The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Mar 2019
ReviewDiagnostic Categories for Eating Disorders: Current Status and What Lies Ahead.
The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) for 6 feeding and eating disorders were published in 2013 and were notable for officially recognizing binge-eating disorder and for articulating criteria for avoidant/restrictive food intake disorder. The criteria and the rationale for them are briefly described, and current and future challenges are discussed.
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Psychiatr. Clin. North Am. · Sep 2018
ReviewNoninvasive Focused Ultrasound for Neuromodulation: A Review.
This article covers noninvasive focused ultrasound (FUS) and its potential for neuromodulation. Although diagnostic uses of ultrasound are well known, its potential to noninvasively alter brain activity is a relatively new subject of research. ⋯ This article aims at providing an updated review of the literature related to the role of LIFU in neuromodulation and the progress of animal as well as human research done on this topic. It also includes a critical review of the safety concerns slowing the translation of LIFU research into clinical trials.
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Psychiatr. Clin. North Am. · Sep 2018
ReviewDeep Brain Stimulation in Psychiatry: Mechanisms, Models, and Next-Generation Therapies.
Deep brain stimulation has preliminary evidence of clinical efficacy, but has been difficult to develop into a robust therapy, in part because its mechanisms are incompletely understood. We review evidence from movement and psychiatric disorder studies, with an emphasis on how deep brain stimulation changes brain networks. ⋯ We describe how dimensional approaches to diagnoses may aid that identification. We discuss the use of network/circuit biomarkers to develop self-adjusting "closed loop" systems.
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Trends in brain stimulation include becoming less invasive, more focal, and more durable with less toxicity. Several of the more interesting new potentially disruptive technologies that are just making their way through basic and sometimes clinical research studies include low-intensity focused ultrasound and temporally interfering electric fields. It is possible, and even likely, that noninvasive brain stimulation may become the dominant form of brain treatments over the next 20 years. The future of brain stimulation therapeutics is bright.
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Psychiatr. Clin. North Am. · Sep 2017
ReviewEmergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies, Part 2: Special Psychiatric Populations and Considerations.
Patients who present to the emergency department (ED) with mental illness or behavioral complaints merit workup for underlying physical conditions that can trigger, mimic, or worsen psychiatric symptoms. However, there are wide variations in quality of care for these individuals. Psychiatry and emergency medicine specialty guidelines support a tailored, customized approach to patients. Our group has long advocated a dynamic comanagement approach for medical clearance in the ED, and this article summarizes best-practice approaches to the medical clearance of patients with psychiatric illness, tips on history taking, system reviews, clinical/physical examination, and common pitfalls in the medical clearance process.