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Recognizing Resistance in the Therapeutic EnvironmentDespite the proliferation of competing psychoanalytic theories in the past three decades, for most analysts the recognition and interpretation of resistance (as well as transference) remains at the core of psychoanalytic technique. While resistance has been defined as encompassing all of a patient's defensive efforts to avoid self-knowledge (Moore and Fine), operationally it means those behaviors that help the patient ward off disturbing feelings such as anxiety, anger, disgust, depression, envy, jealousy, guilt and shame.
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Migraine-Preventive Medications: Guidelines for SuccessMigraine-Preventive Medications:Guidelines for Success
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A CASE REPORT: Prepartum or Postpartum Psychosis?Did this woman have (untreated) postpartum psychosis when she became pregnant a second time-- or was this a separate, rare case of prepartum psychosis?
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Psychiatric Conditions Affecting Physicians With Disruptive BehaviorThis study highlights the need to consider a holistic approach when discussing the problem of disruptive behavior in health care settings.
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Treatment Adherence: Strategies and Best PracticesTreatment nonadherence in psychiatric patients contributes to increased suicide rates, illness exacerbation, hospitalization, and mortality. This Special Report countdown highlights the psychiatrist’s role in addressing barriers to treatment in a number of scenarios.
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Psychiatric Comorbidity Associated With Pathological GamblingGambling has become a major recreational activity in the United States. Formerly confined to a few states such as Nevada and New Jersey, legal gambling opportunities have exploded across the nation in the past 2 decades.
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Neurotransmitters, Pharmacologic Synergy, and Clinical StrategiesAlthough studies now suggest that some psychotropic medication regimens have a somewhat higher success rate than the one-third rule would have predicted, psychiatrists are still left with the problem of why it is that only one third to one half of patients who are treated get better, and why fewer still sustain that improvement over time
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Mini Quiz: Cultural Diversity and the Young PatientWhat are the benefits of exploring cultural issues with a young patient and family before proceeding with treatment?
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New York State Moves Toward Involuntary Residential Commitment of the Mentally IllSeveral incidents of serious violence, including the death of one woman, have pushed the issue of involuntary commitment of the noncompliant mentally ill higher on the priority list of the government of New York State.
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Psychopharmacology of Autism Spectrum DisordersAutism is a highly prevalent, highly heterogeneous disorder of unknown etiology. Studies to clearly establish the efficacy of various classes of psychoactive drugs are scarce. Nonetheless, available findings do support the efficacy of atypical antipsychotics and antidepressants in treating the core symptoms of repetitive behavior.
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AAPS Sues over Maintenance of CertificationJane Orient, MD, comments: Many physicians are outraged, not only by the cost -- an expense which must be incurred to maintain certification, but also by the fear that MOC is being advanced as a requirement for hospital privileges, and perhaps even maintenance of licensure. More here. . .
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Sexual Impulsivity Disorders: Psychiatric "Orphans"Paraphilias and paraphilia-related disorders (nonparaphilic sexual compulsivity or sexual addiction) are sexual disorders that predominantly afflict men.
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Brain Pathways: New Approaches to Structure-Function LocalizationIs it time again for greater unification of neurology and psychiatry?
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The “Bar-Coding” of Patients With Electronic Health RecordsDigital technology is a valuable tool, but if it dazzles us with its speed and control, there is the risk that we may forget the old way of connecting.
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Introduction: A Biopsychosocial Model of CareThe past decade has been an exciting one for the field of psychosomatic medicine. It has been recognized as a specialty and now has a certification examination. In this Special Report, we discuss some of the approaches that are being taken to special populations within the psychosomatic medicine community.
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Key Stressors in Transplant PsychiatryHere: A summary of indicators for stress and anxiety in patients undergoing transplantation, and why it is important for psychiatrists to be aware of these factors.
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What Psychiatrists Need to Know About the Determination of Dispositional CapacitySome of the most challenging decisional capacity consultations are requests to determine if a patient has the capacity to participate in discharge planning.
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Touched With Fire: Film and Social Media Address StigmaFilm can be a powerful vehicle for conversation and social change in the fight against psychiatric stigma.
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Diagnosis and Treatment of Bipolar Disorder in Children and AdolescentsSince 1980, criteria for diagnosing bipolar disorder in adults have also been used to diagnose mania in children, with some modifications to adjust for age.
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Bereavement, Grief, and Depression: Clinical Update and ImplicationsAn in-depth CME on DSM-5 criteria for persistent complex bereavement disorder and the clinical management of pathological reactions to the death of a loved one.
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Special Risk Management Issues in Child and Adolescent PsychiatryNumerous studies have documented the increasing prevalence of mental health and substance abuse issues in youths nationwide. As many as 1 in 5 children and adolescents in the United States have a behavioral or emotional disorder.
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Behavioral Comorbidities in Rheumatoid ArthritisWhile tremendous therapeutic advancements have been made, patients with rheumatoid arthritis (RA) have a myriad of comorbidities, including fatigue, depression, and sleep disturbances. Data on the comorbidity of psychiatric disorders with arthritis are also striking: according to the NIMH Catchment Area program, the lifetime prevalence of psychiatric disorders among patients with RA is 63%.
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Nonverbal Learning Disabilities and Sensory Processing DisordersIn our presentation at the 2006 annual meeting of the American Academy of Child and Adolescent Psychiatry, we suggested that child psychiatrists who come across a child with the profile of the following hypothetical case should consider whether the child may have deficits that are not currently covered by DSM-IV nosology: either a nonverbal learning disability (NVLD) or a sensory processing disorder (SPD).
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Hoarding in Late Life: Implications for CliniciansDSM-5 criteria for hoarding disorder necessitate that the hoarding behaviors cause clinically significant impairment in the patient’s ability to function.
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The Treatment Around the CornerA psychiatrist attempts to stay positive while facing her parents' and loved ones' premature deaths-ever reminding us that hope springs eternal.
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Pharmacological Management of Treatment-Resistant Anorexia NervosaOnly 13% to 50% of AN patients are considered recovered 1 to 2 years posttreatment, and 20% to 30% go on to develop a chronic and unremitting course of AN. How can we improve these outcomes?
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The Impact of Screen Media on ChildrenIn essence, screen media constitute neurologically potent, arousing input to the developing brain. Unlike conventional toxins, their effects are mediated by sense organs. However, they have demonstrable effects on brain activity, and on behavior and function.
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Collaborative and Integrated Care in Pediatrics: Part of the Solution to the Child Mental Health CrisisIn this CME, learn more about implementing formal or informal collaboration with the primary care clinicians with whom you share care of your child patients.
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The Substance Abuse HandbookThe Substance Abuse Handbook offers a comprehensive, clinically oriented approach to the treatment of addictive disorders. It contains a wealth of useful information, ranging from causes of addiction to different modes of treatment.
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Next Steps: Solutions and Recommendations For HealingClimate change is a devastating existential threat that can exaggerate preexisting inequities and health/mental health problems. As mental health professionals committed to understanding deep emotional wounds and addressing complexities of relationships, psychiatrists have the tools to assist in bridging the current gaps.
