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.

Most effective antidepressants directly or indirectly increase the synaptic concentrations of serotonin (5-HT) and/or norepinephrine (NE) by blocking the reuptake of one or both of the neurotransmitters. This property was initially discovered with the tricyclic antidepressants (TCAs). Their various additional interactions at different receptors and ion channels are not required for antidepressant action, but are responsible for the poor tolerability and toxicity in overdose of the early antidepressants.

The selective serotonin reuptake inhibitors are effective and well tolerated. Selective norepinephrine reuptake inhibitors, such as reboxetine, also have proven antidepressant activity. A selective action on one or the other of the principal monoamines thus appears to be sufficient for antidepressant activity. The idea that a dual action on both neurotransmitters might produce greater efficacy in certain patients led to the development of the serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants, which block the reuptake of both 5-HT and NE without the nonspecific, side-effect–inducing interactions of the TCAs. The three SNRIs—venlafaxine, milnacipran, and duloxetine—constitute a new class of antidepressants.

Antidepressant response rates rarely exceed 60% to 70% and remission rates are usually <50%. Although SNRIs clearly provide superior efficacy in certain populations, their use has not dramatically changed antidepressant therapy. The search for agents that are more effective, rapidly acting, and better tolerated continues. However, clinicians must find ways to better use the antidepressants that are available today. This supplement, based on a symposium held at the International Forum on Affective Disorders in Budapest in December 2007, discusses several everyday problems in the treatment of depression, with a focus on SNRIs.

Epilepsy in children and adolescents is associated with a higher rate of comorbid psychiatric disorders than other chronic childhood illnesses. This article describes various psychiatric disorders that occur in children and their effects on brain development, neurologic and intellectual function, and psychological adaptation for children and their families.

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.

Medical presentations can be enhanced by systematically collecting audience feedback. This is readily accomplished with polling systems, called audience response systems. Several systems are now available that are small, inexpensive, and can be readily integrated into standard powerpoint presentations without the need for a technician. Use of audience response systems has several advantages. These include improving attentiveness, increasing learning, polling anonymously, tracking individual and group responses, gauging audience understanding, adding interactivity and fun, and evaluating both participant learning and instructor teaching. Tips for how to write questions for audience response systems are also included.

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.

Patients with schizophrenia have a markedly reduced lifespan compared with the general population. In the United States today, patients with schizophrenia have an average life expectancy of ∼61 years, about 20% lower than that of the general population, in which life expectancy is ∼76 years.

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.