Perinatal depression is widely considered to be a major public health problem. Anxiety disorders are also common among women of childbearing years, but the course and consequences of anxiety during pregnancy have not yet been established.

Almost all studies of the prevalence and consequences of perinatal anxiety have used questionnaire measures of anxiety. Unlike the Edinburgh Postnatal Depression Scale, questionnaire measures of anxiety symptoms have not been validated for pregnant or postpartum patients, thus it is unclear to what degree these measures are detecting anxiety versus typical physical symptoms associated with pregnancy and infant care. For example, many items on the Beck Anxiety Inventory, including difficulty breathing, facial flushing, unsteadiness, light headedness, sweating, and indigestion, commonly occur during pregnancy. In a study of >8,000 women, more women scored above a cut-off score on the anxiety subscale of the Crown-Crisp Index during weeks 18 and 32 of pregnancy compared to 8 weeks and 8 months postpartum. Three studies have administered selected modules from the Structured Clinical Interview to postpartum women. All three studies found that >50% of women with postpartum anxiety disorders were not depressed and that anxiety disorders were at least as common postpartum as major depression. Antenatal anxiety was associated with an increased risk of postpartum depression, even after controlling for antenatal depression.

The present paper is aimed at providing an outline of the process of reconceptualization of cognitive functions and emotions in neuropsychology, recently promoted by the acknowledgment of complex, nonlinear dynamics in brain structure and function.

A 79-year-old woman is referred by her primary care physician for an evaluation regarding a possible psychiatric diagnosis. Until now, she has had an unremarkable medical and psychiatric history. For the past 4 months, the family has observed increasing confusion. She has been repeating statements that she has just made, evidences increasing forgetfulness, such as misplacing her keys and checkbook, and, on one occasion, went to the grocery store but could not remember which items she needed to purchase. There has also been a history of insomnia, some irritability, and she becomes agitated over trivial issues related to household activities. She has had a reduction in appetite and has lost 5 pounds. Furthermore, she has complained of fatigue and a decrease in energy. Her husband indicated that she rarely drinks alcohol. She has not mentioned suicidal ideation directly but she has become increasingly concerned that her affairs are in order. Two of her friends died in the previous year and one was admitted to a nursing home.

Trichotillomania (TTM), or hair pulling, in children and adolescents is a heterogeneous disorder requiring a sophisticated approach to each patient. Hair pulling in a young, preschool child may have a different etiology and prognosis than hair pulling in an adolescent. Treatment providers must have a clear understanding of an individual's hair-pulling history, family interactions, and comorbid psychiatric diagnoses. Behavioral strategies are the primary treatment for most children and adolescents, although there may be indications for pharmacotherapy in some individuals. While research in adult TTM has been increasing in recent years, fewer studies have investigated childhood hair pulling. This article will discuss aspects of TTM unique to children and adolescents and will provide a clinical description of childhood hair pullers and treatment strategies.

Over the last two decades, there has been a resurgence of interest in cerebral mechanisms underlying many psychiatric disorders. The changes in our understanding of the syndrome called obsessive-compulsive disorder (OCD) reflect this shift of perspective. Although OCD remains a syndrome that is quintessentially psychiatric, it has been increasingly recognized that it also has a neurological dimension that merits study in its own right, using the concepts and tools of clinical neurology.

With the increasing number of new brain stimulation techniques now available and on the horizon, does electroconvulsive therapy (ECT) still have a role? As clinicians and researchers we say most definitely “yes”. ECT is the most effective and rapidly acting treatment for severe forms of depression and other disorders. Transcranial magnetic stimulation has shown promise but mainly for less severely ill and less treatment resistant patients. Deep brain stimulation (DBS) has shown promise for the more resistant cases but its invasiveness limits its use. Results from only ∼50 patients treated worldwide are available and at present it is not approved by the United States Food and Drug Administration for depression. Vagus nerve stimulation, less invasive than DBS but still a surgical procedure, is presently FDA approved for acute treatment resistant depression but published efficacy rates fall short of those seen with ECT. Therefore, there continues to be an important role for ECT in the treatment of severe psychiatric disorders. But will ECT always be there when our patients need it? Somewhat unexpected recent developments at the FDA may impact the future availability of ECT to severely depressed patients. Here we provide background on the classification of ECT devices, the FDA reclassification process, and the process for providing FDA input in these critical deliberations.

The science of infertility has advanced rapidly over the past decade, in many respects without regard to the enormous demands that are placed on all participants undergoing an infertility work-up and treatment. Among these demands are a variety of potential psychological effects that must be addressed in the initial patient visit with continued counseling throughout the infertility work-up process. This article reviews the psychological factors that may affect individual patients and couples experiencing infertility, with special attention given to the common manifestations of stress. The need for physicians to provide early and ongoing attention to emotions is emphasized, and a biopsychosocial approach to infertility evaluations is outlined.