Emotional expression, or “affect,” covers a range of temporal domains. There are “emotions,” moment-to-moment fluctuations which, while intensely experienced, come and go within minutes. When a given emotional state lasts longer – hours, days, or months – it is described as “mood.” Finally, there is “temperament,” a lifelong emotional disposition considered to be part of one’s constitutional makeup (1). When temperament manifests as “affective” – that is to say, appears as a similar but less severe variant of a disordered mood state – things start to get interesting.
Continue reading » “Affective Temperaments Part I: What Can Personality Traits Teach Us About Mood States?”Blog
Can Anti-inflammatory Drugs Treat Depression? Some Promising New Evidence But Not Yet Enough
The connection between physical ailments and mood is not a new one. It is well-established that medical illness, ranging from infections to cardiovascular disease, can result in increased symptoms of depression, while depression can predispose people to become physically sick more often. Now, a growing body of evidence shows that depression and physical illness have something important in common: inflammation.
Continue reading » “Can Anti-inflammatory Drugs Treat Depression? Some Promising New Evidence But Not Yet Enough”Understanding Premenstrual Dysphoric Disorder (PMDD)
Imagine a mood disorder in which intense mood swings come predictably every month, wreaking havoc on any idea of calm normalcy. Depressed mood, lethargy, decreased interest and hopelessness occur along with marked irritability, anger, agitation and insomnia. One has the sense of being overwhelmed and “out of control.” Arguments and heightened tearfulness ensue. Then everything returns to normal for the next week or two, only to be turned upside down by the dreaded monthly roller-coaster.
Continue reading » “Understanding Premenstrual Dysphoric Disorder (PMDD)”“Plastics”
Many of us of a certain age will never forget the sage, one-word piece of occupational advice given to Benjamin Braddock in the movie, The Graduate: “Plastics.” In the early 1960’s, plastics were thought to be the next big area of economic growth. Benjamin, as we all remember, takes in this recommendation with alienated befuddlement. However from the vantage point of 21st century psychiatric research, this advice may have been unwittingly prescient.
Continue reading » ““Plastics””Bipolar Disorders and the Case of the Missing Self
Every few years, a new author comes along who is uniquely capable of giving voice to the ineffable aspects of their experience with serious mood problems: Kay Jamison with her (An) Unquiet Mind, William Styron who perceived Darkness Visible, and Sylvia Plath’s The Bell Jar are the more modern prototypes. Recently, a freelance journalist, Linda Logan, published a brief piece in the New York Times: The Problem With How We Treat Bipolar Disorder 1. This mini-memoir is second-to-none in capturing the roller-coaster ride that is far-too-often the case with this illness.
Continue reading » “Bipolar Disorders and the Case of the Missing Self”Brain Problems in Bipolar Disorder: What We Know and How We Know it, circa 2013.
“Is there something wrong with my brain?” “Does part of my brain not work correctly?” Each time we make a diagnosis of bipolar disorder in our practice, these questions inevitably and understandably come up. People want to know about their illness. This conversation is often an essential part of the treatment.
Continue reading » “Brain Problems in Bipolar Disorder: What We Know and How We Know it, circa 2013.”Postpartum Troubles Point to Increased Risk of Future Bipolarity
In our clinical work, we are always striving to determine who is at high risk of developing bipolar disorder. Our patients come to us with a variety of mood and anxiety problems. Often, those who are ultimately diagnosed with bipolar disorder have experienced a long period of misdiagnosis and incorrect treatment.
Continue reading » “Postpartum Troubles Point to Increased Risk of Future Bipolarity”The Treatment of ADHD: ADDenda
I can’t resist adding some extra ideas to Dr. Plyler’s review of Amy Arnsten’s article, Catecholamine Influences on Dorsolateral Prefrontal Networks 1. As he indicated, ADHD is one of the conditions on which we focus in this practice. Dr. Arnsten’s paper made several points that deserve special emphasis.
Continue reading » “The Treatment of ADHD: ADDenda”Fine-Tuning our Understanding of the ADHD Brain
The greater our understanding of an illness state, the better we are able to treat it. As one of the core disorders in our practice, we constantly review and update our knowledge on ADHD. In the course of a recent review, I came across a wonderful compilation issue on ADHD in Biological Psychiatry (Biol Psychiatry June 15 2011, vol. 69). The review issue covers a wide range of topics from psychostimulants as cognitive enhancers to the molecular genetics of ADHD. The most relevant and clinically applicable article, however, was Amy Arnsten’s paper on “Catecholamine Influences on Dorsolateral Prefrontal Cortical Networks” (Biol Psychiatry. 2011 June 15;69(12):e89-99). She does a masterful job of presenting complex material in a clear and elegant manner. Dr. Arnsten is able to capture the fluidity and dynamics of cortical functions associated with ADHD while still giving the reader anchor points that are useful in everyday clinical practice.
Continue reading » “Fine-Tuning our Understanding of the ADHD Brain”IPSRT as monotherapy in bipolar II disorder: can psychotherapy be more than an ‘adjunct’ in the treatment of bipolar disorder?
Clinicians who work with patients suffering from bipolar disorder have known this for quite some time: medication alone, while helpful in controlling many of the acute symptoms of bipolar disorder, is not enough to help patients manage this complex illness. Patients often feel overwhelmed by the diagnosis and need support to adjust to the realities of fluctuating mood states, which frequently result in interpersonal and occupational dysfunction. For these and other reasons, psychotherapy is an important component of bipolar disorder treatment.
Continue reading » “IPSRT as monotherapy in bipolar II disorder: can psychotherapy be more than an ‘adjunct’ in the treatment of bipolar disorder?”