What's New | Decker

Oppositional defiant disorder (ODD) has a high prevalence and substantial morbidity
Diagnosis of ODD is based on a careful history, interview, mental status examination, and collateral information from school.
Disruptive mood dysregulation disorder is a new DSM-5 diagnosis that should be carefully considered in the differential diagnosis of children and adolescents with ODD
Genetic and neuroimaging studies have examined the possible neurobiological basis of ODD, but to date there is no definitive biomarker or biological findings in ODD.
Parent behavioral management training and psychosocial interventions are the cornerstone of treatment planning for ODD.

Oppositional defiant disorder (ODD) has a high prevalence and substantial morbidity
Diagnosis of ODD is based on a careful history, interview, mental status examination, and collateral information from school.
Disruptive mood dysregulation disorder is a new DSM-5 diagnosis that should be carefully considered in the differential diagnosis of children and adolescents with ODD
Genetic and neuroimaging studies have examined the possible neurobiological basis of ODD, but to date there is no definitive biomarker or biological findings in ODD.
Parent behavioral management training and psychosocial interventions are the cornerstone of treatment planning for ODD.

The concept of “dynamic kinking,” or the urethral compression that occurs with physical exertion, is critical to understanding the mechanism by which a tension-free midurethral sling works for stress urinary incontinence.
No significant difference in subjective or objective outcomes has been noted for transobturator versus retropubic slings, with success rates ranging from 80 to 90%.
Sling complications are either functional or mesh specific. The most common mesh-specific complication is mesh exposure, which occurs in 0 to 4.4% of cases.

Cognitive-behavioral therapy (CBT) is typically more structured and shorter duration and centers on identifying thoughts and beliefs and how they impact feelings and behaviors. The therapist helps individuals label and challenge these thoughts and beliefs, and often homework is assigned to identify and counter these as they occur in their daily life.
All guidelines agree that an antidepressant trial should be a minimum of 4 weeks and up to 8 to 12 weeks at an adequate duration and dose. Even with dozens of antidepressant therapies on the market, overall response rates are still suboptimal, and remission rates remain low.
There are few data on long-term use of antidepressants. Studying relapse and prevention therapies is challenging because of the heterogeneity of the disease and difficulty retaining subjects in long-term antidepressant studies.

Large randomized trials of Pap and HPV cotesting found that after extended follow-up, the incidence of invasive cervical cancer was significantly lower in women initially screened with HPV-based testing compared with cytology alone.
Screening that includes assessment of HPV status provides 60 to 70% greater protection against invasive cervical carcinomas compared with cytology alone.
Vaccination rates for the HPV vaccine, approved in the United States since 2006, are well below national goals, and provider recommendation has been found to be the most important factor influencing a patient’s or parent’s decision as to whether or not to accept the HPV vaccine.

Emerging role of beta agonist therapy for treatment of OAB
The pharmacologic use of onabotulinumtoxinA (Botox®) upgraded to strongest rating of “standard" (strength of evidence grade B) by the amended 2014 AUA/SUFU guidelines.
Studies reporting trigonal injections of Botox may be associated with superior continence rates

Surgery for neurogenic bladder aims to protect the upper urinary tract and optimize continence.
Major factors to consider are the injury level, gender, habitus, dexterity, and cognitive functions.
Surgical options for storage and emptying failure are discussed, including indication, technique, and complications.
New surgical technology and regenerative medicine are mentioned together.

Ultrasonography criteria for the diagnosis of early pregnancy loss have recently been redefined.
Medical and surgical management are safe and effective, and should be influenced largely by patient preference.
Recommendations regarding interval to next conception have recently shifted away from the traditional 3 months.

IM Psychiatry