Tardive Dyskinesia: Finally Some Good News, by Allan Tasman, MD
We’ve been waiting since 1953, the year chlorpromazine was introduced to the US as a revolutionary treatment for schizophrenia, for an active treatment for tardive dyskinesia (TD) that the FDA judged to be effective. This year, the FDA approved valbenazine as the first-line treatment specifically indicated for TD. Dr. Tasman reminds us that of course, it isn’t cheap; much like many recent breakthrough medications, it has an annual cost likely to be in the tens of thousands of dollars.
Hearing Voices and Psychiatry’s (Real) Medical Model, by Ronald W. Pies, MD
Critics misconstrue the nature of the medical model used in clinical psychiatry—and often overlook the seminal contributions psychiatrists have made to the psychological understanding of “hearing voices.” What is “the real medical model” in psychiatry?
Warning: Antidepressants May Cause Messaging Manslaughter, by James L. Knoll IV, MD and George David Annas, MD
Neither time nor science has given pause to the trend of condemning widely used and beneficial medications—antidepressants. This legal strategy continues. Attorneys use “experts” to testify that these medications can produce all manner of illegal behaviors—from murderous rage to callous lack of empathy to manipulative criminal behaviors. Here, the authors give a brief update on the research in this area, along with an illustrative criminal case that received international media attention—the case of Commonwealth v Michelle Carter—more popularly known as the “texting suicide case.”
What Do Climate Change and Physician Burnout Have in Common?, H. Steven Moffic, MD
Although we are experts in addressing trauma of all kinds, the psychological toll of climate-related events will require a different paradigm for approaches to disaster psychiatry. In terms of ethical priorities, taking care of ourselves is secondary to taking care of patients, even though our own well-being correlates with quality of care. American psychiatry is on the cusp of recognizing and tackling both physician burnout and climate change.
ECT: History of a Psychiatric Controversy, by Greg Eghigian, PhD
History of Psychiatry Editor Greg Eghigian interviewed Jonathan Sadowsky, PhD, author of Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy. ECT has had—and continues to have—both its champions and detractors. And historians who have written on the subject have largely fallen into the same pattern, seeing it either as a technology of social control or as an instance of unmitigated progress. How did Dr. Sadowsky’s your book differ from these?
Not Enough Seating? Time for a Beating!!, by Harvey Roy Greenberg, MD
Overbooking airline seats and bumping travelers from a flight is legal. So is compelling a passenger to surrender a seat when an insufficient number accept compensation for leaving. The practice backfired when Dr. David Dao refused to give up his seat on United Express Flight 3411 out of Chicago bound for Lexington in April. Dao maintained he needed to get home to take care of his patients. After attendants couldn’t persuade him to deplane, Chicago Airport Security was summoned. And the rest is history.
Clinical Conundrum: Approaching Bipolar Diagnosis Four Ways, by James Phelps, MD
In an informal reader survey, respondents who identified as practicing psychiatrists and psychiatric nurse practitioners are using 4 different diagnostic approaches to bipolar disorder. When given descriptions of how to look for bipolar disorders in new patients, no single approach was the clear winner. Can you imagine surgeons using 4 different approaches to the diagnosis of appendicitis?
Clozapine, Mortality, and Self-Harm in Treatment-Resistant Schizophrenia, by Brian Miller, MD, PhD, MPH
Clozapine is the “gold-standard” antipsychotic for patients with treatment-resistant schizophrenia. However, it remains underutilized for several reasons, including concerns about potential adverse effects and the need for serial blood monitoring.
Several updates to ICD-10-CM affect the diagnostic codes used by mental health practitioners. One important update involves the codes for substance use disorders.
Assisted Outpatient Treatment Enters the Mainstream, by E. Fuller Torrey, MD
Dr. Torrey reviews common misconceptions about assisted outpatient treatment--and how this tool can help selected mentally ill patients who are most difficult to treat.
Can Diet Treat Depression?, by Chris Aiken, MD
Although supported by basic science, it’s still a sea change to think that diet can treat depression. A new clinical trial puts that idea to the test.