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CBT for PsychosisHow to make cognitive behavioral therapy for psychosis feasible in a busy practice with limited resources.
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Is Pathological Gambling Really a Problem?-You Bet!With more and more Americans engaging in gambling activities, odds are high that psychiatrists may see patients who have some sort of gambling problem. What can be done about this problem, and how can these patients best be treated?
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Measures To Take After Diagnosis of Violence or DangerOnce the potential for violent behavior has been identified in a patient, how should it be dealt with? What steps can the clinician take to ensure the physical and legal safety of themselves and their patients? Furthermore, what are the clinician's legal and ethical responsibilities if the patient does commit a violence act?
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Adolescent Nonsuicidal Self-Injury: Evaluation and TreatmentIn working with adolescents, mental health care professionals often draw on their own developmental experiences to help guide their patients; however, nonsuicidal self-injury (NSSI) is not likely to be a personal experience that psychiatrists can often draw on.
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Preparing for the Graying of the World: Meeting the Needs of Older AdultsHow will economic development influence management of population aging so that the dignity and rights of older persons are respected and protected, particularly those who are vulnerable because of mental illness, social isolation, or physical debility? Insights here.
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Reducing the Risk of Addiction to Prescribed MedicationsPhysicians are often conflicted regarding prescription medications for pain, especially pain complicated by insomnia and anxiety. Concerns that patients may become addicted to medications, exacerbated by limited time available to get to know patients, can lead to underprescribing of needed medications, patient suffering, and needless surgery. At the other extreme, pressure to alleviate patients' distress can lead to overprescribing, needless side effects, and even addiction.
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Ethical Issues in Disclosing to Patients: Should Patients Be Allowed to Read Their Charts?Federal law now strongly supports a patient’s right to view his or her psychiatric record on request. Here: a look at the ethical and legal issues.
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Impulse Control Disorders: Clinical Characteristics and Pharmacological ManagementImpulse control disorders are common psychiatric conditions in which affected individuals typically report significant impairment in social and occupational functioning, and may incur legal and financial difficulties as well.
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Knee pain in an 81-year-old manAn 81-year-old man presented to an urgent care facility with a 1-year history of pain in his right knee.
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Assessing Violence Risk in Psychiatric Inpatients: Useful ToolsPsychiatrists who work in inpatient units are faced with daily decisions about predicting which patients will be violent, both in the hospital and after discharge. These decisions are often made using unstructured clinical judgment based on the clinician's experience and knowledge of the literature. How long such judgment stays the standard of care remains to be seen, because psychiatric researchers have produced a number of assessment and management tools to improve the accuracy and use of violence risk assessment. This article briefly outlines 3 tools: the Brøset Violence Checklist (BVC), the Classification of Violence Risk (COVR), and the Historical Clinical Risk-20 (HCR-20).
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rTMS for Antidepressant NonrespondersAdjunctive rTMS for antidepressant nonresponders? Researchers performed a randomized comparison with current antidepressant treatment approaches.
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Social Media and DepressionMore social media use was associated with more depression in this study. Findings suggest that clinicians need to ask about social media use by people who are depressed.
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The Practice of Nonsuicidal Self-injury in Adolescents-Part 3In this final of a 3-part podcast series, Brian Smith, MD, discusses the how’s, the why’s, and the treatment options for adolescents who harm themselves.
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The Facts About Violence Against Historically Disadvantaged PersonsRacial/ethnic and sexual orientation minorities and women historically have been relegated to social, legal, and economic disadvantage in the United States.
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The Dynamics of Psychosis: Therapeutic ImplicationsContemporary ideas about psychotic conditions and clinical approaches for treatment.
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Custody DisputesCustody disputes often produce anxiety for all involved. Whether you are a treating child psychiatrist or custody evaluator, it is imperative to have a clear idea of your role.
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Treating Tobacco Dependence in Patients With Psychiatric ComorbiditiesWhat does the new set of U.S. Public Health Service guidelines for treating tobacco dependence say? Should everyone, regardless of mental health status, receive treatment?
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Traumatic Brain Injury Among Veterans Returning From Afghanistan and IraqThis article addresses the epidemiology, diagnosis, and treatment of mild TBI among combat veterans, with a particular focus on blast injury and the presence of comorbid posttraumatic stress disorder (PTSD).
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Translational Research: Pathway to Improved Practice?Advances in basic behavior and neuroscience research have been stunning, but until quite recently, efforts to encourage the clinical application of new knowledge have not kept pace. To aid in applying new knowledge to important public health issues, the National Institutes of Health has placed emphasis on "translational research," which aims to provide a bridge between basic research and clinical care. Particularly promising areas of study are highlighted.
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Where Psyche Meets Soma in AsthmaAsthma is a serious health condition that can be exacerbated by emotional triggers. Furthermore, depression in these patients can affect treatment compliance, thus worsening prognosis. What role does psychiatry play in treating these patients?
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Mini Quiz: Physical Assault in the Clinical SettingVerbal de-escalation involves validating a patient’s experience, establishing a collaborative relationship, and finding solutions to ensure the patient’s needs are met. More in this quiz.
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Strategies to Reduce and Prevent Restraint and Seclusion in Pediatric PopulationsHere's compelling reason for judicious use of restraint and seclusion, and a review of various alternative approaches.
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The Vote on Tutu: Fair Hearing?More details on the APA Assembly meeting in Washington discussing Desmond Tutu being designated as convocation speaker for the American Psychiatric Association’s recent annual meeting.
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The Border Zone Between bvFTD and Primary Psychiatric DisordersIn this CME, learn more about frontotemporal lobar degeneration and the several overlapping syndromes that it encompasses, as well as how to distinguish behavioral variant frontotemporal lobar degeneration from other psychiatric disorders.
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The NIMH Research Domain Criteria (RDoC): New Concepts for Mental DisordersThe Research Domain Criteria (RDoC) program: how it evolved, clinical applications, and goals.
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Frontolobular Cystic Mass and Hydrocephalus in Woman With Headache and LethargyA previously healthy 35-year-old woman was admitted to a New York City hospital after presenting to the emergency department (ED) with a 10- to 14-day history of generalized weakness, progressive frontal headache, and lethargy. She immigrated to Brooklyn, New York, from urban Haiti 9 years previously and had not returned to Haiti since. She denied any recent travel elsewhere and had no pets. An HIV antibody test, performed 4 months before ED presentation, was negative.
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Pay-for-Performance: Is It Quality or Cost That Matters?Insurance, Medicare, Pay-for-performance, P4P
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Treatment of Depression in Adolescents: TADS Results and Future DirectionsThe Treatment for Adolescents With Depression Study (TADS) represents the single largest and potentially most informative clinical trial of adolescents with depressive illness. The overall aim of the study was to investigate the effectiveness of standard interventions for adolescent outpatients with moderate to severe depression.
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Healthcare Policy: From Washington, D.C., to Your PracticeI believe that holistically understanding health policy - as seen through both “donkey” and “elephant” eyes - makes me a better clinician.
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Adult Implications of Childhood MaltreatmentMaltreatment at an early age casts a very long shadow. Here: a look at the long-term effects of early childhood trauma.
