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Serotonin Reuptake Inhibitor and Bleeding Risk, Part 2: Gastrointestinal (GI) Bleeding, Malignancy, Pregnancy, and Surgical ConsiderationsIn this CME article, review literature on SRI-related bleeding complications in patients with GI bleeding, malignancy, perioperative settings, pregnancy, and hormonal therapy.
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Exploring Affect-Focused Psychotherapies for LGBTQ+ Patients With PTSD at APA 2023Experts discuss findings from a new trial exploring affect-focused psychotherapies for LGBTQ+ patients with PTSD at the 2023 APA Annual Meeting.
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Love, Alzheimer Disease, and Medical Aid in DyingApproximately 6.5 million Americans are living with Alzheimer disease today, and that number is projected to rise to about 13 million by 2050.
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Suicidal Self-Injurious Behavior in People With BPDUnlike other forms of self-injury, suicidal self-injury has special meaning, particularly in the context of borderline personality disorder. How is suicidal self-injury differentiated from non-suicidal self-injury in these patients, and how can their behavior be properly assessed and treated?
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Dr John C. Whitehorn: A Wise and Gentle ManDr John C. Whitehorn shaped mental health policy at the national level, and his influence is still alive in his former residents and the young psychiatrists we have trained.
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Combining Psychopharmacology, Psychotherapy and PsychoanalysisThe advent of safer psychopharmacological agents with less troublesome side effects, along with increasing knowledge of the broad array of syndromes treatable with medication, have led to a vast expansion in treatment options available to the psychiatrist. Studies and clinical experience demonstrate that employing psychotropic medication in combination with psychoanalysis or psychodynamic psychotherapy now occurs with increasing frequency.
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Psychotic Depression: Underrecognized, Undertreated-and DangerousHere: the history of psychotic depression for the Study of the Pharmacotherapy of Psychotic Depression (STOP-PD), a summary its epidemiology, significance, diagnostic complexity, and treatment, as well as case vignettes.
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The Psychiatrist's Role in Choosing a Nursing HomeFor elders confronted with the necessity of living in a nursing home, the choice of facility is a decision with profound consequences-for their health, their quality of life and their family finances. Nursing home care may cost $50,000 a year or even more, and more than half of all elders begin their nursing home stays by paying the costs out of pocket. That imposing sum can purchase excellent care, or can pay the rent for a place that is literally "worse than death" for the unfortunates who live there.
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Computers in the Consulting RoomComputerized information resources are being introduced into psychiatric practice settings, but some psychiatrists question whether they are really needed.
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Vision Loss and Depression in the ElderlyThe emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).
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An Update on Pica: Prevalence, Contributing Causes, and TreatmentIn this overview of pica, we review its causes and prevalence. In addition, we discuss some of the associated complications as well as current treatment strategies.
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Assessment of Decisional CapacityVoluntary informed consent is, with rare exceptions, a necessary, albeit not sufficient, defining precondition of ethical clinical treatment, and it is essential for enrollment in clinical research trials.
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Crossing the Blood-Brain Barrier: Integrating Scientific Innovation With Socio-Ethical Reflection in Predictive MedicineIn this article, we discuss recent advances in drug transporters and nutrient-transporter interactions that can impact drug bioavailability in the systemic circulation and the brain. We also present emerging research strategies that may facilitate the discovery and clinical development of predictive diagnostic tests to identify patients at risk for treatment resistance.
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The Assessment and Management of Depression in Children With AsthmaAsthma is one of the most impairing diseases of childhood, affecting more than 6% of children. Each year, it is responsible for 14 million lost school days and $3 billion in treatment costs.
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Witchcraft or Mental Illness?I don’t believe in witches or ghosts or things that go bump in the night. I’ve always thought that the Salem witch trials were a result of mass hysteria (on the part of the persecutors) rather than a phenomenon of dark forces at work. And seeing Arthur Miller’s The Crucible a few years ago, only confirmed my suspicions. So I was gratified to see Dr Quintanilla’s poster at this year’s meeting of the American Psychiatric Association. As a physician and researcher, she factually explains the fallacy of witchcraft. Looking at historical documents dating back to the 15th century, Dr Quintanilla was able to match the symptoms of people condemned as witches with associated neurological and psychiatric disorders, such as epilepsy and hysteria. [Editor’s Note: Natalie Timoshin]
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Introduction: The State of Addiction PsychiatryThe articles in this Special Report provide a broad, cross-cutting perspective on the current state of addiction psychiatry, insofar as it may pertain to your own clinical practice.
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Assessing the Violent Patient: An Additional Case of Legal ImplicationsAssessing the Violent Patient: An Additional Case of Legal Implications
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Cognitive Complaints: Their Role in Detecting MCI and DementiaShort of mass screening of the elderly using a neuropsychological test or some yet-to-be-determined biomarker, persons with cognitive disorders come to the attention of the health care system only when symptoms are recognized. Occasionally, physicians identify cognitive deficit on routine examination or when they notice patients having trouble following instructions (eg, taking medications properly)
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Comfortably Numb: How Psychiatry Is Medicating a NationIn Comfortably Numb, author Charles Barber reports that in 2002, 16% of the inhabitants of Winterset- a quintessentially American town in Iowa-had an antidepressant prescribed for them and asks, “Why did Winterset want to get numb?” With this question, Barber begins a journey through the world of psychiatry and psychopharmacology that spans most of the book.
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Chronic Disease Self-Management Programs in PsychiatryThrough patient self-management, mental health clinicians can transfer the focus from managing symptoms to allowing patients to live well in the context of their mental illness and medical comorbidities.
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Introduction: The Challenges of Treating Older AdultsWith more and more baby boomers turning 65 every day, there will be an enormous increase in elderly patients needing psychiatric care over the next 20 years.
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PTSD in the Emergency SettingThe following 3 cases illustrate the diagnostic challenges related to differentiating brain injury and posttraumatic stress disorder (PTSD) in patients presenting to the emergency department (ED) in the acute period following a traumatic injury. Such patients pose a dilemma for ED clinicians because of the interplay between head injury and PTSD in the clinical presentation of cognitive impairments in the aftermath of trauma.
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Forensic Evaluations: Testamentary CapacityThis article focuses primarily on the issues facing a psychiatrist who has been retained as an expert witness in a will or trust contest involving claims of a lack of capacity.
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The Neuroscience of Psychotherapy: Healing the Social Brain, Second EditionCozolino reveals how much those “givens” have strong scientific underpinnings and underlines the urgency of re-integrating them into the training and the minds of 21st century therapists.
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Opportunities and Challenges in Treating Adolescents and Young Adults With Major Depressive DisorderHalf of all mental health disorders occur by age 14. Early interventions may mitigate progression to more serious and persistent mental health concerns.
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Commentary: The Moral High (Low?) Ground of Assisted SuicideThere is and has been much debate about the issue of assisted suicide as physicians, lawyers and lay people argue the pros and cons of assisting in someone's death. The physician who agrees to participate in this endeavor points out that his or her concern is to alleviate suffering. Notwithstanding that, painkillers are notoriously prescribed in inadequate, understrength doses; people with serious illness who are depressed are considered unlikely candidates for treatment of their depression because, sayeth the physician: "It is only natural, understandable, to be depressed with that kind of terrible illness."
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Understanding PharmacogeneticsThe idea that drug response could be based on a patient's genetic background first surfaced over 100 years ago. Since then, technology has advanced to the point where prescribing medications based on a patient's genetic makeup no longer seems like science fiction. This article looks at the latest research on the pharmacogenetics of psychotropic medications and shows how far we still have to go.
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Managing the Psychiatric Manifestations of Parkinson Disease: An UpdateParkinson disease (PD) is a progressive neurodegenerative disorder affecting 1% of people 65 years and older. The core symptoms include the motor manifestations of tremor, bradykinesia, and rigidity.
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Giving Valproic Acid a Higher Priority in Bipolar PatientsIs valproic acid dismissed out of hand? Three doctors discuss its potential as a treatment.
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Posttraumatic Stress Disorder and MemoryTrauma, by definition, is the result of exposure to an inescapably stressful event that overwhelms a person's coping mechanisms. Since it would be immoral to expose laboratory subjects to the sort of overwhelming stimuli that give rise to the dissociated sensory reexperiences characteristic of posttraumatic stress disorder (PTSD), we are uncertain to what degree the vast literature involving laboratory studies of less stressful events is relevant to understanding how people process traumatic memories.
