People who weren't getting out of bed are getting up and doing productive things. They are re-engaging with their families, and they are focusing on things they want to accomplish before they die.
Dependent Personality Disorder
While regulatory controls on methadone clinics for opioid dependence resulted in treatment being physically and functionally isolated from conventional medical care, the delivery of an office-based treatment of buprenorphine and the buprenorphine/naloxone combination product over the last decade has facilitated the return of treatment to “mainstream medicine both for psychiatry and primary care."
Knowing from the start how a personality is organized, especially as theorized by Karen Horney—appreciating the primary and repressed moves of the patient, inner dictates, claims, idealized image, and intrapsychic defensive maneuvers—makes the help we offer most likely to succeed.
Addressing the Underlying Causes of Treatment Resistance
New technologies pose challenges in the need to maintain boundaries and confidentiality. The same boundaries and ethical standards that existed in the 20th century must be thoughtfully applied with all new and developing technologies of the 21st century.
The goal of palliative care is to prevent and relieve suffering and to improve quality of life for people facing a serious, complex illness.
Opioid Dependence and XR Naltrexone
The debate within the medical profession over “conflicts of interest” (COIs) has often been shrill, and sometimes seems to be based on misunderstandings or myths about what COIs entail. In this psychiatrist’s view, it is helpful to step back from confident proclamations, acknowledge that the issues involved are complex, and aspire to some semblance of humility. Nobody has cornered the market on “the right way” to deal with COI in the realms of medical research, publication, and education.1 At the same time, as Alan Stone, MD, has noted (personal communication, August 27, 2009), ethical considerations lie at the heart of any debate on COI—in particular, the ancient dictum, “Do no harm.” Indeed, ethicist James M. DuBois has pointed out a direct connection between some types of COI and harm to the general public: “Mental health consumers are at risk when studies that involve questionable scientific and publication practices are translated into therapeutic practice.”1(p205)
There is currently a small but impressive evidence base that shows that psychological and interpersonal factors play a pivotal role in pharmacological treatment responsiveness.
Both cognitive-behavioral and pharmacological treatments for panic disorder have been found to be effective over the short term. Not all patients, however, can tolerate or fully respond to these approaches, and the effectiveness of these interventions over the long term remains unclear.