Dear Colleagues:

Welcome to the July issue of Psychiatry 2010. We start this issue with Trend Watch, in which the authors provide information on patient-reported side effects from a cross-section of real-world patients taking atypical antipsychotics. More than half of the respondents reported experiencing a side effect as a result of atypical antipsychotic medication, and of those experiencing a side effect, less than 25 percent reported this side effect to their physicians. Jonathan M. Meyer, MD, Assistant Clinical Professor Psychiatry, University of California, San Diego, California, Staff Psychiatrist and Medical Director, Mental Health Intensive Case Management Program VA, San Diego Healthcare System, and Staff Psychiatrist, Patton State Hospital, Patton, California, provides an excellent commentary on this data.

Next, in this month’s installment of The Interface, Sansone and Sansone take a look at road rage and the factors that may contribute to it, including Axis I and II disorders. As the authors state, “Being aware of these contributory factors to road rage may improve general clinical awareness of the nature and treatment of perpetrators.”

Following this, welcomed guest contributor Dr. Ronald Pies stirs the pot and gets us thinking with another stimulating commentary. This month, he is joined by Drs. Kristy Lamb and Sidney Zisook, and together they review and discuss the studies bearing on the validity of the bereavement exclusion for the diagnosis of major depression. The authors conclude that the exclusion is not supported by the best available data, and they propose revisions for Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition.

We are also pleased to include in this issue a study by Alphs et al. The authors assess the ability of mental health professionals to use the 4-item Negative Symptom Assessment instrument (NSA-4), derived from the Negative Symptom Assessment-16, to rapidly determine the severity of negative symptoms of schizophrenia. The investigators found that clinicians from a variety of geographic practices can, after brief training, use the NSA-4 effectively to rapidly assess negative symptoms in patients with schizophrenia.

Next, Lakshmanan et al present an intriguing case of dissociative identity disorder complicated by bipolar disorder. The authors describe the collaborative method they used between the psychologist and psychiatrist to effectively treat this patient. The authors stress importance of carefully diagnosing and treating existing comorbid conditions, which they believe may be the most important aspect in treating dissociative identity disorder.

Following this, in this month’s Psychiatry and Neurology installment, Sanders and Gillig focus on gait and describe the usefulness of its assessment in psychiatry. For those doubters out there, the authors said it best: “Most psychiatric readers likely ask themselves whether any examination at all might better be delegated to an extender or consultant. However, even the most constrained specialists get to watch most of their patients walk a few steps.”

Next, Sansone et al surveyed 75 internal medicine outpatients to examine whether four general queries about mental healthcare utilization (“Have you ever been seen by a psychiatrist?,” “Have you ever been hospitalized in a psychiatric hospital?,” “Have you ever been in counseling?,” and “Have you ever been on medication for your nerves?”) would evidence correlations with various aspects of sleep disturbance as measured by the Pittsburgh Sleep Quality Index. The authors found that while individuals with greater mental healthcare utilization do not evidence differences in overall sleep quality compared to those with low utilization, they do report more disturbances in sleep.

And finally, Dr. Meymandi provides us with another beautifully written piece about the art of music. This month, he describes Hazrat Inayat Khan, his branch of Sufism, and his music. Enjoy the remaining weeks of summer!

Amir Kalali, MD
Editor,  Psychiatry 2010