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Harvard Mental Health Letter: March 2009

Articles in this issue:

Understanding the risks of antipsychotic treatment in young people

Advice for managing side effects in children and teenagers.

Antipsychotic prescriptions for children and teenagers have increased dramatically since the late 1990s, although the FDA has approved only three such drugs for use in young people: haloperidol (Haldol), thioridazine (Mellaril), and risperidone (Risperdal). An analysis of data from the Medical Expenditure Panel Survey, an annual compilation of information about health care services used by 23,000 to 35,000 Americans, found that the number of children and teenagers taking antipsychotics more than tripled between 1997 and 2005, increasing from 0.2% to 0.7% of all youths. Other studies have reported similar increases.

A ...

Treating obsessive-compulsive disorder

 

Options include medication, psychotherapy, surgery, and deep brain stimulation.

Obsessive-compulsive disorder (OCD), which affects 2% to 3% of people worldwide, often causes suffering for years before it is treated correctly — both because of delays in diagnosis and because patients may be reluctant to seek help. One review estimated that, on average, patients with OCD take more than nine years to be diagnosed correctly, and 17 years to receive appropriate care.

Although OCD tends to be a chronic condition, with symptoms that flare up and subside over a patient's lifetime, effective help is available. Only about 10% of patients ...

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Overcoming cocaine or stimulant addiction

Medications offer modest help; vaccines are in development.

Illegal stimulants include cocaine, methamphetamine (also known as speed, meth, ice, or crank), and methylenedioxymethamphetamine (often called MDMA or ecstasy). These are among the most commonly abused drugs in the world — and also some of the toughest for addicts to quit.

The Substance Abuse and Mental Health Services Administration estimates that in 2007, about 22 million Americans 12 and older met the criteria for substance abuse or dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Of that total, 1.6 million were dependent on cocaine, while 406,000 ...

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In brief: Study suggests how to tailor cognitive behavioral therapy for patients with eating disorders

Patients with eating disorders who also had problems with self-esteem or interpersonal relationships responded favorably to treatment that combined cognitive behavioral therapy with counseling to address their underlying issues.

In brief: Brain scans indicate that depression can increase pain perception

Seriously depressed young adults who were exposed to a painful stimulus showed brain activity that suggests depression may heighten the emotional response to pain while also decreasing the brain's ability to adjust to it.

Questions & answers

Q. Why does it feel good to improvise?

A. A jazz musician posed this question, but a skier or a carpenter could well have asked the same thing. Improvisation is an essential element of creativity, both at work and at play. Certainly the hard work that leads to mastery of any skill is an important source of pride and esteem. But accomplished musicians and athletes (not to mention anyone who has invested time and energy in learning a trade or profession) cherish what such mastery enables: a state of mind of being in a "zone," or what the psychologist Mihály ...

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