Psychiatric Times Vol 23 No 14

British Study: Older Antipsychotics Just as Good

December 01, 2006

A new study comparing the benefits of second-generation antipsychotics (SGAs) with their older counterparts in patients with schizophrenia has yielded a surprising result. The study, funded by the UK National Health Service, found that the overall differences between first- and second-generation antipsychotics did not reach statistical significance.

The Bipolar Handbook: Real-Life Questions With Up-to-Date Answers by Wes Burgess

December 01, 2006

Bipolar disorder is often seen as a perplexing illness by patients and clinicians alike. In recent years, there has been a growing appreciation in psychiatric circles of the disorder's prevalence. This increased attention has filtered its way down to the general public, which, in turn, has produced sometimes sensationalistic media portrayals of manic depression, a number of speculative books about historic figures and noted artists who purportedly had the illness, and an array of self-help books marketed to individuals (and their families) afflicted with the disorder.

Patients Underreporting Medical Conditions

December 01, 2006

Patients with a serious mental illness (SMI), such as schizophrenia or bipolar disorder, may underreport co-occurring medical conditions. Dr Amy Kilbourne and colleagues performed a cross-sectional analysis of 35,857 patients from the Department of Veterans Affairs (VA) National Registry to determine whether SMI patients were less likely to report a co-occurring medical condition. Results were published in the August 2006 issue of The Journal of Nervous and Mental Disease.

Medicare Proposes Outpatient Payment Cuts

December 01, 2006

The Centers for Medicare and Medicaid Services (CMS) wants to again cut its payment to hospitals and community mental health centers (CMHCs) for outpatient psychiatric care in 2007. The benefit on which the CMS is focusing is called partial hospitalization; it is paid to a facility for treatment of a patient recovering from an acute psychiatric episode. Physicians must certify that in the absence of treatment in the partial hospitalization program (PHP), a patient would require inpatient psychiatric care. Typically, patients in a PHP spend 4 to 8 hours a day, 4 days a week, receiving intensive outpatient psychiatric care.

A Subspecialty of Growing Importance

December 01, 2005

Although forensic psychiatry is a formal subspecialty, general clinicians are often called upon to perform the bulk of forensic assessment. As such, the need for some basic training in and knowledge of forensic psychiatry is clearer than ever.

MTV Network Increasing Mental Health Awareness at College Campuses

December 01, 2006

MTV isn't just broadcasting music videos and reruns of The Real World anymore. In November, its sister network aimed at college campuses-mtvU-began a new campaign called "Half of Us," which provides information and support to students attending colleges across the country.

Domestic Violence Linked to Increased Risk of Psychiatric Disorders in Women

December 01, 2006

The study found that both young men and young women with psychiatric disorders were at greatest risk for being involved in abusive relationships. In addition, after controlling for a history of disorder at age 18 and for lifetime conduct disorder, findings from the study imply a connection between being in a clinically abusive relationship (defined as resulting in injury and/or official intervention) and a woman's risk at age 26 of major depressive episodes, marijuana dependence, and posttraumatic stress disorder.

Sleeping Through Detox Poses Hazards

December 01, 2005

Anesthesia-assisted rapid opioid detoxification has been touted as a painless way to kick an addiction. In a randomized trial comparing it to two other rapid detox methods, it was found to be similar on several methods, but resulted in greater risks for life-threatening adverse events. Opioid dependency is a chronic, remitting disorder and the greatest need is not a fast painless method of getting detoxed, but a reliable method of maintaining abstinence.

CATIE Phase I Helps Clinicians Tailor Schizophrenia Treatment

December 01, 2005

Are all treatments for schizophrenia created equal? With Phase I of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study completed, five pharmacological options have been compared in an attempt to answer this question. Results from this portion of the trial have been released and are discussed.

Ethical Issues in Forensic Psychiatry With Children and Adolescents

December 01, 2005

Forensic examinations involving children and adolescents are particularly difficult, due to the vulnerability of this patient population. What ethical guidelines should be followed and what sorts of pitfalls should clinicians attempt to avoid?

The Role of PTSD in Litigation

December 01, 2005

Attempting litigation based on a claim of posttraumatic stress disorder can be difficult. What is the proper DSM definition of PTSD and in what ways can and can't it be used in court to properly defend a client? What should the role of the psychiatrist be in this process?

Setting Up a Forensic Psychiatry Practice

December 01, 2005

Forensic psychiatry is increasingly emerging into treatment psychiatry as a respected subspecialty. However, there are important clinical and business distinctions between the practice of treatment psychiatry and the practice of forensic psychiatry. The essential components of setting up a forensic psychiatry practice are outlined.

Preventing and Reducing Professional Liability Risk Related to Psychopharmacology

December 01, 2005

Several significant factors have converged to impact and heighten concern about the potential for malpractice litigation related to psychopharmacology. Current influences as well as frequent sources of professional liability risk related to psychopharmacology are reviewed and suggestions for preventing and reducing risk are made.

Forensic Issues in Consultation-Liaison Psychiatry

December 01, 2005

Consultation-liaison psychiatrists frequently encounter clinical situations that have legal implications. Competency evaluations, which are the most common legal question in C&L psychiatry, are reviewed in this article. In addition, the authors discuss guardianship, decision making in patients who refuse treatment, confidentiality and the role of the psychiatric consultant in against medical advice discharges.

Compulsive Buying Disorder Affects 1 in 20 Adults, Causes Marked Distress

December 01, 2006

More than 1 in 20 adults nationwide suffer from compulsive buying, according to a telephone survey of 2500 adults. And contrary to popular opinion, “compulsive buying appears to be almost as common in men as in women,” according to Lorrin M. Koran, MD, first author of a recently published prevalence study of compulsive buying behavior in the United States. Six percent of women and 5.5% of men in the study reported symptoms considered to be consistent with compulsive buying disorder.

Issues and Challenges in the Diagnosis and Treatment of Mentally Ill Hispanic Patients

December 01, 2006

Despite the accepted validity of Hispanic as a distinct demographic and cultural category, we have only fragmentary evidence and scarce guidelines regarding the treatment of mentally ill Hispanic Americans. This article provides a brief review of the topics with the most clinical relevance to diagnosis and treatment of mental disorders in Hispanic Americans.

Psychological Features of Human Reproductive Cloning: A Twin-Based Perspective

December 01, 2006

Debates surrounding the psychological implications of human reproductive cloning (HRC) escalated in 1997, following the 1996 birth of Dolly, the cloned Scottish lamb. Aside from the physical risks to which cloned persons might be subjected, there was concern over psychological implications associated with family structure and relationships. Would cloned persons be deprived of autonomy and independence? Would parents impose unfair expectations on children who were their genetic replicas?

Health and Psychiatric Issues in Children of Rural Methamphetamine Abusers and Manufacturers

December 01, 2006

Many abusers of methamphetamine in rural areas manufacture the drug for their personal use. These "mom-and-pop cooks" produce methamphetamine in and around homes where children are also living. This article provides an overview of the mental health of children whose parents abuse methamphetamine.

Race-Based Traumatic Stress

December 01, 2006

In 2001, the US Surgeon General issued a report about the status of mental health with respect to racial and ethnic minority groups, which stated that ethnic and racial disparities were likely due to racism and discrimination. Empiric investigations have linked racism to poor mental health and have shown that racism is stressful and compromises the mental health of persons of color.

Psychological Aspects of Human Reproductive Clones: What Can We Infer From the Clone-Like?

December 01, 2006

The world began to face the prospect of human cloning when the journal Nature published Dolly the sheep's "birth announcement" in the form of a letter authored by Wilmut and colleagues. But despite all the attention given the issue, including two presidential commissions, the psychological consequences of cloning have been little addressed.

The Right to Refuse Treatment

December 01, 2006

Among the numerous challenges facing psychiatric care providers today, few experiences are as ubiquitous as treatment refusal. Tragically, it is often the case that the very patients who are most inclined to refuse treatment are the ones who are in most need of it.

Concerns About Practice Guidelines

December 01, 2006

Several readers have responded with comments and concerns regarding my column, "Do Physicians Use Practice Guidelines?" Since the issues these readers raised are important and concern many psychiatrists, they merit some discussion.

Religious/Cultural Heritage and Patient Perceptions of Psychotropic Drugs

December 01, 2006

One of the major concerns of health professionals working in the area of psychiatry is understanding the conditions under which patients adhere to prescribed treatments. While adherence is linked to some extent to the patients' comprehension of their illness, it is also a function of their social and demographic characteristics, such as age, social milieu, or sex. Another attribute also merits our attention, however: the patient's cultural affiliation and in particular, his or her religious background.

Challenges and Obstacles in Treating Mentally Ill Black Patients

December 01, 2006

As the United States becomes more culturally, racially, and ethnically diverse, psychiatry will be faced with the need to treat more diverse populations. This article focuses on challenges and obstacles encountered when treating black patients with mental illness.

CRPS Type I and Mental Illness

December 01, 2006

Dr Steven King provided an interesting summary of complex regional pain syndrome (CRPS) in Psychiatric Times (Complex Regional Pain Syndrome, June 2006, page 9). We felt it would be useful to provide some additional observations on the relationship between CRPS type I and psychological causes of pain.

Is the DSM the Bible of Psychiatry?

December 01, 2006

A discussion of the intellectual, social, and historical similarities and differences between sacred texts and the DSM would require a full-length book, but we will concentrate here on 5 main aspects: controversy, communication, interpretation, change, and power.

Effects of Culture on Recovery From Transient Psychosis

December 01, 2006

Analyzing data gathered in a 10-nation study of psychoses by the World Health Organization (WHO), Susser and Wanderling1 found that the incidence of nonaffective psychoses with acute onset and full recovery was about 10 times higher in premodern cultures than in modern cultures. Transient psychoses with full recovery were comparatively rare in modern cultures. Such a dramatic difference begs for explanation.

Culture and Urban Mental Health

December 01, 2006

Mostly because of increased speed and decreased costs of communication and transportation, cities are growing increasingly diverse in their population. Consequently, cultural factors have taken center stage in the understanding of urban mental health. This article will focus on the main approaches to urban mental health and briefly summarize the 3 lines of research in this area. It will then discuss the main themes of a vast body of literature on the cultural aspects of urban mental health.

Racial Profiling in Psychiatry: Does It Help Patients?

December 01, 2006

Should psychiatrists follow these leads and use a patient's race or ethnicity to guide treatment decisions? In this article, I will describe the evidence that supports racial profiling in psychiatry and will explore some of the relevant concerns.

The Concept-Laden Prescription

December 01, 2006

Compared with the many recent articles addressing medications' multiple meanings for the patients who take them and the psychiatrist-therapists who prescribe them, there has persisted in the literature and in clinical practice a curious literal conception of the prescription itself. This article challenges the idea that the only medication that can be prescribed comes in the form of pills or tablets; on the contrary, ideas constitute some of the most potent "medication" known.

Genetic Counseling in Psychiatry: Preparing for Anticipated Demand

December 01, 2006

In a recent article on genetic counseling in psychiatry, Christine Finn, MD, and Jordan W. Smoller, MD, ScD, noted that family and twin studies have documented the familiality and heritability of schizophrenia, bipolar disorder, major depression, anxiety disorders, autism, attention-deficit/hyper- activity disorder (ADHD), and Tourette syndrome, among others, and that molecular genetic studies have begun to identify possible susceptibility loci for several of these disorders, most notably schizophrenia.

Recognizing and Treating Depression in Asian Americans

December 01, 2006

Compared with other ethnic groups, Asian Americans underuse mental health services, resulting in delayed treatment and higher attrition rates. A report by the surgeon general states that the underutilization is because of the shortage of bilingual services, the low percentage of health care insurance coverage, and the Asian American tradition of using mental health treatment only as a last resort.

Does the Biopsychosocial Model Help or Hinder Our Efforts to Understand and Teach Psychiatry?

December 01, 2006

In this essay, I approach the question about the BPSM from the perspective of a teacher of psychiatry, medical school dean responsible for (among other matters) student career advising, and clinician. In those capacities, my duties include fostering an understanding of psychiatric disorders among medical students and residents, instilling confidence in and respect for the discipline of psychiatry among students as well as nonpsychiatric colleagues, and explaining psychiatric diagnosis and treatment to patients and their families.

Vagus Nerve Stimulation and Depression: Conflict of Interest's "Perfect Storm"?

December 01, 2006

In July 2005, the FDA approved a new type of therapy for treatment-resistant depression: vagus nerve stimulation (VNS). However, the approval process incited controversy because the scientific team that was assigned to review the device rejected its approval unanimously 3 separate times. The reviewers were unimpressed with the efficacy research underlying the device, since the only reported placebo-controlled trial showed no significant difference between active and sham VNS.