Brain stimulation, alternative medicine, and impulsivity and compulsivity.

Dr. Hollander is the editor of this journal, Esther and Joseph Klingenstein Professor and Chairman of Psychiatry at the Mount Sinai School of Medicine, and director of the Seaver and New York Autism Center of Excellence in New York City. I am pleased to announce that CNS Spectrums is launching two new columns this month. Stefano Pallanti, MD, PhD, introduces the timely new column “Brain Stimulation,” which synthesizes the practical applications of the latest brain stimulation techniques and relates these findings to new understandings in neuropsychiatry. This column will be co-written by Thomas E. Schlaepfer, MD. Uriel Halbreich, MD, initiates his new column, “The Well-Rounded Brain,” which systematically and critically reviews the evidence and myths of complementary and alternative medicine. This too is especially timely, since our patients are already taking such treatments, and clinicians need to understand the knowledge and evidence base for such approaches. Tics and Tourette syndrome (TS) are common comorbidities of patients diagnosed with ADHD. Stimulant medications for ADHD have been associated with tic exacerbations, thus limiting their utility in this patient subgroup. Atomoxetine has been explored as an alternative treatment as one of the few non-stimulants available to treat ADHD. There are, however, few case studies describing the impact of atomoxetine on tics. Jessica Sears, MD, and Nitin C. Patel, MD, present a unique case of a patient, without any prior history of a movement disorder, who developed tics following a single dose of atomoxetine, that did not improve until interventional therapy was initiated. A goal of future treatments may be to enhance prefrontal dopamine without increasing nigrostriatal dopamine in patients with tics and ADHD. Kelsie T. Forbush, MA, and colleagues examine neuropsychological and personality characteristics in pathological gambling disorder (PG), a condition which has been associated with fronto-temporal dysfunction and maladaptive personality traits, such as impulsivity and novelty seeking. Subjects with PG had impaired decision making on the Iowa Gambling Task, elevated levels of impulsivity, novelty seeking, and harm avoidance and lower levels of selfdirectedness and cooperativeness. Of interest, personality traits were better predictors than neuropsychological characteristics of whether someone has PG. However, it is of interest that there may be multiple developmental trajectories to impulsivity, including long-term trait impulsivity as well as neurocognitive deficits associated with impaired decision making and frontal disinhibition. In clinical samples, body dysmorphic disorder (BDD) is associated with substantial suffering and reduced quality of life. Limited surveys report widely varying prevalence estimates. To better establish the prevalence of BDD, Lorrin M. Koran, MD, and colleagues conducted a nationwide prevalence survey in the United States. They found that the estimated prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BDD among respondents was 2.4% (49 out of 2,048) (by gender: 2.5% for women, 2.2% for men), exceeding the Editor’s Letter