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  • Perspective

    Mental Illness — Comprehensive Evaluation or Checklist?

    The debate over revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) is of more than intramural interest, for the way in which the promised fifth edition (DSM-5) resolves the debate will shape the nature and scope of psychiatric services for years to come. Now established as the…

    • May 17, 2012
    • McHugh P.R. and Slavney P.R.
    • N Engl J Med 2012; 366:1853-1855
    • Free Full Text

    In its fifth edition, the Diagnostic and Statistical Manual of Mental Disorders should correct a categorization scheme based on clinical appearance, which offers no way of making sense of mental disorders and fosters a diagnostic method reliant on symptom checklists.

  • Original Article

    Suicide and Cardiovascular Death after a Cancer Diagnosis

    A large body of evidence suggests high levels of distress and psychiatric symptoms among patients who receive a diagnosis of cancer.– Patients with cancer have been shown to be at increased risk for suicide– and cardiovascular events.– However, most results have been interpreted to be…

    • April 5, 2012
    • Fang F., Fall K., Mittleman M.A., et al.
    • N Engl J Med 2012; 366:1310-1318

      In this study of more than 6 million Swedes during 1991–2006, patients were at increased risk for suicide or death from cardiovascular causes after a diagnosis of cancer. Risks were especially high immediately after diagnosis and for cancers with a poor prognosis.

    • Images in Clinical Medicine

      Kayser–Fleischer Rings in Wilson's Disease

      Figure 1.

      • March 22, 2012
      • Schrag A. and Schott J.M.
      • N Engl J Med 2012; 366:e18
      • Free Full Text

      An 18-year-old woman presented with color and temperature changes in her hands, as well as intermittent tremor of the hands for 3 years. She also reported involuntary right arm movements and difficulties with concentration.

    • Editorial

      Discontinuing Donepezil or Starting Memantine for Alzheimer's Disease

      Donepezil, the most frequently prescribed cholinesterase inhibitor for the treatment of Alzheimer's disease, was marketed in 1997 on the basis of the results of 3-month and 6-month clinical trials showing that patients had improvements in cognitive test scores and in the ability to perform daily…

      • March 8, 2012
      • Schneider L.S.
      • N Engl J Med 2012; 366:957-959

        Donepezil, the most frequently prescribed cholinesterase inhibitor for the treatment of Alzheimer's disease, was marketed in 1997 on the basis of the results of 3-month and 6-month clinical trials showing that patients had improvements in cognitive test ...

      • Original Article

        Donepezil and Memantine for Moderate-to-Severe Alzheimer's Disease

        Most studies evaluating cholinesterase inhibitors for the treatment of Alzheimer's disease have focused on patients with mild-to-moderate disease. Despite questions about the methods used in the trials and about the clinical significance of reported benefits,, guidelines advocate treatment with a…

        • March 8, 2012
        • Howard R., McShane R., Lindesay J., et al.
        • N Engl J Med 2012; 366:893-903
        • CME

        In patients with moderate or severe Alzheimer's disease receiving donepezil, those assigned to continue donepezil had less cognitive decline than did those assigned to discontinue donepezil. The combination of donepezil and memantine did not confer benefits over donepezil alone.

      • Perspective

        Protecting Service Members in War — Non-Battle Morbidity and Command Responsibility

        On August 31, 2011, a 24-year-old soldier from California died from complications of rabies treatment. He was infected months earlier, from a dog bite he sustained in Afghanistan. His death provides a glimpse of the risk of disease and non-battle injuries that service members face in war. Although…

        • February 23, 2012
        • Chretien J.-P.
        • N Engl J Med 2012; 366:677-679

          Although traumatic brain injury and traumatic amputations may be signature wounds of the Afghanistan and Iraq wars, the toll on military personnel from diseases and nonbattle injuries is substantial — and largely preventable. The critical element is command support.

        • Review Article

          Genomic Medicine: Genomics, Intellectual Disability, and Autism

          Intellectual disability, which is characterized by significant limitations in both intellectual functioning and adaptive behavior that begin before the age of 18 years, affects 1.5 to 2% of the population in Western countries. A diagnosis of intellectual disability is usually made when IQ testing…

          • February 23, 2012
          • Mefford H.C., Batshaw M.L., Hoffman E.P.
          • N Engl J Med 2012; 366:733-743
          • Free Full Text

          The authors discuss the substantive impact of recent advances in genomic technologies on the diagnosis and understanding of intellectual disability and autism.

        • Case Records of the Massachusetts General Hospital

          Case 5-2012 — A 39-Year-Old Man with a Recent Diagnosis of HIV Infection and Acute Psychosis

          Presentation of Case. Dr. Carlos Fernandez-Robles: A 39-year-old man with a recent diagnosis of human immunodeficiency virus (HIV) infection was transferred to this hospital from another hospital because of fever, sweats, and psychosis. The patient had been well until 4 months before admission,…

          • February 16, 2012
          • Freudenreich O., Basgoz N., Fernandez-Robles C., Larvie M., Misdraji J.
          • N Engl J Med 2012; 366:648-657
          • CME

          A 39-year-old man with a recent diagnosis of HIV infection was admitted to this hospital with fever and bizarre, nihilistic delusions, including statements that he had died. A diagnostic procedure was performed.

        • Original Article

          Antenatal Thyroid Screening and Childhood Cognitive Function

          Active secretion of thyroid hormone in the fetus does not start until about 18 to 20 weeks' gestation. Studies in animals suggest that until fetal hormone secretion begins, the fetus is dependent on circulating free thyroxine (T4) in the mother for growth and development, including central nervous…

          • February 9, 2012
          • Lazarus J.H., Bestwick J.P., Channon S., et al.
          • N Engl J Med 2012; 366:493-501
          • CME

          In this randomized trial, antenatal screening (at a median gestational age of 12 weeks 3 days) and treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age.

        • Editorial

          The Debate over Thyroid-Function Screening in Pregnancy

          Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring. In surveys, almost half the obstetricians in private practices in Maine and the majority of obstetricians in a…

          • February 9, 2012
          • Brent G.A.
          • N Engl J Med 2012; 366:562-563

            Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring.1 In surveys, almost half the obstetricians in private practices in ...

          • Review Article

            Current Concepts: Cognitive and Neurologic Outcomes after Coronary-Artery Bypass Surgery

            Patients referred for coronary revascularization procedures are older and are likely to have more extensive extracardiac vascular disease than those referred for such procedures in the past. Despite these trends, mortality rates for coronary-artery bypass grafting (CABG), without concurrent…

            • January 19, 2012
            • Selnes O.A., Gottesman R.F., Grega M.A., et al.
            • N Engl J Med 2012; 366:250-257
            • CME

            For patients undergoing coronary-artery bypass grafting (CABG), adverse neurologic outcomes, including stroke and cognitive decline, are major concerns. Even mild cognitive deficits before surgery may be a marker for cerebrovascular disease and increased risk.

          • Original Article

            ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults

            Medications that are used to treat attention deficit–hyperactivity disorder (ADHD) are prescribed for more than 2.7 million children in the United States each year and have been considered to be relatively safe.– However, reports of adverse events from Canada and the United States that have…

            • November 17, 2011
            • Cooper W.O., Habel L.A., Sox C.M., et al.
            • N Engl J Med 2011; 365:1896-1904
            • Free Full Text

            This large study found no increased risk of cardiovascular events in children and young adults using attention deficit–hyperactivity disorder (ADHD) drugs. Although the data are compatible with nearly a doubling of risk, the study was underpowered and the absolute event rate was quite low.

          • Review Article

            Current Concepts: Drug-Resistant Epilepsy

            Fifty million people in the world have epilepsy, and there are between 16 and 51 cases of new-onset epilepsy per 100,000 people every year. A community-based study in southern France estimated that up to 22.5% of patients with epilepsy have drug-resistant epilepsy. Patients with drug-resistant…

            • September 8, 2011
            • Kwan P., Schachter S.C., Brodie M.J.
            • N Engl J Med 2011; 365:919-926
            • CME

            Nearly a quarter of patients with seizures have drug-resistant epilepsy. This review examines how this diagnosis should be established and how to recognize pseudoresistance. It explains possible mechanisms of drug-resistant epilepsy and presents treatment strategies.

          • Case Records of the Massachusetts General Hospital

            Case 26-2011 — A 7-Year-Old Boy with a Complex Cyst in the Kidney

            Presentation of Case. A 7-year-old boy was seen in an outpatient clinic at this hospital because of a complex cyst in the kidney. The patient was born by vaginal delivery after an uncomplicated 38-week gestation. His birth weight was 3.04 kg. A diagnosis of tuberous sclerosis complex (TSC) was made…

            • August 25, 2011
            • Paul E., Thiele E.A., Shailam R., Rosales A.M., Sadow P.M.
            • N Engl J Med 2011; 365:743-751
            • CME

            A 7-year-old boy with tuberous sclerosis complex was seen because of an increasingly complex cyst in the left kidney, seen on serial imaging studies. A diagnostic procedure was performed.

          • Special Article

            Malpractice Risk According to Physician Specialty

            Despite tremendous interest in medical malpractice and its reform,– data are lacking on the proportion of physicians who face malpractice claims according to physician specialty, the size of payments according to specialty, and the cumulative incidence of being sued during the course of a…

            • August 18, 2011
            • Jena A.B., Seabury S., Lakdawalla D., Chandra A.
            • N Engl J Med 2011; 365:629-636
            • Free Full Text
            • CME

            In this analysis of data from a national liability insurer, 7.4% of physicians faced a malpractice claim each year, although 78% of claims did not result in payments to claimants. The authors estimate that 75 to 99% of physicians will face a malpractice claim by the age of 65.

          • Perspective

            Smoking and Mental Illness — Breaking the Link

            "My doctor told me I'm too stressed out to quit smoking," remarked a woman hospitalized with severe depression. "Well, 43 years later, I'm still stressed and I'm still smoking." This woman's dilemma is all too familiar to health care providers and patients seeking the ideal time to treat tobacco…

            • July 21, 2011
            • Prochaska J.J.
            • N Engl J Med 2011; 365:196-198
            • Free Full Text

            Many clinicians see smoking and mental illness as inextricably linked and believe that smoking in the mentally ill is particularly challenging to treat. Such myths have contributed to the devastating consequences of tobacco use in this population.

          • Clinical Implications of Basic Research

            SHANK3, the Synapse, and Autism

            Autism spectrum disorders present a paradox of great heterogeneity and great specificity. Well over 100 genetic disorders yield an autism phenotype, most through specific but distinct mechanisms, and many of which affect the synapse. SHANK3 (SH3 and multiple ankyrin repeat domains 3) is known to be…

            • July 14, 2011
            • Herbert M.R.
            • N Engl J Med 2011; 365:173-175

              Variants of SHANK3, a gene encoding a structural component of the postsynaptic density, have been associated with autism. Mice engineered to carry mutant genes showed autism-like behavioral features that included repetitive grooming and disinclination to socialize.

            • Editorial

              Meaningful Placebos — Controlling the Uncontrollable

              In this issue of the Journal, Wechsler et al. report data from a study that compared four interventions involving patients with asthma (ClinicalTrials.gov number, NCT01143688). They found that three of the interventions — active albuterol, sham albuterol, and sham acupuncture — were all equally…

              • July 14, 2011
              • Moerman D.E.
              • N Engl J Med 2011; 365:171-172

                In this issue of the Journal, Wechsler et al.1 report data from a study that compared four interventions involving patients with asthma (ClinicalTrials.gov number, NCT01143688). They found that three of the interventions — active albuterol, sham albuterol,...

              • Case Records of the Massachusetts General Hospital

                Case 18-2011 — A 35-Year-Old HIV-Positive Woman with Headache and Altered Mental Status

                Presentation of Case. Dr. Mikael Rinne (Neurology): A 35-year-old right-handed woman with human immunodeficiency virus (HIV) infection was admitted to this hospital because of headache and altered mental status after a motor vehicle accident. Earlier that day, while driving without a seatbelt, the…

                • June 16, 2011
                • Costello D.J., Gonzalez R.G., Frosch M.P.
                • N Engl J Med 2011; 364:2343-2352
                • CME

                A 35-year-old woman with stable HIV infection was admitted to this hospital because of headache and altered mental status. Brain imaging revealed diffuse white-matter abnormalities. A diagnostic test was performed.

              • Clinical Practice

                Mild Cognitive Impairment

                Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 70-year-old…

                • June 9, 2011
                • Petersen R.C.
                • N Engl J Med 2011; 364:2227-2234
                • CME
                • Full Text Audio

                This article reviews the diagnosis of mild cognitive impairment, its implications for the subsequent development of dementia, and potential management strategies. The possible use of imaging and biomarkers to identify persons at high risk is discussed.

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              Medical Meetings Pediatrics Conferences and Meetings

              2012 Certifying Examinations of the American Board of Pediatrics

              The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

              Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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