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 caregivers of your patients with dementia asked you about driving safety, refusal to accept the diagnosis, or distressing episodes of agitation? Read about the case of Ms A to learn strategies for managing patients with Alzheimer's disease as it progresses over time. Both medication and caregiver education can help.

Review 2 patient cases that illustrate a looming problem and potential association for individuals with long-term posttraumatic stress disorder (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.

About 50% of patients with bipolar disorder also have a pain disorder. Carbamazepine is the only drug that has guideline-supported robust efficacy in the management of each condition separately. Here, 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.

See all Alzheimer's Disease

ALZHEIMER'S DISEASE

How do you prepare caregivers to handle the loss of function in patients with Alzheimer's disease? Discover ways to provide realistic expectations of the disease and the goals of treatment and to select appropriate treatments to slow functional decline and manage troublesome behavioral and psychological symptoms.

In this review article, Nordberg and colleagues examine the role of butyrylcholinesterase in cholinergic signaling and neurologic conditions, such as Alzheimer’s disease. The rationale for inhibiting cholinesterases in the management of Alzheimer’s disease is discussed.

Have any patients come to you with vision problems that their eye doctors can't solve? Read this Primary Care Companion interactive case report to learn about how these symptoms may be indicative of a variant of Alzheimer's disease or a precursor. Diagnostic tests and potential treatments are discussed.

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

One of the most difficult patients to manage is the individual with agitated dementia. Still, there is no clear clinical strategy for treating the agitated, acting-out, demented patient. Dr Meyers summarizes what is known and describes her experience with Mr A, a 71-year-old man who lived in a residential care facility and had hit his roommate “with fists and a belt.”

Don’t be too quick to reach for your prescription pad to handle disruptive behaviors in patients with dementia. Instead, Dr Tariot recommends using behavioral interventions. Learn more and comment on the PsychsTalk blog.

About 5 million Americans have Alzheimer’s disease. Because the illness is so prevalent, many patients are diagnosed and treated by primary care physicians. This article presents a 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.

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

Recent school shootings call attention to a troubling phenomenon—young men committing violent crimes. Dr Jantz attributes much of this shocking behavior to the way that boys are treated at their earliest, formative ages. Normal boyhood behavior is labeled as unruly and unacceptable, and families and schools just don’t understand their brain chemistry. So, what can we do? Find out and comment on our blog.

Mouthwash poisoning in adults is an infrequent presentation to the emergency service. It has been described in children and has led to tighter policies for safety packaging of the mouthwash bottles. Read about a case of mouthwash poisoning in the context of a suicide attempt in an adult man.

Hyponatremia in psychiatric patients is often associated with antidepressant medications. Severe hyponatremia can result in confusion, delirium, seizures, and death. In this Letter to the Editor, explore the case of an anxious man whose self-treatment of anxiety with an herbal beverage containing valerian root worsened hyponatremia.

See all Pain

PAIN

The current study of patients with leg pain from lumbar radiculopathy compares the pain-relieving effects of the serotonin and norepinephrine reuptake inhibiting drug milnacipran to that of placebo. Nerve pain in the legs is studied in addition to tissue pain in the lumbar spine.

Is there a relationship between trauma in childhood and pain in adulthood? The authors of this study examined 5 types of trauma (witnessing violence, physical neglect, emotional abuse, physical abuse, and sexual abuse) in a primary care outpatient sample and their relationship to pain and pain catastrophizing.

Researchers from Duke University conducted a small study of the drug milnacipran in patients who continued to experience knee pain for a year or more despite having an otherwise successful knee replacement. In this open-label study, patients were given milnacipran at doses of 100 to 200 milligrams a day while investigators assessed their knee pain and function with a variety of measures.

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

Sleep problems are associated with concentration problems, mood disorders, and driving accidents. Read this activity to learn how the sleep cycle should function, what processes can be affected by sleep problems, and what systems are involved in enhancing sleep or blocking wakefulness.

There is an increasing need for sleep medicine services for returning veterans. Primary care providers are uncomfortable diagnosing and treating sleep disorders, and patients often have to wait several days before they can be seen by a sleep clinician. In this article, the authors describe a pilot project for primary care–sleep medicine integration established at the Minneapolis VA Medical Center.

While the costs associated with MDD and insomnia have been studied extensively as separate entities, scant research exists to examine the combined roles of MDD and insomnia in health care expenditures and impaired work function. This study evaluated health care utilization, costs, and work productivity loss associated with insomnia in patients newly diagnosed with MDD.

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

A growing number of older adults are being admitted for first-time treatment of substance abuse. In this article, Dr Yarnell reviews the latest literature related to cocaine abuse in later life, as well international guidelines for addiction. She also presents three cases of cocaine use in patients over the age of 50, who were all seen by one provider within a 10-day span in 2013.

The authors of this article investigated the possible anticraving efficacy of high-frequency deep transcranial magnetic stimulation of the bilateral dorsolateral prefrontal cortex in 3 patients with comorbid long-term DSM-IV-TR dysthymic disorder and alcohol use disorder.

Synthetic cannabinoid use continues to increase. The authors of this Letter to the Editor report the case of a woman presenting with severe synthetic cannabinoid physical dependence, smoking “mojo” every 15 minutes during the day and awakening every 45 minutes in full withdrawal to smoke it overnight.