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The Anxious Bipolar PatientTreatment of anxiety can be a challenge, since the mainstay of treatment may adversely affect the course of bipolar disorder.
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Youth-Led Suicide Prevention in an Indigenous Rural CommunitySuicide is a pervasive public health issue for adolescents in Hawaii. In response, a youth leadership model was initiated to empower young leaders in suicide prevention through evidence-based training, relationship building, and community awareness.
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Cultural and Ethnic Issues in PsychopharmacologyThis article aims to provide a glimpse of recent developments that are relevant to cultural and ethnic influences on psychopharmacological responses.
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Telling the Truth in FictionAn author discusses the similarities he has found between creating believable characters and stories and his work as a psychiatrist.
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Contemporary ECT, Part 2: Mechanism of Action and Future Research DirectionsSimply telling patients “we don’t know how ECT works” neglects our abundant knowledge of what this treatment does. The authors review biological actions of ECT and discuss future directions for research.
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Successful Exit Planning for PhysiciansWhether planned or unplanned, a physician's departure from your practice will definitely have an impact, so be prepared.
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The Role of Psychiatrists in HIV PreventionBecause over half of persons with HIV infection have a lifetime history of depression or bipolar disorder, psychiatrists are uniquely positioned to provide both preventive and therapeutic interventions to vulnerable patients.
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Sexual Minority Identity DevelopmentSexual identity development is a complex, multidimensional, and often fluid process. One must consider cognitive, social, emotional, cultural, and familial complexities among other aspects of the individual’s experience to contextualize a narrative concerning sexual identity development.
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Mood Disorders in 3 Clinical ReportsUseful information about mood disorders in 3 key areas-bipolar disorder, comorbid ADHD and depression, and suicide risk.
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The Lost Birds of Wounded KneeI remember as a child gathering wild greens with my Cherokee grandmothers, 2 generations of them, and hearing the lilt of spoken Cherokee. I can still see myself listening quietly in the corner of the room while others came to visit my great-grandmother, a respected traditional healer. We were poor. There is no other way to say it. My mother carried water from a well in the middle of the field, and I remember before going outside to play in the snow that we wrapped bread sacks around our feet to keep them dry. But as a child, while life was hard and even harsh at times, it felt safe and constant.
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Trendspotter: Technology Must Prove Its ValueThe challenge of new technology - as in the example of robot-assisted surgery - is that costly innovations often become the standard of care before there’s sufficient evidence to tell whether they add real value that justifies their expense.
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Mini Quiz: Behaviorally Compromised PatientsIn the emergency department, how should patients with behavioral disturbances and especially those with illnesses such as dementia, TBI, autism spectrum disorder, and intellectual disability be managed? Take the quiz and learn more.
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Tools for Assessing Generalized Anxiety DisorderGeneralized anxiety disorder (GAD) is a chronic, impairing and highly comorbid psychiatric condition. A small but sufficient group of empirically supported instruments to assess the severity of GAD are now available.
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Awakenings with the New AntipsychoticsThe explosion of neuroscience developments in this "Decade of the Brain" now provides people with schizophrenia a new generation of antipsychotic therapies. For many, these medications (e.g., clozapine [Clozaril], olanzapine [Zyprexa], risperidone [Risperdal], and quetiapine [Seroquel]) produce an improvement over their "old" antipsychotics in terms of side effects and, for some, clinical response. For a select few, however, these medications can produce dramatic improvement, akin to what Sacks (1990) termed an "awakening." These medications create exciting opportunities to use psychotherapy, group work and rehabilitation with a population historically relegated to back wards or triaged to "case management."
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Investigating the SAINT iTBS Protocol for Bipolar I DepressionThe Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) for treatment-resistant major depressive disorder has now demonstrated promise for reducing depressive symptoms of bipolar I disorder in an open-label feasibility and safety trial.
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Rape-Related PTSD: Issues and InterventionsRape is a crime that is defined as an unwanted sexual act that results in oral, vaginal, or anal penetration. Generally speaking, there are 2 major types of rape. Forcible rape involves unwanted sexual penetration obtained by the use of force or threat of force. Drug- or alcohol-facilitated rape occurs when the victim is passed out or highly intoxicated because of voluntary or involuntary consumption of alcohol or drugs. Rape can happen to boys and men as well as to girls and women but this article will focus primarily on women.
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Assassins in London and Washington Force Changes in the Insanity DefenseAcross the centuries, March has been an eventful month for the insanity defense on both sides of the Atlantic, and the McNaughten rule remains the prevalent standard to this day.
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Pandora Replies to Dr FrancesIn his recent David Letterman–like Top 19 list of DSM5 issues, Allen Frances1 targeted a proposed revision of the DSM-IV diagnosis of Pedophilia, and 2 proposed new diagnoses: Hypersexual Disorder (HD) and Paraphilic Coercive Disorder. He protests the inclusion of pubescent teenagers in the definition of the proposed revision of Pedophilia (including the renaming of it as Pedohebephilic Disorder) and criticizes the quality of writing of these criteria.1 As the chair of the DSM5 Work Group responsible for those draft criteria, I need to address his poorly reasoned claims.
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Antonio Damasio’s Descartes’ Error: Emotion, Reason, and the Human BrainDescartes’ Error1 can be read in 2 ways. To start, it works as an engagingly written, accurate piece of science journalism (which is something that we need more of; it’s hard to imagine running a democracy without it).
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Cultural Aspects of the Pharmacological Treatment of Depression: Factors Affecting Minority and YouthThe cultural and demographic profile of the United States is undergoing a rapid transformation. In many areas of the country, there is no longer an ethnic majority but a multiplicity of racial and cultural groups.
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Broadening Your Practice: Opportunities in Executive and Organizational ConsultationSeveral case examples of how psychiatrists can be a valuable asset in a workplace environment are given. What are the similarities and differences between this situation and clinical practice?
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A Look at the 988 Soft LaunchA practical guide to understanding the new behavioral health emergency number and creating effective messaging for patients, families, and colleagues.
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Algorithms Assisted By InformaticsSeveral international algorithm projects are underway, some of which have been in use for years. What are the roadblocks for their successful implementation?
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The World of Personality Disorders in 6 Clinical ReportsHere's what's new in personality disorders: DBT treatment, DSM-5 criteria, borderline personality disorder, narcissistic personalities, and mentalization-based treatments.
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The Ethical Policies and Involvement in Enhanced Interrogations of US Psychologists After 9/11The article “Mental Health Professionals in the ‘Enhanced’ Interrogation Room” on the cover of this issue provides an invaluable service. It documents psychologists’ and physicians’ involvement in enhanced interrogation programs.
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This Is the Water: The Social Determinants of Mental Health and the Future of PsychiatryHere's why we need more effective training, practice, and advocacy regarding the social determinants of mental health.
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Raising the Bar on Geriatric Mental Health Competency TrainingThe authors make the case for national education mandates from accreditation organizations and congressional support to require enhanced education of all clinicians who care for older adults.
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Electroencephalography in NeuropsychiatryThe recent evolution of neuropsychiatry/behavioral neurology as a subspecialty represents a paradigmatic shift regarding the responsibility of psychiatrists in diagnosing and managing behavioral disorders with concomitant and demonstrable brain pathology such as dementia or head injury. This authors define the clinical usefulness of electroencephalography in evaluating neuropsychiatric disorders.
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Are Migraines and Bipolar Disorder Related?Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite. In some patients, an organic mental syndrome can be part of a migraine attack (Davidoff, 1995). In other patients, an acute psychotic condition is the dominating clinical feature. This presentation, with paranoid delusions, hallucinations and anxiety, has been described in families with hemiplegic migraine (Spranger et al., 1999). Migraine is, therefore, an important differential diagnosis in relation to episodic phenomena with a mixture of somatic and psychiatric symptoms. In addition, psychosocial stress is the most common precipitating factor for a migraine attack (Davidoff, 1995).
