Dear Colleagues:
Welcome to the October 2011 issue of Innovations in Clinical Neuroscience. We start this edition with “The Interface” by Sansone and Sansone. The authors examine the literature regarding the treatment of bipolar disorder by primary care physicians. The authors find that the complicated nature of diagnosis and treatment of bipolar disorder makes primary care physicians reluctant to manage this patient population.
Next, Dr. Harvey provides us with his next installment of “Update on Cognition.” In this edition, Dr. Harvey reviews cognitive deficits and impairments in everyday functioning that manifest in people with major depressive disorder, bipolar disorder, or schizophrenia. He focuses on symptoms of depression and how they impact each of these diagnoses differently. Dr. Harvey states, “…depression has a major adverse impact on everyday functioning in all variants of severe mental illness, and improving its recognition (in the case of schizophrenia) and management has the potential to reduce the adverse impact of severe mental illness on everyday functioning.”
Following this, Turner et al describe the use of an independent, blinded, relapse monitoring board to assess the primary outcome (relapse) in an international clinical trial of risperidone long-acting therapy adjunctive to standard-care pharmacotherapy for patients with bipolar disorder. Primary efficacy results were similar and significant for investigator- and relapse monitoring board-determined relapses. Ten discrepancies were noted. The authors conclude that use of the relapse monitoring board supports the validity of the study by incorporating a level of standardization to mitigate the risk that local practice in different cultures and medical systems at the sites would confound study results.
Next, Dr. Ali provides us with an in-depth review of delirium, a complex condition that often occurs in hospitalized, critically ill patients. The author reviews some of the more supported theories on the pathophysiology of delirium, as well as its methods of detection, modifiable risk factors, and mood and psychotic symptoms.
Following this, Dr. Talih describes an interesting case of kleptomania that was potentially worsened by multiple factors occurring in the patient’s life. The author describes the treatment modalities used in this case, including the use of the Yale-Brown Obsessive Compulsive Scale as a surrogate marker to gauge response to treatment, as well as provides a brief literature review on kleptomania.
Finally, we wrap up the issue with one of Dr. Targum’s “Research to Practice” interviews. This month, Dr. Targum interviews Dr. Maurizio Fava from Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts. Dr. Fava shares his expert views on fatigue, a residual symptom often seen during major depressive disorder treatment. Dr. Fava describes symptoms of fatigue, how to determine the causes of fatigue, and how to manage its symptoms.
Sincerely,
Amir Kalali, MD
Editor, Innovations in Clinical Neuroscience
