From the Editor-in-Chief's Desk

T his issue of the Journal is notable for the breadth of inquiry represented, both as to subject and to method. As usual, it includes very welcome additions to the research concerning the effectiveness of a number of psychotropic medications in various populations, as well as studies of risk factors, treatment modalities, and serious pharmacologic side effects that warrant further attention.

That last point applies to the work of Chien et al., who detail the case of an adolescent female who attempts suicide following the prescription of sodium oxybate for narcolepsy. That this orphan drug could account for this patient's severe psychiatric symptoms and self-injurious behavior serves to open our eyes: what in one pharmaceutical agent is a target of therapy can easily be an unwanted and even fatal side effect in another, and vice versa.

Elsewhere authors examine other rare etiologies and expressions of severe psychiatric symptoms. Ray et al. write of a young male diagnosed with pediatric autoimmune neuropsychiatric disorders (PANDAS) whose comorbid diagnosis of hyperimmunoglobulin D syndrome (HIDS, or “Dutch fever”) may account for his obsessive compulsive disorder symptoms—or, as they suggest, “may constitute a special subgroup of PANDAS.” And Paul et al. provide a detailed look at a male Hispanic adolescent presenting with anorexia nervosa, fitting and necessary at a time when this eating disorder is ascendant both in males and in non-Caucasian races. Their blunt advice: “Clinicians must be aware and screen for eating disorders in all young patients, regardless of their gender or ethnicity.”

These individual stories are complemented by Baeza et al.'s signal investigation of the use of psychotropic medications and seclusion and restraint to manage aggressive behavior in the adolescent psychiatric inpatient population. It is difficult to summarize their findings or to detail a particular way forward. Suffice it to say, many of their findings will not come as a surprise to professionals familiar with inpatient psychiatric units. However, the lack of “structured” application of these methods of behavior modification described, and the strong correlation between violent aggression and “a higher frequency of prior psychiatric hospitalizations,” paints a vivid picture both of hospital staffs doing the best they can and a system that demands a healthy dose of introspection. Or as Baeza et al. put it, further research is “sorely needed.”