Fibromyalgia: Psychiatric drugs target CNS-linked symptoms

Sharon B. (Shay) Stanford, MD
Assistant professor of psychiatry and family medicine, Assistant director, Women’s Health Research Program, University of Cincinnati College of Medicine, Cincinnati, OH

Patients with fibromyalgia are a heterogeneous group, yet many describe a common experience: seeing multiple physicians who seem unable or unwilling to provide a diagnosis or treat their symptoms. This situation may be changing with the recent FDA approval of an anticonvulsant and 2 antidepressants for managing fibromyalgia symptoms.

These medications—pregabalin, duloxetine, and milnacipran—reflect a revised understanding of fibromyalgia as a CNS condition, rather than an inflammatory process in the muscles or connective tissue. As a result, psychiatrists—because of our experience with CNS phenomena and managing antidepressant and anticonvulsant medications—are likely to play a larger role in treating fibromyalgia.

Listen to Dr. Stanford discuss "Is fibromyalgia a somatoform disorder?"

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‘Night owls’: Reset the physiologic clock in delayed sleep phase disorder

R. Robert Auger, MD
Assistant professor of psychiatry and medicine, Mayo Clinic College of Medicine Consultant, Mayo Center for Sleep Medicine, Rochester, MN

Delayed sleep phase disorder (DSPD)—characterized by a pathological “night owl” circadian preference—is seen most commonly in adolescents and is associated with psychiatric morbidity, psychosocial impairment, and poor academic performance. Proper identification of the condition can be enhanced with a variety of assessment tools, and successful treatment requires an awareness of potential endogenous and exogenous contributors.

This article describes what is known about DSPD and uses the case example to illustrate diagnostic assessment and treatment choices. Intriguing data support various pathophysiologic explanations for DSPD. Facilitating the adjustment of patients’ physiologic clocks is the overall goal in managing DSPD.

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Compulsive bruxism: How to protect your patients’ teeth

Bernard Friedland, BChD, MSc, JD
Assistant professor of oral medicine, infection, and immunity, Harvard School of Dental Medicine, Boston, MA

Theo C. Manschreck, MD, MPH
Professor of psychiatry, Harvard Medical School, Boston, MA

Oral habits such as bruxism—compulsive grinding or clenching of the teeth—can be a manifestation of obsessive-compulsive disorder (OCD) and other anxiety disorders. Bruxism also may be a side effect of selective serotonin reuptake inhibitors (SSRIs) used to treat OCD and depression. Other oral conditions can complicate treatment of these disorders.

Potentially serious sequelae of bruxism and similar behaviors include:

• wearing down of teeth (more common)

• necrosis of the pulpal tissues that results in non-vital teeth (less common).

The following case underlines the need for early referral to a dentist and close follow-up for patients who have tooth-related behaviors or are taking medications associated with a risk for such behaviors.

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Is Darwin still relevant? Advanced human brain breaks evolutionary rules

Henry A. Nasrallah, MD, Editor-in-Chief

You may have noticed the buzz about Charles Darwin in the news: 2009 marks the 200th anniversary of his birth and the 150th anniversary of his monumental description of evolution in On the Origin of Species. Celebrations are scheduled around the world to honor the scientist who coined the phrase “natural selection” to explain the heritable process by which adaptive evolution occurs.

But is Darwin’s theory of evolution still relevant? The “game-changer” that is transforming evolution is the genetic mutation that led to dramatic growth in the primate cortex—especially the frontal lobe—culminating in the emergence of Homo sapiens. The overdeveloped brain that has helped our species adapt and survive may be transforming us into predators of all other species and a hazard to our planet.

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