New CME Series

Treating and Caring for the Patient With Moderate-to-Severe Alzheimer’s Disease

  • Effective Communication Strategies to Help Patients and Caregivers Cope With Moderate-to-Severe Alzheimer’s Disease
  • Managing Patients With Moderate-to-Severe Alzheimer’s Disease: Expectations, Treatments, and Prognosis

The Impact of Oral Medications on the Treatment of Multiple Sclerosis

  • Current Standards of Treatment in MS and the Role of Oral Agents
  • Switching Therapies in MS: What Are the Options?
  • Recognizing and Overcoming Potential Barriers to Oral Medications for MS
  • Identifying and Addressing Unmet Therapeutic Needs in MS

See all Neurology Reports

FEATURED ARTICLES

Have you wondered how you could reliably make a diagnosis of ADHD and differentiate it from a learning disorder or another psychiatric condition? Have you been uncertain about the value of neuropsychological testing in this endeavor? If you have, then this case vignette and discussion should prove useful in your evaluation and management of patients and their families.

Discover results from a study that assessed fibromyalgia patients’ self-reported quality of life and pain based on perceptions of physician attitudes, trust in physicians, perceptions of medical professionals, type of treatment, and various demographic variables.

Do you screen for restless legs syndrome in your patients with sleep disturbances? In this Neurology Report, find out how misconceptions about restless legs syndrome can hinder its correct diagnosis and learn how diagnostic criteria and associated features can improve your ability to recognize this condition.

See all Alzheimer's Disease

ALZHEIMER'S DISEASE

This review follows the progress of rivastigmine over the years, from the basics of its pharmacology, mechanism of action, and key historic clinical milestones with oral capsules, to more recent evidence on the use of rivastigmine transdermal patch in dementia management.

Giving your patients an early, accurate diagnosis of Alzheimer's disease enables them to begin treatment sooner to slow cognitive and functional decline. Explore this Neurology Report to learn about laboratory and imaging tests to help diagnose Alzheimer's disease and the available therapies to slow disease progression.

In this article, review practical, evidence-based, expert opinion regarding the role of the primary care physician in the assessment and management of dementia due to Alzheimer’s disease. The recommendations presented here are based on current guidelines and consensus documents.

See all Autism

AUTISM

Autistic disorder is characterized by qualitative impairments in reciprocal social interaction, verbal and nonverbal communication, among other characteristics.

Autism is a neurodevelopmental disorder with childhood onset characterized by atypical developments.

See all Dementia

DEMENTIA

Read about 2 patient cases that illustrate a looming problem and potential association for individuals with long-term PTSD—the development of dementia. Both patients were veterans who had years of treatment for PTSD. They developed dementia before age 65 years and had Parkinson-like motor symptoms.

Diagnose and manage Ms A, an 84-year-old woman whose cognitive changes began about 1 year ago. She is increasingly repetitive, no longer able to manage her finances, and occasionally misses medication doses. Ms A still drives short distances and keeps up her self-care, but she has been irritable with her daughter.

When Mr A, a 68-year-old man, presents to Banner Alzheimer’s Institute, his wife says his short-term memory has been declining for 3 years. He is irritable and states that the things he forgets are things that he does not want to remember. In private, Mr A’s wife also reports “tactless” behaviors and loss of empathy toward others. What is causing his symptoms?

See all Headache

HEADACHE

A vast array of idiopathic somatic complaints are common among depressed persons across the lifespan.

Headaches account for a high percentage of office visits to primary care physicians.

See all Movement Disorders

MOVEMENT DISORDERS

Comprehensive Behavior Intervention for Tics (CBIT) is a safer and effective alternative to antipsychotics for the treatment of Tourette’s disorder. This report describes the case of a 5-year-old child with Tourette’s disorder who benefited from the components of CBIT.

Tardive dyskinesia is a well-known side effect of conventional antipsychotics. Fluvoxamine may be an effective treatment for neuropsychiatric disorders via sigma-1 receptor agonism. Here, Albayrak and colleagues report 5 cases in which fluvoxamine was beneficial for both postpsychotic depressive disorder and tardive dyskinesia in patients with schizophrenia.

Read about the case of a 60-year-old woman who developed a disabling intention tremor in her hands, head, and jaw 2 months after aripiprazole was added to lamotrigine treatment.

See all Multiple Sclerosis

MULTIPLE SCLEROSIS

Early diagnosis of MS is critical for patients to begin disease-modifying therapy as soon as possible. Find out how to apply updated diagnostic criteria to recognize MS in its early stages and to rule out similar conditions using appropriate tests.

Do you tailor your treatment plan for patients with MS according to their disease course? Here, get an overview of the benefits and adverse effects of the available disease-modifying agents for MS, and discover how to select appropriate relapse treatment.

Read this true patient case and commentary to review the story of Mr A, a 35-year-old veteran with debilitating multiple sclerosis who is facing the emotional consequences of his illness while residing at a nursing home unit.

See all Other

OTHER

Does a known neurocognitive disorder diagnosis in older adults result in heightened caregiver confidence for medication management and regimen adherence? To answer this question, the authors of this study examined the differences in medication management behaviors for family caregivers of mildly impaired older adults with or without a formal neurocognitive disorder diagnosis.

Capgras’ syndrome is a disorder in which a person holds a delusion that a close relative like a spouse or parent has been replaced by an identical looking imposter. Read about a case of Capgras’ syndrome in an 80-year-old man with dementia.

In this article, Dr Urgeles and colleagues report the neuropsychiatric profiles of 2 adult patients with Williams syndrome, a rare genetic disorder, and co-occurring generalized anxiety disorder and depressive symptoms. They discuss strategies that were adopted for pharmacologic intervention.

See all Pain

PAIN

Dr Rahman and colleagues review carbamazepine’s history and discuss other treatment options for chronic pain and bipolar disorder. They also explore issues of obesity and polypharmacy in this population and explain how carbamazepine has unique properties that bolster its place in the management of this comorbidity.

Is milnacipran a safe and effective treatment for improving cognitive function in fibromyalgia? To find out, the authors of this article conducted a 13-week trial. Patients were randomized to receive milnacipran or placebo for 6 weeks, followed by a 1-week washout and then cross over to the other arm for another 6 weeks. Assessments were performed at each visit.

Chronic pain is the leading reason patients see their primary care physician, and the burden of pain and depression in those with medical illness is particularly severe. Watch this virtual slide show to learn about the co-occurrence of these conditions and what that means for treating your patients.

See all Parkinson's Disease

PARKINSON'S DISEASE

The authors of this Letter to the Editor report 4 cases of long-term chronic pain that improved dramatically following administration of aripiprazole, a partial dopamine agonist.

Read about the case of Mr A, a 41-year-old patient with Parkinson’s disease who presented in a mental health clinic after experiencing new-onset compulsive behavior with the dopamine agonist ropinirole. For the past few months, he was having intense sexual desires, an increase in appetite, and had started gambling.

This Letter to the Editor describes the case of Ms A, a 64-year-old patient in a skilled nursing facility whose psychotic symptoms completely remitted with a combination of aripiprazole and divalproex. She also experienced improvement in Parkinson’s disease symptoms, specifically tremor and akinesia.

See all Sleep

SLEEP

How well are sleep problems being managed in your patients with PTSD? Insomnia, nightmares, sleep apnea, and sleep movement disorders are common in these patients. Read this article to learn about diagnosing and managing these conditions so that you can better help your patients with PTSD.

Low-dose doxepin has produced a range of favorable results compared to previous hypnotics in healthy adults and elderly persons with insomnia. The aim of this article is to investigate the efficacy and safety of low-dose doxepin for insomnia in depressed patients.

Cognitive-behavioral therapy is an evidenced-based treatment for insomnia; however, its use is limited due to lack of trained therapists. This study looked at the effects of cognitive-behavioral therapy for insomnia sleep skills education on the quality of sleep in patients attending a psychiatry partial hospitalization program.

See all Stroke

STROKE

Have you ever wondered how people cope with the devastating sequelae of strokes?

We read with interest the recenetly published discussion concerning the use of atypical antipsychotic medications in the primary care setting.

Is it reasonable to assume that just about everyone becomes depressed following a stroke?

SUBSTANCE ABUSE/ALCOHOLISM

See all Substance Abuse/Alcoholism

Have you ever wondered whether your patients truly understand the consequences of their substance abuse? Then, explore the case of Mr A, a 51-year-old former musician with chronic alcoholism and multiple inpatient rehabilitation stays for addiction counseling and detoxification. The authors provide guidelines for treating patients with alcoholism.

When you screen your patients for alcohol use disorder (AUD), do you ask them if their parents had problematic alcohol use? More than 1 in 5 US adults has a parent with AUD, and parental AUD more than doubles the risk of AUD in offspring. Read this journal CME article to find out more about AUD in parents and their children.

Authors of this Letter to the Editor describe the case of Mr A, a 42-year-old man who was admitted to a treatment program after his second arrest for driving under the influence of an unknown substance. He had prescriptions for quetiapine and gabapentin and misused these 2 medications together to replace the illicit drugs he had taken in the past.