In this issue of CNS Spectrums we examine some underserved populations who continue to have real unmet needs. For example, patients in forensic and correctional settings have serious psychopathology resulting in substantial morbidity and mortality, and yet human subjects concerns have led them to be very much understudied. Likewise, patients with treatment-resistant obsessive-compulsive disorder (OCD) are quite common, and yet, compared with other disorders such as schizophrenia, few resources have been devoted to addressing their substantial functional disability. Finally, cognitive dysfunction in the elderly is an enormous problem, yet little work has addressed the role of gonadal dysfunction, or male menopause, in specific cognitive deficits of the elderly.

Mr. F is a 60-year-old Caucasian, married, unemployed male who presented to the outpatient department of the Veterans Administration (VA) ∼10 months ago with a chief complaint of sleep difficulties. Approximately 12 years ago he had been diagnosed with posttraumatic stress disorder (PTSD) and a major depressive episode (MDE). He received very little treatment, either medication or therapy, at that time. He presented after being followed in a Veteran's Center for weekly to biweekly supportive therapy with a counselor for ∼6 months. He had gone to the Veteran's Center due to the encouragement of his wife. She had noted that he was becoming increasingly irritable and isolative at home and she had asked him to seek help for his anger and irritability. An event occurred in which he broke a chair after watching war-related news coverage and that made her insist that he present for treatment.

In this article, the literature examining the relationship between testosterone and various cognitive domains in elderly men is reviewed. The review focuses on the role of endogenous testosterone levels and the effects of androgen depletion and replacement. The cognitive domains most commonly linked to testosterone include memory and visuospatial function. Indeed, the literature suggests that in certain conditions (ie, hypogonadism, cognitive impairment) testosterone levels may be significantly associated with memory and visuospatial function, but not other cognitive functions. Studies with larger sample sizes and more sensitive cognitive measures are indicated, as questions remain about the potential role of testosterone as a cognitive enhancer.

This report describes the case of a young man with a large calcification in the right thalamus that was first diagnosed at 9 years of age. Case history reveals specific eating rituals and other obsessive-compulsive personality traits during the patient's childhood and adolescence, fulfilling diagnostic criteria of obsessive-compulsive personality disorder. After a critical life event the patient develops anorexia nervosa. We suggest that our case and further literature provide evidence for an involvement of specific thalamic structures, such as the dorsomedial nucleus, in the development of anorexia nervosa. Furthermore, the treatment of the patient by a combined psychotherapeutic and pharmacotherapeutic approach is described. We focus on the beneficial effect of the atypical antipsychotic olanzapine, which can induce weight gain by an increase of leptin levels.