This book draws together the entire spectrum of the relevant psychosocial dimensions and data necessary to adequately assist in the evaluation and treatment of patients who may be candidates for bariatric surgery.
Psychiatric Times presents exclusive coverage of the American Psychiatric Association Conference. Here we will report the latest news, resources, and updates from the 2013 APA Conference, the 166th Annual Meeting of the American Psychiatric Association, May 18-22, 2013, in San Francisco, CA. Read More
Test your diagnostic skills and knowledge by quickly identifying and assessing various mental health disorders. The Psychiatric Times Diagnostic Champions' Challenge is meant to educate and entertain. Test your clinical acumen in this activity that is sure to make you think.… Read More
The psychologists appear to believe that large numbers of untreated mentally ill would get better if their psychologists could prescribe medication for them, thereby making up for a resource-poor and underfunded mental health system. There is no lack of prescribers. Psychiatrists know that the biggest problem for the mentally ill isn't a lack of medication, it is the dearth of supportive services available to augment, among other treatments, the taking of medication. So why are psychologists fleeing the duties they have long been mandated to provide? The answer is simple: Money.
All of the forces affecting and influencing my professional life thunder through my day like these footsteps on the bridge. So many times we hear that private practitioners are "dinosaurs" in today's managed health care environment. At times, I admit, I do feel like a hanger-on in some evolutionary cul-de-sac. Yet, as referrals keep coming in, I find myself feeling more and more fit to survive the Darwinian challenges facing psychiatry. Sharing daily life with colleagues I trust and respect better enables me to live with or ignore the "footsteps on the bridge," which in my more optimistic moments I imagine to be the sound of the real "dinosaurs" rumbling off into the mist.
Proponents of SB 694 argue that the doctoral-level training undertaken by psychologists qualifies them to deal with mental illness more so than most physicians. More than 75% of mental health prescriptions are written by general practitioners who have limited training in treating mental illness. They say it makes good sense to set up a system in which psychologists who meet additional educational requirements would be given the authority to prescribe medication. Opponents contend that the training provided for in the bill is inadequate. Many feel that as time brings new and significantly more powerful drugs for the treatment of mental disorders to the market, the arguments against psychologists prescribing will increase.
Over the past decade, cost containment efforts have pushed psychotherapy patients away from psychiatrists and toward the offices of psychologists, therapists and other less expensive mental health workers. The availability of new drug treatments for psychiatric disorders has shifted many psychiatrists' practices away from a long-term therapeutic focus to that of short-term drug treatment. If psychiatry merely reacts to these economic and political forces, rather than managing them with a plan, the future of the field is highly uncertain.
Prior to training in psychiatry, my practice was in a rural primary care setting where I routinely collaborated closely with physician assistants and nurse practitioners. I see prescriptive privileges of one form or another for psychologists to be an inevitability. I watched a similar struggle for nurse practitioner prescriptive privileges in Oklahoma during my stint in primary care. My recommendations to physicians in California would be to endorse prescriptive privileges for other mental health professionals in the format of the "physician extender" model similar to the traditional physician assistant.
A number of parameters determine how many psychiatrists our nation needs. First is the incidence and prevalence of mental disorders. Second is the kind of clinical care individuals with mental disorders will need, and who will provide that care. Individuals with mental disorders require a thorough diagnostic assessment. Does this need to be provided by a psychiatrist? Obviously, some individuals will need medications as an aspect of their care. These medications must be prescribed by a physician. Does that physician need to be a psychiatrist? Some individuals with mental disorders will need psychotherapy. Does the psychotherapy need to be provided by a psychiatrist?
The Americans with Disabilities Act of 1990 (ADA) was to have ushered in a new age of equal opportunity for individuals suffering from physical and mental infirmities. But rather than providing "a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities," the ADA often becomes the legal battleground upon which individuals' rights clash with the economic interests of businesses that bear the brunt of the costs associated with equality.
I find expertise is best defined by the attending psychiatrist. I usually ask them whose opinion they respect in the community, whether that person is acceptable to them to do the evaluation and if their conclusions about disability would be acceptable. If the attendings have no one in mind, I have developed a network of excellent forensic psychiatrists around the country from which I can draw. In this case, I make a suggestion, and ask the attending if the particular provider is acceptable.
An injunction barring further marketing of the generic drug Repronex, recently approved by the Food and Drug Administration, was issued by a U.S. District Court July 25. Although this is the first time that a court has ruled against an FDA determination of generic equivalence in numerous lawsuits brought by manufacturers of reference brand products, it is not the first time that Sporkin has decided against a federal agency. Sporkin wrote, "the FDA cannot selectively choose to reinterpret the FFDCA (Federal Food Drug and Cosmetic Act) and its own implementing regulations in such an arbitrary manner. 'Same' means 'identical,' just as the agency's own regulation say and an agency must follow its own regulations and not arbitrarily reinterpret those regulations."
There's such an enormous need, said Renshaw, noting that a study of 100 white, middle-class, well-educated couples revealed that more than 70% of the women and 50% of the men reported they had sexual problems. "Ours is a small clinic, in no way able to meet the demand for treatment or training from all who request it. About 80 couples a year are treated. The waiting list is much too long. Couples wait between three and 10 months to come in for therapy, a far from ideal situation."
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DSM-5: If You Don't Like the Effects, Look at the Causes •“‘Post-modern’” outlook on psychiatric diagnosis often leads to cynicism and nihilism—as if to say, ‘Nobody really knows anything about anything, and we shouldn’t trust anybody!’ Actually, there is a good deal of secure and well-founded scientific knowledge in psychiatry. ” Add your response...
Migraine and Psychiatric Comorbidity •“Sleep-related bruxism is high among those with fibromyalgia, anxiety, and migraines—but it is often overlooked as a dental problem. A long-acting benzodiazepine at night can make a big difference in patients with migraines who clinch or grind their teeth.” Add your response...
Can a Suicide Scale Predict the Unpredictable? •“The multifaceted nature of suicide requires both formal tools indicated in this article, as well as an awareness of changes in the patient (eg, outlook, behavior, attitude)—these and other factors may indicate suicide risk.” Add your response...
Eco-psychiatry? If you’re thinking, “Aren’t I already dealing with a lot in my daily practice?” you are invited to spend the next few minutes listening to what Dr Steven Moffic has to say about how the environment may be affecting your patients and what impact ecologically-related syndromes might have on DSM-5.
Thinking about suicidal behavior as a diagnosable problem will help bridge the gap in how psychiatrists think about suicidality and how it is perceived by patients and their families. Dr Maria Oquendo elaborates in this video.
ADHD can persist into adulthood and have a significant impact on a person's relationships, careers, and even safety. The ASRS (Adult ADHD Self-Report Scale) is a checklist of 18 questions about symptoms that are based on the diagnostic criteria of DSM-IV. The patient answers the questions and a positive score suggests the need for a thorough clinical evaluation with a healthcare professional.
The Bipolar Spectrum Diagnostic Scale (BSDS) was developed by Ronald Pies, MD and was later refined and tested by S. Nassir Ghaemi, MD, MPH and colleagues. The BSDS arose from Pies’s experience as a psychopharmacology consultant, where he was frequently called on to manage cases of “treatment-resistant depression.” In Pies’s experience, most of these cases eventually proved to be undiagnosed bipolar spectrum disorder.