Prevalence of affective disorder in a sample of young men

Defining and diagnosing involuntary emotional expression disorder

Uncontrollable episodes of emotional expression occur in a variety of neurological conditions. This emotional disinhibition syndrome is characterized by episodes of crying or laughing that are unrelated to or out of proportion to the eliciting stimulus. This syndrome is common among patients with amyotrophic lateral sclerosis, multiple sclerosis, stroke, and traumatic brain injury and a variety of terms and definitions have been used to describe it. The confusing nomenclature has been a barrier to understanding, diagnosis, and treatment of this disorder. The authors propose a unifying term, involuntary emotional expression disorder (IEED), and provide diagnostic criteria for this disorder.

The evaluation of the impaired physician

Recent focus on impaired physicians has made it likely that psychiatrists and other mental health professionals will increasingly be involved in evaluating these individuals. In order to perform the job effectively, evaluators must familiarize themselves with a number of clinical and legal issues inherent in the evaluations. Preevaluation issues include receipt of sufficient information from the referral source, limits of confidentiality, and any potential conflict of interests between the evaluator and the physician to be evaluated. The clinical evaluation requires knowledge of the characteristics of physician substance abuse, of emotional disturbances including suicidality, of the emotional impact of litigation, and of the underlying causes of such unethical conduct as inappropriate prescribing of controlled substances and sexual contact with patients. Recommendations should be based on knowledge of available support systems, monitoring capacity, and options to restrict the physician's practice. Follow-up is essential for rehabilitation to be effective. Our obligations to our patients require our informed involvement with the problem of impaired physicians and with its solution.

Drug use, depression, and adolescents

This article reviews use and depression in adolescents and explores the thesis that depressed mood and deviant actions represent deviant modes of coping and are the result of failed efforts to handle different and sometimes overlapping constitutional and social risk factors. Theories of drug use and depression and various studies in support of the theoretical framework are examined. Implications are suggested for public health interventions and clinical management as derived from the theoretic background and empiric evidence. Also provided are guidelines for assessment and intervention that can be useful for primary care physicians and other professionals working with troubled teenagers.

Anxiety and depression in substance abuse: clinical implications

Accurate diagnosis in patients presenting with anxiety and/or depressive symptoms requires that the contribution of substance abuse be carefully considered. When chemical dependence is identified, detoxification may be all that is necessary. However, if indicated, specific treatment of the mood or anxiety disorder may reduce substance use as well.

Smokers and drinkers in a health maintenance organization population: lifestyles and health status

This study examines, among a large health maintenance organization population, the prevalence of two high-risk lifestyle practices (smoking and problem drinking), their interrelationships, and their relationships with other lifestyle practices, sociodemographic characteristics, and health status measures. Results, based on a random sample of 1,133 adults, showed that smoking and problem drinking are strongly correlated. Individuals with no drinking problems had an age-, sex-, and education-adjusted smoking prevalence of approximately 20%, while problem drinkers smoked at about twice that rate. In addition, reporting one type of problem drinking behavior (binge, chronic, or drinking and driving) at least doubled, and in one instance increased by sixfold, the likelihood of reporting another type of problem drinking behavior. Smokers and problem drinkers were more likely to be younger than age 65, to be irregular seat belt users (smokers and binge drinkers only), and not to belong to voluntary organizations. Results of the analysis suggest that detection, prevention, and treatment of drug use, in general, might prove more beneficial than only focusing on smoking and problem drinking. In addition, because binge drinking and drinking and driving were so widespread among younger age groups, it might prove more beneficial to consider preventive strategies that change the sale and distribution of alcohol and make the environment safer in which to drink, such as providing transportation to get drinkers back home.

Cognitive distortions among depressed and suicidal drug abusers

A very high proportion of drug abusers have psychiatric problems, with depressive symptoms particularly common. Nonabusing depressed patients have been found to demonstrate elevated levels of cognitive distortions, relative to normals, and to benefit from therapies that address such cognitive distortions. The present study investigated the prevalence of cognitive distortions in a sample of 52 inpatient depressed and/or suicidal drug abusers. Levels of cognitive distortion were found to be comparable to those reported in other studies for noninpatient depressed subjects, but lower than those of nonabusing depressed inpatients. Within the present relatively homogeneous sample, degree of cognitive distortion was nevertheless related to levels of depression, hopelessness, and suicidality. It is concluded that cognitive therapy may be indicated for depressed drug abusers.