Irritable bowel syndrome (IBS), a condition common in the health-care setting, can be especially challenging to manage for both the referring physician and the psychiatrist. Much of this difficulty arises from the understanding and treatment of the disorder from a disease-based biomedical approach rather than a biopsychosocial model. The latter model offers a more effective method to understand the development and clinical expression of IBS, and as a result, directly informs subsequent management. This article defines and describes the epidemiology of IBS, reviews its pathophysiology, identifies the role of psychosocial factors using a biopsychosocial model of IBS, and clarifies the role of the mental health professional in its management. IBS management involves identifying psychiatric comorbidities, assessing the patient's perspective of the role of psychosocial factors, offering psychotherapy directed toward adaptive coping mechanisms, providing psychotropic medication consultation, and engaging in ongoing collaboration with the referring physician.

Apathy is a common neurobehavioral feature in a variety of neuropsychiatric disorders. Apathy is often interpreted as a sign of depression or as a nonspecific symptom of other medical conditions. However, recent research indicates that the essential meaning of apathy is lack of motivation. This article presents a framework for the classification and differential diagnosis of apathy and addresses issues related to the assessment and treatment of apathy in neuropsychiatric patients.

Many endocrine disorders present with symptoms of depression, thus differentiating primary depressive disorders from such endocrine conditions can be challenging. Awareness of the typical clinical picture of endocrine disorders is of primary importance. This article discusses a variety of common and uncommon endocrine disorders and the symptomatology that might suggest a depressive illness, and reviews literature on how endocrinopathies can mimic depression. Emphasis is also placed on the role that stress can play in the pathogenesis of endocrine disorders. Psychiatrists should be familiar with the range of presenting symptoms for endocrine disorders, and they should not rely on the presence or absence of stressors to guide their differential diagnosis between depression and endocrine disorder.

The science of infertility has advanced rapidly over the past decade, in many respects without regard to the enormous demands that are placed on all participants undergoing an infertility work-up and treatment. Among these demands are a variety of potential psychological effects that must be addressed in the initial patient visit with continued counseling throughout the infertility work-up process. This article reviews the psychological factors that may affect individual patients and couples experiencing infertility, with special attention given to the common manifestations of stress. The need for physicians to provide early and ongoing attention to emotions is emphasized, and a biopsychosocial approach to infertility evaluations is outlined.

Until recently, several weeks of treatment were required in order to obtain a clinically significant antidepressant response using pharmacotherapy. The present study, using the mouse forced swimming test, investigated possible antidepressant augmentation strategies, together with the probable mechanisms involved in such potentiations. It is clear from this and other similar studies that it is possible to enhance the activity of antidepressant drugs with the addition of other compounds (ie, clonidine, quinine, glyburide, pindolol, or buspirone). These data indicate that direct/indirect manipulation of serotonergic receptor systems potentiates the effect antidepressant drugs (ie, selective serotonergic reuptake inhibitors) in the mouse forced swimming test, and thus establish this model as a reliable preclinical tool for the investigation of possible antidepressant augmentation strategies. It also appears that this model can be used as a method for identifying the mechanisms involved in such treatment strategies.