by Linda Chaudron, M.D., M.S. Psychiatric Times In this article, we will review the clinical assessment and differential diagnosis of the range of postpartum psychiatric disorders. We will focus on postpartum psychosis and will develop this clinical vignette to highlight the clinical, familial and epidemiological links that exist between postpartum psychosis and bipolar disorder (BD). Finally, we will discuss prevention and treatment recommendations for postpartum psychosis, including a review of pharmacological treatment during breastfeeding. The DSM-IV-TR does not classify postpartum psychiatric disorders as diagnostic categories but allows the specifier "with postpartum onset" to be applied to major depressive disorder, bipolar disorder (type I or II) and brief psychotic disorder if the onset of symptoms occurs within the four weeks following childbirth. The DSM-IV-TR does not allow the specifier to be applied to other psychiatric disorders. Despite the DSM-IV-TR definition, clinicians and patients often use the term postpartum depression to describe several psychiatric disorders that occur or are exacerbated after delivery. Researchers also use inconsistent terminology, defining postpartum as anywhere from two weeks to 12 months after childbirth. Regardless of the inconsistencies and the phenomenological debates, there seems to be consensus on the existence of three clinical states: postpartum blues, postpartum depression and postpartum psychosis (Table 1). © 2003 Psychiatric Times. All rights reserved

Keyword: Depression; Hormones & Behavior
Link ID: 4048 - Posted: 06.24.2010

by Kenneth J. Bender, Pharm.D., M.A. Psychiatric Times Acute aggression in child and adolescent psychiatric patients should be addressed with psychosocial crisis management before resorting to medication, according to an expert consensus panel convened by the Center for the Advancement of Children's Mental Health at Columbia University and the New York State Office of Mental Health. Their two-part report in the February Journal of the American Academy of Child and Adolescent Psychiatry reviewed the safety and efficacy of treatments for aggression in young patients (Schur et al., 2003) and offered treatment recommendations and rationale (Pappadopulos et al., 2003). The Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth (TRAAY) were formulated from expert consensus and assessment of available evidence. The recommendations address severe impulsive aggression, including verbal threats of violence toward oneself or others. The recommendations do not extend to predatory aggression or what has been described as planned and self-controlled aggressive behavior (Vitiello et al., 1990). © 2003 Psychiatric Times. All rights reserved.

Keyword: Aggression; Development of the Brain
Link ID: 4047 - Posted: 06.24.2010

By REUTERS CHICAGO, — Infants whose heads suddenly begin to grow rapidly appear to be at risk of autism, perhaps indicating that autism, an increasingly common disorder, may be traced to missed connections in fast-expanding brains, researchers said today. The researchers suggested that the apparent relationship might help in making earlier diagnoses of the disorder. The report also appeared to offer further proof that childhood vaccinations do not cause autism as some have suggested. In a study involving 48 autistic people, 59 percent had accelerated skull growth, and presumably brain expansion, beginning around the age of 2 months and ending between 4 months and a year. Copyright 2003 The New York Times Company

Keyword: Autism
Link ID: 4046 - Posted: 06.24.2010

By SUSAN GILBERT With findings that are bound to rekindle the debate over its effects on children, two studies being published today build on evidence that those who spend long hours in child care may experience more stress and are at increased risk of becoming overly aggressive and developing other behavior problems. One of the studies found that the more time children spent in child care, the more likely they were to be disobedient and have trouble getting along with others, though it suggested that factors like a mother's sensitivity to the child's needs could moderate that outcome. This report is from the Study of Early Child Care and Youth Development, the largest long-term study of child care in the United States, which was undertaken by the National Institute of Child Health and Human Development, a branch of the National Institutes of Health. The findings elaborate on preliminary research that created a storm of debate when presented by the study's investigators at a child development meeting two years ago. Copyright 2003 The New York Times Company

Keyword: Stress; Development of the Brain
Link ID: 4045 - Posted: 07.16.2003

First gene discovered that is switched on only in fat cells of obese mice A gene that gets switched on only in the fat cells of obese mice may be a key to preventing obesity in humans, according to new research at The Rockefeller University in New York City and the Joslin Diabetes Center in Boston. The finding, reported in the August 1 issue of the Journal of Clinical Investigation, marks the first time a gene has been identified that is induced, or activated, in the fat cells of obese animals. According to Rockefeller University professor Markus Stoffel, M.D., Ph.D., lead investigator of the study, the gene, called Foxa-2, inhibits young body cells from becoming mature fat-producing cells called adipocytes. In addition, when this gene is switched on in mature adipocytes, it functions as a brake to slow down further fat production and storage. "We know a lot about the various molecular pathways that stimulate or promote fat production, and the focus has been on trying to block these pathways to fight obesity," says Stoffel. "This pathway is one of only a few that we know of that naturally work to counteract obesity.

Keyword: Obesity
Link ID: 4044 - Posted: 07.16.2003

Moving ahead on diagnosis and possible treatment By Carey Goldberg, Globe Staff, Scientists may slowly be closing in on the psychopath. New research tools, from brain scans to psychological tests, are yielding more sophisticated insights into what makes psychopaths such cold-blooded predators, raising the prospect of improved tests to identify them and possibly even treatment. ''We can treat most other emotional disorders pretty successfully, and we will be able to treat this one soon,'' said Dr. James Blair, a researcher at the National Institute of Mental Health. Psychologists estimate that one in every 100 people is unfeeling enough to qualify as a psychopath, with an especially heavy concentration among criminals. The ranks include serial killers such as Ted Bundy, who charmed and killed dozens of young women in the 1970s, and cannibal-murderer Jeffrey Dahmer, who fatally seduced 17 men and boys before he was caught in 1991, as well as a great many other people who never commit a crime punishable by law, but go through life heartlessly using and manipulating others without remorse. © Copyright 2003 Globe Newspaper Company.

Keyword: Aggression
Link ID: 4043 - Posted: 06.24.2010

A drug has been found to significantly slow the progression of Parkinson's disease. Scientists compared the effect of the drug, ropinirole, with the widely used treatment levodopa. They found that ropinirole was more effective at slowing down the loss of nerve function associated with the early stages of Parkinson's. It was also less likely to cause side effects. However, it was not as effective as levodopa at controlling the symptoms of the disease, such as shaking, lack of coordination and frozen expression. Parkinson's is caused by lack of a crucial brain chemical called dopamine. Levodopa is converted in the brain into dopamine - thus helping to replenish stocks. (C) BBC

Keyword: Parkinsons
Link ID: 4042 - Posted: 07.15.2003

NewScientist.com news service Women are more likely than men to lie about their sex lives, reveals a new study. Women's coyness about their sexual behaviour was unveiled by a US study involving a fake lie detector test. In surveys since the 1960s, men typically report having more sexual partners and than do women - a statistically impossible feat. For example, British men boast an average of 13 partners over a lifetime compared with an average of nine partners for women. Scientists previously explained this anomaly by suggesting men were exaggerating their tally, while women were understating their total. But now Terri Fisher at Ohio State University and Michele Alexander at the University of Maine suggest that men are in fact more truthful in such surveys. © Copyright Reed Business Information Ltd.

Keyword: Sexual Behavior
Link ID: 4041 - Posted: 06.24.2010

By SANDEEP JAUHAR, M.D. The patient couldn't tell me what was wrong, and neither could his 80-year-old mother. He had been lying on the sofa for weeks, she said, and he wouldn't get up. Sloth was a sin, but was it a reason to be admitted to the hospital? They lived in a house in East St. Louis, Ill. He was 56 and single, working odd jobs until recently, when he parked himself on the couch, watching television. He was sleepy most of the time, forgetting appointments and leaving chores unfinished. When confronted, he became irritable and withdrawn. Copyright 2003 The New York Times Company

Keyword: Depression; Hormones & Behavior
Link ID: 4040 - Posted: 07.15.2003

By ERIC NAGOURNEY It is not just that some people don't know their own strength. It may be that nobody does. Researchers have found that people routinely believe they are exerting less force than they really are. The findings, which appear in the current issue of the journal Science, lend insight into the nature of human movement. They may also help explain something less esoteric, the schoolyard fight, said the researchers, from University College London. Copyright 2003 The New York Times Company

Keyword: Pain & Touch
Link ID: 4039 - Posted: 07.15.2003

By NICHOLAS WADE As you write yet another check to cover your children's ruinous college bills, there is definitely a bright side to consider: if you weren't doing this, you'd long since be dead. This cheerful insight comes courtesy of the evolutionary theory of aging. The theory holds that animals generally die shortly after reproducing because extra life would not lead to more surviving offspring, the only criteria for success in evolution's playbook. Species that provide parental care, however, can escape the usual curtain call for a time because in them natural selection has a basis to favor genes that promote post-reproductive longevity — the so-called grandmother effect. This theory, developed by William Hamilton and others, has become the classic explanation of the way evolution tunes the genes that shape the life cycle of each species. But there are various features of the human life cycle it does not explain well: why juvenile mortality is bunched into the first years of life and then declines, for one. Copyright 2003 The New York Times Company

Keyword: Evolution
Link ID: 4038 - Posted: 06.24.2010

By NICHOLAS WADE Bower birds are artists, leaf-cutting ants practice agriculture, crows use tools, chimpanzees form coalitions against rivals. The only major talent unique to humans is language, the ability to transmit encoded thoughts from the mind of one individual to another. Because of language's central role in human nature and sociality, its evolutionary origins have long been of interest to almost everyone, with the curious exception of linguists. As far back as 1866, the Linguistic Society of Paris famously declared that it wanted no more speculative articles about the origin of language. Copyright 2003 The New York Times Company

Keyword: Language; Evolution
Link ID: 4037 - Posted: 07.15.2003

Getting over jet lag may be as simple as changing the temperature --your brain temperature, that is. That's a theory proposed by Erik Herzog, Ph.D. assistant professor of biology in Arts & Sciences at Washington University in St. Louis. Herzog has found that the biological clocks of rats and mice respond directly to temperature changes. Biological clocks, which drive circadian rhythms, are found in almost every living organism. In mammals, including humans, these clocks are responsible for 24-hour cycles in alertness and hormone levels, for instance. The control panel for these daily rhythms is the suprachiasmatic nucleus (SCN), otherwise known as "the brain's Timex." The SCN, located above the roof of the mouth in the hypothalamus, is normally synchronized to local time by light signals carried down the optic nerves. Herzog worked directly with mice SCN cells located in vitro, grown in a dish.

Keyword: Biological Rhythms
Link ID: 4036 - Posted: 07.15.2003

Depression is the second-leading cause of disability worldwide, affecting nearly 10% of the population. According to George S. Zubenko, M.D., Ph.D., professor of psychiatry at the University of Pittsburgh School of Medicine and adjunct professor of biology at Carnegie Mellon University, women are twice as likely as men to develop depression, and genetic differences appear to account for some of that disparity. These latest results build on research published by Dr. Zubenko and his team in October of 2002 that identified a small region of chromosome 2 – equal to 0.01 percent of the human genome – as the potential hiding place for a susceptibility gene for depression in women. "These findings confirm our earlier research suggesting the existence of susceptibility genes that have sex-limited effects on the vulnerability of women to developing severe depression," said Dr. Zubenko. "Over 80% of women in our study who inherited a particular variant of CREB1 developed depressive disorders, while a second version of this gene appeared to have protective effects." CREB1 is a gene that encodes a regulatory protein called CREB that orchestrates the expression of large numbers of other genes that play important roles in the brain and the rest of the body as well. The widespread importance of CREB as a genetic regulator throughout the body suggests that the newly identified CREB1 variants may influence the development of additional psychiatric disorders related to depression, such as alcohol and other substance use disorders, as well as medical conditions that are associated with depression.

Keyword: Depression
Link ID: 4035 - Posted: 06.24.2010

Some people may be more vulnerable to the effects of stress because an area of their brain is smaller than average. Scientists have found an area of the brain called the anterior cingulate cortex is more likely to be small in people who have developed symptoms of post traumatic stress disorder (PTSD). The anterior cingulate cortex is known to play a role in regulating emotion. PTSD is a disturbing psychological condition where people who have lived through a stressful experience relive painful memories against their will. This can lead to feelings of isolation and a sense of losing control - patients sometimes turn to alcohol or other drugs as they attempt to get rid of the flashbacks. Previous studies linked PTSD to structural abnormalities in the brain - in particular in the hippocampus, an area involved in long-term memory. (C) BBC

Keyword: Stress
Link ID: 4034 - Posted: 07.15.2003

By Karen Heyman Scaling what climbers call "big wall," Yosemite's Half Dome appears impossible at the start: A rock face nearly 500 times taller than a person offers only shard-like holds and fingernail-thin cracks for support. But with talent, experience, and enormous focus and discipline, the big wall becomes a series of small, concentrated moves. The climber keeps focused, while the gawkers below admire his courage and question his sanity. California Institute of Technology professor Christof Koch, researcher into the neurobiology of consciousness is an accomplished rock climber. Koch has ascended the wall of neurobiology for more than a decade. In 1990, he and Nobel laureate Francis Crick challenged biologists' skepticism about studying consciousness. In their 1990 Seminars in Neuroscience paper,1 Crick and Koch swept away centuries of philosophical speculation about the so-called mind/body problem in one stroke of scientific pragmatism: Forget trying to define consciousness, just go out and discover it. As Crick wrote in the preface to The Astonishing Hypothesis, the 1994 book that presented their ideas to the lay public: "You do not win battles by debating exactly what is meant by the word battle." But the battle continued: "I would spend the first twenty minutes of ... [a] one-hour talk justifying why I'm not crazy, [that] I'm not with the 'crystal crowd,'" Koch relates. In his latest book, The Quest for Consciousness: A Neurobiological Approach, due out in January 2004, Koch states that he and Crick have revised their earlier proposition that synchronous neuronal oscillations might be at the heart of consciousness. They originally believed that this theory might be the solution to the so-called binding problem: How do differently processed aspects of an object bind together into one percept--red + round + shiny = apple, for example. "Unfortunately, the evidence is slim for a direct relationship," Koch says. "What's much more plausible now is that synchronized firing activity in the 40-Hz range may be necessary to resolve competition.... There's quite a bit of evidence that oscillations might be involved in biasing the selection, but once I'm fully conscious of [the percept], it's unclear whether [the oscillations are really needed.]" ©2003, The Scientist Inc.

Keyword: Miscellaneous
Link ID: 4033 - Posted: 06.24.2010

St. Paul, MN – As the nation gears up for another season of West Nile virus, a new study extends the understanding of the clinical spectrum of West Nile symptoms, and points to extreme muscle weakness or paralysis as a significant cause of complications in affected patients. The study appears in the July 8 issue of Neurology, the scientific journal of the American Academy of Neurology. Detailed examination of 23 patients at the Cleveland Clinic revealed that among the earliest symptoms in 26 percent was a rash, which helped distinguish the disease from another rapid-onset paralytic disorder, Guillain-Barre syndrome. Misdiagnosis is still very common for West Nile virus, according to lead study author Lara Jeha, MD. Other early symptoms include low back pain, limb pain, and gastrointestinal complaints, typical of many viral illnesses. All patients developed fever at some point in their illness. Half the patients developed muscle weakness, which developed rapidly, over the course of three to eight days. For many patients, this progressed to involve all four limbs. In one patient, weakness remained the primary symptom even in advanced disease. Nine patients required mechanical ventilation due to weakness of the breathing muscles. Previous studies had described flaccid paralysis with West Nile virus infection, but details about the various aspects of this weakness were very limited.

Keyword: Movement Disorders
Link ID: 4032 - Posted: 06.24.2010

Nathan Seppa Scientists' best efforts have failed to vanquish amyotrophic lateral sclerosis (ALS). There was no cure for the nerve-degenerating disease when it struck down baseball star Lou Gehrig 64 years ago, and there is none today. In fact, scientists have yet to pinpoint a cause of the disease except in individuals with certain rare genetic mutations. In the August Nature Genetics , researchers report on other, more common genetic variations that crop up in ALS patients more often than they do in healthy people. Experiments show that similar genetic variations leave mice vulnerable to the sort of nerve degeneration seen in ALS patients, says Peter Carmeliet of Leuven University in Belgium. He and his colleagues compared genetic profiles of 750 ALS patients with those of 1,219 healthy people of similar age in Belgium, Sweden, and Great Britain. The people with ALS were nearly twice as likely to have one of two variant forms of a gene for the protein called vascular endothelial growth factor (VEGF). Copyright ©2003 Science Service.

Keyword: ALS-Lou Gehrig's Disease
Link ID: 4031 - Posted: 06.24.2010

NewScientist.com news service Human brains are wired to underestimate the amount of force exerted on other people, a study of "tit-for-tat" experiments has revealed. As well as qualifying the teary "she hit me harder" playground argument and explaining why we can't tickle ourselves, the discovery may provide insight into some self-delusional symptoms of schizophrenia. To test the notion that the brain downplays sensations generated by body movements because it can predict what will happen, Daniel Wolpert and colleagues at University College London in the UK engaged six pairs of adult volunteers in "tit-for-tat" experiments. © Copyright Reed Business Information Ltd

Keyword: Pain & Touch; Muscles
Link ID: 4030 - Posted: 06.24.2010

NewScientist.com news service Some animals will go to extraordinary lengths to scale the social ladder, remaining small until an opportunity arises and then changing size and sex to move up a rung, reveal US scientists. A study of clownfish, an anemone-dwelling marine fish known for its bright orange and white patterning, has found that hierarchical boundaries are so entrenched in their "culture" that subordinates control their size and growth rate to the millimetre. When the position at the top of a group becomes vacant, social climbers will go as far as changing sex. Clownfish reside in discrete groups dominated by the top- ranking female breeder. Her lower-status male partner is next, followed by up to four progressively smaller and lower- ranking, non-breeding subordinates. © Copyright Reed Business Information Ltd.

Keyword: Sexual Behavior
Link ID: 4029 - Posted: 06.24.2010