E-mail, instant messaging (IM), video chat, and social networks—notably blogs and online communities such as Facebook and Twitter—have emerged as essential business and social communication tools.1 Electronic communication is speedy and efficient, crossing continents in seconds (e-mail) or, in some cases, nanoseconds (as with Google Wave and Skype technologies).
In today’s practice of medicine, it is highly unlikely that any physician entering into or already in practice will remain in the analog age without some type of health information technology. Computers today are just as important to the psychiatric office as was the proverbial couch, and they play a central role in data collection, storage, and retrieval in various domains such as scheduling, billing, and record keeping. For the novice or even for the experienced purveyor of electronic goods, to evaluate the numerous technologies available for their relevance to digital practice can be rather daunting. This article serves as a guide to the practicing psychiatrist to determine what technologies will be most useful—if not mission-critical.
Since the inception of the modern era of psychopharmacology, psychotropics have been the mainstay of the care of psychiatric patients all over the world, irrespective of their cultural and ethnic backgrounds. Until recently, however, variations in treatment response across populations, including effectiveness, dosing strategies, and adverse-effect profiles, have received minimal attention.
The onset of psychiatric illness in a child is a life-changing event for families. Families from immigrant and ethnocultural communities often must come to an understanding of their child’s psychiatric difficulties while simultaneously interacting with an unfamiliar health care system and its practitioners.
During the past 2 decades, there has been enormous growth of interest in and visibility of cultural psychiatry. Much of this is due to the steady increase in migration of the world’s population from low-income to higher-income regions and countries.
Until the early 19th century, psychiatry and religion were closely connected. Religious institutions were responsible for the care of the mentally ill. A major change occurred when Charcot1 and his pupil Freud2 associated religion with hysteria and neurosis. This created a divide between religion and mental health care, which has continued until recently. Psychiatry has a long tradition of dismissing and attacking religious experience. Religion has often been seen by mental health professionals in Western societies as irrational, outdated, and dependency forming and has been viewed to result in emotional instability.3
Hy Bloom provided an expert psychiatric report in a multiple murder case in which the accused, who had schizophrenia and depression, had killed his wife and 2 children. Before the murders, the accused had been seeing a psychiatrist and family physician for treatment of the mental disorders.
The United States Census Bureau projects that by 2010 nearly 13% of the US population will be over the age of 65. The elderly are one of the most rapidly growing segments of the US population and are expected to account for more than 20% of the total population by 2050.1 In 2001, the prevalence of dementia in North America was 6.4%. A 49% increase in the number of people with dementia is expected by 2020, and a 172% increase by 2040.2 Patients with dementia may lack the capacity to consent to treatment. The need to evaluate capacity to consent to treatment will therefore increase as the aging population grows.
In the 33 years since I began medical school, psychiatric knowledge has greatly increased in depth and breadth, rendering much of what I originally was taught about diagnosis and treatment in need of revision. Critical concepts in malpractice have also been codified and studied since that time. We can now educate ourselves on the constituents of malpractice, as opposed to the vague admonitions I received in medical school to “watch out for the lawyers.”
Many forensic psychiatrists are known for never shrinking from a controversial subject. So it is with leading forensic psychiatrists Drs Donna M. Norris and Marilyn Price. In the November issue, they took on a sensitive subject that desperately needs more attention: firearms and mental illness.
I take it as an article of faith that anyone who expects to be taken seriously as a mental health law scholar must write at least one Tarasoff article that is taken seriously.1-9 Notwithstanding the personal implications and its centrality to mental health professionals, in my 30 years of teaching and writing about the intersection of psychiatry and law, I had managed to avoid that rite of passage. I was not comfortable and found it difficult to say something original on a topic that has been so extensively explored. Part of the lure of this field of the law was that unlike constitutional law or property, which had long ago been carved up by some old dead white guys, mental health law was young, vibrant, and alive. As of 2009, all of Tarasoff authors, save one, had long since died. Nonetheless, unable to refuse the editor’s request and hold my head high as a Psychiatric Times editorial board member, I take this opportunity to revisit the decision in the hope of gaining new insights.
Patients who exaggerate, feign, or induce physical illness are a great challenge to their physicians. Trained to trust their patients’ self-reports, even competent and conscientious physicians can fall victim to these deceptions. In doing so, the treating physician may unwittingly provide support for specious claims of illness or injury by conferring official diagnoses, or by delivering treatments that transform the patient from a pretender into a person with a genuine, although iatrogenic, medical problem (eg, via adrenalectomy, pancreatectomy, serial amputation).1-3
The right of American citizens to own, register, and carry firearms has a significant history of federal and/or local regulation dating to the early 18th century.1 With the passage of the federal Gun Control Act of 1968, persons who have been treated for mental illness and/or substance abuse are among a defined group restricted from owning and carrying firearms.2-4 While violence is often portrayed in the media as related to persons with mental illnesses, there are limited research data to support this idea.5
The prevalence of depression in children and adolescents ranges from 2% to 8% in the general population, which indicates that depression in this population is a major public health concern. This is especially apparent when rates of depression are compared with other serious medical conditions in childhood, such as diabetes, which has a prevalence of 0.18%.
Anxiety disorders are one of the most common psychiatric disorders in children and adolescents, but they often go undetected or untreated. Identification and effective treatment of childhood anxiety disorders can decrease the negative impact of these disorders on academic and social functioning in youth and their persistence into adulthood.
Eating problems are common in children and adolescents, and eating disorders typically have their onset during these developmental periods.1 Anorexia nervosa is a serious and potentially life-threatening disorder associated with severe food restriction, overexercise, malnutrition, and distorted thinking about body shape and weight. The typical age of onset is early adolescence (ages 12 to 15 years). Bulimia nervosa is characterized by periods of restriction followed by binge eating and purging behaviors (eg, vomiting, laxative use, overexercise) and often begins during middle adolescence (ages 15 to 17 years). A variety of social, developmental, genetic, and familial factors have been implicated in the etiology of these disorders, but their cause is unknown.
Physicians generally display better health and have lower rates of all-cause mortality than the general population.1 However, their education, nutrition, and lifestyle do not offer similar protection from substance abuse and dependence. Prevalence rates of alcohol abuse and dependence among physicians are about equal to those seen in the population as a whole, while prescription drug misuse and dependence rates are far higher.2,3 Addiction impairs more physicians than any other disease.4
Self-administration of drugs of abuse often causes changes in the brain that potentiate the development or intensification of addiction. However, an addictive disorder does not develop in every person who uses alcohol or abuses an illicit drug. Whether exposure to a substance of abuse leads to addiction depends on the antecedent properties of the brain.
Surveys show that approximately 60% of the general population has gambled within the past 12 months.1 The majority of people who gamble do so socially and do not incur lasting adverse consequences or harm. Beyond this, approximately 1% to 2% of the population currently meets criteria for pathological gambling.2 This prevalence is similar to that of schizophrenia and bipolar disorder, yet pathological gambling often goes unrecognized by most health care providers.
Cigarette smoking is pervasive among persons who are being treated for substance use disorders. The prevalence is 3- to 4-fold higher than in the general population. Whereas approximately 20% of adults in the United States currently smoke, between 75% and 95% of persons in treatment programs for addictions are cigarette smokers.1-3 The consequences of dual addictions to cigarettes and other substances of abuse are dire. In a frequently cited study conducted over a decade ago, approximately 50% of patients who were followed after inpatient substance abuse treatment died of tobacco-related causes—a rate that exceeded deaths from alcohol-related causes (34%).3 These high tobacco-related mortality rates reflect not only the greater prevalence of smoking in this population but also the tendency for persons with substance abuse disorders to start smoking at a younger age, to be more dependent on nicotine, and to be particularly susceptible to certain types of cancer secondary to combined use of tobacco and alcohol (eg, cancers of the head and neck).4-6