Norman Sussman, M.D.

Clinical realities
Sussman N.
2010 ;17(8):14-15, Primary Psychiatry
— id: 112438, year: 2010, vol: 17, page: 14, stat: Journal Article,

Improving diagnosis and follow-up of patients diagnosed with ADHD
Sussman N.
2010 ;17(2):16-, Primary Psychiatry
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Thanking our peer reviewers
Sussman N.
2010 ;17(1):17-18, Primary Psychiatry
Listed on the next page are those who served as peer reviewers this past year. Their efforts are crucial to the integrity of the content of Primary Psychiatry. In taking the opportunity to acknowledge our peer reviewers, it is also timely to remind our readers that all articles considered for publication are reviewed by myself and at least two experts on their subject. Any Continuing Medical Education supplements that are published go through a separate peer review/content validation by the Mount Sinai School of Medicine. I do not oversee those supplements, as they are supported via educational grants from industry, and I have elected to avoid even a perception that I might be in a position to influence the content of these supplements
— id: 107400, year: 2010, vol: 17, page: 17, stat: Journal Article,

The generic drug dilemma
Sussman N.
2010 ;17(6):16-17, Primary Psychiatry
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The importance of expertise
Sussman N.
2010 ;17(9):17-18, Primary Psychiatry
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In psychiatry, good treatment starts with accurate diagnosis
Sussman, Norman
2010 ;17(3):16-17, Primary Psychiatry
Most of the articles in this issue of Primary Psychiatry address different ways to diagnose mental disorders and their manifestations. Given the reliance on diagnostic criteria and rating scales, our understanding of what clinical entities represent are constantly evolving. It is important that we keep-current about any data that improve our efforts to understand the disorder at hand.
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In session with Kiki Chang, MD: Bipolar disorder in children and adolescents
Sussman, Norman
2010 ;17(4):23-26, Primary Psychiatry
This article presents an interview with Kiki Chang, MD. Dr. Chang is associate professor of Psychiatry and Behavioral Sciences in the Division of Child Psychiatry at the Stanford University School of Medicine in California. His research includes brain imaging, genetics, and medication and psychotherapy trials. Dr. Chang provides readers with answers to the following questions (among others): How is bipolar disorder diagnosed in children and adolescents? How is that diagnostic process different than for an adult? Do you think that bipolar disorder has become a default diagnosis in children and adolescents? Does family history of alcoholism help predict whether there is a higher risk of bipolar disorder? Do you think bipolar disorder is caught most of the time now, or is there still a ways to go in terms of recognition?
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Reducing the trial and error factor in antidepressant treatment
Sussman, Norman
2010 ;17(5):16-18, Primary Psychiatry
Selecting the best strategy to optimize antidepressant response is a major ongoing clinical challenge. The need for more effective approaches for producing remission has been made clear by recent evidence that confirms treatment with any single antidepressant drug produces remission in only ~33% of patients, and that when antidepressants do work, they are of most benefit to those with more severe depressive symptoms. Patients with moderate levels of depression who seek care because they are either distressed or impaired by their symptoms may, paradoxically, be more difficult to bring into remission than those with a more pronounced disorder. An abundance of studies have shown that numerous augmentation or switching strategies may be effective for some patients, but no body of evidence demonstrates consistent superiority of any. In summarizing lessons learned from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, the most ambitious attempt to date to address the question of antidepressant enhancement options, Rush wrote that 'the gap between what we do in practice and what we know is very large.' In the near future, another study should be published that looks at whether it is better to start treatment with a combination of antidepressants rather than monotherapy. In anticipation of that article, I want to review the STAR*D trial and its major finding and describe the Combining Medication to Enhance Depression Outcomes (CO-MED), which looks at whether it is better to start treatment with two drugs instead of one.
— id: 111395, year: 2010, vol: 17, page: 16, stat: Journal Article,

Time will tell: Many side effects are not detected until decades of use
Sussman, Norman
2010 ;17(4):16-17, Primary Psychiatry
While reading the Wall Street Journal on the morning of March 8, 2010, I came across the following headline under the New Medical Findings section: 'Say What? New Risk in Pain-Reliever Use,' (Singer-Vine, 2010). This was of particular personal interest to me because in recent years there has been decline in my hearing, along with an increase in tinnitus. Reading this article made me question whether years of using ibuprofen for various ailments had caused or contributed to my hearing problems. It also caused me to realize how often it is that we only find out about some serious drug adverse effect many years or even decades after it has come into clinical use. The current article discusses this issue, especially as it relates to the use of antidepressants.
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2010 drug interaction review
Sussman, Norman
2009 ;16(12):22-, Primary Psychiatry
This issue of Primary Psychiatry presents the 2010 Guide to Psychiatric Drug Interaction's, a regular feature of this publication. Authored by Sheldon H. Preskorn, MD, and David A. Flockhart, MD, PhD--both respected authorities on the subject of psychotropic pharmacodynamics and pharmacokinetics--it is invaluable to any clinician, even those who do not specialize in the treatment of mental illness. Underscoring the public health implications of this topic, the authors note that a recent Health and Human Services report noted that 7% of Americans >18 years of age and >20% of Americans >65 years of age had taken >=5 prescription medications in the week and patients with psychiatric disorders are at increased risk relative to other age-matched patients for being on multiple medications and complex regimens, which makes-them particularly vulnerable to drug interactions. Prescribers should appreciate that psychiatric medications do not interact principally on the basis of their therapeutic use but instead on the basis of their pharmacokinetic and pharmacodynamic properties. A rational and informed approach to drug interactions, based on pharmacokinetic and pharmacodynamic knowledge, can reduce the chance of adverse effects and improve patient outcomes. What makes this educational review so useful is that it contains so many clear and concise tables and figures that accompany the text. I encourage all those who read this review to refer to it throughout the year.
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An interview with Jerome M. Siegel PhD: Narcolepsy
Sussman, Norman
2009 ;14(6):295-297, CNS spectrums
Presents an interview with Jerome M. Siegel. Jerome M. Siegel, PhD, is professor of psychiatry at the University of California, Los Angeles, former president of the Sleep Research Society, and the recipient of Merit and Javits awards from the National Institutes of Health and the Distinguished Scientist award from the Sleep Research Society. His laboratory has made discoveries concerning the role of hypocretin in human narcolepsy and Parkinson\'s disease. He has studied the phytogeny of sleep as a clue to sleep function, discovering that the primitive mammal platypus has rapid eye movement sleep and that marine mammals can go without extended periods of sleep for long periods without ill effects.
— id: 101931, year: 2009, vol: 14, page: 295, stat: Journal Article,

An interview with Samuel Gandy, MD, PhD: Alzheimer\'s disease
Sussman, Norman
2009 ;14(5):248-251, CNS spectrums
Presents an interview with Samuel Gandy. Samuel Gandy, MD, PhD, is Mount Sinai Professor of Alzheimer\'s Disease Research, professor of neurology and psychiatry, associate director of the Mount Sinai Alzheimer\'s Disease Research Center in New York City, and past chair of the National Medical and Scientific Advisory Council of the Alzheimer\'s Association. As an international expert in the metabolism of amyloid that clogs the brain in patients with Alzheimer\'s disease, Dr. Gandy has written over 150 original papers, chapters, and reviews on this topic. In 1989, he and his colleagues discovered medications that could lower the formation of amyloid. He has received continuous National Institutes of Health funding for his research on amyloid metabolism since 1986.
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Deep brain stimulation
Sussman, Norman
2009 ;16(7):24-26, Primary Psychiatry
Presents an interview with Wayne K. Goodman. Dr. Goodman is chairman in the Department of Psychiatry at Mount Sinai School of Medicine in New York City. He previously served as director of the Division of Adult Translational Research and Treatment Development at the National Institute of Mental Health in Bethesda, Maryland. Dr. Goodman is a member of the American College of Neuropsychopharmacology a distinguished fellow of the American Psychiatric Association, and member and past chair of the Food and Drug Administration's Psychopharmacologic Drug-Advisory Committee. A pioneering researcher in the field of obsessive-compulsive disorder (OCD), Dr. Goodman is the principal developer of the Yale-Brown Obsessive Compulsive Scale, the gold standard for assessing OCD. In this interview, Goodman discusses the role of deep brain stimulation in the treatment of psychiatric disorders.
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Getting ready for the comparative effectiveness research board
Sussman, Norman
2009 ;16(4):14-15, Primary Psychiatry
The stimulus bill, which creates the Federal Coordinating Council for Comparative Effectiveness Research, is a top priority for President Obama's administration in its mission to provide more care and better quality care, and to make health care more cost effective. Although not mandated, one goal of the new board will be cost control. A comparative effectiveness board could provide accurate guidance for clinicians making treatment decisions. There are several pitfalls that will need to be addressed.
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Improving clinical monitoring for potential postpartum depression
Sussman, Norman
2009 ;16(3):15-16, Primary Psychiatry
Two studies published in the February issue of the Archives of General Psychiatry suggest that taking a careful psychiatric history and performing a timely, routine blood test can predict the likelihood of developing postpartum depression (PPD) and of needing hospitalization. In each article, the authors described some of their findings as being 'remarkable.' Given that the focus of this issue Primary Psychiatry is women's mental health, I thought it useful to share the published information with you.
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In session with Andreas V. Alexopoulos, MD, MPH: Epilepsy
Sussman, Norman
2009 ;16(3):27-30, Primary Psychiatry
Presents an interview with Andreas V . Alexopoulos. Dr. Alexopoulos is staff physician in the Epilepsy Center of the Neurological Institute at the Cleveland Clinic in Ohio. Some of the topics being discussed in this interview are: clinical research work, diagnosis, and treatment of epilepsy.
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In Session with Gordon Parker, MB BS, MD, PhD, DSc, FR
Sussman, Norman
2009 ;16(9):31-34, Primary Psychiatry
Dr. Parker is Scientia Professor of Psychiatry at the University of New South Wales (UNSW) and Executive Director of the Black Dog Institute in Sydney, Australia. He was formerly Head of the School of Psychiatry at UNSW and Director of the Division of Psychiatry at Prince of Wales and Prince Henry Hospitals. An active researcher, Dr. Parker has focused on modeling psychiatric conditions (depressive, bipolar, and personality disorders) and examining causes, mechanisms, and treatments for mood disorders. In this interview with Dr. Parker, the following topics are discussed: antidepressant efficacy; antidepressants as maintenance therapies; antipsychotics with antidepressant effects; placebo rates; patient response to medication; efficacy study design; and new promising treatments for depression.
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In session with Jerome M. Siegel, PhD: Narcolepsy
Sussman, Norman
2009 ;16(1):32-34, Primary Psychiatry
Presents a session with Jerome M. Siegel. Jerome M. Siegel is professor of psychiatry at the University of California, Los Angeles, former president of the Sleep Research Society, and the recipient of Merit and Javits awards from the National Institutes of Health and the Distinguished Scientist award from the Sleep Research Society. His laboratory has made discoveries concerning the role of hypocretin in human narcolepsy and Parkinson's disease. He has studied the phytogeny of sleep as a clue to sleep function, discovering that the primitive mammal platypus has rapid eye movement sleep and that marine mammals can go without extended periods of sleep for long periods without ill effects.
— id: 100650, year: 2009, vol: 16, page: 32, stat: Journal Article,

In session with Sarah H. Lisanby, MD: Transcranial magnetic stimulation therapy
Sussman, Norman
2009 ;16(8):27-30, Primary Psychiatry
Presents an interview with Sarah H. Lisanby on transcranial magnetic stimulation therapy (TMS). Topics discussed include the development of TMS, FDA appoval of TMS, the difference betwen TMS and magnetic resonance imaging, and how TMS works as psychiatric treatment.
— id: 106398, year: 2009, vol: 16, page: 27, stat: Journal Article,

Medlineplus: A useful website
Sussman, Norman
2009 ;16(1):17-18, Primary Psychiatry
MedlinePlus gathers information from National Library of Medicine, the National Institutes of Health, and other government agencies and health-related organizations. Preformulated MEDLINE searches are included and link to medical journal articles. There are numerous links to other sites that are very useful. To test the Website, I clicked on the topic 'Panic Disorder' on the link to ClinicalTrials.gov. It provided specific information about 36 clinical trials that are currently recruiting subjects. This Website will prove very helpful for clinicians who want to refer patients to research protocols.
— id: 100651, year: 2009, vol: 16, page: 17, stat: Journal Article,

Mental Health Parity Act becomes the law on October 3, 2009
Sussman, Norman
2009 ;16(10):10-11, Primary Psychiatry
Amidst the heated debate about American healthcare reform, most citizens of the country--including healthcare providers and patients--may be overlooking a major change in mental health insurance that became effective early this month. Currently, ~70% of adults and 80% of children requiring mental health services do not receive help, in large part because of discriminatory insurance practices. A new law addresses this long-known discrimination against mental health care that does not exist for medical or surgical treatment. Known as the Mental Health Parity Act (MHPA), it requires that the annual or lifetime dollar caps on mental health benefits be no lower than the dollar limits for medical and surgical benefits. It applies to coverage offered by a group health plan or health insurance issuer that provides coverage in connection with a group health plan. Officially known as The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (The Wellstone-Domenici Parity Act), it was signed into law on October 3, 2008 by President George W. Bush when it was attached to the highly publicized Troubled Asset Relief Program. As I understand it, while MHPA is now the law, in most cases the Act will apply to plans beginning in the first plan coverage year that is 1 year after the date of enactment. For most plans, this will mean the effective date begins on January 1, 2010.
— id: 111397, year: 2009, vol: 16, page: 10, stat: Journal Article,

New psychotropics, serotonin, and weight gain: Looking for answers
Sussman, Norman
2009 ;16(5):10-11 May, Primary Psychiatry
Typically, they lost weight soon after starting treatment, regained that weight over several weeks or months, and then, in some instances, started reporting weight increases of 20-80 pounds over several months of treatment. Most of these patients never had a serious weight problem in the past. It seemed likely that they were gaining weight from the fluoxetine. Moreover, many patients reported that they were not eating more or different food. I would be very interested in knowing whether the effects of psychotropic agents on body weight, especially when patients do not report significant increases in the amount and composition of food intake, may be mediated by some mechanism involving a shift in the activity of adipose tissue type.
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New-generation antipsychotics: Are they being overprescribed?
Sussman, Norman
2009 ;16(2):15-16, Primary Psychiatry
Most practicing psychiatrists who are asked why they opt for use of new-generation antipsychotics will say that it is because of their lowered risk of causing tardive dyskinesia (TD). Had that same question been asked several years ago, the answer might have been that these drugs are more effective in treating negative symptoms; have fewer side effects overall, thus improving the probability of patient compliance; and are less likely to produce adverse cardiovascular events than the older medication. However, it seems that the justification for the prescription of new-generation antipsychotics becomes more difficult with each new independent study.
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Nicotine and schizophrenia
Sussman, Norman
2009 ;16(6):10-11, Primary Psychiatry
Nicotine is an alkaloid found in tobacco. It has long been known that use of tobacco, mainly in the form of cigarettes, is much more prevalent among patients with depression and schizophrenia. From the perspective of both healthcare providers and patients, this is often one of the most difficult aspects of psychiatric hospitalization. It is standard policy in most hospitals to forbid smoking on inpatient units, a situation that adds to the discomfort of patients admitted to psychiatric hospitals. By being forced to quit smoking, not only do they experience nicotine withdrawal, but, emerging evidence suggests, their psychiatric symptoms may get worse and they may become more prone to agitation. As a result, nicotine withdrawal can increase aggressive behavior.
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Omega-3 fatty acids: Complementary and alternative medicine in psychiatry
Sussman, Norman
2009 ;16(6):25-27, Primary Psychiatry
Presents a session with Marlene Freeman, MD in which the interviewer gathers her views on the use of omega-3 fatty acids in complementary alternative medicine in psychiatry. Dr. Freeman is a lecturer at Harvard Medical School and staff psychiatrist at Massachusetts General Hospital in Boston. Her research and clinical interests focus on mood disorders in women. Her particular interest is in treatment research that takes into account patient preferences and safety for the perinatal period. This has led her to focus on integrative medicine strategies. Dr. Freeman also focuses on the accurate and broad dissemination of evidence-based information to healthcare providers and the public.
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Predicting depression and antidepression response: The long and short of it
Sussman, Norman
2009 ;16(8):14-15, Primary Psychiatry
In last month's issue, I commented on recent research that the gene responsible for expression of the serotonin transporter (5-HTT) modulates the effect of life stressors and the development of major depressive disorder. Caspi and colleagues cited a polymorphism in the 5-HTT-linked polymorphic region (5-HTTLPR), that results in two common alleles, termed 'short'(s) and 'long'(l). The 's' allele was found to be associated with increased risk for depression, especially when exposed to loss or environmental stress. I also pointed out that a new study found that the 5-HTTLPR gene may not be as critical as believed, since the original finding had not been consistently replicated. The authors found no evidence that the serotonin transporter genotype alone or in interaction with stressful life events is associated with an elevated risk of depression in men alone, women alone, or in both sexes combined. Yet, here we are a month later and two new articles published in the July issue of British Journal of Psychiatry brings us back to 5-HTTLPR as a focal point of research on the prediction of who will develop depression and the prediction of antidepressant response.
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Selecting a first-line antidepressant: New analysis [Column/Opinion]
Sussman, Norman
2009 ;16(3):19-22, Primary Psychiatry
My considerations go into the selection of an antidepressant. These include the overall clinical status of the patient, including comorbid disorders, use of other medications, sensitivities to certain side effects, and past history (if any) of treatment with antidepressants. A perennial question involving antidepressants is: Which drug is most effective? As a prescriber and an educator, I am constantly scanning the literature for studies that demonstrate differences in antidepressant efficacy tolerability, and safety. Individual studies, usually funded by the companies that market antidepressants, have been of limited value, given what we now know about publication bias.
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Staying well-informed
Sussman, Norman
2009 ;16(11):10-11, Primary Psychiatry
The contributions to this month's issue of Primary Psychiatry cover a range of topics: dementia, attention-deficit/hyperactivity disorder (ADHD), secondary mania, and complications resulting from off-label use of medication. To the extent that there is a theme to this issue, it is that we ultimately are better clinicians if we are both well informed about the diagnostic and therapeutic literature and are flexible in applying this information when evaluating patients and developing a treatment plan. For example, the sudden onset of psychosis in an adult should lead us to look for possible underlying medical disease as a cause. Treating the symptoms without a full workup can prevent more timely diagnosis and treatment of the real cause of the presenting symptoms. Similarly ADHD remains a controversial diagnosis, and there are many clinicians who overlook this diagnosis or are reluctant to treat patients with this condition. Those who are skeptical about the validity of ADHD and that it persists into adulthood should review the recent literature about the risks and benefits of treatment before denying effective interventions to these patients. Part of what patients and their families expect is that, at best, we clinicians find that there is nothing seriously wrong. If we find a potentially life-altering or life-threatening condition, then patients want to hear that it can be effectively treated.
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Unintended consequences of FDA antidepressant warnings
Sussman, Norman
2009 ;16(9):14-, Primary Psychiatry
By now most readers of Primary Psychiatry are familiar with the October 2003 alert by the Food and Drug Administration Public Health Advisory citing the risk of suicidality for pediatric patients taking antidepressants. In February 2005, the FDA went further, asking that antidepressant product information contain a black box warning to that effect In May 2007, the warning was extended to young adults 18-24 years of age. Even before the actual warnings were added to the medications, declines in patients being diagnosed with depression were observed, as was a decrease in the prescription of selective serotonin reuptake inhibitors (SSRIs). The drop in prescriptions for SSRIs extended to adult patients, a group not found to be at increased risk for suicide with antidepressants and a group not cited in the warnings. A new analysis by investigators at the Center for Drug Evaluation and Research confirms that patients under 25 years of age who take antidepressants do have a higher risk of suicide, and those above that age do not. The investigators concluded that risk of suicidality associated with antidepressant use is strongly age dependent. 'Compared with placebo, the increased risk for suicidality and suicidal behavior among adults under 25 [years of age] approaches that seen in children and adolescents. The net effect seems to be neutral on suicidal behavior but possibly protective for suicidal ideation in adults aged 25-64 [years] and to reduce the risk of both suicidality and suicidal behavior in those aged >=65 [years]. ' For participants with non-psychiatric indications, suicidal behavior and ideation were extremely rare.
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Why replication matters
Sussman, Norman
2009 ;16(7):14-15, Primary Psychiatry
Psychiatric literature abounds with research reports that purport to find some biochemical, anatomic, or genetic marker that correlates significantly with a major psychiatric syndrome. These findings typically receive widespread publicity in the general press and become incorporated in academic presentations. For example, early in my career reports appeared that cited the 'pink spot' which was said to represent abnormal transmethylation in schizophrenic patients. There were studies of bufotenine, which was supposedly found in the urine of patients with schizophrenia. In the early 1880s, an abnormal dexamethasone suppression test was widely accepted as a diagnostic tool for major depressive disorder (MDD). Most recently, it has become almost universally accepted that a single gene (the gene responsible for expression of the serotonin transporter) modulates the effect of life stressors and the development of MDD. The source of the latter belief was a study published by Caspi and colleagues in 2003. They cited a polymorphism in the serotonin transporter (5-HTT)-linked polymorphic region (5-HTTLPR), a 44-base pair insertion/deletion polymorphism in the promoter region of the gene coding for the 5-HTT that results in two common alleles, termed ''short''(s) and ''long''(l). The s allele was found to be associated with increased risk for depression, especially when exposed to loss or environmental stress.
— id: 104891, year: 2009, vol: 16, page: 14, stat: Journal Article,

Hepatic assist devices: will they ever be successful?
Sussman, Norman L; McGuire, Brendan M; Kelly, James H
2009 Feb;11(1):64-68, Current gastroenterology reports
Hepatic assist remains elusive. Bioartificial livers (BALs), consisting of liver cells or tissue in a synthetic housing, have been promising but have not proven successful in clinical trials. Artificial livers that consist of sophisticated sorbents and membranes cannot support a failing liver but may shorten episodes of acute decompensation in patients with stable cirrhosis. These artificial livers are most likely to find a place as temporary support prior to transplantation. True liver support will require a BAL. This article proposes goals for making a clinically useful BAL, with attention to systems biology and potential sources of hepatocytes
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Kaplan & Sadock's pocket handbook of clinical psychiatry
Sadock, Benjamin J; Sadock, Virginia A; Cancro, Robert; Sussman, Norman; Ahmad, Samoon
Princeton NJ : Recording for the Blind & Dyslexic, 2008,
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Cognitive behavioral therapy for obsessive-compulsive disorder
Susman, Norman
2008 ;15(7):39-42 Jul, Primary Psychiatry
Presents an interview with Andrea Allen on cognitive behavioral therapy for obsessive-compulsive disorder.
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Developing and applying new therapeutic tools and competencies
Sussman, Norman
2008 ;15(4):14-15 Apr, Primary Psychiatry
In this issue, Ahmad Ghanizadeh, MD, and Mohsen Kianpoor, MD (see record 2008-18358-005) provide a case report on the cessation of risperidone-induced incontinence by valproate in a child with pervasive developmental disorder. They begin by noting that risperidone may be associated with a high rate of urinary incontinency among children with developmental disorders. There are several cases of risperidone-induced incontinency (eg, in autistic children). Some of the studies reported enuresis in cases where patients were taking both risperidone and a selective serotonin reuptake inhibitor. Although there are some explanations for the possible association of risperidone and enuresis, the authors do not have any explanation for this possible effect of valproate on cessation of incontinency.
— id: 92707, year: 2008, vol: 15, page: 14, stat: Journal Article,

Explaining the cognitive enhancing effects of drugs that treat ADHD
Sussman, Norman
2008 ;15(8):19-20, Primary Psychiatry
The clinical use of psychostimulants to treat attention-deficit/hyperactivity disorder (ADHD) is widespread, but the neural mechanisms responsible for their cognition-enhancing/behavioral-calming have never been adequately explained. This lack of clarity makes it more difficult to address criticisms that these drugs are not effective or are harmful. The fact is that stimulants are high on the list of controversial psychotropic medications. Apart from unanswered questions about how these drugs work, a major reason for concern about the use of drugs like amphetamines and methylphenidate is that they have a potential for diversion for recreational use, or some argue, may result in abuse among those who use them therapeutically. Another source of controversy is the fact that these agents are primarily used to treat children and adolescents with ADHD, a diagnosis that itself is actively questioned in the press. Most recently there have been reports that influential researchers at Harvard Medical School may not have adequately disclosed the extent of their relationships with manufacturers of ADHD medications, these reports have raised additional questions about the validity of some studies that show very favorable risk-benefit profiles when these drugs are used to treat ADHD. Not being a specialist in child in adolescent psychiatry, nor having ever done research or consulted for a marketer of psychostimulants, I can only make observations based on my reading of the literature, reports from my patients, and accounts from patients' family members.
— id: 100659, year: 2008, vol: 15, page: 19, stat: Journal Article,

FDA warnings and suicide rates: Unintended consequences
Sussman, Norman
2008 ;15(10):22-23 Oct, Primary Psychiatry
In 2003, regulators in the United Kingdom and the United States became aware of clinical trial data suggesting that selective serotonin reuptake inhibitors increase the risk of thoughts of suicide and suicidal behavior in children and adults. There were no youths who committed suicide in these trials, but some did exhibit thoughts or acted in ways that were termed 'suicidality.' In 2004, following highly publicized public hearings, the US Food and Drug Administration issued a general warning about the increased risk for youths taking antidepressants.
— id: 97117, year: 2008, vol: 15, page: 22, stat: Journal Article,

Fibromyalgia
Sussman, Norman
2008 ;15(11):31-34, Primary Psychiatry
The current article presents a session with Dennis C. Turk on Fibromyalgia. Dr. Turk is John and Emma Bonica Professor of Anesthesiology and Pain Research and director of the Fibromyalgia Research Program at the University of Washington in Seattle, Washington. While his research has been funded by the National Center for Health Statistics, National Center for Medical Rehabilitation Research, and numerous private foundations, he has consistently received funding from the National Institutes of Health since 1977. Dr. Turk has published over 450 journal articles and chapters in erudite texts and written and edited 13 volumes, including The Pain Survival Guide: How to Reclaim Your Life.
— id: 93517, year: 2008, vol: 15, page: 31, stat: Journal Article,

Focus on schizophrenia
Sussman, Norman
2008 ;15(6):17-18 Jun, Primary Psychiatry
An understanding of the etiology of schizophrenia has eluded theoreticians and investigators for centuries. The question of whether it is possible to recover from the disorder has also proven to be frustrating to those seeking an understanding of the true course of the illness. Three of the feature articles in this issue of Primary Psychiatry provide overviews of some of the most important recent findings about these issues.
— id: 92709, year: 2008, vol: 15, page: 17, stat: Journal Article,

Improving recognition and management of clinical problems
Sussman, Norman
2008 ;15(2):17-18 Feb, Primary Psychiatry
There is no theme to this issue of Primary Psychiatry. Instead, This issue features a series of articles that help fill some gaps involving common clinical situations that confront clinicians who treat psychiatric patients. A self-authored article provides a brief overview of medical complications that may arise in the course of treatment with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. Unlike common side effects, such as sexual dysfunction or weight gain, less common adverse reactions may have serious consequences for the patient. Among the possible side effects discussed are bleeding abnormalities, hyponatremia, bone loss, and serotonin toxicity. Because most of our readers are non-psychiatrists and might encounter patients exhibiting these problems, it is useful to increase awareness of these events. In this way, patients might be spared unnecessary work-ups and prolonged suffering due to non-recognition of the side effects discussed.
— id: 92702, year: 2008, vol: 15, page: 17, stat: Journal Article,

In session with Anita H. Clayton, MD: An update on the sexual side effects of medication
Sussman, Norman
2008 ;15(3):43-46 Mar, Primary Psychiatry
Presents a session with Anita H. Clayton, MD on the sexual side effects of medication. Dr. Clayton is David C. Wilson professor of psychiatry and professor of clinical obstetrics and gynecology at the University of Virginia in Charlottesville. She is distinguished fellow of the American Psychiatric Association and certified by the American Board of Psychiatry and Neurology. Dr. Clayton is consulting editor for the Journal of Sex & Marital Therapy and received the Columnist of the Year award in 2005 for her bi-monthly column in Primary Psychiatry, 'Considerations in Women's Mental Health.' In 2007, her book, Satisfaction: Women, Sex and the Quest for Intimacy, was published for the general public.
— id: 92703, year: 2008, vol: 15, page: 43, stat: Journal Article,

In session with Benjamin J. Sadock, MD: The comprehensive textbook of psychiatry, 8th edition
Sussman, Norman
2008 ;15(1):37-40 Jan, Primary Psychiatry
The article presents a session with Benjamin J. Sadock discussing the Comprehensive Textbook of Psychiatry, 8th Edition. Dr. Sadock is Menas S Gregory professor of psychiatry and vice chairman at the New York University (NYU) School of Medicine. He is attending psychiatrist at the Bellevue and Tisch Hospitals and is consulting psychiatrist at Lenox Hill Hospital. He was appointed Faculty Scholar at the NYU School of Medicine in 2000. Dr. Sadock is author and editor of over 100 publications and book reviewer for psychiatric journals, including the American Journal of Psychiatry.
— id: 92699, year: 2008, vol: 15, page: 37, stat: Journal Article,

In session with James D. King, MD: The status of the primary care field in relation to psychiatric care
Sussman, Norman
2008 ;15(5):32-34 May, Primary Psychiatry
Presents an interview with James D. King. Dr. King is president of the American Academy of Family Physicians (AAFP), which respresents 94,000 physicians and medical students nationwide. He is volunteer faculty at the University of Tennessee Center for Health Sciences, Memphis, and medical director of Chester County Healthcare Services in Selmer. In 1997, Dr. King received the Family Physician of the Year Award from the Tennessee Academy of Family Physicians. As member of the board of directors of FamMedPAC, the AAFP's political action committee, Dr. King advocates the legislative goals of family medicine to members of Congress.
— id: 92850, year: 2008, vol: 15, page: 32, stat: Journal Article,

In Session with Neil E. Hutcher, MD
Sussman, Norman
2008 ;15(8):37-39, Primary Psychiatry
Presents an interview with Neil E. Hutcher on issues concerning bariatric surgery; techniques used for the procedure; and successful outcomes after surgery.
— id: 100658, year: 2008, vol: 15, page: 37, stat: Journal Article,

In session with Samuel Gandy, MD, PhD: Alzheimer's Disease
Sussman, Norman
2008 ;15(9):39-42, Primary Psychiatry
Presents an interview with Samuel Gandy, Mount Sinai Professor of Alzheimer's Disease Research, professor of neurology and psychiatry, associate director of the Mount Sinai Alzheimer's Disease Research Center in New York City, and past chair of the National Medical and Scientific Advisory Council of the Alzheimer's Association. As an international expert in the metabolism of amyloid that clogs the brain in patients with Alzheimer's disease, Dr. Gandy has written over 150 original papers, chapters, and reviews on this topic. In 1989, he and his colleagues discovered medications that could lower the formation of amyloid. He has received continuous National Institutes of Health funding for his research on amyloid metabolism since 1986.
— id: 100661, year: 2008, vol: 15, page: 39, stat: Journal Article,

In session with Sanjay J. Mathew, MD: Ketamine: New pathways of medication
Sussman, Norman
2008 ;15(6):31-34 Jun, Primary Psychiatry
Presents a brief session with Sanjay J. Mathew on Ketamine. Dr. Mathew is assistant professor of Psychiatry at the Mount Sinai School of Medicine (MSSM) in New York City. A board-certified psychiatrist, Dr. Mathew is also attending physician in the Mood and Anxiety Disorders Program at the Mount Sinai Medical Center. In 2007, he received the American Foundation for Suicide Prevention Pfizer Travel Award as well as the Lamport Research Award from MSSM. In addition to therapeutic approaches for treatment- resistant depression and anxiety, Dr. Mathew's research involves magnetic resonance imaging and spectroscopy applications to anxiety and mood disorders.
— id: 92708, year: 2008, vol: 15, page: 31, stat: Journal Article,

In session with Susan J. Diem, MD, MPH: Depression, antidepressants, and bone loss
Sussman, Norman
2008 ;15(4):27-29 Apr, Primary Psychiatry
Presents a session with Susan J. Diem, MD, MPH on depression, antidepressants, and bone loss. Dr. Diem is assistant professor of medicine at the University of Minnesota. She is a general internist, epidemiologist, and clinical trialist of women's health. In addition, her clinical practice is primarily focused on perimenopausal and postmenopausal women. Dr. Diem is co-investigator on the Study of Osteoporotic Fractures, a prospective cohort study funded by the National Institutes of Health that examines the risk factors for osteoporosis and fractures in postmenopausal women.
— id: 92706, year: 2008, vol: 15, page: 27, stat: Journal Article,

Maintaining quality of life for seriously ill children and young adults
Sussman, Norman
2008 ;15(7):21-22 Jul, Primary Psychiatry
Unlike most issues of Primary Psychiatry, the focus this month is on a specific clinical facility rather than particular diseases and treatments. In deciding to devote this issue to a discussion of the Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders (SDHCC) at the New York University (NYU) Langone Medical Center in New York City, it is hoped that many readers who are in a position to influence decisions and funding involving clinical services for children and young adults will use the SDHCC model to create similar programs in their communities. While all centers endeavor to provide excellent, state of the art medical care, sometimes sensibilities about environment in which services are provided can be left wanting.
— id: 97580, year: 2008, vol: 15, page: 21, stat: Journal Article,

Medical Complications of SSRI and SNRI treatment
Sussman, Norman
2008 ;15(2):37-41 Feb, Primary Psychiatry
The selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors, drugs originally introduced as treatments for depression, are now extensively prescribed for a variety of other medical and psychiatric disorders as well. Their appeal as first-line agents derives from their simplicity of use and relative absence of life-threatening side effects. The most common adverse events associated with the use of these drugs tend to affect quality of life issues such as sexual function and desire, body weight, sleep, and emotional reactivity. However, there are some side effects that, while uncommon, can produce complications that present in a medical or surgical context. Consequently, patients may undergo unnecessary physical and laboratory examination as well as unneeded medical/surgical intervention. In some instances they may endure these side effects for extended periods.
— id: 92701, year: 2008, vol: 15, page: 37, stat: Journal Article,

New approaches to overlooked conditions
Sussman, Norman
2008 ;15(9):22-23, Primary Psychiatry
It seems logical that someone with a chronic medical illness would become depressed as a consequence of prolonged pain, suffering, disability, or all of these, coupled with doubts about the prospects of recovery. Yet, there is surprisingly little discussion about depression as a natural consequence of a serious medical illness. Murali Rao, MD, DFAPA, FAPM, reviews some of the shortcomings in the current approaches to this patient population. Rao reports that approximately 33% of physically ill patients have depressive symptoms and major depressive disorder is at least twice as common in hospitalized medical patients compared to depression in the general population. However, he notes that one major limitation is the lack of guidance on diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision with respect to depression in the medically ill. As a result, depressive illness is often under-diagnosed and under-treated in those with coexisting physical illnesses. The assessment of both conditions and the interaction between them is critical in managing these patients. Rao describes approaches to diagnosis in these cases and recommends therapeutic interventions.
— id: 100662, year: 2008, vol: 15, page: 22, stat: Journal Article,

Topics in this issue
Sussman, Norman
2008 ;15(3):23-23 Mar, Primary Psychiatry
This issue of Primary Psychiatry covers a broad range of topics. Anton A. Subuh Surja, MD, and colleagues address the prevalent stigmatization of depressed people who also abuse alcohol. They note that depression comorbid with alcohol abuse is common. As a consequence of this stigma, these dual-diagnoses patients receive inadequate assessment and treatment, which in turn compromises prognosis and leads to relapse. The authors note that alcohol and other substance abusers tend to engender negative feelings from healthcare professionals. Underlying mood disorders, if undiagnosed and unmanaged, can result in suicide. Thus, there is a need to teach better attitudes that improve outcomes and foster professionalism. Among many points made in the article, the authors note that when depression and its associated symptoms are present, treatment of depression is mandatory. Patients may require altered doses of psychotropic medication since alcohol induces hepatic enzymes and can result in liver dysfunction. Interventions for social, occupational, or legal disruptions may be needed. Substance abuse therapies must always be made available.
— id: 92704, year: 2008, vol: 15, page: 23, stat: Journal Article,

Treating sleep disorders in patients with psychiatric disorders
Sussman, Norman
2008 ;15(5):21-22 May, Primary Psychiatry
In this issue of Primary Psychiatry, an article by Surilla Randall, PhD, and colleagues, provides an overview of what is known regarding the efficacy and safety of popular nonprescription products used for insomnia. Both the prevalence of chronic (estimates can range from approximately 10% to 50%) and self-treatment with over-the counter (OTC) sleep aids, herbal and dietary supplements, and/or alcohol are very common. The authors report the findings of a survey that showed that 25.9% of respondents reported using some substance to aid their sleep. Of those who used medications (either prescription, OTC drugs, or both) to improve sleep, 57% reported using OTC sleep aids. The authors note that most of the evidence about the efficacy and safety of OTC sleep aids is inconclusive, mainly due to problems with research design and lack of placebo-controlled groups. There is also little data to support long-term usage. As with other sedating agents, prolonged use of antihistamine drugs may result in tolerance and/or dependence and produce daytime sleepiness. The authors concede that treatment of insomnia with antihistamine-containing OTC sleep aids may help occasional mild insomnia. The data on other non-prescription sleep aids is too limited or inconsistent in results to consider their use. While alcohol may have initial sedative effects, it is associated with rapid tolerance development and dose escalation.
— id: 92851, year: 2008, vol: 15, page: 21, stat: Journal Article,

What is a generic drug?
Sussman, Norman
2008 ;15(1):15-16 Jan, Primary Psychiatry
This past December, the United States Food and Drug Administration approved duloxetine for the maintenance treatment of major depressive disorder in adults. Long overlooked, the issue of delaying or preventing a return of depressive illness has become a focus of both clinical and research interest. Until now, compared to acute efficacy trials, few maintenance studies have evaluated the efficacy of pharmacotherapy for the prevention of recurrence. One reason is that maintenance and relapse prevention studies take significantly longer to conduct than acute efficacy studies, making them difficult to complete and expensive. These studies, if they are done, occur after the drug is approved for acute treatment, so requiring completion of such studies at New Drug Application filing will delay approvals and patient access to novel treatments. Many patients need to be enrolled because discontinuation rates after 3 months in most studies are approximately 50%. In most trials, the drop-out rate at 6 months is 70%. In a study of the elderly, approximately one-third of patients who originally responded to paroxetine alone or in combination psychotherapy relapsed within 2 years. Relapse rates in the Sequenced Treatment Alternatives to Relieve Depression study were also high.
— id: 92700, year: 2008, vol: 15, page: 15, stat: Journal Article,

Multi-organ iron overload in an African-American man with ALAS2 R452S and SLC40A1 R561G
Sussman, Norman L; Lee, Pauline L; Dries, Andrew M; Schwartz, Mary R; Barton, James C
2008 ;120(3):168-173, Acta haematologica
BACKGROUND: X-linked sideroblastic anemia (XLSA) is associated with iron overload and mutations in ALAS2, which encodes 5-aminolevulinate synthase. There are few reports of XLSA in persons of sub-Saharan African descent. METHODS: A 47-year-old African-American man had microcytic anemia, elevated iron measures, cardiomyopathy, hepatic cirrhosis, diabetes mellitus, a history of cocaine use and hepatitis C. We amplified and directly sequenced his genomic DNA to detect mutations of SLC40A1, HFE, TFR2, HAMP, HJV and ALAS2. RESULTS: The subject's transferrin saturation was 100% and his serum ferritin was 2,960 ng/ml. An MRI scan revealed diffusely decreased T(2) signals of the heart, liver and pancreas. Transjugular right endomyocardial and liver biopsy specimens revealed marked iron deposition in cardiac myocytes and hepatocytes, and cirrhosis. He died of progressive cardiomyopathy. He was hemizygous for ALAS2 R452S (exon 9; c.1354C-->A) and heterozygous for SLC40A1 R561G (exon 8; c.1681A-->G). He did not have coding region mutations in HFE, TFR2, HAMP or HJV. CONCLUSIONS: ALAS2 R452S largely explains this patient's microcytic anemia and multi-organ iron overload and dysfunction. SLC40A1 R561G may have increased his iron absorption and overload further. Acquired factors, especially cocaine use and hepatitis C, may have contributed to his clinical phenotype
— id: 94917, year: 2008, vol: 120, page: 168, stat: Journal Article,

Augmentation in depression and other issues
Sussman, Norman; Nelson, J. Craig
2008 ;15(11):22-23, Primary Psychiatry
Both clinicians and researchers have long known that the majority of depressed patients do not achieve or sustain a complete recovery from their disorders on most therapies. This has led to anecdotal reports and to clinical trials that suggest a broad range of interventions involving some combination of medications. The Sequenced Treatment Alternatives to Relieve Depression study examined response to treatment in a large sample of 3,671 patients with major depressive disorder. The patients were those typically encountered in primary care and psychiatry settings. The study found that even after 12-14 weeks of adequately dosed citalopram, only 37% of the patients achieved remission. The study indicates that most patients will require additional treatments. The common choices after initial treatment failure are to switch to another antidepressant, add a second antidepressant start psychotherapy or augment with a compound not approved for use as an antidepressant. Many different compounds have been used for augmentation including stimulants, modafinil, buspirone, pindolol, estrogen, and testosterone. Few controlled studies of these agents have been performed, and with the exception of a single modafinil study the controlled studies have failed to show an advantage for augmentation with these agents. Thyroid augmentation has been more extensively studied. Reviews and meta-analyses indicate thyroid augmentation does accelerate response but the placebo-controlled trials in resistant depression fail to show an advantage.
— id: 93518, year: 2008, vol: 15, page: 22, stat: Journal Article,

Acute hepatic dysfunction with abdominal pain and ascites
Agha, Aamer; Sussman, Norman
2007 ;9(2):31-31, MedGenMed: Medscape General Medicine
— id: 94919, year: 2007, vol: 9, page: 31, stat: Journal Article,

Are anxiety and depression actually the same disorder?
Sussman, Norman
2007 ;14(4):15-16 Apr, Primary Psychiatry
The dilemmas facing clinicians who diagnose and treat psychiatric disorders are different than the issues that confront practitioners specializing in cardiology, endocrinology hematology gynecology or virtually any other field of medicine. In the case of most mental disorders, causation has not been established, diagnosis is based on clusters of symptoms, and treatments have a tendency to be non-specific. For example, I have given and heard lectures over the years on the differential diagnosis of depression and anxiety Typically, variation in the focus of these talks included distinguishing between anxiety symptoms associated with depression, coexisting anxiety and depression, and mixed anxiety-depression. Often, these disorder distinctions seemed forced, with many points of differentiation reflecting a greater degree of diagnostic certainty than appeared to exist in real-world clinical care. In both clinical and epidemiologic samples, major depressive disorder (MDD) and generalized anxiety disorder (GAD) display substantial comorbidity and/or symptom overlap. (journal abstract)
— id: 73996, year: 2007, vol: 14, page: 15, stat: Journal Article,

Bipolar disorder: Changing patterns of diagnosis and treatment
Sussman, Norman
2007 ;14(10):15-16 Oct, Primary Psychiatry
In many respects, the diagnosis and treatment of psychiatric disorders represents one of the most daunting tasks in medical practice. There is diagnostic uncertainty and unpredictability of treatment response, even with some of the most frequently encountered disorders. This is particularly evident when it comes to defining and managing bipolar disorder. At the moment, for example, there are several areas of controversy involving the disorder. The first issue is the possibility that this disorder is being over diagnosed. The second issue is whether antidepressants are helpful in treating patients with bipolar disorder, and more importantly whether they carry a risk of aggravating the illness over time.
— id: 93527, year: 2007, vol: 14, page: 15, stat: Journal Article,

Counterproductive FDA advisories
Sussman, Norman
2007 ;14(2):15-16 Feb, Primary Psychiatry
In the December New England Journal of Medicine, Gregory E. Simon, MD, MPH, an investigator in the Center for Health Studies at Group Health Cooperative in Seattle, and chair of the Scientific Advisory Board of the Depression and Bipolar Support Alliance, addresses the widely publicized findings from the ongoing Food and Drug Administration meta-analysis of antidepressant-associated suicidal thoughts and behavior in clinical trials. In his commentary, Simon emphasizes the importance of careful monitoring of all depressed children and adolescents for increased risk of suicidal behavior after initiation of therapy. This is consistent with an FDA advisory that is has been added to the product information of all antidepressants and some mood stabilizers, even though the studies in question involved only some of the newer agents such as bupropion, citalopram, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, and venlafaxine. An additional label change, based on a more recent analysis of the data, will extend this warning to those <25 years of age. (journal abstract)
— id: 75705, year: 2007, vol: 14, page: 15, stat: Journal Article,

Current developments in electroconvulsive therapy
Sussman, Norman
2007 ;14(3):34-37 Mar, Primary Psychiatry
Dr. Kellner is professor and chair of the Department of Psychiatry, and assistant dean for clinical research at the University of Medicine and Dentistry of New Jersey in Newark. He is also co-director of the electroconvulsive therapy (ECT) service at The University Hospital in Newark with George Petridesr MD, and was editor of The Journal of ECT from 1994-2004. Dr. Miner's ongoing research includes studies comparing different ECT types and methods for optimizing maintenance ECT. This article presents an interview with Dr. Kellner on the current developments in ECT.
— id: 75706, year: 2007, vol: 14, page: 34, stat: Journal Article,

Diabetes and depression
Sussman, Norman
2007 ;14(6):13-14 Jun, Primary Psychiatry
This month, the American Diabetes Association (ADA) holds its 67th Annual Scientific Sessions in Chicago. Papers presented at this meeting have received increased media coverage as diabetes mellitus has become a major public health concern. Physicians in all specialties are seeing more patients diagnosed with diabetes. However, psychiatrists are in a unique position because many medications currently used to treat mental disorders potentially induce or worsen glycemic control, with atypical antipsychotics being the most clearly demonstrated to adversely affect glucose regulation and cause weight gain. As this issue of Primary Psychiatry focuses on depression and response to treatment, it is appropriate to address some recent research findings about the possible relationship between depression, antidepressants, and diabetes.
— id: 93524, year: 2007, vol: 14, page: 13, stat: Journal Article,

Do not use antidepressants in patients with bipolar disorder
Sussman, Norman
2007 ;14(5):15-16 May, Primary Psychiatry
There are exceptions, but as the title of this editor's note suggests, clinicians should re-examine use of antidepressants in patients with bipolar disorder. This entails differentiating two types of depression, which is a difficult task for primary care physicians (PCPs). In a recent issue of the New England Journal of Medicine, a study--which any clinician who treats depressed patients should read or at least understand--reported the results of a controlled trial evaluating the effectiveness of antidepressants as short-term treatment of episodes of major depression in patients with bipolar disorder. The study was part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a collaboration sponsored by the National Institute of Mental Health and designed to evaluate the effectiveness of treatments for bipolar disorder and provide results that are generalizable to routine clinical practice.
— id: 92718, year: 2007, vol: 14, page: 15, stat: Journal Article,

Identifying risk factors for suicide
Sussman, Norman
2007 ;14(11):15-16, Primary Psychiatry
Suicide is the ultimate act of a hopeless and suffering individual. Those who know the victim frequently describe the suicide as senseless. Yet, the person who takes his or her own life experiences and perceives the future as more unbearable than death. Feeling trapped, unbearably agitated, or shamed, the victim sees death as a friend. However, to families and acquaintances, or to the health professional that may have treated that person, the suicide is inevitably traumatic. Everyone who cared about the victim is somehow diminished by the act.
— id: 92739, year: 2007, vol: 14, page: 15, stat: Journal Article,

Improving detection and prevention of suicide
Sussman, Norman
2007 ;14(12):15-15 Dec, Primary Psychiatry
This issue of Primary Psychiatry contains Part 2 of our review of emerging insights into the causes and management of suicidal patients. Eric A. Fertuck, PhD, and colleagues provide an overview of the nature of suicidality in borderline personality disorder (BPD). They note that this common condition is associated with one of the highest rates of healthcare utilization in both the psychiatric and primary care setting. BPD is characterized by suicidal ideation and behavior. The approximately 10% rate for suicide completion in BPD is 400 times greater than the rate in the general population. This article is written with the needs of primary care physicians (PCPs) in mind, so that they become better able to recognize the clinical manifestations of BPD and the treatment options for those patients who are suicidal. The article emphasizes that primary care is often the best setting for both the identification of those at risk for suicide and for the prevention of suicidal behavior.
— id: 92713, year: 2007, vol: 14, page: 15, stat: Journal Article,

In session with Eric M. Plakun, MD: The impact of suicide on physicians
Sussman, Norman
2007 ;14(4):35-37 Apr, Primary Psychiatry
Dr. Plakun is director of admissions and professional relations, a treatment team leader, psychotherapy supervisor, a member of the management group of the Erik H. Erikson Institute for Education and Research, and co-principal investigator of a prospective study of treatment outcome that utilizes objective measures of psychodynamic constructs at the Austen Riggs Center in Stockbridge, Massachusetts. He is also a distinguished fellow of the American Psychiatric Association and chair of its Committee on. Psychotherapy by Psychiatrists. (journal abstract)
— id: 73994, year: 2007, vol: 14, page: 35, stat: Journal Article,

In session with Joseph F. Goldberg, MD: Bipolar disorder
Sussman, Norman
2007 ;14(11):42-46, Primary Psychiatry
Presents a session with Joseph F. Goldberg on bipolar disorder. Dr. Goldberg is director of the Affective Disorders Program at Silver Hill Hospital in New Canaan, Connecticut, and associate clinical professor of psychiatry at the Mount Sinai School of Medicine in New York City. His research focuses on the treatment and clinical features of bipolar disorder. He has also received research grants from the National Alliance for Research in Schizophrenia and Depression, the American Foundation for Suicide Prevention, and the Stanley Foundation.
— id: 92737, year: 2007, vol: 14, page: 42, stat: Journal Article,

In session with Michael B. Whitlow, MD, PhD: The dermatological side effects of pharmacologic agents
Sussman, Norman
2007 ;14(5):40-42 May, Primary Psychiatry
Presents a session with Michael B. Whitlow, MD, PhD, on the dermatological side effects of pharmacologic agents. Dr. Whitlow is a dermatologist in private practice, and clinical associate professor of dermatology at New York University Medical Center, both in New York City His clinical interests include allergic and immunologic skin disease.
— id: 92714, year: 2007, vol: 14, page: 40, stat: Journal Article,

In session with Naomi Wray, PhD: Anxiety and comorbid measure associated with plexin A2
Sussman, Norman
2007 ;14(9):42-45 Sep, Primary Psychiatry
Presents a session with Naomi Wray, PhD on anxiety and comorbid measures associated with the gene encoding plexin A2. Dr. Wray is a statistical geneticist specializing in the genetics of complex diseases. She is senior research officer at Queensland Institute of Medical Research in Brisbane, Australia, where she leads the Anxiety and Depression Study of the Genetic Epidemiology Laboratory. The study represents a powerful design to identify a large cohort of individuals for genetic analysis for whom comorbidity between depression and anxiety subtypes is fully documented.
— id: 92732, year: 2007, vol: 14, page: 42, stat: Journal Article,

In session with Russell T. Joffe, MD: The impact and psychological manifestations of thyroid dysfunction
Sussman, Norman
2007 ;14(6):36-38 Jun, Primary Psychiatry
Presents an interview with Russell T. Joffe on impact and psychological manifestations of thyroid dysfunction.
— id: 93520, year: 2007, vol: 14, page: 36, stat: Journal Article,

In session with Stephen R. Marder, MD: Newer antipsychotics and the differences between clinical experiences and clinical trials
Sussman, Norman
2007 ;14(10):31-34 Oct, Primary Psychiatry
Presents a session with Stephen R. Marder on newer antipsychotics and the differences between clinical experiences and clinical trials. Dr. Marder is professor at the Semel Institute of Neuroscience and Human Behavior at the University of California, Los Angeles (UCLA); director of the Veterans Integrated Service Network 22 Mental Illness Research, Education, and Clinical Center at the Department of Veterans Affairs in Los Angeles; and director of the Section on Psychosis at the UCLA Semel Institute. Dr. Marder's research has focused on the treatment of schizophrenia and the pharmacology of antipsychotics.
— id: 93525, year: 2007, vol: 14, page: 31, stat: Journal Article,

Interpreting antidepressant clinical trials
Sussman, Norman
2007 Oct-Dec;19(4):215-220, Annals of clinical psychiatry
BACKGROUND: Psychiatrists and other clinicians make decisions about antidepressant medications with little understanding on how to interpret the research literature. METHODS: Pertinent clinical literature is reviewed. RESULTS: The author reviews levels of evidence, study design, statistical significance, p values, defining outcomes, drop outs, and basic analytic strategies such as last observation carried forward and mixed-effects model repeated measures. Several recent clinical trials are dissected to illustrate these concepts. CONCLUSIONS: Clinicians need to develop greater sophistication at interpreting research findings. No single study is definitive, and comparative antidepressant trials suffer from low statistical power
— id: 75461, year: 2007, vol: 19, page: 215, stat: Journal Article,

Lessons from Last Year's Landmark Studies
Sussman, Norman
2007 ;14(1):11-12 Jan, Primary Psychiatry
2006 may be remembered as the year in which two long-awaited, landmark, non-industry-sponsored psychopharmacology studies were published. One of these studies, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, is discussed in detail by Roy H. Perlis, MD, guest editor of this issue of Primary Psychiatry, as well as by the contributors to the Clinical Focus section of this issue. Dr. Perlis outlines and the authors present their perspectives on the results of the STAR*D trial. In addition, an upcoming issue of Primary Psychiatry will present an interview with Andrew Nierenberg, MD, one of the investigators in the STAR*D trial. Accordingly, my comments will largely focus on the second landmark study of last year, the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). (journal abstract)
— id: 70998, year: 2007, vol: 14, page: 11, stat: Journal Article,

Side effects of psychotropic medications: Importance of postmarketing surveillance
Sussman, Norman
2007 ;14(9):14-15 Sep, Primary Psychiatry
One of the most important needs in clinical medicine is improved post-marketing surveillance of adverse drug reactions. Headlines in the popular press have recently highlighted an increasing number of drugs that have been in use for years that suddenly are withdrawn from the market or are tagged with a so-called 'back-box warning' of a potentially life-threatening treatment-emergent event. Yet, there are numerous side effects of psychotropic drugs that are undesirable or that impact quality of life, that go unrecognized by prescribes.
— id: 92736, year: 2007, vol: 14, page: 14, stat: Journal Article,

Tardive dyskinesia
Sussman, Norman
2007 ;14(8):35-38 Aug, Primary Psychiatry
The current article presents an interview with Jeffery A. Lieberman, discussing tardive dyskinesia. Dr. Lieberman is the Lawrence E. Kolb Chairman of Psychiatry at the Columbia University College of Physicians and Surgeons and director of the New York State Psychiatric Institute in New York City. Dr. Lieberman's research focuses on the neurobiology, pharmacology and treatment of schizophrenia and related psychotic disorders.
— id: 92724, year: 2007, vol: 14, page: 35, stat: Journal Article,

The developmental process for the diagnostic and statistical manual of mental disorders, fifth edition [Column/Opinion]
Sussman, Norman
2007 ;14(7):44-47 Jul, Primary Psychiatry
Presents an interview with Darrel A. Regier on the development and use of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).
— id: 92721, year: 2007, vol: 14, page: 44, stat: Journal Article,

The Sequenced Treatment Alternatives to Relieve Depression Study: Recent results
Sussman, Norman
2007 ;14(2):31-34 Feb, Primary Psychiatry
This article presents an interview with Dr. Andrew A. Nierenberg, associate director of the Depression Clinical and Research Program at Massachusetts General Hospital, associate professor of psychiatry at Harvard Medical School in Boston, and director of the National Institute of Mental Health Bipolar Trials Network. The Sequenced Treatment Alternatives to Relieve Depression study, sponsored by the National Institute of Mental Health, was created to instruct clinicians on what to do next if one treatment does not bring patients to remission. This study is discussed.
— id: 73593, year: 2007, vol: 14, page: 31, stat: Journal Article,

Thyroid augmentation: Reassessing an overlooked strategy
Sussman, Norman
2007 ;14(7):14-15 Jul, Primary Psychiatry
The interview with Russell I Joffe, MD, that appeared in the June 2007 issue of Primary Psychiatry focused my attention on the use of thyroid augmentation in psychiatry to enhance antidepressant drug response. It reminded me of when I was a resident and first heard Arthur Prange, Jr., MD, in 1975 describe the successful use of this strategy. I then wondered why I do not routinely use thyroid hormone as an intervention for my treatment-resistant patients. Study results are mixed. However, as Dr. Joffe pointed out, a meta-analysis of clinical trials showed that patients taking triiodothyronine (T3) are twice as likely to respond to antidepressant treatment versus placebo. He noted that there is consistency across these studies that augmentation with T3 is effective with tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs).
— id: 92723, year: 2007, vol: 14, page: 14, stat: Journal Article,

Translating Science Into Service: Lessons Learned From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study
Sussman, Norman
2007 ;9(5):331-337, Primary care companion to the Journal of clinical psychiatry
Objective: The purpose of this review is to summarize lessons learned from, and limitations of, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, focusing on measurement-based care.Data Sources: PubMed and MEDLINE were searched from 1980 through 2006 using terms such as depression, major depressive disorder, augmentation, switching, measurement-based care, and remission. Other relevant articles were identified by checking reference lists of the identified studies.Study Selection: A total of 60 studies were initially identified, which resulted in 34 studies used in this review. The salient criteria used for selection of studies centered on whether results had implications for clinical practice and provided lessons that could be learned and practically applied to real-life settings.Data Extraction: Data were extracted from the STAR*D trial and associated studies that were pertinent to everyday problems encountered by mental health professionals in the community: determination of whether the optimum strategy for a particular patient involves 'augmentation' or 'switching' of a patient's medication.Data Synthesis: Measurement-based care is essential in order to identify the two thirds of patients who do not achieve remission with the first treatment strategy. Timely changes in antidepressant therapy can improve outcomes.Conclusions: The STAR*D trial underscores the importance of measurement-based care in identifying patients who may not have achieved remission with an initial antidepressant, enabling alternative options such as augmentation or switching to be prescribed to meet this ultimate goal of therapy
— id: 94918, year: 2007, vol: 9, page: 331, stat: Journal Article,

What next? Overcoming treatment resistance
Sussman, Norman
2007 ;14(3):15-16 Mar, Primary Psychiatry
In this month's Primary Psychiatry, each feature article addresses an aspect of treatment involving complicated psychiatric disorders. Specifically, each article focuses on patients who do not respond to 'first-line' interventions and sometimes do not respond to conventional treatments at all. In many of these cases, a therapeutic dilemma is whether to try a sequence of alternative therapies or use multiple agents, called drug cocktails. Treatment failure sometimes also leads patients to seek out alternative therapies, such as nutrients and vitamins, or procedures that have not been extensively studied for their efficacy and safety. (journal abstract)
— id: 75707, year: 2007, vol: 14, page: 15, stat: Journal Article,

Geriatric psychiatry
Sussman, Norman; Grossberg, George T
2007 ;14(8):14-15 Aug, Primary Psychiatry
With the aging of the post-World War II baby boomers, we are on the cusp of explosive growth in the United States population >65 years of age. Indeed, Americans >85 years of age, proportionally constitute the most rapidly growing segment of our population. Accordingly this issue of Primary Psychiatry focuses on geriatric psychiatry. An increasingly common problem with advanced age is Alzheimer's disease. Advanced age is the number one risk factor for Alzheimer's disease. Currently, 5 million older Americans are affected by this disorder, and the number will grow to nearly 30 million by the year 2050. At the moment, there is no known way to prevent Alzheimer's disease.
— id: 92728, year: 2007, vol: 14, page: 14, stat: Journal Article,

Rates of remission/euthymia with quetiapine in combination with lithium/divalproex for the treatment of acute mania
Sussman, Norman; Mullen, Jamie; Paulsson, Bjorn; Vagero, Marten
2007 ;100 Suppl 1:S55-S63, Journal of affective disorders
OBJECTIVE: The aim of this analysis was to compare the rates of remission/euthymia in patients with bipolar mania receiving quetiapine in combination with lithium/divalproex (QTP+Li/DVP) versus placebo (PBO) in combination with Li/DVP (PBO+Li/DVP). METHODS: A pooled analysis of two (one 3-week and one 6-week) double-blind studies of a total of 370 patients hospitalized with bipolar I mania who received quetiapine (up to 800 mg/day) in combination with Li (mean serum concentration 0.76 mEq/L) or DVP (mean serum concentration 69.5 mug/mL) was performed. For both studies, data were analyzed at Day 21. In addition, for the 6-week study, data were analyzed at Day 42. Five different criteria for remission/euthymia were used: (i) Young Mania Rating Scale (YMRS) score </=12; (ii) YMRS score </=12 plus a Montgomery-Asberg Depression Rating Scale (MADRS) score </=10; (iii) YMRS score </=12+MADRS score </=8; (iv) YMRS score </=8; and (v) YMRS score </=8 plus a score </=2 for the YMRS core items of Irritability, Speech, Content, and Disruptive/Aggressive Behavior. RESULTS: In the pooled analysis, Day 21 remission rates (YMRS </=12) were significantly higher in patients treated with QTP+Li/DVP compared with those who received PBO+Li/DVP (48.7% versus 33.0%, p=0.003). Rates of remission/euthymia (YMRS </=12+MADRS </=10) were similarly improved with QTP+Li/DVP compared with Li/DVP alone (43.2% versus 26.5%, p=0.001). Using the most stringent criteria (YMRS </=12+MADRS </=8), rates of remission/euthymia were again significantly higher with QTP+Li/DVP than with Li/DVP alone (38.4% versus 25.9%, p=0.014). More patients treated with quetiapine met the stringent criterion of YMRS </=8 (31.9% versus 24.3%; p=NS). A trend in favor of quetiapine was also observed for the more stringent criterion of YMRS </=8 plus core items </=2 (28.1% versus 23.2%; p=NS). For the 6-week study, at Day 42, YMRS was </=12 in 68.3% of patients treated with QTP+Li/DVP compared with 57.3% of those who received PBO+Li/DVP (p=NS). Respective rates based on the remission criterion of YMRS </=8 were 36.5% and 32.3% (p=NS), and with YMRS </=8 and core items </=2 were 53.8% and 45.8% (p=NS). However, a significant difference was observed between patients treated with QTP+Li/DVP versus those treated with PBO+Li/DVP using criteria of YMRS </=12+MADRS </=10 (63.5% versus 49.0%, p<0.05) or YMRS </=12+MADRS </=8 (61.5% versus 46.9%, p<0.05). CONCLUSIONS: At Days 21 and 42, quetiapine combined with Li/DVP compared to Li/DVP monotherapy yielded significant, sustained improvements in the rate of clinical remission/euthymia in patients with bipolar mania. Longer-term studies are warranted to assess whether quetiapine combined with other mood stabilizing medications can yield even longer-term resolution of symptoms of acute mania while concurrently preventing emergence of depressive symptoms
— id: 71874, year: 2007, vol: 100 Suppl 1, page: S55, stat: Journal Article,

Treatment of Attention-Deficit/Hyperactivity Disorder
Weisler, Richard H; Sussman, Norman
2007 ;14(1):39-42 Jan, Primary Psychiatry
Presents an interview, conducted by Norman Sussman, of Dr. Richard Weisler, on the treatment of attention-deficit/hyperactivity disorder (ADHD). Topics covered through the questions and answers include the following: (1) common confounding differential diagnostic issues when determining if a patient has ADHD; (2) advantages to using methylphenidate or amphetamines for the treatment of ADHD; (3) concerns of abuse with stimulant treatment; (4) common side effects of stimulants; (5) effectiveness of the antidepressant bupropion in treating ADHD; (6) other drug treatments for ADHD; and (7) factors concerning the underdiagnosis and undertreatment of ADHD.
— id: 70994, year: 2007, vol: 14, page: 39, stat: Journal Article,

In Session with David A. Lewis, MD: Cognition in Schizophrenia
Lewis, David A; Sussman, Norman
2006 ;13(9):35-37 Sep, Primary Psychiatry
This article presents an interview with Dr. David A. Lewis. Dr. Lewis is director of the Translational Neuroscience Program in the Department of Psychiatry, director of the National Institute of Mental Health Conte Center for the Neuroscience of Mental Disorders, and professor in the Departments of Psychiatry and Neuroscience at the University of Pittsburgh in Pennsylvania. He is also associate director of basic research at the Western Psychiatric Institute and Clinic in Pittsburgh. Dr. Lewis is associate editor of the Encyclopedia of Neuroscience, section editor of Neuroscience, and deputy editor of the American Journal of Psychiatry, and serves on numerous editorial boards. Among his most recent honors, Dr. Lewis received the Bristol-Myers Squibb Foundation Freedom to Discover Grant in Neuroscience, as well as the National Alliance for Research on Schizophrenia and Depression Lieber Prize. (journal abstract)
— id: 71885, year: 2006, vol: 13, page: 35, stat: Journal Article,

Treatment of hepatitis C infection
Stribling, Rise; Sussman, Norman; Vierling, John M
2006 Jun;35(2):463-486, Gastroenterology clinics of North America
HCV infection is one of the leading causes of chronic liver disease worldwide,and it results in cirrhosis, liver failure, and HCC. As a result, hepatitis C cirrhosis has become the principal indication for liver transplantation. Ironically,HCV infection can be cured with available antiviral therapies, but only a minority of infected persons has ever been treated. The current standard of therapy isa combination of PEG-IFNalpha and ribavirin, which produces high rates of SVRs(absence of detectable HCV RNA at least 24 weeks after cessation of therapy):42% to 56% in genotype 1 and 75% to 84% in genotypes 2 and 3. Recent reports indicate that the less frequent genotypes 4, 5, and 6 also are responsive to combination therapy. Recommendations for treatment of conventional and special patient populations were reviewed in detail. Newer therapeutics that are entering clinical trials provide hope that SVRs may be possible in patients who are difficult to treat and in nonresponders to current therapy
— id: 94921, year: 2006, vol: 35, page: 463, stat: Journal Article,

A Form of Collaboration
Sussman, Norman
2006 ;13(6):13-13 Jun, Primary Psychiatry
Over the years I have learned that when repeated interventions seem to fail or be poorly tolerated, it is best to get another opinion from a respected colleague. It is my philosophy that any patient who remains ill after several months of treatment should be sent for another opinion. To reassure the patient, the clinician should clarify that he or she is not being 'dumped' or punished for not getting better. If referral represents an appropriate measure among specialists, it certainly is something that should be routine on the part of primary care physicians (PCPs). Several articles in this issue discuss circumstances where referrals can be used to improve patient outcomes.
— id: 71886, year: 2006, vol: 13, page: 13, stat: Journal Article,

Call for papers
Sussman, Norman
2006 ;13(2):40- Feb, Primary Psychiatry
Presents a call for papers for the Primary Psychiatry journal. Primary Psychiatry is accepting submissions of review articles, case reports, original research articles, treatment algorithms, and educational reviews. Letters to the Editor are also encouraged. Some suggested topics are: psychiatric illnesses in conjunction with medical and physiological illnesses, and the treatment of psychiatric disorders.
— id: 62753, year: 2006, vol: 13, page: 40, stat: Journal Article,

Depression--augmentation or switch after initial SSRI treatment
Sussman, Norman
2006 Jun 15;354(24):2611-2613, New England journal of medicine
— id: 71875, year: 2006, vol: 354, page: 2611, stat: Journal Article,

Drug-Drug Interactions
Sussman, Norman
2006 ;13(4):12-13 Apr, Primary Psychiatry
Unpredictability is the hallmark of psychotropic drugs. Even when used alone, patient response is difficult to predict, both in terms of therapeutic effect and adverse reactions. This uncertainty is magnified when patients are prescribed multiple drugs, whether psychotropic agents or of a different type of medication. Concurrent use of more than one medication complicates treatment because drug interactions are so ubiquitous. Since few prescribers have an encyclopedic knowledge of potential drug-drug interactions (DDIs), most clinicians, like myself, rely on references that list the most important DDIs. Included in this issue is an updated edition of Primary Psychiatry's '2006 Guide to Psychiatric Drug Interactions,' authored by Sheldon H. Preskorn, MD, and David Flockhart, MD, PhD. Considerable time and effort in preparing this educational review has yielded both accurate and clinically useful information. (journal abstract)
— id: 64605, year: 2006, vol: 13, page: 12, stat: Journal Article,

Editor's note: Memory Impairment as an Underrecognized Medication Side Effect
Sussman, Norman
2006 ;13(8):13-14 Aug, Primary Psychiatry
In recent years, I have seen patients who demonstrate wonderful therapeutic response to treatment with medication, yet who complain bitterly of some annoying side effect, such as daytime drowsiness, insomnia, dry mouth, sexual dysfunction, nausea, or tremor. In many cases, their medication needs to be discontinued, even though it provided unmistakable benefit. One side effect that appears to be common and underrecognized is cognitive impairment, most often in the form of recall impairment and word finding, or, as one patient recently reported, 'noun finding' problems. In an extreme example, one patient with ongoing memory impairment was diagnosed with dementia, which rapidly cleared when one of his psychotropics was discontinued. (journal abstract)
— id: 68825, year: 2006, vol: 13, page: 13, stat: Journal Article,

Editor's note: The Impact of Wartime Experiences
Sussman, Norman
2006 ;13(3):12-13 Mar, Primary Psychiatry
Although the diagnosis of posttraumatic stress disorder (PTSD) was only introduced into the official psychiatric nomenclature in 1980, the mental health consequences of traumatic experiences--especially as a result of military combat--have long been recognized. Gail H. Manos, MD, serves as guest editor for this issue of Primary Psychiatry, which focuses on PTSD in combat veterans. Dr. Manos and her associates provide insights into the disorder and make recommendations for management. With uniformed soldiers in Iraq, Afghanistan, and elsewhere, this is a timely subject for all those involved in providing medical care. (journal abstract)
— id: 71887, year: 2006, vol: 13, page: 12, stat: Journal Article,

Evidence-based psychotherapies
Sussman, Norman
2006 ;13(5):13-14 May, Primary Psychiatry
A recent editorial in the American Journal of Psychiatry commented on the difficulties involved in studying the effectiveness of psychotherapy. The authors noted that the need to manualize and standardize the treatment delivered in psychotherapy studies often fails to reflect clinical practice. They also pointed out that the cost and pragmatics of conducting long-term therapy studies makes most treatment trials uncharacteristically brief. Despite these limitations, efforts continue to be made to complete studies that can help confirm or disprove the value of psychotherapy. (journal abstract)
— id: 64603, year: 2006, vol: 13, page: 13, stat: Journal Article,

Good News: Maintenance Treatment of Depression
Sussman, Norman
2006 ;13(11):13-14, Primary Psychiatry
In the past year it has been hard to find encouraging news about psychotropic medications. The general press and news programs contain reports of studies that question the efficacy and safety of many widely prescribed antidepressants and antipsychotics. The result has been a diminution of expectations for these drugs as patients read about suicide risk, or as in the recently published Sequenced Treatment Alternatives to Relieve Depression study, that even after a third course of treatment fewer than 70% of depressed patients went into remission. Psychopharmacology has always drawn considerable hostility from many sources, including Scientologist-funded groups that have a clear agenda, psychotherapists who feel that symptom relief is not as important as insight, and those who philosophically object to use of medications to treat disorders. I think it is timely to point out, however, that considerable, credible research evidence has emerged within the past year that attests to the fact that antidepressants are in fact effective, especially in reducing the risk of relapse or recurrence. (journal abstract)
— id: 69565, year: 2006, vol: 13, page: 13, stat: Journal Article,

In session with Michael H. Stone, MD: Borderline personality disorder
Sussman, Norman
2006 ;13(5):36-39 May, Primary Psychiatry
Dr. Norman Sussman interviewed Dr. Michael H. Stone concerning the etiology, diagnosis, and treatment of bipolar personality disorder. Dr. Stone is professor of clinical psychiatry at Columbia College of Physicians and Surgeons in New York City, and attending psychiatrist at the Mid-Hudson Forensic Psychiatric Hospital in New Hampton, NY. He is on the editorial board of the Journal of Personality Disorders, and is a trustee of the American Academy of Psychoanalysis. A life fellow of the American Psychiatric Association, Dr. Stone is also a member of the American College of Psychiatrists.
— id: 71883, year: 2006, vol: 13, page: 36, stat: Journal Article,

IN session with Philip Seeman, MD, PhD
Sussman, Norman
2006 ;13(2):37-40 Feb, Primary Psychiatry
This document contains an interview with Philip Seeman, MD, PhD. Dr. Seeman is professor in the Departments of Pharmacology and Psychiatry at the University of Toronto, and is a Fellow of the Royal Society of Canada. He is associate editor of Synapse and on the editorial board of Molecular Brain Research. Dr. Seeman has received 25 awards, including the Lieber Award of the National Alliance for Research in Schizophrenia and Depression, the Stanley Dean Award of the American College of Psychiatrists, the first Prix Galien Award in North America, the Pasarow Foundation Award in Neuropsychiatry, and the Canada Council Killam Prize. His work on the membrane actions of drugs led to the discovery of the antipsychotic receptor, now renamed the dopamine D-sub-2 receptor. This research forms an experimental basis for the dopamine hypothesis of schizophrenia.
— id: 62754, year: 2006, vol: 13, page: 37, stat: Journal Article,

Pain Sensitivity as a Variable in Psychiatric Disorders
Sussman, Norman
2006 ;13(10):13-13 Oct, Primary Psychiatry
Pain symptoms represent an area of diagnostic and therapeutic overlap between psychiatry, primary care, and neurology. Some form of pain or physical discomfort prompts most visits to a primary care physician (PCP). Similarly, psychiatric disorders often have a somatic, or physical, dimension to their presentation; however, these may not be the reason a patient seeks help. Among the mental disorders, both mood and anxiety disorders are characterized as much by physiologic disturbances as those involving psychologic or emotional functioning. Examples include dry mouth, palpitations, and weight loss, as well as assorted complaints of headache, gastrointestinal disturbances, and difficulty breathing. (journal abstract)
— id: 70148, year: 2006, vol: 13, page: 13, stat: Journal Article,

Predicting Risk of Depression and Antidepressant Response
Sussman, Norman
2006 ;13(12):17-18 Dec, Primary Psychiatry
Few readers of Primary Psychiatry have much interest in molecular genetic studies involving the promoter region of the serotonin transporter gene (SLC6A4), more commonly abbreviated as 5-HTTLPR. However, as findings more consistently demonstrate involvement of the 5-HTTLPR genotype in the onset of depression following adverse life events, I thought this might be an interesting topic for this month's Editor's Note since it appears that the science behind this research may soon be relevant to clinical practice. (journal abstract)
— id: 71002, year: 2006, vol: 13, page: 17, stat: Journal Article,

Suicidality and Antidepressants: Now What?
Sussman, Norman
2006 ;13(1):13-14 Jan, Primary Psychiatry
The past 2 years have seen bumper crops of Food and Drug Administration (FDA) product safety alerts, better known as warnings, involving antidepressants and related compounds. The FDA mandated a black-box warning be added to all antidepressant product labels. Given the controversy and confusion engendered by this label change, and given the fact that it applied to all antidepressants, the editorial staff of Primary Psychiatry asked several prominent psychiatrists to submit their views on this clinical phenomenon. The intent was to provide our readers with some expert opinions on the implications of these label changes for their treatment decisions. Some authors review the evidence behind the FDA's decision to issue a black-box warning about the risk of suicidality (suicidal thoughts and behavior) in children and adolescents during treatment with antidepressants. In the next article, some authors opine that the revised labeling may improve the selection and monitoring of medication in depressed young people. The authors provide guidelines to enhance the safety of antidepressant use. Also in this issue is a feature article on malingering in the clinical setting. Another unusual psychiatric phenomenon, pseudohallucinations, is discussed in a case report.
— id: 71888, year: 2006, vol: 13, page: 13, stat: Journal Article,

The Next Miracle
Sussman, Norman
2006 ;13(9):13-13 Sep, Primary Psychiatry
A recent headline on the Internet read: 'The Next Miracle Antidepressant: Ketamine!' Along with newspaper wire services, this Web site was reporting on a National Institute of Mental Health study that found that ketamine, which is used clinically as an anesthetic and horse tranquilizer, can produce a rapid and marked relief for depression. In addition, this improvement, which occurs after a single intravenous dose, can last as long as 1 week. The importance of the study is that it points the way to the development of more effective treatments for depression. Ketamine is postulated to produce its antidepressant effects by targeting N-methyl-D-aspartate (NMDA) receptors in the brain. Other drugs currently in use that work on NMDA receptors are lamotrigine, riluzole, memantine, and acamprosate. Over the next few years, it is likely that we will see studies and case reports describing patients with mood disorders and psychiatric conditions who derive benefits from these agents. (journal abstract)
— id: 69016, year: 2006, vol: 13, page: 13, stat: Journal Article,

Understanding STAR*D Findings
Sussman, Norman
2006 ;13(2):12-13 Feb, Primary Psychiatry
Apart from being disabling in their own right, substance abuse and misuse can interfere with efforts to treat most psychiatric disorders. This issue of Primary Psychiatry addresses the topic of 'Office-Based Management of Addiction.' Guest Editor David M. McDowell, MD, and other contributors provide readers with an understanding of this pervasive problem in our society. They also offer practical strategies for management that can be used in the outpatient setting. Just as in the case of outpatient management of substance abuse, guidelines on appropriate pharmacologic interventions for depression remain unclear. Despite fierce competition among marketers of antidepressants, no drug has convincingly demonstrated superiority over any other in terms of response or remission. Common criticisms of existing antidepressant effectiveness studies include the relatively small size of individual trials, the inclusion of patients who are not representative of those seen in clinical practice, and the sponsorship of almost all recent trials by pharmaceutical companies. Thus, physicians hungry for accurate data welcomed the first results of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) antidepressant mega-trial. (journal abstract)
— id: 62760, year: 2006, vol: 13, page: 12, stat: Journal Article,

Body Dysmorphic Disorder: More Common than You Think
Sussman, Norman [Ed]
2006 ;13(7):13-14 Jul, Primary Psychiatry
Notes that in the late 1970s, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) committee developed the diagnostic criteria for factitious and somatoform disorders. Among the somatoform disorders was a new category called dysmorphophobia. The term was conceptualized as a preoccupation with an imagined or exaggerated defect in appearance. Typically, patients believed that non-existent or minor flaws were ruining their lives, and often sought out plastic surgery. It seemed like a rare disorder, unlikely to be seen in clinical practice. Occasionally, articles would appear about patients who were addicted to plastic surgery. But few papers appeared in the psychiatric literature. The name of the disorder was changed to body dysmorphic disorder (BDD) in 1987 in the DSM-III-R. As a field, psychiatry has learned that BDD is both more common and more debilitating than originally suspected. This issue focuses on BDD and provides our readers with clinically focused articles that will help clinicians to recognize and manage patients with the disorder.
— id: 68632, year: 2006, vol: 13, page: 13, stat: Journal Article,

Profiles in psychiatry: Cognitive-Behavioral Therapy
Sussman, Norman [Ed]
2006 ;13(4):31-34 Apr, Primary Psychiatry
This article presents an interview with Dr. Judith S. Beck on her views of cognitive-behavioral therapy (CBT). Dr. Beck is director of the Beck Institute for Cognitive Therapy and Research in Philadelphia and president and distinguished founding fellow of the Academy of Cognitive Therapy. She has also written many books on the subject of cognitive-behavioral therapy. In this article, Dr. Beck explains the history of CBT, how it differs from other therapies, and how CBT should be practiced.
— id: 71884, year: 2006, vol: 13, page: 31, stat: Journal Article,

Glutamate Transporter Genes and Obsessive-Compulsive Disorder
Sussman, Norman; Arnold, Paul Daniel
2006 ;13(10):32-35 Oct, Primary Psychiatry
Presents an interview with Dr. Paul Daniel Arnold, MD, FRCPC on the topics of glutamate transporter genes and obsessive-compulsive disorder (OCD). Dr. Arnold is currently a scientist-track investigator and staff psychiatrist at the Hospital for Sick Children in Toronto, Canada. His research activities focus on the molecular genetics of early-onset obsessive-compulsive disorder (OCD). Dr. Arnold's clinical work involves the assessment and treatment of children with OCD and obsessive-compulsive spectrum disorders.
— id: 70143, year: 2006, vol: 13, page: 32, stat: Journal Article,

Treating Late-Life Depression
Sussman, Norman; Nelson, J. Craig
2006 ;13(12):33-36 Dec, Primary Psychiatry
Presents an interview with J. Craig Nelson on the topic of treating late-life depression. Dr. Nelson is professor of psychiatry, director of geriatric psychiatry and holds the Leon J. Epstein, MD, chair in geriatric psychiatry at the University of California, San Francisco. His research and expertise focus principally on the description and treatment of adult and geriatric depression, as well as the psychopharmacology of antidepressants. Among many accomplishments, Dr. Nelson received the Yale Residents Outstanding Teacher award in 1995 and 2001, and the Distinguished Yale Alumni Award in 2006. He wrote Geriatric Psychopharmacology in 1998. Dr. Nelson was one of the founding members of the American Society of Clinical Psychopharmacology and served as its president from 1999 to 2003.
— id: 71882, year: 2006, vol: 13, page: 33, stat: Journal Article,

Jaundice in a traveler returning from India
Woofter, Aaron; Sussman, Norman
2006 ;8(1):48-48, MedGenMed: Medscape General Medicine
— id: 94920, year: 2006, vol: 8, page: 48, stat: Journal Article,

Kaplan & Sadock's pocket handbook of clinical psychiatry
Sadock, Benjamin J; Sadock, Virgina A; Cancro, Robert; Sussman, Norman; Ahmad, Samoon
Philadelphia PA : Lippincott Williams & Wilkins, 2005,
— id: 908, year: 2005, vol: , page: , stat: ,

Kaplan & Sadock's pocket handbook of psychiatric drug treatment
Sadock, Benjamin J; Sadock, Virginia A; Sussman, Norman
Philadelphia : Lippincott Williams & Wilkins, 2005,
— id: 944, year: 2005, vol: , page: , stat: ,

Prescriber beware
Sussman N
2005 ;12(5):13-14, Primary Psychiatry
— id: 55928, year: 2005, vol: 12, page: 13, stat: Journal Article,

Mania remission rates and euthymia with quetiapine combination therapy
Sussman, N; Mullen, J; Sweitzer, DE
2005 MAR ;20(6):S140-S141, European psychiatry
— id: 56294, year: 2005, vol: 20, page: S140, stat: Journal Article,

"How High Do You Go"?
Sussman, Norman
2005 ;12(4):13-13 Apr, Primary Psychiatry
Argues that questions regarding medications and dosages are very revealing, because they show that astute clinicians recognize that many patients derive additional therapeutic benefits when the dose of their medication is raised above the maximum level recommended in the product information for that drug. The use of high doses has not been systematically studied, may expose the patient to unanticipated risk, and certainly exposes the clinician to medico-legal risk if something untoward occurs. There needs to be a mechanism that provides clinicians with guidance on this issue. The American Psychiatric Association would provide a service to both patients and clinicians by forming a task force of experts to develop guidelines on dosing.
— id: 55773, year: 2005, vol: 12, page: 13, stat: Journal Article,

Anxiety disorders in the clinical setting
Sussman, Norman
2005 ;12(11):12-, Primary Psychiatry
The November and December issues of Primary Psychiatry are devoted to helping our readers better understand current diagnoses and treatments for anxiety disorders, which include generalized anxiety, social anxiety, simple phobia, posttraumatic stress, panic disorder, and obsessive-compulsive disorder. Anxiety disorders often impair functioning and are always distressing. There are serious consequences when anxiety disorders fail to be diagnosed and treated. The trivialization of anxiety disorders is most likely due to the fact that anxiety is a normal emotion. These disorders are also misdiagnosed because the symptom of anxiety occurs in virtually all major psychiatric disorders. I would like to share a few observations based on my experience that might prove helpful in the clinical setting.
— id: 63112, year: 2005, vol: 12, page: 12, stat: Journal Article,

Dealing With Uncertainty
Sussman, Norman
2005 ;12(12):12-12 Dec, Primary Psychiatry
Presents a brief introduction of the current issue by the editor. This article mainly focuses on the article 'Determination of Malingering in Disability Evaluations' by Roger Z. Samuel and Wiley Mittenberg, which covers the topic of clinicians having to deal with the task of determining whether a patient's malingering is simply a part of some dishonest motives, or is a result of a more serious psychological condition such as somatization disorder, hypochondriasis, or conversion disorder. A brief discussion of the uncertainty of understanding the mechanisms of action of psychiatric drugs is also presented.
— id: 71889, year: 2005, vol: 12, page: 12, stat: Journal Article,

Exchange of Clinically Relevant Information
Sussman, Norman
2005 ;12(3):13-13 Mar, Primary Psychiatry
In addition to a comprehensive 'Clinical Focus' section on anxiety disorders, this issue of 'Primary Psychiatry' introduces a new feature: 'Profiles in Psychiatry.' Given the frequently imprecise nature of psychiatric diagnosis and the unpredictability of treatment response, even the most expert clinician is often at a loss about how to manage a complicated case. Based on the recommendations of the journal's editorial board, who submitted the names of leading psychiatrists with established expertise in areas that might be of interest to primary care providers and psychiatrists alike, several distinguished clinician-researchers have been interviewed. The first of these interviews appears in this issue, with Eric Hollander, MD, answering questions about obsessive-compulsive disorder and related conditions. The editors and contributors of 'Primary Psychiatry' constantly strive to provide clinically meaningful unbiased information. Authors are encouraged to be critical of what they perceive to be incorrect or misleading guidance about diagnosis and treatment. It matters to the staff at 'Primary Psychiatry' that the publication is appreciated by its readers, and that they are helping to improve the quality of psychiatric treatment in the community.
— id: 51770, year: 2005, vol: 12, page: 13, stat: Journal Article,

Getting focused
Sussman, Norman
2005 ;12(10):13-13 Oct, Primary Psychiatry
For many patients, medication and psychotherapy fail to adequately treat their psychiatric disorders. The recent interest in brain stimulation as an alternative to existing interventions is an outgrowth of the unmet need of many patients for therapies that address their symptoms and provide both immediate and long-term relief. The clinical focus of this issue is on emerging techniques that do not produce cognitive dysfunction, that extend the therapeutic range to include obsessive-compulsive disorder and movement disorders, and that appear to provide sustained efficacy. This issue also includes a 'Letter to the Editor,' in which Roger Z. Samuel reports two cases of unusual olanzapine-associated side effects in children. Another letter submitted by Karim Sedky and colleagues, addresses the problem of stimulant-induced appetite suppression and reviews some treatment options. A feature article by Kelvin L. Chou and colleagues, discusses Parkinsonian side effects of atypical anti-psychotics in the elderly. This issue also features an interview with Donald Klein one of the key figures in this history of modern psychopharmacology.
— id: 71890, year: 2005, vol: 12, page: 13, stat: Journal Article,

Medical and Psychiatric Disorders Have More in Common Than You Think
Sussman, Norman
2005 ;12(1):13-13 Jan, Primary Psychiatry
Whenever I see distinctions made between psychiatric and medical disorders, it strikes me as being somehow inaccurate or misleading. I understand that there is an existing convention that categorizes depression, mania, and anxiety as being major mental disorders, and hypertension, diabetes, and obstructive pulmonary disease as being in the medical domain. My take on it, however, is that all of these conditions are in fact medical disorders. The January 2005 issue of Primary Psychiatry marks the debut of the first column by James L. Levenson, MD (see record 2005-01478-009), 'Updates in Psychosomatic Medicine and Consultation-Liaison Psychiatry.' The column 'Evidence-Based Psychogeriatrics,' authored by Gary J. Kennedy, MD, (see record 2005-01478-010), is also featured in this issue. Finally, I want to thank Stephen Ross, MD, (see record 2005-01478-011), for serving as guest editor for this issue's Clinical Focus section on Alcohol Use Disorders.
— id: 48895, year: 2005, vol: 12, page: 13, stat: Journal Article,

Much More Work to be Done
Sussman, Norman
2005 ;12(7):13-13 Jul, Primary Psychiatry
Provides a brief introduction to the current issue of Primary Psychiatry (Vol 12[1]). The main focus of this issue is the psychiatric aspects of Parkinson's disease (PD).
— id: 58711, year: 2005, vol: 12, page: 13, stat: Journal Article,

Too Good to Be True
Sussman, Norman
2005 ;12(6):13-13 Jun, Primary Psychiatry
Comments on the article 'Worrisome ailment in medicine: misleading journal articles,' by A.W. Mathews (2005). The article begins with the line, 'Doctors and patients who rely on articles in prestigious medical journals for information about drugs have a problem: the articles don't always tell the full story.' The essence of the Wall Street Journal article-that clinical trials are often manipulated at every stage, extending from study design to statistical analysis and the discussion section of the final report-comes as no surprise to most academic psychiatrists. In fact, most academic psychiatrists have probably been complicit in the kinds of activities cited.
— id: 56328, year: 2005, vol: 12, page: 13, stat: Journal Article,

Why did this happen to me?
Sussman, Norman
2005 ;12(9):11- Sep, Primary Psychiatry
This editorial addresses psychiatric research into the factors that lead to the development of depression during childhood and adolescence and the subsequent perpetuation in adulthood. Genetic predisposition, environmental factors, and events during development all play a role, with genetics probably being the dominant force. Psychiatry continues to unravel the mystery of why mental illness occurs, what changes in the body are associated with psychiatric illness, and most importantly, how these disorders can be prevented or treated.
— id: 62658, year: 2005, vol: 12, page: 11, stat: Journal Article,

Commentary on Treatment-Resistant Depression
Sussman, Norman [Ed]
2005 ;12(2):13-13 Feb, Primary Psychiatry
The guest editor of this issue, David L. Dunner, MD, presents an overview of what is an underrecognized problem in the treatment of mental disorders: depressed patients who are treatment resistant. The articles in this issue provide a thorough and up-to-date review of treatment-resistant depression (TRD). One of the articles address the status of neuroimaging in depressed persons with inadequate treatment response. Another article discusses the absence of available evidence to guide the management of depressed outpatients who do not achieve a satisfactory outcome after one or more treatment effects. Another article describes the current treatment augmentation options and the rationale for their use. One article reviews the role of electroconvulsive therapy (ECT) in TRD. They conclude that these liabilities are present in this population as well.
— id: 51779, year: 2005, vol: 12, page: 13, stat: Journal Article,

Prescribing in the Google Era
Sussman, Norman [Ed]
2005 ;12(8):11-12 Aug, Primary Psychiatry
The Internet has given patients the ability to have the same access to the latest information about medications as physicians. On several recent occasions, patients have learned of both new uses and of potential risks associated with a medication before I have. One of my patients told me about a feature on Google that sends an e-mail when any new information about a chosen subject appears anywhere on the Internet. What impressed me most during the first week of using this new tool is that the Food and Drug Administration has clearly changed the way it does business when it comes to going public about potential safety problems with medications. I am frequently asked how a clinician can remain current in his or her knowledge of psychotropic drugs. The first step is to acquire a solid understanding about the basic risks and benefits of all medications. Once this has been done, the Internet can serve as an easy way to access clinically relevant, current information.
— id: 71891, year: 2005, vol: 12, page: 11, stat: Journal Article,

In Session with Eric Hollander, MD
Sussman, Norman; Hollander, Eric
2005 ;12(3):24-27 Mar, Primary Psychiatry
Presents an interview with Eric Hollander. Hollander is professor of psychiatry; director of the Compulsive, Impulsive, and Anxiety Disorders Program; director of clinical psychopharmacology; and director of the Seaver and New York Autism Center of Excellence at Mount Sinai School of Medicine in New York City. According to Professor Hollander , obsessive-compulsive disorder (OCD) is currently classified as an anxiety disorder and is characterized by obsessional thoughts and/or compulsive rituals that cause distress or interfere with functioning. Obsessions can be thoughts, impulses, or images that cause anxiety and are intrusive. These anxiety-provoking thoughts frequently cause compulsive rituals, which are designed to either neutralize the thoughts or reduce the anxiety. He believes that obsessional thoughts, rituals, and routines are relatively common in the general population. They can be a good thing, because they help to stay organized, think ahead, and seek information. From a survival standpoint, it makes sense that these symptoms persist within the general population, as they may be helpful for the human species. They only become a disorder when they start to become time-consuming, cause distress, or interfere with functioning.
— id: 51764, year: 2005, vol: 12, page: 24, stat: Journal Article,

Modelling in vitro hepatotoxicity using molecular interaction fields and SIMCA
Clark, Robert D; Wolohan, Philippa R N; Hodgkin, Edward E; Kelly, James H; Sussman, Norman L
2004 Jul;22(6):487-497, Journal of molecular graphics & modelling
There is currently a great deal of interest in creating computational tools for predicting the pharmacological properties of drug development candidates, ranging from physicochemical properties such as pK(a) and solubility to more complex biological properties such as oral bioavailability and toxicity. The limiting factor in many cases is a shortage of good data from which to construct training sets. In other cases, large amounts of data are available, but they use surrogate end-points or are comprised of compounds very different from those usually encountered in drug discovery and development. In such cases large training sets and global models are not necessarily better than local models based on smaller data sets. Such considerations make it as important to examine the available data carefully so as to avoid over-interpretation of the models obtained as it is to minimise errors in prediction per se. The kinds of complications likely to be encountered for in vitro hepatotoxicity modelling are discussed in general terms and illustrated in particular by SIMCA analysis of data obtained from assays of cultured hepatocytes for a large, structurally diverse data set and a smaller, much more focussed one
— id: 94922, year: 2004, vol: 22, page: 487, stat: Journal Article,

Mania remission rates and euthymia with quetiapine combination therapy
Sussman, N; Mullen, J; Sweitzer, DE
2004 JUN ;7(3):S158-S158, International journal of neuropsychopharmacology
— id: 50485, year: 2004, vol: 7, page: S158, stat: Journal Article,

Atypical neuroleptics: The changing landscape
Sussman, Norman
2004 ;11(8):12-18 Aug, Primary Psychiatry
Conventional antipsychotic medications, such as haloperidol and chlorpromazine, are hardly prescribed anymore, even by psychiatrists. The so-called atypical neuroleptics, such as olanzapine, risperidone, ziprasidone, aripiprazole, and quetiapine, have taken their place. In fact, the increasing use of atypical neuroleptics in the primary care setting is one of the most significant trends in psychopharmacology today. For some of these atypicals, more than a third of prescriptions come from nonpsychiatrists. This is the result of evidence for new uses for these medications. Originally developed and approved by the Food and Drug Administration as treatments for schizophrenia, clinical experience and controlled trials have shown that atypical neuroleptics possess multiple clinical properties. This is most evident in the treatment of mood disorders. These medications have, in essence, become broad-spectrum psychotropic agents. For prescribers who still think of drugs in categorical terms the expanding spectrum of uses for the atypical antipsychotics creates a conceptual dilemma. The possibility of inappropriate drug selection or overlooked side effects is the fact that many primary care physicians (PCP) get their information about medications almost exclusively from pharmaceutical sales and marketing activity. Thus, prescribing atypical neuroleptics is far from simple.
— id: 46379, year: 2004, vol: 11, page: 12, stat: Journal Article,

Borderline Personality and Bipolar Disorders: Is There a Connection?
Sussman, Norman
2004 ;11(10):13-13 Oct, Primary Psychiatry
The October issue of 'Primary Psychiatry' contains the concluding articles to the two-part 'Clinical Focus' series on bipolar spectrum disorders and comorbidity. In reading one of the articles on borderline personality disorder (BPD), I was reminded of the fact postulated by our guest editor, that BPD had become part of the bipolar spectrum. Patients with BPD exhibit frequent anger, impulsivity, and stormy interpersonal relationships. BPD is also characterized by mood instability- among other symptoms-and can be difficult to diagnose because of the overlap of its symptoms with mood disorders. At the very least, BPD may be mistaken for major depression or bipolar disorder. The possibility that BPD may represent a form of bipolar disorder influences my decisions when formulating a treatment plan. Some real benefits for both the patient and myself include the fact that I approach the disorder as being within the domain of conditions that have proven, effective treatments. Otherwise, when the diagnosis 'personality disorder' is made, it often carries a negative judgmental quality, which is reflected in the disparaging term 'character pathology.'
— id: 47211, year: 2004, vol: 11, page: 13, stat: Journal Article,

Bridging Psychiatric and Medical Disorders
Sussman, Norman
2004 ;11(4):11-11 Apr, Primary Psychiatry
This issue of 'Primary Psychiatry' focuses on the diagnosis and treatment of children and on interventions that differ from commonly prescribed antidepressants. The articles represent topics that bridge psychiatric and physical disorders, and thus fall into the broadly conceptualized domain of comorbidities. Natan Gadoth, (see record 2004-95123-011) one of the world's leading authorities on Kleine-Levin Syndrome, provides our readers with an up-to-date review of what is known about the disorder. The strongest evidence of an autoimmune basis for a psychiatric disorder is discussed by Swedo and Grant (see record 2004-95123-012). Linda D. Leary and Maltha J. Morrell (see record 2004-95123-014) provide a timely update on the use of new antiepileptic drugs in children. Finally, a case report of effective treatment of patient with schizoaffective disorder and polysubstance abuse by Charles A. Cahill (see record 2004-95123-015) serves to remind readers of the importance of compliance in treatment success.
— id: 46404, year: 2004, vol: 11, page: 11, stat: Journal Article,

Current conceptualization of bipolar disorder
Sussman, Norman
2004 ;11(9):13-13 Sep, Primary Psychiatry
The editorial discusses the current conceptualization of bipolar disorder. Few primary care physicians (PCPs) may recognize the name Hagop S. Akiskal, MD, who first observed that classic bipolar I disorder is very different than bipolar II disorder. He further characterized bipolar illness as a spectrum of disorders, each with complex clinical features, epidemiology, comorbid patterns. Next month's issue of PrimaryPsychiatry will contain three additional 'Clinical Focus' articles on bipolarity and comorbidity written by authors invited by Dr. Akiskal. Although they are unrelated to Dr. Akiskal's section on the bipolar spectrum, the importance of scientific validity in managing bipolar disorder is touched upon in two additional articles in this issue. In an 'Educational Review,' James C-Y. Chou, (see record 2004-19757-017) researcher and lecturer, critically examines the American 'Psychiatric Association's 'Practice Guideline for Treatment of Patients with Bipolar Disorder.' Published in 2002, the guideline summarizes available research evidence and expert opinion. In the 'Featured Articles' section, Tanya R. Anderson (see record 2004-19757-014) and colleagues emphasize the importance of recognizing the potential for and need to closely consider the side effect profile of medications used to treat patients with bipolar disorders.
— id: 46877, year: 2004, vol: 11, page: 13, stat: Journal Article,

Fundamental principles of pharmacology and management
Sussman, Norman
2004 ;11(2):10-10 Feb, Primary Psychiatry
This review offers extensive discussions of the underlying physiology and pharmacology behind drug interactions, as well as resources for additional information on the subject. The Clinical Focus articles in this issue of Primary Psychiatry address the topics of neuroleptic malignant syndrome (NMS), depression and cardiovascular disease, and depression among the elderly. R. Christensen, (see record 2004-12488-007) reviews one of the few life-threatening side effect associated with psychotropic drugs: NMS. S. H. Chin and R. Balon (see record 2004-12488-008) describe the case of a 46-year-old man who developed depression soon after the onset of an acute coronary event. M. Mathews (see record 2004-12488-009) and colleagues provide useful geriatric depression rating scales and an overview of treatment options. It is also worth mentioning that older patients are at the most risk for experiencing untoward, serious consequences of drug-drug interactions.
— id: 46402, year: 2004, vol: 11, page: 10, stat: Journal Article,

Recognizing the Limitations of Extant Knowledge
Sussman, Norman
2004 ;11(12):13-13 Dec, Primary Psychiatry
This issue of 'Primary Psychiatry,' guest edited by Susan G. Kornstein, and Uriel Halbreich is devoted to women's mental health, specifically premenstrual syndrome and premenstrual dysphoric disorder. Also included is a timely review of the epidemiology, etiology, assessment, and treatment of erectile dysfunction, by Robert Taylor Segraves. Not long ago, there were few good options for the treatment of erectile dysfunction, none of them pharmacologic. However, sildenafil, introduced in 1998, and subsequently vardenafil (2003) and tadalafil (2003), not only have proven to be remarkably effective medications for many men, but have entered popular culture as a subject of conversation. The safety and ease of administration of these new treatments permits them to be prescribed by psychiatrists. Regardless of specialty, all physicians can use Segraves' article (see record 2005-00027-015) as a concise source of clinically useful information.
— id: 48066, year: 2004, vol: 11, page: 13, stat: Journal Article,

The "file-drawer" effect: Assessing efficacy and safety of antidepressants
Sussman, Norman
2004 ;11(7):12-12 Jul, Primary Psychiatry
Stemming from the discussion of antidepressant treatment studies in children, and perhaps of more lasting importance, has been the growing awareness that all the evidence from clinical trials in all therapeutic areas is not routinely made available to prescribing physicians. The journal 'Primary Psychiatry' rarely publishes clinical trial results. The reason being that these studies can give a false picture of available research findings. Instead it focuses on review articles by researchers or clinicians that reflect the broader literature or real-world experience. Of course, even prestigious experts may disagree on how evidence should be interpreted and how it should be translated into actual patient care. Thus, greater access to study results will allow a serious debate to take place. With more information available, clinicians can acquire a solid knowledge of how to read and understand study design and analysis. Many articles and columns over the past two years in 'Primary Psychiatry' have addressed topics that enhance understanding of research findings.
— id: 71892, year: 2004, vol: 11, page: 12, stat: Journal Article,

The Full Disclosure Era
Sussman, Norman
2004 ;11(11):13-13, Primary Psychiatry
The author finds it amazing the certainty with which many physicians explain why they use one psychotropic drug over another as a first-line agent. They differentiate drugs on the basis of questionable evidence with conclusions that are not a result of clinical observation, a broad range of experience with available agents, or a critical reading of research papers. The most egregious information loophole-the selective disclosure of clinical trial results-will soon be closing. He addresses one problem that may not be addressed in this new full disclosure era as being the misuse of scientific posters. Posters represent a synopsis of the study, usually containing preliminary findings. By virtue of their 'bare bones' content, posters often omit crucial information and rarely allow a viewer to form conclusions about the quality of the study or the validity of its findings. Posters are also used as de facto study multipliers.
— id: 47589, year: 2004, vol: 11, page: 13, stat: Journal Article,

Toward an effective predictor of treatment response
Sussman, Norman
2004 ;11(6):12-12 Jun, Primary Psychiatry
Presents an introduction to this issue of the journal. This issue focuses on a long standing and most productive aspect of research into the mechanisms of action of psychotropic drugs, the long-term impact of medications on brain structure and function, and the underlying pathophysiology of mental disorders. From the very beginning, psychopharmacology has been limited by the unpredictability of response to medications. While a clinician can select a medication based on its effectiveness for a specific disorder, there is no way to predict whether a patient will respond to that medication. Over the years, theories have emerged that suggested it was possible to select a drug based on a biological marker. There was also discussion of depression-type (D-type) scores that not only were supposed to help predict preferential response, but also to distinguish between bipolar and unipolar depression. presented in this issue represents an area of investigation that will eventually yield clinically useful insights into both the causes of depression and the basis of antidepressant activity.
— id: 46363, year: 2004, vol: 11, page: 12, stat: Journal Article,

Treating the Growing Population of Older Patients
Sussman, Norman
2004 ;11(5):12-12 May, Primary Psychiatry
The 'Clinical Focus' section of this issue is devoted to geriatric depression. This topic becomes of greater importance to a larger portion of the population as the population ages. Linda H. Harpole and John W. Williams Jr. (see record 2004-15308-006) provide a broad overview of the assessment and management of depression in older adults. Jordan F. Karp and Charles F. Reynolds (see record 2004-15308-007) discuss the use of medication to treat depression in the elderly. In the next article, Patricia A. Arean (see record 2004-15308-008) reviews psychotherapy as an 'effective, evidence-based intervention for late-life depression.' She notes that only two forms of therapy are currently considered evidence based: cognitive-behavioral therapy and interpersonal therapy. Christopher F. Murphy and George S. Alexopoulos (see record 2004-15308-009) continue the discussion of cognition and late-life depression in the last 'Clinical Focus' article in this issue.
— id: 46364, year: 2004, vol: 11, page: 12, stat: Journal Article,

Weighing Treatment Risks and Benefits
Sussman, Norman
2004 ;11(1):14-14 Jan, Primary Psychiatry
This month's issue of 'Primary Psychiatry' focuses on geriatric psychiatry, a field where understanding the risks and benefits of prescribing psychotropics plays a particularly important role. In the case of older adults, knowing and appreciating the safety issues behind a medication is considerable, since changes that occur with aging may affect treatment and management of psychiatric disorders. From a physician's standpoint, safety might play a more important role in drug selection. Minimizing the risk (ie, the possibility of suffering harm or loss, or choosing a course of action involving uncertain danger) associated with a particular medication is a key aspect of safely prescribing psychotropics. Thus, as a rule, the presence of a warning or caution deters use of a medication as a first-line agent. Despite a clean side-effect profile, even drugs with one or two possible adverse events, such as seizure, cardiac conduction effects, Stevens-Johnson syndrome, diabetes, liver failure, or pancreatic failure, can alter clinicians' comfort levels and affect prescription writing.
— id: 46424, year: 2004, vol: 11, page: 14, stat: Journal Article,

Applying neuropharmacy when treating patients with depression
Ashton, Adam Keller; D'Mello, Dale A; Dantz, Bezalel; Hefner, Jaye; Leon, F George; Matson, Gary A; Montano, C Brendan; Pradko, James F; Sussman, Norman; Winsberg, Bertrand
2003 Dec;Suppl:S34-S39, Journal of family practice
— id: 71878, year: 2003, vol: Suppl, page: S34, stat: Journal Article,

Treatment regimens for managing depression in family practice
Ashton, Adam Keller; D'Mello, Dale A; Dantz, Bezalel; Hefner, Jaye; Leon, F George; Matson, Gary A; Montano, C Brendan; Pradko, James F; Sussman, Norman; Winsberg, Bertrand
2003 Dec;Suppl:S48-S60, Journal of family practice
— id: 71877, year: 2003, vol: Suppl, page: S48, stat: Journal Article,

The scope of the problem: physical symptoms of depression
Dantz, Bezalel; Ashton, Adam Keller; D'Mello, Dale A; Hefner, Jaye; Leon, F George; Matson, Gary A; Montano, C Brendan; Pradko, James F; Sussman, Norman; Winsberg, Bertrand
2003 Dec;Suppl:S6-S8, Journal of family practice
— id: 71880, year: 2003, vol: Suppl, page: S6, stat: Journal Article,

Response to treatment: gaining and maintaining remission from depression
Hefner, Jaye; Ashton, Adam Keller; D'Mello, Dale A; Dantz, Bezalel; Leon, F George; Matson, Gary A; Montano, C Brendan; Pradko, James F; Sussman, Norman; Winsberg, Bertrand
2003 Dec;Suppl:S61-S62, Journal of family practice
— id: 71876, year: 2003, vol: Suppl, page: S61, stat: Journal Article,

Depression and comorbid medical illness: therapeutic and diagnostic challenges
Leon, F George; Ashton, Adam Keller; D'Mello, Dale A; Dantz, Bezalel; Hefner, Jaye; Matson, Gary A; Montano, C Brendan; Pradko, James F; Sussman, Norman; Winsberg, Bertrand
2003 Dec;Suppl:S19-S33, Journal of family practice
— id: 71879, year: 2003, vol: Suppl, page: S19, stat: Journal Article,

From paper to patient: how do you translate science into clinical practice?
Matson, Gary A; Ashton, Adam Keller; D'Mello, Dale A; Dantz, Bezalel; Hefner, Jaye; Leon, F George; Montano, C Brendan; Pradko, James F; Sussman, Norman; Winsberg, Bertrand
2003 Dec;Suppl:S40-S47, Journal of family practice
— id: 94923, year: 2003, vol: Suppl, page: S40, stat: Journal Article,

A 4-step program for the diagnosis and management of depression
Montano, C Brendan; Ashton, Adam Keller; D'Mello, Dale A; Dantz, Bezalel; Hefner, Jaye; Leon, F George; Matson, Gary A; Pradko, James F; Sussman, Norman; Winsberg, Bertrand
2003 Dec;Suppl:S9-18, Journal of family practice
— id: 94924, year: 2003, vol: Suppl, page: S9, stat: Journal Article,

A Continually Evolving Field of Medicine
Sussman, Norman
2003 ;10(7):14-15 Jul, Primary Psychiatry
Failure to consider the true profiles of available drugs reduces the probability of a successful treatment outcome. It is essential that prescribing physicians remain current in their knowledge of psychopharmacology as it is a rapidly and continually evolving field of medicine. This demands ongoing commitment to following the emerging literature about the selection and use not only of psychotropic agents but of drugs used to treat nonpsychiatric disorders which may also aid in the treatment of mental illness or mitigate side effects of psychotropic drugs. In keeping with a pattern that has been seen in recent years, new agents are being developed and marketed. In addition to knowing about the profiles of new agents, clinicians should recognize that they are getting better at anticipating which patients are more likely to have therapeutic responses to specific drugs, and what types of problems are likely to emerge. As a rule, dosing of psychotropic drugs is not a major safety consideration. Optimal dose ranges for new drugs are determined during clinical trials.
— id: 46409, year: 2003, vol: 10, page: 14, stat: Journal Article,

A wealth of new information
Sussman, Norman
2003 ;10(6):11-11 Jun, Primary Psychiatry
Introduces the special issue on the diagnosis and treatment of eating disorders over the life cycle.
— id: 46432, year: 2003, vol: 10, page: 11, stat: Journal Article,

Counteracting Metabolic Side Effects
Sussman, Norman
2003 ;10(11):14-14, Primary Psychiatry
The article throws light on the usage of antiepileptic drugs (AEDs) in the treatment of psychiatric disorders and counteracting the metabolic side effects of psychotropics. Recently Food and Drug Administration (FDA) announcement that a new label citing 'possibility of an increased risk of diabetes,' will be required for all AEDs and atypical antipsychotics. The label is being enforced to make prescribers and patients more aware of the tendency of these classes of drugs to produce increases in blood sugar. The FDA action is due to emerging evidence that schizophrenic patients are at increased risk for developing diabetes. However, as the FDA acknowledges, it is unclear whether the individual drugs differ in their potential for unmasking or inducing clinical diabetes or ketoacidosis. The encouragement of closer scrutiny is a positive development as most primary care physicians have been unaware of the controversy surrounding the issue of diabetes and pharmacologic treatment. Closer observation might also prove helpful in determining the magnitude of glucose dysregulation as a problem in clinical practice and in clarifying whether weight gain and diabetes is truly a class effect, or whether each drug carries a differential risk. To most clinicians, this article will represent an accurate and concise resource for optimal drug selection and use.
— id: 46425, year: 2003, vol: 10, page: 14, stat: Journal Article,

Helping us to help you better
Sussman, Norman
2003 ;10(5):13-13 May, Primary Psychiatry
The article gives an introduction to the present issue of the journal Primary Psychiatry and also reflects on the complexity of the treatment of psychological disorders. Despite efforts to simplify diagnosis and treatment, the clinical management of depression, bipolar disorder, attention deficit/hyperactivity disorder, schizophrenia, and other common disorders remains complex. Clinical presentation of disorders can be confusing, especially when there are comorbid disorders, and there is still no way to predict with certainty how well a given intervention will affect an individual patient. An example of the complexity of psychiatric treatment is the diversity not only of psychopharmacology agents available, but also the types of psychotherapy used. In this issue of Primary Psychiatry, Dean Schuyler serves as guest editor for a series of articles on cognitive therapy. Dr. Schuyler and the authors featured in this issue provide a useful introduction for those unfamiliar with cognitive-behavioral approaches to psychiatric treatment. Because the journal already has the largest circulation of any psychiatric publication, it has the responsibility and potential for promoting the need for timely information.
— id: 46371, year: 2003, vol: 10, page: 13, stat: Journal Article,

Misuse of 'Evidence': An Open Secret
Sussman, Norman
2003 ;10(9):14-14 Sep, Primary Psychiatry
The main problem with exclusive reliance on randomized-controlled trials as evidence is the selective publication of study findings. It is an open secret that negative or failed studies rarely make it into journals or become presented as posters. It is not uncommon for there to be a positive published trial of a psychotropic, with another four, six, or eight unpublished studies that fail to demonstrate a therapeutic effect greater than that seen with a placebo. The existence of these so-called file-drawer studies makes any meaningful analysis of the data impossible. It is understandable that sponsors of trials would not want to make public results that do not support positive perceptions of their compound. Clinicians would be well-served to be familiar with the full existing body of research data on any treatment they prescribe. Ideally, they should also be able to understand the design and statistical terms and concepts used in research. Listed in the accompanying table in this article are some of these terms and concepts which you may or may not be familiar with.
— id: 46407, year: 2003, vol: 10, page: 14, stat: Journal Article,

Obsessive-Compulsive Disorder: A Commonly Missed Diagnosis in Primary Care
Sussman, Norman
2003 ;10(12):14-14 Dec, Primary Psychiatry
The article presents information on the obsessive compulsive disorder (OCD). Primary care physicians need to understand that there are many instances in which Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria do not reflect current expert conceptualizations of OCD, and other psychiatric disorders. OCD is an anxiety disorder characterized by complaints of persistent or repetitive thoughts (obsessions) or behaviors (compulsions). OCD patients feel compelled to continue even while recognizing that the thoughts or behaviors may be excessive or inappropriate. He or she typically experiences significant distress if somehow unable or prevented from engaging in the obsessive or compulsive thoughts or acts. Physicians should screen for OCD as part of every new patient evaluation. Selective serotonin reuptake inhibitors and clomipramine represent the comerstones of intervention; however, even well-chosen-treatments may not work, or may take months to show clear-cut results. In many cases, augmentation with a variety of agents, including atypical antipsychotics, stimulants, and clonidine, are necessary to reduce manifestations of OCD.
— id: 46439, year: 2003, vol: 10, page: 14, stat: Journal Article,

Our primary goal
Sussman, Norman
2003 ;10(2):12-12 Feb, Primary Psychiatry
This journal's most important consideration is to provide clinically useful information to primary care physicians and psychiatrists. An example of a clinical issue unique to women is that of premenstrual syndromes, which are discussed in this issue's article by Linda S. Kahn and Uriel Halbreich (see record 2004-12632-009). In an interesting article on health management, David C. Hellerstein and Gregory B. Biedermann (see record 2004-12632-011) discussed how united States Drug Enforcement Agency scheduling restrictions have influenced physician prescribing habits. As Alison M. Kerr (see record 2004-12632-012) points out in her article regarding the role of the physician in treating individuals with Rett Syndrome, ongoing research provides 'fresh insights to understanding the brain.' Dawna Duncan Armstrong (see record 2004-12632-013) elucidates the underlying neuropathology of Rett Syndrome and other disorders involving genetic abnormalities. Lastly, Michael S. Salman (see record 2004-12632-014)presents an article on facial paralysis and Bell's palsy in children.
— id: 46415, year: 2003, vol: 10, page: 12, stat: Journal Article,

The future of psychiatry, primary care, and OB/GYN
Sussman, Norman
2003 ;10(4):11-11 Apr, Primary Psychiatry
I would like to thank Harlan R. Gephart, for serving as guest editor for the articles in this issue on 'Attention-Deficit/Hyperactivity Disorder: Diagnosis and Treatment Through Adulthood.' Dr. Gephart's guest editor's (see record 2004-12636-009) note provides a nice introduction to the topic, giving me the opportunity to use this space to acknowledge the new members of the 'Primary Psychiatry,' Editorial Advisory Board and address additional contributions to the journal. Our new members serve to broaden the range of medical specialties represented, including psychiatry, primary care, and obstetrics and gynecology. They will not only bring their expertise to the process of selecting topics for future issues, but also for selecting contributors. In addition to the new board members, I would like to point readers to this month's new columns. The article by Donald S. Robinson, (see record 2004-12636-012) discusses how features of Food and Drug Administration-sanctioned studies influence trial design and analysis. The article by Anita H. Clayton, (see record 2004-12636-010) discusses depressive disorders in women. She reviews biological differences, psychosocial and behavioral factors, age-related considerations, and racial/ethnic characteristics that distinguish the diagnostic and treatment differences between men and women.
— id: 46389, year: 2003, vol: 10, page: 11, stat: Journal Article,

The implications of weight changes with antipsychotic treatment
Sussman, Norman
2003 Jun;23(3 Suppl 1):S21-S26, Journal of clinical psychopharmacology
Patients receiving treatment with atypical antipsychotics commonly experience weight gain, which can cause considerable distress and can have deleterious effects on cardiovascular health. Because of the associated weight gain and potential direct effects on glucose metabolism, atypical antipsychotics have also been linked to the development of type II diabetes mellitus. Data on long-term treatment with these agents show that clozapine and olanzapine, followed by risperidone, were associated with the greatest degree of weight gain. A large body of data suggests that during long-term treatment, patients receiving the atypical antipsychotic quetiapine experience minimal weight gain. Data also suggest that quetiapine treatment does not increase the risk of developing type II diabetes. The use of atypical antipsychotics is increasing, as these agents are being prescribed for schizophrenia in lieu of conventional antipsychotics. Furthermore, these drugs have efficacy for treating other conditions such as bipolar disorder. Physicians prescribing atypical antipsychotics must be aware of the risk of weight gain and its associated comorbidities
— id: 39171, year: 2003, vol: 23, page: S21, stat: Journal Article,

The Origin and Impact of Stress
Sussman, Norman
2003 ;10(8):14-15 Aug, Primary Psychiatry
The author notes that the focus of this issue of 'Primary Psychiatry' is on posttraumatic stress disorder (PTSD), and Gail Manos (see record 2004-12641-004) has provided an excellent guest editor's note on the topic. The author reminisce about some of major contributions to the conceptualization of stress as a pathogen. In addition, he reviews some of the emerging research into novel treatments related to the regulatory systems that may mediate the expression of stress-associated psychiatric symptoms and disorders.
— id: 46382, year: 2003, vol: 10, page: 14, stat: Journal Article,

The voice of clinical psychiatric medicine
Sussman, Norman
2003 ;10(1):13-14 Jan, Primary Psychiatry
The January 2003 issue of 'Primary Psychiatry' marks its 10th year of continuous publication. Based on comments from colleagues, this journal has become regarded as a reliable source of unbiased and clinically useful information for psychiatrists and primary care physicians. We are attempting to synthesize information derived from the clinical and research sides in order to provide our readers with a perspective that reflects clinical reality. In addition, considerable mistrust surrounds the use of psychotropic drugs. By providing sound information, we hope that the content provided in this issue helps to correct misconceptions that lead to some of this antipathy. Throughout 2003, this issue will focus on such topics as attention deficit with hyperactivity disorder, geriatric psychopharmacology, eating disorders, psychotropic drug interactions, and the psychology of addiction. We will also introduce new columns on women's mental health, psychogeriatrics, and clinical research methods.
— id: 46422, year: 2003, vol: 10, page: 13, stat: Journal Article,

When Conventional Approaches Fail
Sussman, Norman
2003 ;10(10):14-15 Oct, Primary Psychiatry
The article gives an introduction to the articles included in the October, 2003 issue of the journal 'Primary Psychiatry'. William P. Carter and Lindsay J. Pindyck (see record 2004-12643-004) notes that while many drugs offer some benefit to some patients, topiramate and zonisamide have shown particular promise in the treatment of binge-eating disorder. Next, Jeffrey L. Berlant (see record 2004-12643-005) presents a review of the role of antiepileptic drugs (AEDs) in the treatment of Posttraumatic Stress Disorder (PTSD). He describes the brain fear circuitry and neurology of PTSD and discusses how the mechanisms of AED action may relate to potential targets of intervention in treatment of PTSD. Jonathan E. Shaywitz and Michael R. Liebowitz (see record 2004-12643-006) discuss AED treatment of generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder. In the next article Myrick et al. (see record 2004-12643-007) discuss the increased understanding of the use of AEDs in the treatment of addictive disorders. The association between migraine and psychiatric disorders is discussed in an article by Stephen D. Silberstein (see record 2004-12643-008). In the last article, Erasamo A. Passaro (see record 2004-12643-009) reviews the relationship between psychiatric disorders and epilepsy.
— id: 46405, year: 2003, vol: 10, page: 14, stat: Journal Article,

The value of intervention
Sussman, Norman (Ed)
2003 ;10(3):11-11 Mar, Primary Psychiatry
The article gives an introduction to the papers included in the present issue of 'Primary Psychiatry'. Among the potential benefits of recent breakthroughs in the understanding of genetics and genomics, none carry more importance than improved treatment and possibly even prevention of diseases before they present clinical signs and symptoms. The present issue offers a review of the current status of research into the genetics and genomics of schizophrenia. Tsuang and colleagues (see record 2004-12635-009) note that it is now generally accepted that susceptibility to schizophrenia is genetically determined. By establishing a genetic risk profile, early intervention may attenuate the symptoms that emerge in 'high risk' children. John Norton (see record 2004-12635-010) reports on antidepressant withdrawal associated with fluoxetine. David Marcotte (see record 2004-12635-013) presents an original article on a chart review of nearly 300 patients with a diagnosis of bipolar disorder or cyclothymia who were treated with topiramate long-term. Finally, P. Waverly Davidson (see record 2004-12635-014) provides original research on patients who present to an emergency room with complaints of pain.
— id: 46396, year: 2003, vol: 10, page: 11, stat: Journal Article,

Chronic Marijuana Use and the Treatment of Mentally Ill Patients
Sussman, Norman; Westreich, Laurence
2003 ;10(9):73-76 Sep, Primary Psychiatry
(from the journal abstract) Knowledge that a patient with a psychiatric disorder is a chronic marijuana smoker presents the clinician with a dilemma: should the patient be treated even with ongoing use of marijuana or should the patient be advised to stop smoking? Although these decisions are made on a case-by-case basis, it would be helpful if some basic guidelines could be developed for treatment decisions in these cases. This article reviews some of the findings from recent research and combines it with the clinical experience of the authors in order to provide some help in understanding the difficulties patients have in discontinuing marijuana and of the ways in which continued use may complicate efforts to treat the underlying psychiatric disorder.
— id: 46406, year: 2003, vol: 10, page: 73, stat: Journal Article,

Six-year perspectives on the safety and tolerability of nefazodone
Dunner, David L; Laird, Lyle K; Zajecka, John; Bailey, LaGenia; Sussman, Norman; Seabolt, Julia L
2002 ;63 Suppl 1:32-41, Journal of clinical psychiatry
— id: 71881, year: 2002, vol: 63 Suppl 1, page: 32, stat: Journal Article,

Choosing an atypical antipsychotic
Sussman, Norman
2002 Aug;17 Suppl 3(1):S29-S33, International clinical psychopharmacology
The atypical antipsychotics vary in terms of their pharmacological profiles, particularly in relation to their tolerability, effects on safety parameters and patient acceptability. Olanzapine, risperidone and ziprasidone are associated with extrapyramidal symptoms (EPS) in a dose-dependent manner, whereas quetiapine has been shown to produce a significantly lower incidence of substantial EPS effects than haloperidol, and less EPS requiring treatment than risperidone. Similarly, unlike risperidone and haloperidol, quetiapine treatment has been associated with a significant reduction in serum prolactin levels, and has normalized raised prolactin levels after discontinuation of previous treatment. Weight gain is also one of the major unwanted adverse effects of treatment with many antipsychotic drugs but, in contrast, quetiapine has demonstrated a neutral or 'normalizing' effect on body weight. In comparison with other antipsychotics, quetiapine has been shown to possess a favourable safety profile, with no requirement for routine blood, thyroid, or liver monitoring during treatment. Overall, quetiapine therapy has produced high levels of patient satisfaction and compliance and this, coupled with its efficacy in reducing psychoses of various origins, has made it an attractive treatment option in both patients at increased risk of EPS, and the general population
— id: 39317, year: 2002, vol: 17 Suppl 3, page: S29, stat: Journal Article,

Effects of nefazodone on body weight
Sussman, Norman; Seabolt, Julia L
2002 ;63(Suppl1):38-41, Journal of clinical psychiatry
Discusses anecdotal evidence suggesting a relationship between weight gain and selective serotonin reuptake inhibitor therapy and compares these effects with nefazodone. Effects of nefazodone on body weight are discussed. Conclusions suggest nefazodone has minimal effects of body weight in patients receiving the drug for acute or long-term treatment of major depression.
— id: 27285, year: 2002, vol: 63, page: 38, stat: Journal Article,

Gabapentin as prophylaxis against steroid-induced mania
Ginsberg, D L; Sussman, N
2001 Jun;46(5):455-456, Canadian journal of psychiatry
— id: 139593, year: 2001, vol: 46, page: 455, stat: Journal Article,

Review of atypical antipsychotics and weight gain
Sussman N
2001 ;62 Suppl 23(1):5-12, Journal of clinical psychiatry
Prescribing an antipsychotic for a patient with schizophrenia requires a risk-benefit analysis. Weight gain has become an issue recently as a result of reports that 2 of the atypical antipsychotic agents, clozapine and olanzapine, are associated with a higher risk than other drugs of causing excessive weight gain. Some degree of weight gain may occur with any atypical antipsychotic agent, particularly early in treatment. A more important consideration is the long-term effects of the atypical antipsychotic on body weight, since many of the patients in this population require chronic therapy. This is important because weight gain is an adverse effect that is associated with noncompliance and medical problems. In this article, I review recent reports about the weight effects of different atypical antipsychotic drugs. To provide accurate understanding of the effects of atypical antipsychotic agents, data analyses should include both short-term and long-term findings, the relationship of changes in body weight to pretreatment body mass index (BMI), relationship to dose, both intent-to-treat and complete analyses, and presentation of both mean and median changes in weight. It is also important to know whether the studies have been done in an inpatient or outpatient setting, since patients who are institutionalized may be less likely to exhibit increases in body weight. Such complete information and multidimensional analysis would minimize obfuscation about the true nature of a drug's impact on body weight
— id: 26638, year: 2001, vol: 62 Suppl 23, page: 5, stat: Journal Article,

Effects of nefazodone on body weight: a pooled analysis of selective serotonin reuptake inhibitor- and imipramine-controlled trials
Sussman N; Ginsberg DL; Bikoff J
2001 Apr;62(4):256-260, Journal of clinical psychiatry
BACKGROUND: Evidence suggests that the newer antidepressant drugs may differ with respect to their effects on body weight, especially during long-term treatment. However, the published data about treatment-emergent weight change with the newer antidepressants are limited. Most reports of unexpected selective serotonin reuptake inhibitor (SSRI)-associated weight gain are anecdotal or from small controlled trials. To determine if differences exist among the newer antidepressants, the authors retrospectively analyzed data from clinical trials comparing nefazodone with SSRIs and with imipramine. METHOD: Weight change data supplied by Bristol-Myers Squibb from 6 completed clinical trials comparing the antidepressant nefazodone (N = 523) with 3 SSRIs, fluoxetine, sertraline, and paroxetine (N = 513), as well as 3 trials comparing nefazodone (N = 225) with the tricyclic antidepressant imipramine (N = 224) were analyzed. In all studies, nefazodone was found to be equal in efficacy to the comparator antidepressants. Studies that included both acute and long-term treatment phases were included in the analysis. Acute phases of the trials lasted either 6 or 8 weeks, and long-term phases varied in duration from 16 to 46 weeks. The analysis included summarizing the number and percentage of patients in each group with a > or = 7% change in body weight from baseline at any point in the long-term and acute phases, at endpoint, and at week 16 of the long-term phases. RESULTS: Using 7% or greater weight change as the measure of clinical significance, 4.3% of SSRI-treated patients had lost weight at any point in the acute phase versus 1.7% of those treated with nefazodone (p = .017). However, at any point during the long-term phase, significantly more SSRI-treated patients than nefazodone-treated patients showed a significant increase in body weight (17.9% vs. 8.3%; p = .003). At any point in the acute phase, significantly more imipramine-treated patients than nefazodone-treated patients had a 7% or greater increase in body weight (4.9% vs. 0.9%; p = .027), and for the long-term phase the comparison yielded 24.5% versus 9.5%. The difference during the long-term phase was statistically significant in women (p = .017), but not in men (p = .078) due to the small numbers of men in each group. CONCLUSION: SSRIs caused more weight loss during short-term treatment but more weight gain during long-term treatment. These results lend support to the observation that some antidepressants have a greater expected risk of weight gain than others during long-term therapy
— id: 20640, year: 2001, vol: 62, page: 256, stat: Journal Article,

Introduction - Weight gain and glucose regulation during antipsychotic drug treatment
Sussman, N
2001 JUN ;62(6):3-4, Journal of clinical psychiatry
— id: 54849, year: 2001, vol: 62, page: 3, stat: Journal Article,

A Treatment Algorithm for Attention Deficit Hyperactivity Disorder in Cocaine-Dependent Adults: A One-Year Private Practice Study with Long-Acting Stimulants, Fluoxetine, and Bupropion
Castaneda R; Sussman N; Levy R; Trujillo M
1999 Mar;20(1):59-71, Substance abuse
A subgroup of adults in private treatment for cocaine dependence in remission reported a therapeutic effect from cocaine during the initial phases of cocaine addiction and, also, met DSM-IV criteria for ADHD. We report evidence that study subjects probably medicated their ADHD symptoms with cocaine and describe a 1-year treatment algorithm featuring long-acting stimulants that was effective in the management of their ADHD and cocaine dependence. Nineteen stable patients in full remission from all substance dependence were entered into an open label, prospective, treatment trial for ADHD. The treatment schedule consisted of the progressive introduction-and discontinuation of ineffective medication-of each of several medications in the following order: fluoxetine, bupropion, pemoline, sustained-release methylphenidate, dextroamphetamine spansules, and methamphetamine gradumets. Treatment of ADHD was successful. Several treatment regimens, especially those including long-acting stimulants, alone or in combination with other agents, were highly effective. All but 1 of the 19 subjects had a fully effective response for at least 1 full year. Mean UTAH scale scores were 7.4 before any medications were administered and 1.6 at the end of the study. Treatment proved successful in suppressing ADHD symptoms, with minimal cocaine slips or side effects
— id: 39337, year: 1999, vol: 20, page: 59, stat: Journal Article,

"Round Table Meeting, Barcelona, 24 October 1998: Introduction"
Sussman N
1999 ;64:1-1, Round table series (Royal Society of Medicine)
— id: 15950, year: 1999, vol: 64, page: 1, stat: Journal Article,

Conclusion
Sussman N
1999 ;64:59-59, Round table series (Royal Society of Medicine)
— id: 15948, year: 1999, vol: 64, page: 59, stat: Journal Article,

Current and future role of anticonvulsants in anxiety and bipolar disorders
Sussman N; Cowen P; Nicholson B; Freeman M; Heffner T
1999 ;64:49-58, Round table series (Royal Society of Medicine)
— id: 15949, year: 1999, vol: 64, page: 49, stat: Journal Article,

Venlafaxine XR therapy for major depression and anxiety disorders. The clinical implications that its advantages pose
Sussman, N
1999 Nov;106(6 Suppl):31-36, Postgraduate medicine
An evolution in antidepressant development in recent decades has resulted in agents with selective mechanisms of action. Although agents with a single selective mechanism of action were initially thought to have advantages over other antidepressants, investigators now recognize that combined-action antidepressants, such as venlafaxine and clomipramine, may offer additional advantages in terms of increased efficacy and improved tolerability. In fact, a growing body of clinical evidence suggests that compared with the single-action selective serotonin reuptake inhibitors, both venlafaxine and once-daily venlafaxine extended release (venlafaxine XR) have shown an enhanced efficacy that extends over the entire spectrum of major depression and anxiety disorders, an earlier onset of action, less tendency to cause weight gain, and a low risk for potentially serious drug-drug interactions with many commonly used medications. These advantages make venlafaxine XR an important option for the treatment of major depression and anxiety disorders
— id: 101452, year: 1999, vol: 106, page: 31, stat: Journal Article,

The role of antidepressants in sexual dysfunction
Sussman, Norman
1999 ;17(1):9-14 Mar, Journal of clinical psychiatry monograph series
Nearly all antidepressants approved for use in the US have the potential to cause sexual dysfunction. Decreased libido, erectile dysfunction, and delayed orgasm or anorgasmia have all been reported with most of the available antidepressants. In choosing an antidepressant agent, clinicians should bear in mind that all of the available agents are approximately equal in antidepressant efficacy, but the adverse effect of sexual dysfunction may have a particularly detrimental impact on long-term treatment compliance.
— id: 71893, year: 1999, vol: 17, page: 9, stat: Journal Article,

Effects of psychotropic drugs on weight
Sussman, Norman; Ginsberg, David
1999 ;29(10):580-594 Oct, Psychiatric annals
Reviewed the literature discussing weight gain and loss as side effects of psychotropic drugs. Such psychotropic drugs include antidepressants (selective serotonin reuptake inhibitors [SSRIs], nefazodone hydrochloride, venlafaxine hydrochloride, mirtazapine, and bupropion hydrochloride), antipsychotics, and mood stabilizers (lithium, valproate sodium, carbamazepine, gabapentin, lamotrigine, and topiramate). Causes of weight gain include decreased metabolic rate, increased food intake, and reduced physical activity. Few studies address the prevalence and extent of weight changes associated with treatment of psychiatric disorders. Clinical trials do not always comprehensively examine weight changes, especially delayed weight gain. Studies showed that SSRIs can induce short-term weight loss, which can be therapeutic, but that the drug is associated with long-term weight gain.
— id: 71894, year: 1999, vol: 29, page: 580, stat: Journal Article,

A review of the effects of moderate alcohol intake on psychiatric and sleep disorders
Castaneda R; Sussman N; Levy R; O'Malley M; Westreich L
1998 ;14:197-226, Recent developments in alcoholism
In this chapter we discuss the effects of moderate ethanol consumption on the treatment of psychiatric and sleep disorders. A review of the literature on the interactions of ethanol with neurotransmitters and psychotropic medications suggests that although ethanol affects the clinical course of psychiatric and sleep disorders by different mechanisms, it does so principally through perturbations it causes in the balance of central nervous system neurotransmitter systems, which may modify the clinical course of primary psychiatric and sleep disorders and undermine the therapeutic response to psychotropic medications. Neurotransmitter responses may also be manifested clinically by rebound phenomena, akin to a subsyndromal withdrawal, which affect sleep and precipitate anxiety and mood symptoms. In addition, ethanol also modifies the clearance and disposition of a variety of psychotropic metabolites and interferes with their clinical effectiveness. We recommend that most psychiatric patients, and all patients with sleep disorders, should abstain from even moderate ethanol use, as this may adversely affect their clinical course and response to treatment
— id: 7308, year: 1998, vol: 14, page: 197, stat: Journal Article,

Anxiolytic antidepressant augmentation
Sussman N
1998 ;59 Suppl 5:42-48, Journal of clinical psychiatry
The administration of anxiolytic drugs often accompanies treatment with antidepressant medications. Although benzodiazepines help alleviate the secondary depressive symptoms of anxiety and sleep disturbance, they do not actually enhance antidepressant response. On the other hand, the anxiolytic agent buspirone does facilitate direct antidepressant response, largely through its ability to activate both presynaptic and postsynaptic 5-HT1A receptors and thus modulate serotonin release. Several case studies and open-label trials have demonstrated the effectiveness of buspirone as an augmentation agent. Because buspirone is also associated with few adverse effects, it appears to be both effective and safe in the augmentation of antidepressant pharmacotherapy
— id: 57265, year: 1998, vol: 59 Suppl 5, page: 42, stat: Journal Article,

Background and rationale for use of anticonvulsants in psychiatry
Sussman N
1998 ;65 Suppl 1(1):SI7-S14, Cleveland Clinic journal of medicine
— id: 39436, year: 1998, vol: 65 Suppl 1, page: SI7, stat: Journal Article,

Rethinking side effects of the selective serotonin reuptake inhibitors: Sexual dysfunction and weight gain
Sussman N; Ginsberg D
1998 ;28(2):89-97, Psychiatric annals
Discusses selective serotonin reuptake inhibitors (SSRIs) and their side effects. Side effects are typically categorized by organ system involvement (e.g., hematologic, nervous, renal) and frequency of occurrence (e.g., frequent, infrequent and rare). There could be 1 of 4 side effects: early onset-time limited, early onset-persistent, later onset, and withdrawal-emergent. Sexual dysfunction and weight gain can also be associated with SSRI use. The exact incidence, cause or causes, and optimal management of each of these side effects need to be determined. One potential outcome from studies of these side effects is that this research may reveal the underlying physiological mechanisms that mediate drug effects on appetite and sexual functions.
— id: 8170, year: 1998, vol: 28, page: 89, stat: Journal Article,

Antidepressant augmentation: conclusions and recommendations
Sussman N; Joffe RT
1998 ;59 Suppl 5:70-73, Journal of clinical psychiatry
— id: 57264, year: 1998, vol: 59 Suppl 5, page: 70, stat: Journal Article,

Introduction: augmentation of antidepressant medication
Sussman N; Joffe RT
1998 ;59 Suppl 5:3-4, Journal of clinical psychiatry
— id: 12104, year: 1998, vol: 59 Suppl 5, page: 3, stat: Journal Article,

A review of the effects of moderate alcohol intake on the treatment of anxiety and mood disorders
Castaneda R; Sussman N; Westreich L; Levy R; O'Malley M
1996 May;57(5):207-212, Journal of clinical psychiatry
BACKGROUND: There is no published review to help the clinician clarify the potential role of moderate ethanol consumption in patients being treated for anxiety and mood disorders. Product labels and textbook chapters routinely warn the individual against the consumption of ethanol when using prescription psychotropic drugs. A general understanding is that the reason for this recommendation is the potential for adverse synergistic effects or sedation and decreased psychomotor performance. What is overlooked by this emphasis on safety is the effect of alcohol use both on the underlying psychiatric disorder being treated and on the effectiveness of drug therapy. METHOD: We review the available literature on the interactions of ethanol with neurotransmitters and psychotropic medications and explore the clinical consequences of these interactions. RESULTS: Ethanol might affect anxiety and mood disorders by different mechanisms. Principal among these are the effects of ethanol on multiple neurotransmitter systems, which adapt in different ways to the acute and/or chronic presence of ethanol. Perturbations in the balance of CNS neurotransmitter systems may modify the acute clinical course of primary mood disorders and undermine the therapeutic response to psychotropic medications. Ethanol also modifies the clearance and disposition of psychotropic metabolites and interferes with their clinical effectiveness. Neurotransmitter responses may additionally be manifested clinically by rebound phenomena, akin to a subsyndromal withdrawal, which affect sleep and precipitate anxiety and mood symptoms. Recent alcohol use also may alter the subjective interpretation of the patient's 'internal milieu,' causing confusion and eliciting reactive psychopathology. CONCLUSION: While much research remains to be done, there is abundant evidence that patients with mood and anxiety disorders should abstain from even moderate ethanol use, as this adversely affects their clinical course and response to treatment
— id: 56862, year: 1996, vol: 57, page: 207, stat: Journal Article,

Drug craving and other negative reactions after abrupt substitution of nefazodone for other serotonergic agents
Castaneda, R; Levy, R; Westreich, L M; Sussman, N
1996 Oct;57(10):485-486, Journal of clinical psychiatry
— id: 126559, year: 1996, vol: 57, page: 485, stat: Journal Article,

A double-blind, placebo-controlled study of vigabatrin three g/day in patients with uncontrolled complex partial seizures. Vigabatrin Protocol 024 Investigative Cohort
French, J A; Mosier, M; Walker, S; Sommerville, K; Sussman, N
1996 Jan;46(1):54-61, Neurology
This study compared the efficacy and tolerability of vigabatrin 3/day as add-on therapy with that of placebo in patients with focal epilepsy whose complex partial seizures were difficult to control with established antiepilepsy drug therapy. We enrolled 203 patients; 182 (90 placebo; 92 vigabatrin) received drug therapy under double-blind conditions. We increased the daily dosage to 2.5 g/day during a 4-week titration segment and maintained it at 3 g/day during the 12-week maintenance segment. By analyses we found a statistically significant lower frequency of seizures (complex seizures plus partial seizures secondarily generalized) at the end of the study for patients receiving vigabatrin than for those receiving placebo. The median monthly frequency was reduced by three seizures per 28 days in the placebo group (baseline, 8.3; end of study, 7.5) (p = 0.0002). Therapeutic success (a 50% reduction from baseline in mean monthly seizure frequency) was attained in 40 of the vigabatrin patients (43%) compared with 17 of those treated with placebo (19%) (p < 0.001). Vigabatrin significantly increased the mean number of seizure-free days per 28 days (2.2 days) compared with placebo (0.5 days) (p = 0.0024). Mean trough serum vigabatrin concentration during therapy was 8.6 +/- 7.7 micrograms/ml. The oral clearance of vigabatrin was determined to be 7.8 L/hr, and the elimination half-life was 8.4 hours. No clinically important changes in MRI, evoked potential, or other laboratory tests were noted during vigabatrin treatment. The results of this study indicate that 3 g/day vigabatrin is more effective than placebo as add-on therapy. Vigabatrin was well tolerated, compliance was high with twice-daily administration, and therapy did not result in clinically relevant drug interactions
— id: 102084, year: 1996, vol: 46, page: 54, stat: Journal Article,

Pocket handbook of psychiatric drug treatment
Kaplan, Harold I.; Sadock, Benjamin J.; Kaplan, Harold I.; Cancro, Robert; Sussman, Norman
Baltimore, Md. : Williams & Wilkins, c1996,
— id: 527, year: 1996, vol: , page: , stat: ,

Update in the pharmacotherapy of depression
Sussman N; Stahl S
1996 Dec 30;101(6A):26S-36S, American journal of medicine
— id: 12444, year: 1996, vol: 101, page: 26S, stat: Journal Article,

Reactions of patients to the diagnosis and treatment of cancer
Sussman N
1995 Feb;6 Suppl 1:4-8, Anti-cancer drugs
More effective diagnosis and improved treatment have changed cancer from an inevitably fatal to an often curable disease. As a consequence, considerable care needs to be exercised in discussing both the diagnosis and treatment of the disease with the patient or, in the case of children, the parent. Initial reactions to learning that one has cancer include fear of death, disfigurement and disability; fear of abandonment and loss of independence; fear of disruption in relationships, role functioning, and financial standing; and denial, anxiety and anger. An important role of the physician is to recognise these fears and emotions and encourage the patient to share his or her thoughts. It is also important to provide necessary information both to correct misconceptions and to provide hope. Treatment-related concerns add a second source of distress to the patient and, if not optimally addressed, may prejudice the completion of effective treatment. Long courses of treatment may cause the patient to become much sicker symptomatically from the treatment than from the disease itself. Children, in particular, may be unable to tolerate treatment-related side effects. Especially demoralising for the patient are commonly used anti-cancer agents with high emetogenic potential. These include cisplatin, dacarbazine, streptozocin, actinomycin and nitrogen mustard. In many cases, patients suffer so badly from the symptoms of nausea and vomiting that they refuse further treatment. They describe cytotoxic, drug-induced nausea and vomiting as a nightmare. The recent introduction of a new class of anti-emetic agents, the 5-HT3-receptor antagonists, has improved patient quality of life during cytostatic treatment and, in some cases, permitted more aggressive therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 12809, year: 1995, vol: 6 Suppl 1, page: 4, stat: Journal Article,

Neurology for non-neurologists
Weinreb, Herman J.; Chou, James C.-Y.; Wisniewski, Thomas; Golomb, Jamie; Hiesiger, Emile M.; Sussman, Norman; Rapoport, David; Henry, Katherine; Krishna, Ranga; Kricheff, Irvin I.; Stiller, Keith
[Irvington, NY] : Pass the Boards, c1995,
— id: 512, year: 1995, vol: , page: , stat: ,

The potential benefits of serotonin receptor-specific agents
Sussman N
1994 Feb;55 Suppl:45-51, Journal of clinical psychiatry
Antidepressant drugs are effective for about three in four people with depression. For reasons that are not understood, individual patients who do not respond to one drug often respond to another. Differences in mechanisms of action may thus be important in determining treatment success or failure. In addition to efficacy, drug side effect profile also determines treatment outcome. In general, the fewer or less severe the side effects of a drug, the greater the degree of compliance with treatment. A major consequence of the introduction of selective serotonin-specific antidepressants is greater patient acceptance due to fewer side effects. Still, some patients are unable to tolerate the nervousness, insomnia, or sexual dysfunction associated with these drugs. Drugs that are even more specific in that they act on specific serotonin receptor subtypes, rather than only by blocking serotonin uptake, may provide efficacy and fewer side effects for patients who do not respond to or tolerate less specific agents
— id: 57309, year: 1994, vol: 55 Suppl, page: 45, stat: Journal Article,

The uses of buspirone in psychiatry
Sussman N
1994 ;12(1):3-21, Journal of clinical psychiatry monograph series
Buspirone's (BUS) anxiolytic-like activity in animal models prompted clinical trials of its antianxiety effects. In these trials BUS was found to be comparable with benzodiazepines (BZDs) in reducing symptoms of anxiety. In contrast to BZDs, BUS was shown to be devoid of significant sedative or withdrawal effects. It was also found to spare both cognitive and psychomotor performance. Subsequent clinical experience has confirmed the favorable pharmacologic profile of BUS. The 2 major limitations of BUS are its lack of antipanic activity and reduced anxiolytic effects in patients who were recently withdrawn from BZDs. New clinical uses of BUS that have significance in psychiatric practice are its antiaggression/antiagitation activity, its augmentation effects in antidepressant therapy, and its antidyskinetic activity. Discussion among R. J. Goldberg, N. Sussman, K. Rickels, R. E. Rakel, and A. J. Gelenberg follows.
— id: 8180, year: 1994, vol: 12, page: 3, stat: Journal Article,

TREATMENT STRATEGIES FOR COMPLICATED ANXIETY - DISCUSSION
LIEBOWITZ, MR; FRANCES, AJ; SUSSMAN, N
1993 MAY ;54(12):17-20, Journal of clinical psychiatry
— id: 54118, year: 1993, vol: 54, page: 17, stat: Journal Article,

Special practices in group psychotherapy
Porter, Kenneth; Kaplan, Harold I; Sadock, Benjamin J; Edwards, Nancy; O'Hearne, John J; Berger, Milton M; Sussman, Norman
Comprehensive group psychotherapy (3rd ed.) Baltimore, MD, US: Williams & Wilkins Co, 1993,
(from the book) [book section covering several chapters] /// 'Combined Individual and Group Psychotherapy' / Kenneth Porter / [argues that] combined individual and group therapy is one of the most effective of all therapies /// 'Structured Interactional Group Psychotherapy' / Harold I. Kaplan and Benjamin J. Sadock / [describes] the technique of structured interactional group psychotherapy [which] is applicable to many group settings and is easily taught /// 'Dream Work in Group Psychotherapy' / Nancy Edwards / [describes] a variety of therapeutic approaches [that] have been made to the use of dreams in group psychotherapy /// 'Nonverbal Behavior in Groups' / John J. O'Hearne / [describes] the clinical use of nonverbal communication [in group therapy] /// 'Use of Video in Group Psychotherapy' / Milton M. Berger / [describes] the positive values of using video [recording and playbacks] in group psychotherapy /// 'Integrating Psychopharmacology and Group Psychotherapy' / Norman Sussman / [describes a] frequent combination of therapeutic modalities [involving] the use of group therapy and [psychotropic] medication
— id: 4633, year: 1993, vol: , page: 314, stat: Chapter,

How to manage anxious patients who are depressed
Sussman N
1993 May;54 Suppl:8-16, Journal of clinical psychiatry
According to the official nomenclature and the approved indications for psychotropic drugs, anxiety and depression are mutually exclusive, and antidepressants and anxiolytics have a single indication. In clinical settings, however, anxiety and depressive symptoms frequently coexist, and the effects of psychotropic drugs often overlap. Both diagnosis and treatment may be complicated by uncertainty about the primary disorder and the optional therapeutic approach. Available treatment strategies include antidepressants, benzodiazepines, azapirones, and combined antidepressant/anxiolytic therapy. Considerations in reflecting a particular treatment strategy include drug side effects, patient age and medical status, and patient expectations. Recent studies have suggested that antidepressants are effective anxiolytics and that some anxiolytics produce antidepressant effects. Ultimately, any selection should be made based on relative benefits and risks of each approach
— id: 13185, year: 1993, vol: 54 Suppl, page: 8, stat: Journal Article,

Integrating psychopharmacology and group psychotherapy
Sussman N
Comprehensive group psychotherapy Baltimore : Williams & Wilkins, 1993,
— id: 3865, year: 1993, vol: , page: 363, stat: Chapter,

Treating anxiety while minimizing abuse and dependence
Sussman N
1993 May;54 Suppl:44-51, Journal of clinical psychiatry
Anxiety is common and often disabling. Although effective treatments are available, the use of antianxiety medication remains controversial. Some of the controversy involves the relative benefits of psychological versus pharmacologic interventions. Much of the expressed concern, however, relates to the risks of abuse and dependence associated with standard antianxiety drugs. In some instances, concern about these risks prevents patients from receiving potentially effective treatment. In other instances, failure to recognize possible abuse and dependence results in a clinical dilemma. This presentation will address the factors involved in anxiolytic drug dependence and abuse, including patient characteristics and the pharmacologic profiles of anxiolytic drugs. Specific recommendations about how to minimize abuse and dependence through such measures as diagnostic assessment, patient education, drug selection, and treatment planning will be offered
— id: 13186, year: 1993, vol: 54 Suppl, page: 44, stat: Journal Article,

THE 1ST DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL OF A PARTIAL BENZODIAZEPINE AGONIST ABECARNIL (ZK-112-119) IN GENERALIZED ANXIETY DISORDER
Ballenger, JC; Mcdonald, S; Noyes, R; Rickels, K; Sussman, N; Woods, S; Patin, J; Singer, J
1991 Aug;27(2):171-179, Psychopharmacology bulletin
This is the first reported controlled trial of a partial benzodiazepine agonist, abecarnil, utilized in the treatment of generalized anxiety disorder (GAD). It was a sequential dose- finding study comparing 15-30 mg/day, 7.5-15 mg/day, and 3-9 mg/day to placebo for 3 weeks of treatment followed by abrupt discontinuation through placebo substitution. Although the two higher dose groups had high incidence of central nervous system (CNS) sedative adverse effects, the 3-9 mg/day group tolerated the medication well with no dropouts. The 3-9 mg/day group, in comparison to the two higher doses and placebo, demonstrated efficacy in global improvement ratings and Hamilton Anxiety Scale (HAM-A) scores. At Week 3, 61 percent of the abecarnil 3-9 mg/day group was rated as at least 50 percent improved on the HAM-A, compared to 30 percent of the placebo group. With abrupt discontinuation there were mild to moderate withdrawal symptoms and loss of efficacy in the two higher dose groups. However, in the 3-9 mg/day abecarnil group, there were few withdrawal symptoms and almost no loss of efficacy following discontinuation
— id: 32162, year: 1991, vol: 27, page: 171, stat: Journal Article,

Factitious disorders
Sussman, Norman
Comprehensive textbook of psychiatry Baltimore : Williams & Wilkins, 1989,

— id: 4280, year: 1989, vol: , page: 1136, stat: Chapter,

Neuroleptics in anxiety
Chou, James C; Sussman, Norman
1988 ;18(3):172-175 Mar, Psychiatric annals
Discusses studies that show 3 neuroleptics (i.e., loxapine, thioridazine, trifluoperazine) to be effective in reducing nonpsychotic anxiety. It is argued that possible side effects do not warrant its use, except in cases of psychosis and anxiety or in anxiety accompanied by cognitive deficits or senility.
— id: 71896, year: 1988, vol: 18, page: 172, stat: Journal Article,

Interrelationships between major depression and the anxiety disorders: Clinical relevance
Fogelson, David L; Bystritsky, Alexander; Sussman, Norman
1988 ;18(3):158-167 Mar, Psychiatric annals
Discusses the clinical significance of the coexistence of anxiety and depression in the same patient. A number of mixed states are discussed involving major depression and a variety of anxiety disorders. The symptomatic differentiation and treatment of anxiety and depression are outlined for emotional, physiological, cognitive, and behavioral symptoms. Guidelines are given for long-term medication strategies and psychosocial interventions. The most frequent manifestations involve combinations of major depression with any of the panic disorders, panic attacks, obsessive-compulsion disorder, and generalized anxiety.
— id: 71897, year: 1988, vol: 18, page: 158, stat: Journal Article,

Current issues in benzodiazepine use for anxiety disorders
Sussman, Norman; Chou, James C
1988 ;18(3):139-145 Mar, Psychiatric annals
Discusses the predominant use of benzodiazepines to treat anxiety disorders, noting side effects such as psychomotor and cognitive impairment, depression, aggression, mania, and dependence. It is argued that the efficacy of benzodiazepines usually outweighs the risks, but it is not easy, due to decreased efficacy, to switch benzodiazepine users to the promising nonbenzodiazepine anxiolytic, buspirone.
— id: 71895, year: 1988, vol: 18, page: 139, stat: Journal Article,

STRESS AND MEDICAL ILLNESS IN THE ELDERLY
Sussman, N
1987 Jan;54(1):41-46, Mount Sinai journal of medicine
— id: 31336, year: 1987, vol: 54, page: 41, stat: Journal Article,

Treatment of anxiety with buspirone
Sussman, Norman
1987 ;17(2):114-120 Feb, Psychiatric annals
Provides an overview of buspirone treatment of anxiety, including pharmacokinetics, dosage considerations, drug interactions, time course of improvement, side effects, patient selection, and use in place of or concurrently with benzodiazepines. Buspirone reduces the symptoms of anxiety without impairment of patient functioning, risk of abuse, or withdrawal symptoms. Important issues for psychiatrists and physicians concerning buspirone are presented.
— id: 71898, year: 1987, vol: 17, page: 114, stat: Journal Article,

Munchausen's syndrome: A reconceptualization of the disorder
Sussman, Norman; Borod, Joan C; Cancelmo, Joseph A; Braun, Devra
1987 ;175(11):692-695, Journal of nervous & mental disease
Suggests that the original categories of factitious disorders delineated in Diagnostic and Statistical Manual of Mental Disorders (DSM-III) do not provide for the diagnosis of commonly seen forms of factitious illness. The case of a 43-yr-old female with factitious disorder, which exemplifies the complex interaction of personality factors and psychosocial stressors that can produce a picture of factitious disorder (with medical and psychiatric symptoms), is presented. The history of the patient's illness, her hospital course, and pychological assessments are described.
— id: 71899, year: 1987, vol: 175, page: 692, stat: Journal Article,

DIAZEPAM, ALPRAZOLAM, AND BUSPIRONE - REVIEW OF COMPARATIVE PHARMACOLOGY, EFFICACY, AND SAFETY
Sussman, N
1986 Nov;21(11):1110-111?, Hospital formulary
— id: 31009, year: 1986, vol: 21, page: 1110, stat: Journal Article,

THE BENZODIAZEPINES - SELECTION AND USE IN TREATING ANXIETY, INSOMNIA, AND OTHER DISORDERS
Sussman, N
1985 Mar;20(3):298-305, Hospital formulary
— id: 31088, year: 1985, vol: 20, page: 298, stat: Journal Article,

Somatoform disorders: Before and after DSM-III
Hyler, Steven E; Sussman, Norman
1984 ;35(5):469-478 May, Hospital & community psychiatry
Discusses the DSM-III category of somatoform disorders, described as disorders for which there are no demonstrable organic findings or known physiological mechanisms and for which psychological factors are judged to be important in the initiation, exacerbation, or maintenance of the disturbance. The somatoform disorders are divided into categories including somatization disorder, conversion disorder, psychogenic pain disorder, and hypochondriasis. The authors review the major features, history, and treatment and survey the recent literature of each disorder. Clinical vignettes are presented to illustrate the symptomatology associated with each disorder. It is noted that there is significantly less research on the somatoform disorders than on more common disorders.
— id: 71900, year: 1984, vol: 35, page: 469, stat: Journal Article,

Chronic factitious disorder with physical symptoms (the Munchausen syndrome)
Hyler SE; Sussman N
1981 Aug;4(2):365-377, Psychiatric clinics of North America
— id: 65737, year: 1981, vol: 4, page: 365, stat: Journal Article,

Psychiatry and the urban setting
Sadock BJ; Kaplan HI; Sussman N
Comprehensive textbook of psychiatry Baltimore : Williams & Wilkins, 1980,
— id: 3943, year: 1980, vol: , page: 3173, stat: Chapter,

Psychiatry and the urban setting
Sadock BJ; Kaplan HI; Freedman AM; Sussman N
Comprehensive textbook of psychiatry Baltimore : Williams & Wilkins, 1975,
— id: 3932, year: 1975, vol: , page: 2498, stat: Chapter,