Adolescent bipolar disorder: a clinical vignette.

Adolescence is a vulnerable developmental phase marked by physical, psychological, and social changes that rapidly expose young people to a wide range of new stressors. When differentiating between bipolar disorder and teenage "acting out," a careful history is important. Adolescent bipolar disorder is a psychiatric illness characterized by fluctuating episodes of mood elevation and depression that is frequently neither recognized nor formally diagnosed.

Pharmacologic management of adult depression.

Major depression is a common and treatable disease. Many patients benefit from pharmacologic treatment and, because there is little variation in antidepressant effectiveness, medication choices should be made based on patient characteristics, safety, and anticipated side effects. Most patients respond favorably to treatment, but many do not have complete symptom relief.

Prevalence of osteoporosis in community-dwelling individuals with intellectual and/or developmental disabilities.

Objective: Measure central bone mineral density (BMD) in community-dwelling individuals with intellectual and/or developmental disabilities.

Design: A cross-sectional study.

Setting: A regional center providing outpatient medical, residential, and day activity services for individuals with intellectual and/or developmental disabilities.

Medical care of adults with mental retardation.

Persons with mental retardation are living longer and integrating into their communities. Primary medical care of persons with mental retardation should involve continuity of care, maintenance of comprehensive treatment documentation, routine periodic health screening, and an understanding of the unique medical and behavioral disorders common to this population. Office visits can be successful if physicians familiarize patients with the office and staff, plan for difficult behaviors, and administer mild sedation when appropriate.

Childhood bipolar disorder: a clinical vignette.

Bipolar disorder in children and adolescents can easily be misdiagnosed, as symptom patterns overlap with other mood disorders and attention-deficit/hyperactivity disorder and commonly differ from adult presentations. A detailed description of the child's behavioral history and previous treatment response is critical to accurate diagnosis. Although studies with children are limited, a number of psychopharmaceuticals have been shown to provide therapeutic benefit.

Alcohol consumption: an overview of benefits and risks.

Published health benefits of regular light-to-moderate alcohol consumption include lower myocardial infarction rates, reduced heart failure rates, reduced risk of ischemic stroke, lower risk for dementia, decreased risk of diabetes and reduced risk of osteoporosis. Numerous complimentary biochemical changes have been identified that explain the beneficial effects of moderate alcohol consumption. Heavy alcohol consumption, however, can negatively affect neurologic, cardiac, gastrointestinal, hematologic, immune, psychiatric and musculoskeletal organ systems.

Successful Pain Management for the Recovering Addicted Patient.

Successful pain management in the recovering addict provides primary care physicians with unique challenges. Pain control can be achieved in these individuals if physicians follow basic guidelines such as those put forward by the Joint Commission on Accreditation of Healthcare Organizations in their standards for pain management as well as by the World Health Organization in their stepladder approach to pain treatment. Legal concerns with using pain medications in addicted patients can be dealt with by clear documentation of indication for the medication, dose, dosing interval, and amount provided.

Teaching Family Physicians About Mood Disorders: A Procedure Suite for Behavioral Medicine.

BACKGROUND AND OBJECTIVES: One of the skills required of family physicians is the ability to recognize and treat individuals suffering from mood disorders. This study represents an interdisciplinary residency training approach that (1) is unique in family practice residencies; (2) trains faculty, residents, and students in mood disorder recognition and treatment; (3) has been evaluated by the Residency Review Committee and found compatible with psychiatry training guidelines; and (4) is adaptable to varied settings. METHOD: Existing psychiatric education at an urban family practice residency program was evaluated.

Bipolar II Disorder in a Primary Care Setting: Clinical Vignette.

Bipolar II disorders may be common in primary care settings, but most cases remain undiagnosed because hypomania is often difficult to recognize. Eliciting a history of recurrent periods of expanded mood interspersed with periods of major depression is important, since antidepressant monotherapy is often unproductive or even counterproductive. Once the diagnosis is made, appropriate medications to alleviate hypomanic episodes and depression should be initiated.

Munchausen Syndrome by Proxy: A Clinical Vignette.

Munchausen syndrome by proxy is the act of one person fabricating or inducing an illness in another to meet his or her own emotional needs through the treatment process. The diagnosis is poorly understood and controversial. We report here the case of a 6-year-old boy who presented with possible pneumonia, nausea, vomiting, and diarrhea and whose mother was suspected of Munchausen syndrome by proxy.

Autism: a medical primer.

Autistic disorder, a pervasive developmental disorder resulting in social, language, or sensorimotor deficits, occurs in approximately seven of 10,000 persons. Early detection and intervention significantly improve outcome, with about one third of autistic persons achieving some degree of independent living. Indications for developmental evaluation include no babbling, pointing, or use of other gestures by 12 months of age, no single words by 16 months of age, no two-word spontaneous phrases by 24 months of age, and loss of previously learned language or social skills at any age.