Toward impacting medical and psychiatric comorbidities in persons with intellectual/developmental disabilities: an initial prospective analysis.

Objective: The purpose of this study was to determine the effectiveness of psychiatric medical services, counseling, and behavioral treatments for adult patients with intellectual disabilities plus behavioral disorders and/or emotional distress.

Methods: Behavioral and medical data were collected at six and 12 months for a consecutive series of 141 adult patients with mild, moderate, or severe/profound intellectual disabilities who had been referred to a dual diagnosis mental health clinic, and treatment outcomes were compared.

Results: Most improvement in behavioral problem severity occurred at six months, then plateaued.

STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder.

Depersonalization/derealization disorder is characterized by depersonalization often co-occurring with derealization in the absence of significant psychosis, memory, or identity disturbance. Depersonalization/derealization is categorized as one of the dissociative disorders, which also includes dissociative amnesia, dissociative fugue, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Although these disorders may be under-diagnosed or misdiagnosed, many persons with psychiatric illness who have experienced trauma report symptoms consistent with dissociative disorders.

Psychogenic nonepileptic seizures.

Objective: All patients who exhibit seizure-like behavior cannot be evaluated by video-electroencephalography if their routine EEGs are negative, as this would be impractical and cost-prohibitive. The present article reviews a decision-making process that can be used for determining if further neurological evaluation is needed, the differential diagnoses and potential comorbidities involved when making this determination, and an approach to conveying the psychogenic nonepileptic seizure diagnosis to the patient that may help reduce symptom frequency.

Design: Literature review.

Psychotherapy and pharmacotherapy for patients with dissociative identity disorder.

There is a wide variety of what have been called "dissociative disorders," including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Some of these diagnoses, particularly dissociative identity disorder, are controversial and have been questioned by many clinicians over the years. The disorders may be under-diagnosed or misdiagnosed, but many persons who have experienced trauma report "dissociative" symptoms.

Extrapyramidal examinations in psychiatry.

Extrapyramidal signs include increased motor tone, changes in the amount and velocity of movement, and involuntary motor activity. They include two groups of signs and related disorders: hypokinetic (similar to Parkinson's disease) and hyperkinetic (similar to Huntington's disease). This article covers some of the neuroscience behind extrapyramidal disorders, the relevance of extrapyramidal signs in the major psychiatric disorders, the major extrapyramidal movement disorders, and how to elicit extrapyramidal signs.

Examining the therapeutic relationship and confronting resistances in psychodynamic psychotherapy: a certified public accountant case.

Psychodynamic psychotherapy is effective for a variety of mental health symptoms. This form of psychotherapy uses patient self reflection and self examination, as well as the therapeutic relationship between the patient and psychiatrist, to explore maladaptive coping strategies and relationship patterns of the patient. A thorough understanding of resistance and the core conflictual relationship theme afford the psychiatrist the ability to facilitate this work.

Reflexes in psychiatry.

Psychiatric patients often do not cooperate fully with the neurologic examination. Reflexes virtually bypass patient effort and are difficult to consciously determine. This article reviews muscle stretch (deep tendon) reflexes, and pathological reflexes including the extensor plantar (Babinski) and primitive release reflexes.

Higher cortical functions: attention and vigilance.

The ability to sustain attention over time (vigilance) is a cognitive function that often is impaired in patients with psychiatric disorders. Attention has been found to be disordered in a number of psychiatric conditions, including attention deficit disorder, schizophrenia, antisocial personality disorder, and the impulse control disorders. Less widely known is the finding that attention also is affected in patients suffering from anxiety disorders, posttraumatic stress disorder, mood disorders, and borderline personality disorder.

Psychiatry, neurology, and the role of the cerebellum.

The cerebellum has long been considered quite separate from the neocortex, and accordingly the understanding of its role has been limited. Recent work has revealed that the cerebellum interacts regularly with the forebrain and it is involved in mood and cognition. In this article, the authors discuss an extensive system of neural circuits connecting the prefrontal, temporal, posterior parietal, and limbic cortices with the cerebellum.

Gait and its assessment in psychiatry.

Gait reflects all levels of nervous system function. In psychiatry, gait disturbances reflecting cortical and subcortical dysfunction are often seen. Observing spontaneous gait, sometimes augmented by a few brief tests, can be highly informative.

Cranial Nerves IX, X, XI, and XII.

This article concludes the series on cranial nerves, with review of the final four (IX-XII). To summarize briefly, the most important and common syndrome caused by a disorder of the glossopharyngeal nerve (craniel nerve IX) is glossopharyngeal neuralgia. Also, swallowing function occasionally is compromised in a rare but disabling form of tardive dyskinesia called tardive dystonia, because the upper motor portion of the glossopharyngel nerve projects to the basal ganglia and can be affected by lesions in the basal ganglia.

Cranial Nerve VIII: Hearing and Vestibular Functions.

Cranial nerve VIII brings sound and information about one's position and movement in space into the brain. The auditory and vestibular systems subserve several functions basic to clinical medicine and to psychiatry. This article covers the basics of cranial nerve VIII, hearing and vestibular systems, including common problems with hearing and balance, problems with hearing and balance that tend to be found in psychiatric patients, and some simple assessments of value in clinical practice.

Cranial Nerve II: Vision.

This article contains a brief review of the anatomy of the visual system, a survey of diseases of the retina, optic nerve and lesions of the optic chiasm, and other visual field defects of special interest to the psychiatrist. It also includes a presentation of the corticothalamic mechanisms, differential diagnosis, and various manifestations of visual illusions, and simple and complex visual hallucinations, as well as the differential diagnoses of these various visual phenomena.

A residency training in rural psychiatry.

Objective: This article describes a residency training program that incorporates a rural didactic curriculum and rural clinical training.

Methods: Residents participate in didactic seminars and a rural clinical rotation.

Results: In this jointly funded (academic-state-agency) model, faculty members from a community-based medical school train psychiatric residents at a rural clinic.

Cranial nerve I: olfaction.

Olfactory (smell) testing is one of the most interesting and revealing individual neurologic tests in psychiatric research. It is also one of the most neglected tests in the clinical practice of psychiatry. There are several diagnostic applications of smell testing in clinical psychiatry.

Dissociative identity disorder: a controversial diagnosis.

A brief description of the controversies surrounding the diagnosis of dissociative identity disorder is presented, followed by a discussion of the proposed similarities and differences between dissociative identity disorder and borderline personality disorder. The phenomenon of autohypnosis in the context of early childhood sexual trauma and disordered attachment is discussed, as is the meaning of alters or alternate personalities. The author describes recent neurosciences research that may relate the symptoms of dissociative identity disorder to demonstrable disordered attention and memory processes.

A survey of american psychiatric residency programs concerning education in homelessness.

Objectives: This study aims to document how psychiatric residencies address homelessness and mental illness, to discover training barriers, and to identify educational recommendations.

Methods: The authors mailed a survey to 178 American psychiatric residency programs, requesting information about didactic and clinical offerings in homelessness. Programs without offerings were asked to provide reasons why.