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Cohen LS, et al. "Treatment of Mood Disorders During Pregnancy
and Postpartum," Psychiatric Clinics of North America
(June 2010): Vol. 33, No. 2, pp. 273–93.
Cooper WO, et al. "Increasing Use of Antidepressants in
Pregnancy," American Journal of Obstetrics and
Gynecology (June 2007): Vol. 196, No. 6, pp. 544.e1–5.
Dimidjian S, et al. "Nonpharmacologic Intervention and Prevention
Strategies for Depression During Pregnancy and the Postpartum,"
Clinical Obstetrics and Gynecology (Sept. 2009): Vol.
52, No. 3, pp. 498–515.
Dadayan L., et al. "For the First Time, a Smaller Jackpot,"
Fiscal Studies (Sept. 21, 2009), pp. 1–20.
Dannon PN, et al. "Topiramate versus Fluvoxamine in the Treatment
of Pathological Gambling: A Randomized, Blind-Rater Comparison
Study," Clinical Neuropharmacology (Jan.–Feb. 2005):
Vol. 28, No. 1, pp. 6–10.
Frascella J, et al. "Shared Brain Vulnerabilities Open the Way
for Nonsubstance Addictions: Carving Addiction at a New Joint?,"
Annals of the New York Academy of Sciences (Feb. 2010):
Vol. 1187, pp. 294–315.
Blanchard EB, et al. "The Role of Stress in Symptom Exacerbation
Among IBS Patients," Journal of Psychosomatic Research
(Feb. 2008): Vol. 64, No. 2, pp. 119–28.
Bloom F, et al. Brain, Mind, and Behavior (Worth
Drossman DA, et al. "Cognitive-Behavioral Therapy versus
Education and Desipramine versus Placebo for Moderate to Severe
Functional Bowel Disorders," Gastroenterology (July
2003): Vol. 125, No. 1, pp. 19–31.
Problem gambling behavior was first mentioned in the medical
literature in the early 1800s, but the American Psychiatric
Association did not classify pathological gambling as a psychiatric
disorder until 1980, in the third edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM). An ongoing discussion in the mental
health community is whether gambling is an impulse control disorder
— as it is currently classified in the DSM-IV — or whether it is better
understood as an addiction, as the DSM-V proposes (see "Symptoms of
Epidemiological studies have found that pathological gambling often
occurs in conjunction with dependence on a chemical substance.
While roughly 1% to 3% of people in the general population develop
a pathological gambling disorder at some point in their lives, as
many as 5% to 33% of people with substance use disorders will do
so. One national survey found that pathological gamblers were five
times as likely as those in the general population to be dependent
on alcohol, and nearly seven times as likely to be dependent on
The DSM-V work group
cited other evidence to support its proposal that pathological
gambling be considered an addiction. Genetic studies suggest that
people who develop pathological gambling or a substance use
disorder are more likely than those in the general population to
have particular gene types (alleles) associated with impulsive
behavior. Brain imaging studies have reported that both substance
use disorders and pathological gambling create similar types of
dysfunctions in a neural circuit involved in reward processing and
Regardless of how pathological gambling is eventually classified,
however, many of the strategies for treating it are based on those
used for substance use disorders. Although there is no consensus
yet about which therapies are best, several have emerged as the
Although pregnancy is a joyful time for many women, others struggle
with depression and other mood disorders. The limited data
available suggest that 7.5% of women who become pregnant develop
major depression, and another 7% have minor depression, before
Consensus is growing that depression during pregnancy should be
treated, for the sake of both the mother and the developing fetus.
Among other risks, untreated depression during pregnancy increases
the likelihood that a woman will have postpartum depression and
give birth to a lethargic, irritable baby whose weight is lower
Medication is one option for treating prenatal depression (see
"Medications for prenatal depression"). In 2003, 13% of pregnant
women used antidepressants at some point during pregnancy. But
anecdotal reports from clinicians suggest that many women prefer
not to take antidepressants during pregnancy, mostly because of
concern about exposing the developing fetus to any type of drug.
Guidelines issued jointly in 2009 by the American Psychiatric
Association (APA) and the American College of Obstetricians and
Gynecologists (ACOG) offer detailed advice for clinicians. In
general, the APA-ACOG guidelines recommend psychotherapy for
pregnant women with mild to moderate depression, and medication for
patients with severe depression, psychosis, bipolar disorder, a
history of suicide attempts, or a co-occurring psychiatric disorder
that requires drug treatment.
Unfortunately, scant research exists on alternatives to medication
— whether psychotherapy or other modalities. As such, a decision
about how best to proceed is an individual one and depends on
clinical experience and the patient's preference.
Functional gastrointestinal disorders affect 35% to 70% of people
at some point in life, women more often than men. These disorders
have no apparent physical cause — such as infection or cancer — yet
result in pain, bloating, and other discomfort.
Multiple factors — biological, psychological, and social —
contribute to the development of a functional gastrointestinal
disorder. Numerous studies have suggested that stress may be
particularly important, however. The relationship between
environmental or psychological stress and gastrointestinal distress
is complex and bidirectional: stress can trigger and worsen
gastrointestinal pain and other symptoms, and vice versa. This is
why psychological therapies are often used in combination with
other treatments — or even on their own — to treat functional
An online study determined that attempting to improve cognitive
ability through "brain training" programs was not effective.
The process of addiction alters the brain's neural connections
and creates environmental cues that can trigger cravings.
I was half listening to the television the other night and heard
something about kids dying from the choking game. What is that?
How can I tell if my child might be playing this game?