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Levodopa-Induced Dyskinesia: Medical and Surgical ManagementIn the 1960s, the treatment of Parkinson disease (PD) was revolutionized by the introduction of levodopa. Soon after its discovery, however, it was observed that continuous treatment was complicated by the emergence of choreoathetoid movements and off episodes.
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Setting the Record Straight: A Response to Frances Commentary on DSM-VThe commentary “A Warning Sign on the Road to DSM-5: Beware of its Unintended Consequences” by Allen Frances, M.D., submitted to Psychiatric Times contains factual errors and assumptions about the development of DSM-V that cannot go unchallenged. Frances now joins a group of individuals, many involved in development of previous editions of DSM, including Dr. Robert Spitzer, who repeat the same accusations about DSM-V with disregard for the facts.
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Chronic Fatigue SyndromeJohn Medina's column, "Chronic Fatigue Syndrome-A Lesson in Big Science", focuses on recent research by the CDC on the genetic aspects of chronic fatigue syndrome (CFS) as reported in Pharmacogenetics and Nature.
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Marijuana Withdrawal Syndrome: Should Cannabis Withdrawal Disorder Be Included in DSM-5?DSM-IV, published in 1994, did not include a cannabis withdrawal disorder diagnosis. DSM-IV-TR clearly stated the reason for the omission: “Symptoms of possible cannabis withdrawal . . . have been described in association with the use of very high doses, but their clinical significance is uncertain.”1
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The Treatment of Persons With Mental Illness in Prisons and Jails: An Untimely ReportThe recent 2014 Joint Report of the Treatment Advocacy Center and the National Sheriffs’ Association could have been a most useful and timely report on the woefully inadequate access to appropriate levels of mental health services for incarcerated seriously mentally ill persons. This author believes the report will only make the problem worse.
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Prenatal Risk Factors in SchizophreniaSignificant research developments in the etiopathogenesis of schizophrenia have occurred during the past several years. One such advance is the "neurodevelopmental" hypothesis that events during early brain development, especially the prenatal and perinatal periods, may play an important causal role in at least some, and perhaps many, cases of schizophrenia.
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Understanding and Treating DeliriumThis CME article reviews the pathophysiology and epidemiology of delirium and provides strategies for assessment, prevention, and management of this syndrome.
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Ground Lost: The False Memory/Recovered Memory Therapy DebateThe recovered memory debate has been the most acrimonious, vicious and hurtful internal controversy in the history of modern psychiatry. From its very beginning in the late 1980s, it has been more an "ad hominem" war, appealing to feelings and prejudices, rather than a matter of reasoned professional disagreement.
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Childhood Obesity and PsychopathologyThe continuation of the epidemic of childhood obesity and overweight has major implications and consequences for future research in psychopathology.
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Understanding the Neurobiological Basis of Drug Abuse: Comorbidity in SchizophreniaIt is clear that the prognosis for schizophrenia is much better when patients achieve drug abstinence, including in the domains of depression, quality of life, and community integration.
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Albert Ellis, PhD (1913 - 2007)What follows is an adaptation of Dr Ellis’s response to a volunteer who took part in a live public workshop demonstration of the Rational Emotive Behavior Therapy approach.
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Exploring the Psychosis-Depression Interface: Clinical ImplicationsA review of the distinction between depressive and psychotic symptom domains, current knowledge about the etiology and neurobiology of depression and psychosis, and how this knowledge can inform the treatment of patients with features of both.
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Understanding and Evaluating Mental DamagesUnlike a pure psychiatric disabilityevaluation, mental and emotionaldamage claims require anassessment of causation. Today, treatingpsychiatrists are increasingly asked toprovide this assessment, since mentaland emotional damages are widelyclaimed in the United States as a remedyin legal actions.
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Telepsychiatry-Based Culturally Sensitive Collaborative TreatmentTelepsychiatry-based Cultural Sensitivity Collaborative Treatment is a promising and effective model to improve treatment of depression in underserved racial and ethnic minority populations. Details here.
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Pediatric Major Depressive Disorder: Questions to ConsiderWhat are the options for treating major depressive disorder in children and adolescents? This case offers readers a chance to give their feedback and to interact with the authors, who will present teaching points based on your comments.
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Overcoming Treatment Resistance: Can Pharmacogenetics Help?Pharmacogenetic testing can provide helpful guidance in the choice of treatment and should be interpreted as a decision-support tool to assist in thoughtful implementation of good clinical care.
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Understanding Medication Discontinuation in DepressionCompared with schizophrenia, adherence behavior has been relatively overlooked in depression and other mood disorders. Major depression is increasingly thought of as a chronic illness. In most chronic illnesses, ideal concordance is the exception, not the rule.
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Checkmate! Managing Panic Disorder Through Chess TherapyThis mode of therapy, still in its infancy, could be used to analyze and monitor a patient’s progress during play.
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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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Discussing and Assessing Capacity for Sexual ConsentHere: basic concepts behind sexual consent capacity and guidance on how to pursue capacity assessments.
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Managing Treatment-Resistant OCDObsessive-compulsive disorder is a prevalent, disabling and chronic illness. Serotonin reuptake inhibitors are the first-line of treatment; however a large proportion of patients will have either a partial or nonresponse. This review outlines the strategies for treatment-resistant OCD, including augmentation agents, alternative monotherapies, intravenous strategies and newer nonpharmacologic somatic treatments under development.
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PTSD Is a Valid Diagnosis: Who Benefits From Challenging Its Existence?PTSD filled a nosological gap by providing a way to characterize the long-lasting effects of trauma exposure.1 This led to a plethora of previously lacking scientific observations. Now the existence of PTSD is being called into question because some of the original assumptions that helped make the case for it have proved to be incorrect.2-4 However, it is possible to update some of the flawed assumptions of PTSD without rescinding the diagnosis. There is no reason to throw the baby out with the bathwater.
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Novel Methods to Predict Outcome Using NeuroimagingNoninvasive brain imaging methods are providing unprecedented views of the structural and functional development and aging of an individual's brain or state of brain pathology. These exciting new may provide novel information relevant to the enhancement of clinical practice.
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What Role Does Serotonin Play in PTSD?As many as 90% of Americans are exposed to at least one traumatic event in the course of their lives. Many more are exposed to more than one traumatic event. Short- and long-term sequelae of traumatic exposure vary greatly and range from complete recovery, to severe and debilitating PTSD.
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Defining Intellectual Disability: The Case of Hall Versus FloridaIn March, the Supreme Court will need to set a national standard for the definition of intellectual disability. In doing so they will inevitably have to address a number of complications that arise when clinical constructs, such as intellectual disability, are used in the courtroom.
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Comorbidity: Schizophrenia With Obsessive-Compulsive DisorderThe co-occurrence of obsessive-compulsive symptoms (OCS) and psychotic illness has been a challenge for clinicians and investigators for more than a century. Over the past decade, interest in this area has burgeoned because of recognition of higher-than-chance comorbidity rates of schizophrenia and OCD.
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Shrink Rap: Three Psychiatrists Explain Their WorkStructured around fictional case vignettes, this book presents the different pathways through which one enters the mental health system. Patients can better judge whether they are being offered the optimal treatment modality and can more effectively assess the stylistic match between themselves and their therapist.
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Veterans Struggle to Adjust to Family LifeOf the 3.6 million military personnel deployed to Operation Iraqi Freedom and Operation Enduring Freedom, over half are married and about 53% are parents. As these veterans return home, the process of reintegration can have a variety of effects.
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Therapeutic Alliance in the Aftermath of an Emergency Crisis VisitA therapeutic alliance can serve to build a trusting relationship between clinician and patient and increase the patient’s feelings of agency and autonomy.
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Mini Quiz: Impulsivity Risk FactorsImpulsivity has long been thought to be an important risk factor for depression and suicide. But recent research suggests that the reality might actually be counterintuitive.
