Dr. Viguera, what are your responsibilities in the Perinatal and Reproductive Psychiatry Program?

The concept of a difficult spell preceding the menstrual period in some women is not new. Hippocrates was said to have noted it, and in 1847, Dr. Ernst von Feuchtersleben said, "The menses in sensitive women is almost always attended by mental uneasiness, irritability, and sadness."

When we were planning this issue, several friends and readers were a bit surprised. "A whole issue on OCD? Is there anything new to say about it?" There's plenty to say that's both new and old.

When it comes to a neuroanatomical understanding of psychiatric symptoms, OCD is considered the superstar of the field. A wealth of data has implicated the involvement of a specific neuroanatomical loop in OCD.

You're a cutting edge psychiatrist. Not only are you great with meds, but you have a passing knowledge of CBT (cognitive-behavior therapy) techniques for the treatment of OCD. Sorry. You're already behind the curve.

First of all, Dr. Koran, I can't resist plugging your marvelous book on OCD (Obsessive-Compulsive and Related Disorders in Adults: A Comprehensive Clinical Guide, 1999, Cambridge University Press). It's readable and chock-full of great information. How did you get into the field of OCD?

The symptoms of OCD have been known for a long time. Who can forget Lady Macbeth at the sink, scrubbing away at the imagined evidence of her guilt. But the term obsessive-compulsive disorder is a relatively recent one.

Where does it hurt? These are the “four little words” that Eli Lilly (in ubiquitous ads) is encouraging us to ask our depressed patients.

Here's a fairly typical scenario: An elderly woman comes to you as a referral from her PCP for the treatment of depression and anxiety. She hands you a well-worn 3-by-5 card with her meds listed in shaky handwriting.

When a patient tells you that she has fibromyalgia, what should you, a psychiatrist, do? Should the diagnosis alter your treatment in any way?