. Cummings mentions that the two articles are not meant to be a comprehensive reference. Rather, they are meant to provide critical information and references that contain information on each topic presented. Constructed for the clinician (primary care practitioner, neurologist, or psychiatrist) who needs rapid access to updated information, these articles also contain information valuable to families that the practitioner can provide through a course of discussions about Alzheimer’s disease and dementia. PP