The 12-month and lifetime prevalences of bipolar I and II disorder in the United States are 2.0% and 3.3%, respectively. Similar to schizophrenia, bipolar disorder is also associated with premature and excess mortality, with an estimated loss of ∼15 years of life expectancy. Most of the excess mortality in individuals with mood disorders results from natural causes, not suicide. Again, similar to schizophrenia, the most common cause of death in patients with bipolar disorder is cardiovascular disease (CVD), which occurs approximately twice as often in this group as in the general population. Although the data are more limited than in schizophrenia, people with bipolar disorder are differentially affected by medical comorbidity. Bipolar disorder is associated with elevated risk of a wide variety of comorbid medical illnesses, including migraine, asthma, chronic bronchitis, hypertension, and gastric ulcer, which compound disability and increase the burden of the disease.

In discussions of diversion and misuse of medications in adult attention-deficit/hyperactivity disorder (ADHD), the word “misuse” is intentionally used. Abuse of a medication refers to excessive use of a drug to achieve a “high,” which may result in addiction to the medication and which causes dysfunction in a patient's life. However, misuse refers to usage of a medication without a prescription or for reasons other than that which it was prescribed. Diversion refers to the diverting of legally prescribed medication into illegal use by other than the patient. Sahakian and Morein-Zamir recently discussed the use of cognitive-enhancing drugs by individuals with a variety of disorders as well as off-label and non-prescription use by the general public. In addition to inappropriate use of medications, patients with ADHD often turn to other substances that are detrimental to their health, such as nicotine.

While the public health perspective prioritizes large populations of affected individuals, our job as clinicians is to help one patient at a time. Over the last 10–20 years, there has been marked improvement in pharmacologic and psychosocial interventions available for patients with anxiety disorders (Slide 8).

The use of antidepressants, particularly the serotonergic and serotonergic noradrenergic agents, have received increased attention as first-line treatment for most of the anxiety disorders, including panic disorder, social phobia, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Antidepressants are often used as first-line therapy for anxiety disorders because of their broad spectrum of efficacy against common comorbidities, especially depression, and because of concern about benzodiazepine-associated dependence, abuse liability, and lack of efficacy for depression and other comorbidities (Slide 9).

These newer antidepressants have advantages over the older antidepressants, particularly the tricyclics and the monoamine oxidase inhibitors, in that they are generally better tolerated and more appropriate for use in potentially suicidal patients because they are less lethal in overdose. However, there are some side effects that may limit their use in some patients. In the case of the serotonergic antidepressants, many patients are hesitant to initiate or maintain treatment due to concerns about sexual dysfunction.

As an individual with autism, I have learned that, unfortunately, some therapists and physicians are unaware of autistics' overly acute senses, specifically hyperacute hearing. For example, the birthday party fun of noise-makers for a normal child was torture for me. There are many first-person reports of people with autism who, like me, find certain loud sounds intolerable.

Some children and adults with autism also have visual sensitivity problems. I enjoyed visually stimulating things such as flags or automatic supermarket doors, but individuals with severe visual sensitivities cannot tolerate even fluorescent lights. In her book, Somebody Somewhere, autistic Donna Williams describes how the flicker from fluorescent lights causes her visual overload. A study conducted by Coleman et al indicates that fluorescent lights can increase repetitive behavior in children with autism.

Autistic sensory problems are highly variable. When I was a child, I liked to play with running water; however, another child with autism may not be able to tolerate the same sound. I was attracted to automatic supermarket doors and I liked to watch them move. Another autistic child or adult may scream and run away from these same automatic doors because sudden movement hurts his or her eyes. Maybe a small anomaly in my visual processing caused me to be attracted to the movement of the doors. A greater anomaly may cause another individual to avoid the same stimulus. Waterhouse et al found it puzzling that I was attracted to strong visual stimuli, yet high-pitched auditory stimuli hurt my ears.

Epilepsy is common, but conditions that imitate epilepsy are even more common. In order to make a correct diagnosis of epilepsy, the clinician must carefully elicit a detailed history of the seizure episode. Realizing the overlap that exists between seizures that define epilepsy and those of other psychiatric conditions can also help in differentiating between epilepsy and an imitator of epilepsy. Deciphering the features of a seizure episode is also key to correct diagnosis.

In this article, the physiological and psychological imitators of epilepsy are described, as well as the features of a seizure episode that should be considered in making a diagnosis. Seizure presentations are also explained followed by a description of common diagnostic pitfalls to avoid.

There is mounting evidence to suggest that the efficacy of all available antidepressants when used as monotherapy to treat major depressive disorder (MDD) is, at best, modest. For example, a meta-analysis of all double-blind placebo-controlled studies of antidepressants published since 1980 revealed response rates of 53% for antidepressants versus 36% for placebo (difference in response rate of 16.8%) (Slide 1). To make matters worse, if one is to assume that “negative trials” (ie, trials which do not demonstrate the superiority of a drug over placebo) are less likely to be published than “positive trials” (trials which demonstrate the superiority of a drug versus placebo), it is quite possible that the margin of efficacy of antidepressants when compared to placebo is ≤16.8%. Thus, if one were to include all unpublished along with published double-blind, placebo-controlled trials of antidepressants for MDD, this efficacy margin could be ≤10%.

Sexual dysfunction is common among patients with epilepsy, but many clinicians do not include inquiries about this aspect of the patient's health in their routine evaluations. This article presents approaches for taking a sexual history and for discussing sexual problems. The utility of standardized sexual dysfunction questionnaires is reviewed and the important elements of appropriate and effective counseling are highlighted.

Psychoneuroendocrinology (PNE) has been a method used in the past to investigate brain biochemical functions in normal and pathological mentation. These studies have subsequently uncovered variations in normal biochemical functioning. It is still being debated, however, how these variations correlate with well-defined psychopathologies.

Future studies in PNE shows promise in many areas of contemporary neurospychiatry. For example, research focusing on variations in neurotransmitter, neuropeptide, and neurohormone secretory tonus might enhance our understanding of specific personality characteristics and behavior. PNE may also be essential in investigating the correlation between hormonal variations and symptoms observed across various psychiatric disorders. PNE might likewise be important for new therapeutic approaches. Finally, PNE can be used to investigate psychoneuroimmunoendocrine relationships.

New PNE methodologies must be developed to make this branch of neuroscience more appropriate for the study of localized brain functions.

There are many new findings in the area of comorbid insomnia. Almost 50% of all cases of chronic insomnia are due to a mental disorder, with depressive illness explaining the majority of cases related to mental disorder (Slide 1). Other common causes of comorbid, or secondary, insomnia include chronic respiratory disease such as asthma and chronic obstructive pulmonary disease, chronic pain, degenerative neurological disease, and some medications such as glucocorticoids and serotonin reuptake inhibitors. A general principle of management of insomnia related to mental or medical disorders is that the principal disorder must be fully treated as part of the insomnia treatment plan. If there is an offending medication, it must be discontinued if possible.