Authors
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An Expectation to HealIn a tale of two cases, the author comes to realize he is but one agent of change in the lives of his patients.
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7 Medical Illnesses That May Present as AnxietyBeyond psychosocial implications of anxiety disorders, an array of physiological effects may ensue.
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Mini Quiz: Perinatal DepressionYour patient is excited to be pregnant. She is currently on sertraline, and has been stable on this for many years. She is very insistent that she would like to stop her medication. What should you do?
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ADHD and Substance Use: Current Evidence and Treatment ConsiderationsBecause comorbid substance abuse is the rule rather than the exception in individuals with ADHD, accurate diagnosis, prognosis, and management of ADHD is challenging even for the most skilled practitioners.
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The Neurobiology of Cocaine Dependence and Its Clinical ImplicationsCocaine dependence is a devastating disorder that is associated with a host of medical and psychosocial risks. This complex disorder is made up of distinct clinical components that are interwoven into a cycle of addiction (Figure 1). Cocaine activates ancient pleasure centers that dominate our thoughts, behaviors, and priorities, producing a pleasure-reinforced compulsion to use the drug. Repeated use dysregulates brain pleasure centers and paves the way to addiction through craving and impaired hedonic function.1 Euphoria and craving drive the cycle of addiction through positive and negative reinforcement, respectively, and they provide targets for pharmacological interventions.
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Why Aren’t We All in Therapy?The looming specter of emotional and physical exhaustion in residency often takes hold well into a physician's career. So what are we doing about it?
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Unraveling the Threads of Trepidation: The Prevalence and Evolving Contours of Anxiety and Traumatic StressAn understanding of evolving risk factors and pathophysiology is vital to optimal clinical management of anxiety disorders and PTSD.
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Mini Quiz: Treatment-Resistant Bipolar DisorderWhat are the guidelines for working with patients who do not respond to FDA-approved medications for bipolar disorder?
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Pathological Lying: Symptom or Disease?Mr A was desperate. He was about to lose yet another job, not because he was at risk for being fired, but because his lying behavior had finally boxed him into a corner. He had lied repeatedly to his colleagues, telling them that he had an incurable disease and was receiving palliative treatment. . .
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Compromised Confidentiality Is Harmful: Military Owes Proof to the ContraryGiven that rates of military suicide have risen to unprecedented levels, the burden of empirical proof in support of weak military mental health confidentiality standards is squarely on the military.
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Identifying and Reducing Professional Liability When Treating Older AdultsActions You Can Take to Decrease Risks While Increasing Patient SafetyIdentifying and Reducing Professional Liability When Treating Older Adults, by Jacqueline M. Melonas, RN, MS, JD and Charles D. Cash, JD, LLM, ARM
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Venlafaxine in the Treatment of Depression: Practical ConsiderationsVenlafaxine (Effexor) is a novel antidepressant recently released to the American market. Its entry into the antidepressant market has been much heralded. The lay press has described the drug as "Prozac with a punch," and many patients were asking for it long before it was available. As the hoopla settles down, we are learning that venlafaxine is a potentially important drug with both advantages and disadvantages over other available antidepressants, including the selective serotonin reuptake inhibitors (SSRIs).
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Metabolic Syndrome in Patients With Major Depressive DisorderAssociated Risk FactorsAlthough most studies have focused on the risk of metabolic syndrome for patients with schizophrenia exposed to atypical antipsychotics, other psychiatric patients appear to be at risk for metabolic disturbances as well.7-9 Major depressive disorder (MDD) may be of particular interest because it is much more common than schizophrenia and is treated with a broad range of psychotropics.
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A Spirited Defense of ECT: From Our ReadersA Psychiatric Times point/counterpoint feature on electroconvulsive therapy elicited strong responses.
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AIDS Dementia: Current Status and New Treatment ApproachesAIDS Dementia: Current Status and New Treatment Approaches
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Inflammation and Treatment Resistance in Major Depression: The Perfect StormNew findings provide powerful evidence that inhibition of inflammation or its downstream effects on mood may open up a host of new approaches to treatment for depression, especially for patients with treatment-resistant depression.
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Forensic Issues in Child Sexual Abuse AllegationsWhen sexual abuse is alleged, children may face investigative interviews, family disruptions, a change in their school environment, mental health counseling, and even trial court testimony.
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Implementation of a Diet Program for Inpatients With SchizophreniaWeight gain is a major concern in patients with schizophrenia, especially in those taking atypical antipsychotics. Although the exact mechanism of weight gain associated with atypical antipsychotics is unknown, we often hear patients complain about an increase in appetite and a decrease in satiety.
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Psychotherapy with Opioid-Dependent PatientsPsychotherapy as a sole treatment for noncoerced opioid addicts in outpatient settings has been shown to have little patient interest and low chances for success. However, when integrated into a treatment plan that includes methadone maintenance and drug counseling, it can be associated with additional benefits for patients who have moderate to severe levels of psychiatric symptoms.
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Intergenerational Transmission of Trauma: An Introduction for the ClinicianParents who have witnessed traumatic events may pass dysfunctional life views on to their children. How much more vulnerable are these second-generation victims to PTSD and other psychiatric disorders?
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Neurostimulation Treatments in Psychiatry: An Overview and Recent AdvancesThere have been considerable advances in the research on and clinical use of neurostimulation for psychiatric disorders, especially mood disorders and MDD. Three of the most recognized are reviewed here. An experimental new treatment-- trigeminal nerve stimulation-- is also briefly discussed.
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Treatment of Military PopulationsWhat psychiatric illnesses are most prevalent among veterans? And how can clinicians help them overcome obstacles to care?
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The Dialogue Between Science and ArtIn a variety of creative fields, psychiatrists have been portrayed in many ways. This Special Report is psychiatry's turn to address creativity with offerings as diverse as the creative arts themselves. From Shakespeare to rock 'n' roll, there's something for everyone.
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Introduction: The Inflammation ConnectionThis 2-part Special Report devotes itself to the new inflammatory world that clinicians and researchers find themselves in. Most of our prior and current preconceptions about the role of immunity and mental illness have been-and are-wrong.
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Bipolar Disorder: Increasing the Effectiveness and Decreasing the Side Effects of TreatmentStudies have shown that many pharmacologic agents are effective in the treatment of acute mania and bipolar relapse education.
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The Conceptualization and Role of Impulsivity: Bipolar Disorder and Substance AbuseImpulsive behaviors play an important role in both bipolar and substance abuse disorders. However, results of studies investigating this link are often ambiguous, in part, due to the multidimensional nature of the impulsivity construct and the fact that many studies use a single measurement technique. We describe a model of impulsivity characterized by three components: response initiation, response inhibition and consequence sensitivity. How these components differ from one another in terms of their use, behavioral theory and biological function is discussed, along with measurement techniques.
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Continuation Treatment and Relapse Prevention in Pediatric DepressionThe prevalence of depression in children and adolescents ranges from 2% to 8% in the general population, which indicates that depression in this population is a major public health concern.1-3 This is especially apparent when rates of depression are compared with other serious medical conditions in childhood, such as diabetes, which has a prevalence of 0.18%.4 The burden of depressive illness-including significant functional impairment in interpersonal relationships, school, and work-on the developing child has been well documented. Affected youths are frequently involved in the juvenile justice system.5-8 Furthermore, adolescents with depression are at increased risk for substance abuse, recurrent depression in adulthood, and attempted or completed suicide.3,9-15
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Children and Video Games: How Much Do We Know?There is no shortage of hyperbole when politicians of all stripes describe the nature and effects of video games. Republican presidential candidate Mitt Romney proclaimed, "Pornography and violence poison our music and movies and TV and video games.
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Unhinged: The Trouble With Psychiatry-A Doctor’s Revelations About a Profession in CrisisUnhinged is one of many books published in the past few years critical of psychiatry. A book of scandals and debates, and a polemic of sorts-a “trahison des clercs”-rather than an intellectual discussion about psychiatry. Therein lies the trouble with psychiatry.
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6 Signs Your Patient Is at Risk for Treatment-Resistant DepressionWhat factors predispose patients to TRD and what treatment strategies achieve response? Find out here, with a bonus case vignette.
