bluuebunny/crossref_metadata_2025 huggingface dataset:
The Existence of Reasonable Doubt as to Revenue Collection and Expense Payment: Implications for Accrual Basis Taxpayers
Authors: Blatz Robert E. , Philipich Kirk L.
Published: March 2009

One of the basic assumptions of accrual accounting is that, in due time, revenue earned in the normal course of business will be collected and liabilities incurred will be paid. Yet, case law indicates that it is inappropriate to impose the income tax on amounts whose collection is reasonably in doubt, even though these amounts are fixed, determinable, and undeniably due the taxpayer. In such an event, taxpayers can either exclude the income item from gross income, viz., the common law doubtful collection exception, or include the item in gross income and charge bad debt expense upon specifically writing off the matching receivable. While the common law doubtful collection exception is conceptually sanctioned by the tax court and the Federal Circuits, conflict exists concerning the level of financial distress required to establish reasonable doubt and the exact point in time when such distress must exist. More important, given that the common law doubtful collection exception is independent of the highly developed body of statutory, regulatory, and case law governing bad debt deductions, opportunities for the common law exception may exist where either the bad debt deduction is unavailable or additional steps are required to sustain the deduction. Conversely, the possible inability of an accrual basis taxpayer to actually pay an expense that meets the three-prong all events test does not, in itself, preclude a deduction of that expense, even where the inability to pay exists at the time of accrual. Thus, where a liability accrues under the three-prong all events test, even the strong likelihood of nonpayment due to the taxpayer's insolvency will not necessarily prevent its accrual and deduction. While several Federal Circuits permit accrual and deduction, even in situations where an obvious inability to pay exists at the time of accrual, the tax court and other Federal Circuits condition accrual and deduction on the taxpayer having a reasonable expectation of payment at the point of accrual. However, even when a deduction meets either of the above tests, the commissioner can still argue that, under the Mooney Aircraft common law economic performance requirement, the deduction does not clearly reflect income. This article explores these apparently conflicting treatments of accruals with the aim of providing tax specialists with a practical yet authoritative guide to the possibilities of income deferral and expense accrual (i.e., acceleration) in instances of reasonable doubt as to ultimate collection or payment.
First Nationwide Study of the Prevalence of the Metabolic Syndrome and Optimal Cutoff Points of Waist Circumference in the Middle East
Authors: Delavari Alireza , Forouzanfar Mohammad Hossein , Alikhani Siamak , Sharifian Afsaneh , Kelishadi Roya
Published: March 2009

OBJECTIVE

The purpose of this study was to provide the first national estimate on the prevalence of the metabolic syndrome and its components and the first ethnic-specific cutoff point for waist circumference in the Eastern Mediterranean Region.

RESEARCH DESIGN AND METHODS

This national survey was conducted in 2007 on 3,024 Iranians aged 25–64 years living in urban and rural areas of all 30 provinces in Iran. The metabolic syndrome was defined by different criteria, namely the definition of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), the International Diabetes Federation (IDF) criteria, and the modified definition of the NCEP/ATP III (ATP III/American Heart Association [AHA]/National Heart, Lung, and Blood Institute [NHLBI]).

RESULTS

The age-standardized prevalence of the metabolic syndrome was about 34.7% (95% CI 33.1–36.2) based on the ATP III criteria, 37.4% (35.9–39.0%) based on the IDF definition, and 41.6% (40.1–43.2%) based on the ATP III/AHA/NHLBI criteria. By all definitions, the prevalence of the metabolic syndrome was higher in women, in urban areas, and in the 55- to 64-year age-group compared with the prevalence in men, in rural areas, and in other age-groups, respectively. The metabolic syndrome was estimated to affect >11 million Iranians. The optimal cutoff point of waist circumference for predicting at least two other components of the metabolic syndrome as defined by the IDF was 89 cm for men and 91 cm for women.

CONCLUSIONS

The high prevalence of the metabolic syndrome with its considerable burden on the middle-aged population mandates the implementation of national policies for its prevention, notably by tackling obesity. The waist circumference cutoff points obtained can be used in the region.
Family-Planning Practices Among Women With Diabetes and Overweight and Obese Women in the 2002 National Survey for Family Growth
Authors: Vahratian Anjel , Barber Jennifer S. , Lawrence Jean M. , Kim Catherine
Published: March 2009

OBJECTIVE

To examine contraceptive practices among diabetic women and obese women.

RESEARCH DESIGN AND METHODS

We analyzed the responses of 5,955 participants aged 20–44 years in the 2002 National Survey for Family Growth. Diabetes, BMI, desire for pregnancy, history of infertility treatment, sexual activity, parity, and demographic variables (age, race/ethnicity, education, marital status, income, insurance, and smoking history) were obtained by self-report. Lack of contraception was defined as absence of hormonal-, barrier-, or sterilization-based methods. Associations among contraception, diabetes, and BMI category were assessed in multivariable logistic regression models in nonsterile, sexually active women.

RESULTS

In unadjusted comparisons among sexually active women who were not sterilized, women with diabetes were more likely to lack contraception than women without diabetes (odds ratio [OR] 2.61 [95% CI 1.22–5.58]). Women with BMI ≥35 kg/m2 were more likely to lack contraception than women with BMI <25 kg/m2(1.63 [1.16–2.28]), but associations between contraception use and lesser degrees of overweight and obesity were not significant. In multivariable models, women who were older (aged ≥30 vs. 20–29 years), were of non-Hispanic black race, were cohabitating, had a history of infertility treatment, and desired or were ambivalent about pregnancy were significantly more likely to lack contraception. The associations among diabetes, BMI, and contraception were no longer significant after these adjustments.

CONCLUSIONS

Older women with diabetes and obesity who desire pregnancy, regardless of pregnancy intention, should be targeted for preconceptive management.
A squalene epoxidase from Nigella sativa participates in saponin biosynthesis and mediates terbinafine resistance in yeast
Authors: Lipinski Marta , Scholz Martin , Pieper Kay , Fischer Rainer , Prüfer Dirk , Müller Kai
Published: March 2009

Squalene epoxidase catalyzes the formation of 2,3-oxidosqualene from squalene and in plants is the last enzyme common to all biosynthetic pathways leading to an array of triterpene derivatives like phytosterols, brassinosteroid phytohormones or saponins. In this work, we present a squalene epoxidase gene (NSSQE1) from the triterpene saponin producing plant Nigella sativa. The gene product showed a high degree of homology to functional squalene epoxidases (SQEs) from Arabidopsis thaliana and was able to complement SQE deficient yeast that harboured a knockout mutation in the underlying erg1 gene. Moreover, the expression of the NSSQE1 gene in ERG1 wild type yeast revealed that NSSQE1 conferred resistance towards terbinafine, an inhibitor of fungal SQEs. The latter suggested that a terbinafine-dependent NSSQE1 selection marker system can be developed for yeast. The gene NSSQE1 was ubiquitously expressed in all plant tissues analysed, including roots where no triterpene saponins are produced. Therefore, we argue that NSSQE1 is a housekeeping gene for triterpene metabolism in Nigella sativa. Similar to triterpene saponins, NSSQE1 was up-regulated by methyl jasmonate in leaves and should also be functionally involved in saponin biosynthesis in Nigella sativa.
SEM analysis of dental enamel morphological structures on the basis of their replicas in patients with systemic calcium deficiency
Authors: Bałczewska Ewa , Klimek Leszek , Palatyńska-Ulatowska Aleksandra
Published: March 2009

The aim of the present study is to examine microscopically the surface of dental enamel by using a scanning electron microscope (SEM), using their replicas formed in female patients with diagnosed periodontal diseases and systemic calcium deficiency. Replicas of dental enamel surfaces in patients referred for treatment of periodontal diseases were subjected to microscopic analysis. The replicas, after coating with platinum-palladium alloy, were examined under the scanning electron microscope at magnifications of 15–5000 x. Densitometric examinations of spine (L2 - L4 segment) revealed bone mineral density BMD T-score lower than −2.5 in 5 patients, in the range of −1.5 to −2.5 in 10 patients, and higher than −1.5 in the remaining patients. Non-homogenous images of surfaces in the form of light and dark areas were observed. Light areas corresponded to damaged surfaces of dental tissues. Patients with higher systemic calcium deficiency had areas lighter in color. More of these areas were found in patients with higher systemic calcium deficiency. It can be assumed that the calcium deficit is likely to appear in the selected dental tissues, particularly in the dental enamel.
A note on the conditional probability of IF-events
Authors: Valenčáková Veronika
Published: March 2009

We formulate a version of the conditional probability of an IF-event considering the Łukasiewicz operations with IF-sets. Also some properties of conditional probability are proved. The results are strengthenings of preceding ones published in [LENDELOVÁ, K.: Conditional IF-probability. In: Soft Methods for Integrated Uncertainty Modelling. Proceedings of the 2006 InternationalWorkshop on Soft Methods in Probability and Statistics (SMPS 2006), Bristol, UK, September 5–7, 2006. Adv. Soft Comput., Springer-Verlag, Berlin, 2006, pp. 275–283].
Did the Prevalence of PTSD Following Hurricane Katrina Match a Rapid Needs Assessment Prediction? A Template for Future Public Planning After Large-Scale Disasters
Authors: Dalton Richard , Scheeringa Michael S. , Zeanah Charles H.
Published: March 2009

Needs assessments are generally developed immediately following disasters to estimate the number of individuals who will develop serious mental health problems, including post-traumatic stress disorder (PTSD), so that necessary treatment resources can be predicted. Following Hurricane Katrina, the authors estimated that approximately 40% of first responders and those most impacted by Katrina would develop PTSD and other mental health problems in the year following the storm. Further, they estimated that among groups of individuals who were less directly impacted, 5% to 30% of individuals would develop PTSD. A review of 10 post-Katrina surveys conducted in New Orleans and southern Mississippi suggests that the needs assessment predictions were in the conservative range. The authors discuss the findings and their ramifications for future need assessments.
 ABOUT THE AUTHORS
Richard Dalton, MD, is with the Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, Louisiana. Michael S. Scheeringa, MD, MPH, and Charles H. Zeanah, MD, are with the Institute of Infant and Early Childhood Mental Health, Department of Psychiatry and Neurology, Tulane University Health Sciences Center.

Address correspondence to Richard Dalton, MD, Department of Psychiatry and Neurology, 1440 Canal St, TB 52, New Orleans, LA 70116; e-mail rdalton@tulane.edu; fax 504-988-4264.

Dr. Dalton, Dr. Scheeringa, and Dr. Zeanah have disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
Develop a needs assessment following a disaster.

Identify specific groups of individuals who are likely to develop posttraumatic stress disorder (PTSD) following a disaster.

Describe the percentage of individuals within specific groups who develop PTSD following disasters such as hurricanes.
Long-term Psychiatric Consequences of Hurricane Katrina
Authors: Ginzburg Harold M.
Published: March 2009

The psychological effects of the stressors and trauma associated with Hurricane Katrina are far from resolved. In this issue of Psychiatric Annals, the reader will learn about the effects of the hurricane on evacuees, first responders, physicians, and other survivors.
Physician-Psychiatrists’ Role in Disaster Response Efforts
Authors: Pejic Nicholas G. , Ginzburg Harold M.
Published: March 2009

Psychiatrists are the only members of the mental health team with medical training and, in most states, with prescriptive authority for U.S. Drug Enforcement Agency (DEA) scheduled (controlled) substances that include many sedative-hypnotics, anxiolytics, stimulants, and narcotics. During a disaster, the community will look to physicians to provide a critical leadership role in the medical management of the disaster causalities. The community will look toward psychiatrists to work with their physician colleagues in treating the mental health complications of serious medical and surgical conditions and replacing the dislocation of medical services for the chronically medically and mentally ill. Psychiatrists must be prepared to accept this role and have the skills and knowledge to do it well.
ABOUT THE AUTHORS
Nicholas G. Pejic, MD, and Harold M. Ginzburg, MD, JD, MPH, are from the Department of Psychiatry, Louisiana State University Health Sciences Center. Dr. Ginzburg is also with the Department of Psychiatry and Neurology, Tulane University Health Sciences Center, and the Department of Psychiatry, Uniformed Services University of the Health Sciences School of Medicine.

Address correspondence to: Harold M. Ginzburg, MD, Clinical Professor of Psychiatry, Suite 200, 3340 Severn Avenue, Metairie, LA 70002; fax 504-613-4913; or e-mail haroldginzburg@hotmail.com.

Dr. Pejic and Dr. Ginzburg have disclosed no relevant financial relationships.
The Role of Corticotropin-releasing Factor in the Pathophysiology of Depression: Implications for Antidepressant Mechanisms of Action
Authors: Martin Elizabeth I. , Nemeroff Charles B.
Published: March 2009

Current antidepressant drugs were developed largely based on two serendipitous findings; first, that monoamine depletion with the antihypertensive agent reserpine causes depression in some patients, and second, that the antitubercular agent isoniazid, which inhibits monoamine oxidase, the enzyme responsible for degrading monoamines extracellularly, was noted to improve patients’ mood. Currently available antidepressants act by blocking presynaptic monoamine transporter proteins, inhibiting monoamine oxidase, and/or by differential actions at pre- and post-synaptic monoamine receptors. Despite relatively low remission rates and the lag time between treatment initiation and symptom resolution, new drug development has been slow. Much recent research has been devoted to identifying a common mechanism of action of antdepressant drugs that is more closely associated with the temporal sequence of symptom resolution. Moreover, identifying the basic underlying pathophysiology of major depressive disorder (MDD) may elucidate novel targets leading to development of more efficient and effective treatment.

ABOUT THE AUTHORS

Elizabeth I. Martin; and Charles B. Nemeroff, MD, PhD, are with the Laboratory of Neuropsychopharmacology, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.

Address correspondence to: Elizabeth I. Martin, 101 Woodruff Circle, Suite 4000 WMRB, Atlanta, GA 30322; or fax 404-727-3233.

Dr. Martin has disclosed no relevant financial information. Dr. Nemeroff has disclosed the following relevant financial information: American Foundation for Suicide Prevention (AFSP), George West Mental Health Foundation, Mt. Cook Pharma, and Novadel Pharma: Member of Board of Directors; National Institutes of Health (NIH): Research Grant Recipient; AFSP, Astra-Zeneca, Forest Laboratories, Janssen/Ortho-McNeil, Quintiles, NARSAD (National Alliance for Research on Schizophrenia and Depression), and PharmaNeuroboost: Member of Scientific Advisory Board; and CeNeRx, Corcept, Novadel Pharma, PharmaNeuroboost, and Reevax: Equity or Shareholder.

This research was supported by NIH MH-77083, MH-69056, MH-58922, MH-39415, MH-42088, and RR-00039.

EDUCATIONAL OBJECTIVES

 Describe how antidepressants, as well as other psychiatric drugs, normalize the disturbances in CRF-containing circuits and HPA axis signaling and that these changes are associated with a favorable treatment response.

Assess how measures of disrupted CRFergic signaling and downstream changes in HPA axis functioning may be used to predict response to antidepressant treatment and risk of relapse.

Determine how individual genetic differences in CRF-related genes may influence predisposition or resiliency to psychiatric disorders as well as likelihood to respond to a given treatment.

 
Signal Transduction in Psychiatry
Authors: Viamontes George I.
Published: March 2009

Signal transduction is the movement of information across different levels of order, with concomitant translation of the informational content into the appropriate format. The term “signal transduction” originated in the physical sciences, but over the past 25 years, it has become a key concept in cell and molecular biology. The mechanisms of action of both psychopharmacology and psychotherapy involve signal transduction at several levels.

 ABOUT THE AUTHOR
George I. Viamontes, MD, PhD, is Regional Medical Director, United Behavioral Health Inc., St. Louis, Missouri, and Assistant Clinical Professor, Department of Psychiatry, University of Missouri-Columbia, Columbia.

Address correspondence to: George Viamontes, MD, PhD, Regional Medical Director, UBH, 13655 Riverport Drive, Fourth Floor, St. Louis, MO 63043; or e-mail viamonte@sbcglobal.net.

Dr. Viamontes has disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES

 Determine how sensory information is converted to neural impulses.

Assess the mechanism of action of the four major types of neural signal transduction at the cellular level.

Describe the mechanism of action of the major neurotransmitter receptors in the brain.
Informed Assent and Informed Consent in the Child and Adolescent
Authors: Alkhatib Anas , Regan Judy , Jackson John
Published: March 2009

In the psychiatric evaluation, parents are an essential source of information prior to treatment. However, there is a fine line between children’s and adolescents’ need for privacy, autonomy, and confidentiality and the parents’ right to protect and choose what is best for their child. Therefore, the clinician may be left to wonder who can provide informed consent. This article discusses informed consent in a clinical setting.
 ABOUT THE AUTHORS
Anas Alkhatib, MD, is a Child and Adolescent Psychiatrist, Riverbend Center for Mental Health, Florence, Alabama. Judy Regan, MD, MBA, JD, is Associate Clinical Professor, Vanderbilt University, Nashville, Tennessee. John Jackson, MD, is Child and Adolescent Psychiatrist, Office of Mental Health Care, Department of Veterans Affairs, Nashville.

Address correspondence to: Anas Alkhatib, MD, anasalkhatib@rcmh.org.

Dr. Alkhatib, Dr. Regan, and Dr. Jackson have disclosed no relevant financial relationships.

The authors thank William Bernet, MD, Professor of Psychiatry, Chief of Forensic Division, Department of Psychiatry, Vanderbilt University, for his help and feedback. They would also like to thank Gagan Dhaliwal, MD, Child and Adolescent, Adult and Forensic Psychiatrist, Huntsville, Alabama, for his support.
 EDUCATIONAL OBJECTIVES
 Review the complexity of child and adolescent assent.

Discuss components of consent and factors that may influence child and adolescent assent.

Describe informed dissent and how it is different from adults’ refusal of treatment.

 
A 19-year-old Black Woman with Psychotic and Depressive Symptoms
Authors: Macaluso Matthew , Khan Ahsan Y.
Published: March 2009

The patient is a 19-year-old, single, black, female high-school student who maintains part-time employment and cares for her 1-year-old son. The patient complained of “hearing voices” for 1 to 2 years, which were worsening several weeks prior to presentation. The voices had commanded her to harm herself and her child in the remote past. The patient did not act on these hallucinations, had reasonable insight into them, and strong family support. The patient stated that the voices made her feel as if someone was coming after her. A computerized tomography (CT) scan without contrast was within normal limits. The patient denied history of seizures or traumatic brain injury.  ABOUT THE AUTHORS Matthew Macaluso, DO, is Chief Resident, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, Kansas. Ahsan Y. Khan, MD, is Associate Professor, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine.

Address correspondence to: Matthew Macaluso, DO, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, 1010 N. Kansas, Wichita, KS 67214; or e-mail mmacaluso@kumc.edu.

Dr. Macaluso has disclosed no relevant financial relationships. Dr. Khan has disclosed the following relevant financial relationships: Pfizer and Wyeth: Member of Speakers Bureau.
Limitations of Evidence in the Practice of Evidence-based Medicine
Authors: Howland Robert H.
Published: March 2009

Evidence-based medicine is a concept that has become widely described, discussed, criticized, and studied in the medical literature. The broad goal of evidence-based medicine is to address two main kinds of decisions — population-based policies and individual medical decisions — that serve to improve health outcomes through the use of the most proven effective treatments. As a result, there have been increased efforts to apply evidence-based medicine concepts to develop treatment guidelines, support medical education, inform individual decision making, and justify insurance coverage policies. The essence of evidence-based medicine is to use evidence (typically research data) related to the effectiveness of medical interventions to guide decisions about whether to use those interventions in clinical practice. In other words, the principles of evidence-based medicine suggest that good policies and clinical practice are based on using evidence that treatment X is helpful for treating disease Y in patient Z. Therefore, the quality of evidence is the critical component in understanding and using evidence-based medicine.
 ABOUT THE AUTHOR
Robert H. Howland, MD, is Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.

Address correspondence to Robert H. Howland, MD, Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213; e-mail: HowlandRH@upmc.edu.

Dr. Howland has disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
 Assess the concept of evidence-based medicine.

Describe the kinds of evidence used in the practice of evidence-based medicine.

Discuss some limitations of evidence used in the practice of evidence-based medicine.
 
A 17-year-old Male with Memory Loss, Aggression, and Poor Social Skills
Authors: Ibishi Nazmie F. , Masala John , Boshnjaku Skender , Musliu Nebi R. , Ukshini Shqipe
Published: March 2009

A 17-year-old boy was brought to the Psychiatric Clinic by his father. The boy had been arrested because he was suspected of throwing an explosive substance into a restaurant. Several people were injured. The court had released him from prison to house arrest. This was the first time the boy had been in prison, and he had no prior criminal offenses.
 ABOUT THE AUTHORS
Nazmie F. Ibishi, MD, and Skender Boshnjaku, MD, are with the University Clinical Center of Kosova, Clinic of Psychiatry, Prishtina, Kosova. John Masala, MD, is a Psychiatrist with Dubrava Prison Hospital, Kosova. Nebi R. Musliu, MD, is with University Clinical Center of Kosova, Clinic for Internal Disease. Shqipe Ukshini is a Psychologist with University Clinical Center of Kosova, Clinic of Psychiatry.

Address correspondence to: Nazmie F. Ibishi, MD, University Clinical Center of Kosova-Clinic of Psychiatry, Prishtina, (Kosova); or e-mail nazmiemb3@hotmail.com.

Dr. Ibishi, Dr. Masala, Dr. Boshnjaku, Dr. Musliu, and Psychologist Ukshini have disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
 Assess the relevance of cognitive deficit and behavioral changes as result of cerebral damage.

Determine the social and legal outcomes of such behavioral disturbance and develop a management strategy.

Detect significant, but not well researched, social function in relation to cognitive deficit, aggression, and criminal behavior.
 
The Dream of Pharmacogenetics
Authors: Fawcett Jan
Published: March 2009

This June issue of Psychiatric Annals, guest edited by Wade Berrettini, MD, PhD, a national resource, has pharmacogenetics as its theme.
Pharmacogenetics
Authors: Berrettini Wade
Published: March 2009

This issue of Psychiatric Annals provides reviews of the pharmacogenetics of such drugs as lithium, antidepressants, anticonvulsants, and naltrexone for the treatment of alcohol addiction.
Pharmacogenetics of Lithium Response
Authors: Cruceanu Cristiana , de Lara Catalina Lopez , Alda Martin , Turecki Gustavo
Published: March 2009

Lithium has been the treatment of choice for bipolar disorder for many years. The element, in its ionic form, was first shown to have medical applications in the 1840s for the treatment of bladder stones and gout. However, it was not until the late 19th century that the therapeutic effects of lithium in bipolar disorder became recognized and its use re-established and made mainstream by John Cade in 1949. A significant amount of credit is attributed to Mogens Schou, who did the first series of systematic trials with bipolar disorder patients during the 1950s and 1960s and proved the short-term and prophylactic efficacy of lithium. Since these discoveries, lithium has been widely prescribed in the treatment of bipolar disorder and the trends continued based on the high success rate with approximately 70% to 80% of patients showing full or partial response. Lithium works particularly well with bipolar disorder as it has been shown efficient both as a prophylactic and as a mood stabilizer in episodic treatment, thus addressing the dual nature of the disease. Given the debilitating nature of bipolar disorder, its lifetime prevalence, and significant occurrence in the general population (1% to 2%), understanding the mode of action of its most efficient line of treatment is an essential endeavor.
 ABOUT THE AUTHORS
Cristiana Cruceanu, BSc; Catalina Lopez de Lara, MD; and Gustavo Turecki, MD, PhD, are with the Department of Psychiatry, Douglas Hospital, McGill University, Montreal, Quebec, Canada. Martin Alda, MD, is with the Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.

Address correspondence to: Gustavo Turecki, MD, PhD, William Dawson Chair, Douglas Hospital, McGill University, 6875 LaSalle Blvd., Verdun, QC H4H 1R3, Canada; or e-mail gustavo.turecki@mcgill.ca.

Dr. Cruceanu, Dr. Lopez de Lara, Dr. Turecki, and Dr. Alda have reported no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
Demonstrate that lithium response aggregates in families, underscoring the importance of family history of therapeutic response in optimal selection of mood stabilizing pharmacotherapy.

Describe the clinical characteristics (episodic course of illness with complete recovery; no rapid cycling), which may predict a good therapeutic response to lithium

Discuss that no specific genes have yet been associated unequivocally with lithium response.
Suicide Among Elderly Minority: Questions Raised by Case Studies
Authors: Mahgoub Nahla , Kotbi Nabil
Published: March 2009

The first case is a 64-year-old man who speaks Mandarin Chinese and who is married, highly educated, and was active in the community until his business went bankrupt. He came to the United States 1 year ago and was looking forward to improving his finances. He left his wife in China because he felt that he was unable to care for her until he found a job. He lived with his brother, who came to the United States several years ago. The patient’s relationship with his brother was distant, and he was unable to engage into society because of a language barrier.
 ABOUT THE AUTHORS
Nahla Mahgoub, MD, is Instructor in Psychiatry and Assistant Attending Psychiatrist, and Nabil Kotbi, MD, is Assistant Professor of Psychiatry and Assistant Attending Psychiatrist, Weill Medical College of Cornell University, New York, NY.

Address correspondence to: Nahla Mahgoub, MD, 21 Bloomingdale Rd, White Plains, NY, 10605; or e-mail namd06@aol.com, nam2024@med.cornell.edu.

Dr. Mahgoub and Dr Kotbi have disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
 Describe the role of ethnicity and minority group status on psychopathology and suicide in late life.

Discuss the risk factors of suicide in elderly minority.

Review the need for further research that describes suicide behavior in elderly minority and proposes prevention strategies.
 
A 71-year-old Woman with Cognitive Deficits and Social Withdrawal
Authors: Mahgoub Nahla
Published: March 2009

Mrs. R is a 71-year-old woman who is retired and lives with her 75-year-old husband. She is a mother of two daughters and grandmother of five grandchildren. Mrs. R is of Irish descent and immigrated to the United States with her parents and younger brother in her late teenage years. She was a student with great ability at school and graduated college. She worked as an English teacher and fulfilled her interest in music. She was married at age 26, and she maintained good social and occupational life.
 ABOUT THE AUTHORS
Nahla Mahgoub, MD, is Instructor in Psychiatry and Assistant Attending Psychiatrist, and Nabil Kotbi, MD, is Assistant Professor of Psychiatry and Assistant Attending Psychiatrist, Weill Medical College of Cornell University, New York, NY.

Address correspondence to: Nahla Mahgoub, MD, 21 Bloomingdale Rd, White Plains, NY, 10605; or e-mail namd06@aol.com, nam2024@med.cornell.edu.

Dr. Mahgoub has disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
 Review the manifestations and differential diagnosis of depression in Alzheimer's disease.

Discuss the risk factors of depression in Alzheimer's disease.

Summarize the recommendations and guidelines for treatment of depression in Alzheimer's disease.
 
Translating Best Practices into Service: Implementing Early Intervention for Psychosis across Canada
Authors: Archie Suzanne , Hobbs Heather , Menezes Natasja
Published: March 2009

Canada is a large, diversely populated country with numerous early intervention (EI) services that have unique characteristics. Many challenges have made the implementation of such services an interesting process that can inform service delivery and program development. Families, consumers, and non-profit organizations have played pivotal roles in advocating for provincial funding of EI services. Many provinces have developed policies for the roll-out of EI services within their jurisdiction, policies that reflect the key principles of the EI paradigm. Canadian centers have developed internationally recognized research programs on first-episode psychosis and EI. Although many provinces have adapted best practice guidelines, many differences exist within and between provinces in the delivery of EI services. Upholding the tenants of EI, while optimizing resource allocation across wide distances and varied populations, remains a challenging balancing act. Yet this task is well worthwhile, given the potential for positive impact by providing timely and high-quality care to young people and their families who are coping with the early stages of psychosis. This overview summarizes the translation of best practices into service delivery for EI programs across Canada.
 ABOUT THE AUTHORS
Suzanne Archie, MD, FRCP(C), is Associate Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, and Clinical Director, Cleghorn Program, St. Joseph’s Healthcare Hamilton, Ontario, Canada. Heather Hobbs, RN, BScN, CBSDipl, Care Coordinator, Cleghorn Program, St. Joseph’s Healthcare Hamilton. Natasja Menezes, MDCM, MSc, FRCP(C), is Assistant Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, and is Psychiatrist, Cleghorn Program, St. Joseph’s Healthcare Hamilton.

Address correspondence to: Suzanne Archie, MD, FRCP(C), 703-25 Charlton Ave. E., Hamilton, ON L8N 1Y2 Canada; fax 905-525-2805; or e-mail jbuffet@mcmaster.ca.

Dr. Archie, Ms. Hobbs, and Dr. Menezes have disclosed no relevant financial relationships.

The authors would like to thank Julie Buffet for all of her assistance in preparing this article. They would also like to thank and acknowledge the following people for the information they provided about early intervention services: Amal Abdel-Baki, Don Addington, Terry Bedard, Gretchen Conrad, Mirella Fata, Tom Hall, Laura Hansen, L. Hanson, Janice Harris, Bill Honer, Cathy Kavanagh, Annette King, Christina Krack, Gord Langill, Elizabeth Lines, Eric Macnaughton, Karen O’Connor, Kola Oyewumi, Bonnie Pape, Karen Tee, John Trainor, and Cheryl Zufelt.
Expanding the Boundaries of Early Intervention for Psychosis: Intervening During the Prodrome
Authors: Auther Andrea M. , Gillett Dodie A. , Cornblatt Barbara A.
Published: March 2009

It has long been recognized that subclinical manifestations of schizophrenia are evident prior to the onset of full psychosis. This period of time, during which changes in behavior begin to emerge and then progress into more specific early signs and symptoms prior to the onset of frank psychosis, is conceptualized as the “prodrome” or “prodromal stage” of schizophrenia. The term prodrome is somewhat of a misnomer, given the connotation that illness will inevitably follow. Despite this semantic problem, the label is in wide use and in this context suggests only the potential for later development of psychosis or schizophrenia. Verification that an individual is truly at-risk for psychosis (or is in the prodromal stage) can only be determined by following subjects over time. Therefore, putatively prodromal individuals are referred to as being at “ultra high risk” or “clinical high risk” for the development of psychotic disorders.
 ABOUT THE AUTHORS
Andrea M. Auther, PhD; Dodie A. Gillett, PhD; and Barbara A. Cornblatt, MBA, PhD, are with The Zucker Hillside Hospital and Feinstein Institute for Medical Research, Glen Oaks, New York.

Address correspondence to: Andrea M. Auther, PhD, The Zucker Hillside Hospital, Recognition and Prevention (RAP) Program, 75-59 263rd Street, Glen Oaks, NY 11004; fax 718-470-8131; or e-mail AAuther@lij.edu.

Dr. Auther and Dr. Gillett have disclosed no relevant financial relationships.

Dr. Cornblatt has disclosed the following relevant financial relationships: Xenoport, Consultant.
 EDUCATIONAL OBJECTIVES
Identify the clinical features of the prodrome of psychosis.

Explain the neurodevelopmental model of psychosis.

Discuss the advantages and disadvantages of the current treatment approaches that target prodromal symptoms.
Information Campaigns: 10 Years of Experience in the Early Treatment and Intervention in Psychosis (TIPS) Study
Authors: Joa Inge , Johannessen Jan Olav , Larsen Tor K. , McGlashan Thomas H.
Published: March 2009

This article presents an overview of the strategies developed and implemented from 1997 to 2007 in an early detection site in Norway as part of the early Treatment and Intervention in Psychosis (TIPS) study. These strategies include intensive Information Campaigns (ICs) about the signs and symptoms of psychosis and easy access to low-threshold detection teams for rapid case identification. Few, if any other studies of first-episode psychosis, have used such a system over so many years in a regular and repeated fashion. The TIPS early intervention program reduced the healthcare sector’s median duration of untreated psychosis (DUP) in first-episode schizophrenia from 15 weeks to 4.5 weeks using a combination of these easy-access detection teams and massive ICs that targeted diverse audiences. Data on 5,230 referrals are presented in this article, along with their sources of referral and the actual number of cases who were identified with a first episode of psychosis via the detection teams as the initial contact point with specialized mental health services. The TIPS study has shown that such strategies are a vital part of bringing persons with first-episode psychosis into adequate treatment earlier, thereby reducing DUP.

ABOUT THE AUTHORS
Inge Joa, RN; Jan Olav Johannessen, MD; and Tor K. Larsen, MD, are with the Stavanger University Hospital, Department of Psychiatry, Regional Centre for Clinical Research in Psychosis, Stavanger, Norway. Thomas H. McGlashan, MD, is with Yale University School of Medicine, Department of Psychiatry, New Haven, CT.

Ms. Joa, Dr. Johannessen, Dr. Larsen, and Dr. McGlashan have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES
Explain the goals of the Early Treatment and Intervention in Psychosis (TIPS) study.

Describe the strategies employed by the TIPS study to achieve its aims, especially through the utilization of information campaigns.

Discuss the results of the TIPS study in terms of community median duration of untreated psychosis (DUP).
Interventions in the Early Stages of Psychosis
Authors: Killackey Eóin , McGorry Patrick D.
Published: March 2009

In nearly all other areas of life, early intervention is seen as an intuitive and sensible way to limit damage and prevent greater problems requiring greater investment for future solutions. So common in our culture is this notion that we have the sayings, “A stitch in time saves nine” and “An ounce of prevention is worth a pound of cure.” In most areas of medicine, early identification and intervention, if not prevention, are seen as the best approaches to disease states. Until relatively recently, psychiatry, particularly in relation to psychotic illnesses, stood alone in being dominated by a culture that dealt in the management of acute behavioral crises and the ultimate development of chronic illnesses. This approach was largely driven by a therapeutic nihilism that whole-heartedly incorporated neo-kraepelinian notions of schizophrenia as an illness of inevitable decline.

ABOUT THE AUTHORS
Eóin Killackey, DPsych, is with the Orygen Research Centre, Victoria, Australia, and the Department of Psychology, University of Melbourne, Victoria, Australia. Patrick D. McGorry, MD, is with the Orygen Research Centre, and the Department of Psychiatry, University of Melbourne.

Address correspondence to: Eóin Killackey, DPsych, 35 Poplar Road, Parkville, 3052, Victoria, Australia; or e-mail eoin@unimelb.edu.au.

Dr. Killackey has disclosed the following relevant financial relationships: Janssen Cilag: Member of Speakers’ Bureau. Dr. McGorry has disclosed the following relevant financial relationships: Janssen Cilag: Grant Recipient.

EDUCATIONAL OBJECTIVES
Explain the treatment approach recommended for people with first-episode psychosis.

Discuss guidelines for medications utilized in first-episode psychosis.

Describe psychological and psychosocial interventions for patients experiencing a first episode of psychosis.
Early Intervention for Psychotic Disorders: A Resident’s Perspective
Authors: Simmons Chantelle
Published: March 2009

Over the past 4 years of my general psychiatry residency training, I have come to appreciate the devastating impact that psychotic disorders can have upon the lives of both patients and their primary support systems. This is particularly true for individuals who have been newly diagnosed with psychotic disorders because they are typically first afflicted with symptoms at a crucial point in their psychosocial (interpersonal, educational, and occupational) development. However, shorter durations of untreated psychosis have been associated with improved clinical outcomes. As a result, I believe that decreasing the duration of untreated psychosis should be an important goal for mental health practitioners.

ABOUT THE AUTHORS

Chantelle Simmons, MD, is an Addiction Psychiatry Fellow at Emory University School of Medicine, Atlanta, Georgia.

Address correspondence to: Chantelle Simmons, MD, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 2004 Ridgewood Drive, Suite 218, Atlanta, GA 30322; fax 404-727-4746; or e-mail csimmo4@emory.edu.

Dr. Simmons has disclosed no relevant financial relationships.
To Sleep, Perchance to Rest
Authors: Fawcett Jan
Published: March 2009

I have always resented the fact that I needed to sleep — to cede a part of my time-limited conscious life to unconsciousness, to rest. There is so much to experience and do, and never enough time. Why should I have to waste it by sleeping? After reading this month’s issue of Psychiatric Annals on insomnia, guest-edited by Thomas Roth, PhD, the fact that I am fortunate to have the capacity for restful sleep is reinforced.
Insomnia and Circadian Rhythm Sleep Disorders
Authors: Zee Phyllis C. , Lu Brandon S.
Published: March 2009

All living organisms exhibit endogenous circadian rhythms in physiology and behavior. In mammals, circadian rhythms are generated by a central clock located in the suprachiasmatic nucleus (SCN) of the hypothalamus. The basic molecular mechanism by which SCN neurons generate and maintain a self-sustaining rhythm is via an autoregulatory feedback loop in which oscillating circadian gene products regulate their own expression through a complex system of transcription, translation, and post translational processes. On average, the frequency of this circadian clock oscillation (free-running period) is slightly longer than 24 hours in humans. Therefore, precise alignment between internal circadian rhythms and the 24-hour physical and social environments requires daily adjustments or entrainment by synchronizing agents. Light, physical activity, and melatonin from the pineal gland are the primary synchronizing or entraining agents for the human circadian clock. Of these, light is the most potent entraining agent.
 ABOUT THE AUTHORS
Phyllis C. Zee, MD, PhD; and Brandon S. Lu, MD, are with the Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

Address correspondence to Phyllis C. Zee, MD, PhD, Northwestern University, Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, Abbott Hall, Chicago, Illinois 60611; or e-mail: p-zee@northwestern.edu.

Dr. Zee and Lu have disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
Identify the role of the suprachiasmatic nucleus (SCN) in the control of sleep-wake function.

Review the signs and symptoms associated with circadian rhythm sleep disorders (CRSD).

Assess the use of bright light and melatonin of the treatment of CRSD.
 
Bereavement and Depression: Implications for Diagnosis and Treatment
Authors: Auster Tracey , Moutier Christine , Lanouette Nicole , Zisook Sidney
Published: March 2009

Bereavement, the grief following the death of a loved one, is an unfortunately common yet excruciatingly painful human experience. Each year more than 8 million Americans encounter the death of a close family member. Two months after the death, about 20% of these grieving individuals (about 1.6 million people) meet Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for major depressive episode (MDE). Yet many clinicians are uncertain about whether and how to treat bereavement-related MDE. In large part, this uncertainty is due to diagnostic ambiguities and symptomatic overlap between bereavement and MDE, a quandary similar to debilitating medical illness where symptoms such as fatigue, low energy, or anorexia, overlap with symptoms of MDE.
 ABOUT THE AUTHORS
Tracey Auster, BA, is with Harvard Medical School/Beth Israel Medical Center, Boston, MA. Christine Moutier, MD; Nicole Lanouette, MD; and Sidney Zisook, MD, are with University of California, San Diego School of Medicine, San Diego, CA.

Address correspondence to: Sidney Zisook, MD, 9500 Gillman Drive, 116A, La Jolla CA 92093.

Ms. Auster, Dr. Moutier, and Dr. Lanouette have disclosed no relevant financial relationships. Dr. Zisook has disclosed the following relevant financial relationships: Aspect and PamLab: Research grant support; and AstraZeneca and GlaxoSmithKline: Speakers’ bureau.
 EDUCATIONAL OBJECTIVES
Differentiate “normal” bereavement from bereavement-related major depression.

Identify when bereaved individuals with depressive symptoms should be treated.

Assemble an evidence-based treatment approach to bereavement-related depression.
 
Bereavement-related Depression
Authors: Shear M. Katherine , Clayton Paula J.
Published: March 2009

This issue of Psychiatric Annals examines bereavement-related depression.
Articles discuss the signs, symptoms and course of bereavement, the
relationship between bereavement and depression, complicated grief, and
sleep disturbance in bereavement.
Bereavement after Suicide
Authors: Jordan John R.
Published: March 2009

The loss of a loved one to death is widely recognized as a challenging stressor event, one that increases risk for the development of many psychiatric conditions. One key risk factor is the mode of death. This article briefly reviews the literature about the impact of suicide as a mode of death on those who are grieving this type of loss, known as suicide survivors. Within suicidology, the term “suicide survivor” has come to refer to a person who is grieving after the suicide of a loved one, not someone who has survived a suicide attempt. This article also describes some of the interventions that may be appropriate for survivors and offers general guidelines for the provision of compassionate bereavement care after a suicide.

ABOUT THE AUTHOR

John R. Jordan, PhD, is in private practice in Wellesley, Massachusetts, and Pawtucket, Rhode Island.

Address correspondence to: John R. Jordan, PhD, 10 Exchange Court, Unit 401, Pawtucket, RI, 02860; fax 401-305-3051; or e-mail: jjordan50@aol.com.

Dr. Jordan has disclosed no relevant financial relationships.
Anxiety Disorders with Comorbid Substance Use Disorders: Diagnostic and Treatment Considerations
Authors: Back Sudie E. , Brady Kathleen T.
Published: March 2009

Anxiety disorders, symptoms of anxiety, and substance use disorders (SUDs) commonly co-occur. The interactions between SUDs and anxiety are multifaceted and variable. Symptoms of anxiety often emerge during the course of chronic intoxication and withdrawal from a number of substances. Anxiety disorders are a risk factor for the development of SUDs and may modify the presentation and course of illness for SUDs. Similarly, SUDs may modify the presentation and course of anxiety disorders. In this article, co-occurring SUDs and anxiety disorders will be briefly reviewed, including prevalence, diagnostic issues, and treatment options.

ABOUT THE AUTHORS

Sudie E. Back, PhD; and Kathleen T. Brady, MD, PhD, are with the Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.

Address correspondence to: Sudie E. Back, PhD, 67 President Street, PO Box 250861, Charleston, SC 29425; fax: 843-792-0528; or e-mail backs@musc.edu.

Dr. Back and Dr. Brady have disclosed no relevant financial relationships

EDUCATIONAL OBJECTIVES

Understand the prevalence of co-occurring anxiety disorders and substance use disorders.

List the major diagnostic considerations in assessing co-occurring anxiety disorders among individuals with substance use disorders.

Demonstrate awareness of the pharmacologic and psychosocial treatments to date in this area.