Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders.

Mental health symptoms secondary to trauma exposure and substance use disorders (SUDs) co-occur frequently in both clinical and community samples. The possibility of a shared aetiology remains an important question in translational neuroscience. Advancements in genetics, basic science, and neuroimaging have led to an improved understanding of the neural basis of these disorders, their frequent comorbidity and high rates of relapse remain a clinical challenge.

Personalized pharmacotherapy for treatment approaches focused at primary insomnia.

The treatment of primary insomnia may be complex and clinically challenging. A comprehensive multidimensional evaluation with a thorough history and physical examination coupled with appropriate testing/imaging will facilitate development of a working diagnosis. Optimal treatment strategies of challenging cases typically involve interdisciplinary team approaches (including a sleep medicine specialist) providing multimodal approaches to treatment, including nonpharmacologic and pharmacologic strategies.

Pharmacotherapeutic management of pain with a focus directed at the geriatric patient.

Twenty percent to 50% of geriatric noninstitutionalized patients are victimized by pain that can result from multiple chronic medical and psychiatric diseases. This article discusses recognizing the barriers that the clinician encounters in evaluating pain in geriatric patients, taking a pain and pain medication history, and establishing a treatment plan to address the patient's experience of pain. It discusses dosage modifications appropriate for the geriatric population and reviews the drugs available to alleviate pain.

Perception, assessment, treatment, and management of pain in the elderly.

Twenty to 50% of community elderly suffer from pain. Up to 80% of the institutionalized elderly report at least one pain problem. Multiple pain etiologies that occur in elderly patients may be the occurrence of multiple chronic diseases: osteoarthritis, RA, cancer, DJD, bone/joint disorders, osteoporosis, surgical pain, trauma, neuropathic pain, and nociceptive pain.

Noncardiac Chest Pain: A Focus on Psychogenic Causes.

Patients presenting with noncardiac chest pain of psychogenic origin are one of the more challenging clinical dilemmas to primary care medicine. Key aspects to recognition of these patients are predominance of autonomic complaints, multiple presentations, clustering of physical complaints and a repeated history of negative cardiac pathology, a clinical profile of anxiety or panic disorder. Therapy can be achieved by the use of benzodiazepines.