Trauma in Psychiatric Practice

The prescription of psychotropic medications for patients with complex comorbid medical and psychiatric conditions is a cornerstone of psychosomatic medicine (PM) practice.

In theory, psychiatrists possess no special skills for determining capacity of a patient to accept or refuse medical care, yet a large percentage of a psychosomatic physician’s work nonetheless involves capacity evaluations.

Currently, there are 350,000 Americans who receive maintenance dialysis for renal failure, and this predominantly elderly population with multiple comorbidities is growing.

This article provides background information on the FGIDs for psychiatrists and a review of recent research on the biopsychosocial mechanisms that contribute to the illness experience.

Custody disputes often produce anxiety for all involved. Whether you are a treating child psychiatrist or custody evaluator, it is imperative to have a clear idea of your role.

Substance use disorders are associated with significant morbidity and mortality that affects individuals and their families. Preventing the onset of an SUD in adolescence remains a critical area of clinical and public health significance.

The diagnosis of T1DM can be devastating to both the child and family. Because of the potential for immediate life-threatening complications of poorly controlled diabetes, family members must readjust their approach to daily living.

Depression, anxiety, and delirium are 3 examples of common but frequently challenging areas of distress in pediatric palliative care patients.

The articles in this Special Report reinforce the lesson that children come with parents. This is one of first lessons that I teach my residents: you can’t work with a kid in a vacuum. Parents who do not feel some connection with a caregiver will not bring their child to treatment or follow the recommendations of the treatment team.

Anxiety disorders are a frequent occurrence in pregnancy. While some worries and anxiety are experienced by more than 50% of pregnant women, a full-blown anxiety disorder involves risk to both mother and fetus and increases the risk of postpartum depression.

Anxiety disorders occur in 18% to 28% of the US general population during any 12-month period. In anxiety disorder, there is a 33% to 45% 12-month prevalence rate for a comorbid substance use disorder (SUD).

In this article, we attempt to leverage state-of-the-art research findings to provide empirically informed perspectives and practices related to these issues.

Exposure-based therapies are highly effective for patients with anxiety disorders, to the extent that exposure should be considered a first-line, evidence-based treatment for such patients. In clinical practice, however, these treatments are underutilized, which highlights the need for additional dissemination and training.

Anxiety disorders are commonly comorbid with bipolar disorder and are responsible for much of the morbidity associated with this condition. Treatment of anxiety can be a challenge, since the mainstay of treatment—serotonergic antidepressants—may adversely affect the course of bipolar disorder. Although other agents are available, there is a dearth of information on the outcomes of anxiety treatment for bipolar patients.

For prescribing psychiatrists who want to offer treatment alternatives to patients who prefer to avoid medication, the evidence is clear that psychotherapy is an effective choice. Even in cases in which medication is accepted, the evidence suggests that psychotherapy may significantly improve patient outcomes.

A therapist forgets about a patient’s appointment. She becomes abnormally angry, unusually forgiving, atypically bored, or excessively voyeuristic. What is going on? The therapist’s countertransference is making itself known.

We are living in an evidence-based era in all fields of medicine, including psychiatry. For the most part, this represents progress because clinicians can start to base their interventions on treatments that have been supported by the results of research studies.

Psychotherapy outcomes and the mechanisms of change that are related to its effects have traditionally been investigated on the psychological and social levels, by measuring changes in symptoms, psychological abilities, personality, or social functioning.

When we write about psychotherapy, we usually write about the patients and their cognitions and psychodynamics; or we talk about the techniques of psychotherapy, schools of psychotherapy, and efficacy studies. These are all songs of psychotherapy.

Although we would all like to believe otherwise, war is not over when a service member returns home. For many, returning home may be where the harder battles begin. Intensive training prepares troops for warfare, but what training do they have to readjust when they return home?