How to Diagnose ADHD in Bipolar Disorder

Topics: ADHD | ADHD Rating Scale-5 | Attention Deficit Hyperactivity Disorder | Bipolar Disorder | Bipolar II | Comorbidity | Diagnosis | Diagnostic Testing | Hypomania | Psychiatric interviewing

Hailey is a 24-year-old woman with bipolar II disorder who has recently come out of a mixed episode. Although her mood symptoms have resolved, she is distracted easily, has difficulty organizing her work, and often forgets important tasks. She read about ADHD online and asks if she can have a stimulant to help her focus. ADHD and hypomania share many

Is EEG Useful in Psychiatry?

Topics: Diagnostic Testing | Neuroscience in Psychiatry | Practice Tools and Tips

Is it useful for psychiatrists to order EEGs on their patients? That’s a perennially controversial question, and one that’s worth revisiting from time to time. The basics of EEG First developed in the 1920s, EEG entails applying electrodes to the scalp’s surface to measure electricity generated by neural activity. The brain works primarily via

Neurofeedback in Psychiatry: What’s the Evidence?

Topics: Diagnostic Testing | Neuroscience in Psychiatry | Practice Tools and Tips

TCPR: You and your UMass colleagues recently reviewed the current research on the efficacy of neurofeedback in psychiatry (Begemann M et al, Trans Brain Rhyth 2016;1(1):19–29). But before going into the research, can you please describe what the procedure is and how it is done? Many of our readers wonder whether neurofeedback is a legitimate or effect

Determining Dementia

Topics: Dementia | Diagnostic Testing | Laboratory Testing in Psychiatry

TCPR: The big question for general psychiatrists is how do we go about efficiently assessing memory in a clinical environment that only allows for a 15- to 20-minute visit? Dr. Budson: If people are actually raising a concern about their memory, that is already something to take seriously. There used to be this rule of thumb that you don’t need to

Pharmacogenetic Testing: An Update

Topics: Diagnostic Testing | Free Articles | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

Given how many essentially equivalent medications we have to choose from, how great would it be to have a test that tells us which drug to prescribe for which patient? Everybody wants personalized medicine, and in some other specialties, such as oncology, this is becoming a standard part of treatment. In this article, we’ll review some of the basics o

Understanding Pharmacogenetics Research

Topics: Diagnostic Testing | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

TCPR: Dr. Uher, you have been a co-investigator on the major studies of pharmacogenetics in psychiatry. It’s a complicated field, and I thought you could explain how the research is actually done. Dr. Uher: The basic goal of this kind of research is to try to find an association between a genetic variant and the clinical response to a particular m

Using Psychiatric Biomarkers in your Practice

Topics: Addiction | Diagnostic Testing | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

Treatment of the psychiatric patient is as much an art as it is a science. Diagnosing and deciding on treatments in psychiatry is based on a series of human interactions. We observe and we listen to patients, we ask questions, we consider their responses, and we synthesize all this information in order to render a judgment. Such judgments are subjective

The GeneSight Genetic Test: A Review of the Evidence

Topics: Diagnostic Testing | Genetics and Psychiatry | Pharmaceutical Industry | Practice Tools and Tips

Assurex Health recently sent me an email inviting me to dine at Legal Seafood to learn about “Clinical Applications of Psychiatric Pharmacogenetics.” I didn’t go, but increasingly I am hearing from colleagues about their experiences at these dinner programs: “What do you think about this GeneSight test? The data looked pretty impressive at this

A Primer on Drug Screening

Topics: Diagnostic Testing | Laboratory Testing in Psychiatry | Practice Tools and Tips

The technology of drug testing has progressed significantly over the years. This is both good and bad for doctors. There are more options, but perhaps too many. There are many types of tests and they vary in terms of the drug detection time frames. Most labs do the initial screen with immunoassays, which involve antibodies to detect specific drugs, a

Ordering Toxicology Screening: Clinical Tips

Topics: Diagnostic Testing | Laboratory Testing in Psychiatry | Practice Tools and Tips

The Use of Rating Scales in Diagnostic Assessment of Children

Topics: Child Psychiatry | Diagnostic Testing

Rating scales have been gaining favor in diagnostic assessment of children with psychiatric and/or neurodevelopmental disorders. Many children have trouble talking directly about their behavior, and rating scales can often help clinicians fill in the blanks. While they have their benefits, misuse or overreliance on rating scales can interfere with the a

Selected Diagnostic and Rating Scales

Topics: Child Psychiatry | Diagnostic Testing

A comprehensive table of selected diagnostic and rating scales. Click to view the PDF..

ADHD as an Executive Function Disorder

Topics: ADHD | Diagnostic Testing

Dr. Barkley’s Suggested Changes toADHD in DSM-5 Add our understanding that ADHD is an executive function and self regulation disorder into the text. It’s not a good idea to change the name (for legal reasons), but DSM needs to explain that this is so much more than simply an attention problem. Get rid of subtyping. The subtypes are really

How Do Psychotherapy and Medication Change the Brain?

Topics: Depressive Disorder | Diagnostic Testing | Free Articles | OCD | Psychotherapy

We know that for many conditions, both medications and psychotherapy work about equally well. Common sense would dictate that there is some final common pathway of neuropsychiatric change underlying the symptomatic improvements we see. But identifying what is happening in a living human brain is extremely tricky. Recently, a number of articles have revi

The MoCA: A Better MMSE?

Topics: Dementia | Diagnostic Testing

Most psychiatrists rely on the Folstein Mini Mental State Exam for a rapid, office-based neuropsychological assessment. It is what we were trained on, and we have given it to so many patients that we can pretty much reel off the items from memory. But the MMSE has some serious limitations. While it is quite sensitive at picking up moderate to severe

Tests to Detect Malingering

Topics: Diagnostic Testing

Psychiatric conditions are easy to fake, because there are no truly objective tests for their diagnoses. In one survey, members of the American Board of Clinical Neuropsychologists estimated that some degree of symptom exaggeration occurs in 39% of mild head injury cases, in 30% of disability assessments, and in 29% of personal injury cases (Mittenberg

The Utility of Neuropsychological Testing

Topics: Diagnostic Testing