Annals of Clinical Psychiatry

ADHD/ADD, once thought to occur only in children, is now recognized as continuing into adulthood in many people. In order to be labeled as such, signs and symptoms must start before age 7 and are primarily characterized by inattention, distractibility, and impulsiveness. Although the exact mechanism is unknown, a number of associated neurochemical and structural abnormalities have been observed. This disorder can negatively affect the educational, social, and occupational lives of those who suffer from its symptoms. It interferes with the ability to establish and maintain close relationships. Pharmacotherapy remains the primary mode of treatment. Stimulants such as dextroamphetamine and methylphenidate are the main drugs utilized; they are available in immediate and longer duration versions. Bupropion is another important medicinal option, and there are a variety of other miscellaneous medications to consider, including modafinil, venlafaxine, tricyclic antidepressants, and guanfacine. Psychotherapy is shown to help control impulsiveness, form more satisfactory relationships, rear children more effectively, and improve organizational and problem-solving skills.

It is suggested that pet-facilitated therapy might be a useful adjuvant on treatment of posttraumatic stress disorder. Some motivation and rationale for this idea is given, and a discussion of method of testing it.

Olanzapine acutely induced disabling hypofrontal symptoms in a 31-year-old male. This occurred after 13 years of exposure to typical neuroleptics without such symptoms. Presumably, hypofrontal symptoms should limit the dose of atypical neuroleptics in some patients. Milder expressions of hypofrontal symptoms should be more common.

Dizziness is a common and costly condition that causes significant distress and impairment yet often confounds appropriate diagnosis and treatment. Among patients presenting for evaluation and treatment of dizziness, rates of panic disorder are elevated to 5 to 15 times the general population rates. In addition, the limited studies to date of dizziness in patients with panic disorder suggest that panic patients frequently experience significant dizziness and often demonstrate evidence of vestibular dysfunction. In this paper we review studies investigating the relationship between panic disorder and vestibular dysfunction. Currently, there are three main explanatory models for the association between panic disorder and vestibular dysfunction: the psychosomatic model, the somatopsychic model, and the network alarm theory. Systematic investigations of the treatment of patients with vestibular symptoms and panic disorder are lacking, though prevalence, associated costs, and disability suggest that they are needed. Serotonin selective reuptake inhibitors are good candidates for future treatment studies.

Until quite recently, the only stressor considered consistent with the diagnosis of PTSD was a catastrophic, out of the ordinary, trauma that almost anyone could be expected to have a severe reaction to. Thus, PTSD was considered relatively rare among non-military populations. More recently, epidemiologic surveys have suggested that PTSD may be much more prevalent than heretofore recognized, and the DSM-IV has opened the door to a much larger variety of stressors (the “A” criterion). Yet, bereavement is not considered the type of stressor capable of producing PTSD. In this study, 350 newly bereaved widows and widowers were assessed for the prevalence of PTSD, its chronicity, comorbidity, and consequences. The diagnosis of PTSD was made on the basis of questionnaire items approximating the DSM-IV criteria for PTSD. At 2 months after the spouse's death, 10% of those whose spouses died after a chronic illness met criteria for PTSD, 9% of those whose spouses died unexpectedly met criteria, and 36% of those whose spouses died from “unnatural” causes (suicide or accident) had PTSD. Symptoms tended to be chronic in at least 40% of the subjects, almost always were associated with comorbid depression, and created substantial morbidity. The results suggested that PTSD may occur after bereavement, and, by extension, other stressors not recognized by official diagnostic systems. The “A” criterion needs further examination.

Clonidine is a centrally acting antihypertensive and has been prescribed widely for more than 20 years. Because it decreases central norepinephrine activity, clonidine has been investigated as an antipsychotic. In most of the preliminary studies, clonidine was tested as the sole antipsychotic agent. We performed a double-blind, placebo-controlled, crossover study to compare a placebo plus a neuroleptic to clonidine plus a neuroleptic in a group of 16 chronically psychotic patients. Of these 16, 3 dropped out secondary to side effects of the clonidine and 1 withdrew from the study. The clonidine dosage varied from 0.2 to 0.6 mg per day. The concurrent neuroleptic (one of the following: haloperidol, thiothixene, thioridazine, mesoridazine, or fluphenazine) averaged 34 mg per day of haloperidol equivalents. Symptoms were monitored using the Psychiatric Symptoms Assessment Scale. The data provided evidence that a clonidine/neuroleptic combination was not more effective than a neuroleptic alone in this group of patients. These data suggest that the central antino-repinephrine activity of a neuroleptic is not potentiated further by clonidine.

Objective: This study sought to determine the prevalence of comorbid personality disorder in euthymic bipolar I patients. Method: Sixty-one outpatients were assessed using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID II) and/or the Personality Diagnostic Questionnaire-Revised (PDQ-R). Results: Thirty-eight percent of bipolar patients met criteria for an Axis II diagnosis based on the SCID II. Bipolar subjects with a history of comorbid alcohol use disorder were significantly more likely to have a SCID II diagnosis (52%) compared to those bipolar subjects without an alcohol use disorder history (24%). Cluster A diagnoses were significantly more common in the bipolar/alcohol use disorder group. The PDQ-R consistently overdiagnosed Axis II disorders, finding 62% of the overall bipolar group to have an Axis II diagnosis. Conclusions: Euthymic bipolar patients may have an increased rate of personality disorders, but much less so than previously reported in studies that did not take into account (1) current mood state, (2) comorbidity for an alcohol use disorder, and (3) instrument used for assessment of Axis II psychopathology.