Current psychiatry reports
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Curr Psychiatry Rep · Apr 2007
ReviewSuicide risk factors in children and adolescents with bipolar disorder.
Suicidal behavior in children and adolescents with bipolar disorder is a major public health problem that remains understudied. Most research on suicidal behavior in bipolar disorder has been conducted in older adolescents and adults and is limited by retrospective design. ⋯ More systematic research is needed to better understand suicidal behavior in bipolar children and adolescents. Increased knowledge of the risk factors that contribute to suicidal behavior should lead to better prevention and treatment.
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Suicidal behavior (ie, thoughts and attempts) in children is an issue of serious concern. In the past, suicide in young children has been largely denied and ignored. However, this is no longer possible, as accumulating evidence supports the existence of suicidal thoughts and actions in preadolescent children. This article explores suicidal behavior in preadolescent children and highlights areas of needed research.
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Curr Psychiatry Rep · Feb 2007
ReviewDelirium and cognitive dysfunction in the intensive care unit.
Delirium is an under-recognized, highly prevalent form of organ dysfunction in the intensive care unit (ICU). It is imperative to be aware of risk factors for delirium in the ICU, some of which are modifiable. ⋯ The tool, the Confusion Assessment Method for the Intensive Care Unit, has enabled determination of the serious sequelae of delirium, including increased mortality, higher cost, longer length of hospital stay, failure of extubation, and burdensome, long-term cognitive impairment. This article reviews prevention and treatment options, and current pharmacologic and nonpharmacologic approaches to delirium, acknowledging limited but improving quality of evidence to date.
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Curr Psychiatry Rep · Oct 2006
ReviewChronic pain and comorbid mood and substance use disorders: a biopsychosocial treatment approach.
Chronic pain is a colossal health care problem that is devastating to the individual afflicted with unremitting pain and frustrating to the beleaguered health care provider attempting to adequately manage this multifaceted disease. The biopsychosocial model of pain management is a promising approach that emphasizes evidence-based medication management in conjunction with cognitive-behavioral therapy and a graded exercise program. ⋯ Effective pharmacologic management of pain and comorbid mood disorders, including the thoughtful use of opioids, can have a dramatic effect in improving the quality of life in patients with chronic pain. The high prevalence of chronic pain in our society and the scarcity of experienced pain medicine physicians necessitate the development of a community-based systems approach to this complex patient population.
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Fibromyalgia is a chronic musculoskeletal pain condition of unknown etiology that predominantly affects women. Lifetime mood and anxiety disorders are common in patients with fibromyalgia and affect the course and severity of fibromyalgia. Recent fibromyalgia clinical trials have included clinical assessments to identify comorbid psychiatric disorders and determine the impact of comorbidity on treatment response. ⋯ Antidepressants or alpha-2-delta ligands should be combined with established mood stabilizers in patients with comorbid fibromyalgia and bipolar disorder. There is also evidence to support exercise and cognitive-behavioral therapy in the treatment of fibromyalgia and mood or anxiety disorders. Many patients would likely benefit from combinations of pharmacologic and nonpharmacologic treatments.