Psychiatric Times Vol 23 No 9

Outcome of Medicare Fee Changes Uncertain

September 01, 2006

There will be some major changes in the Medicare fee schedule for 2007. While psychiatrists are apt to make out better than some other subspecialties, it is unclear whether total payments for psychiatrists will go up or down.

Depression Rates High in Young Women With Acute MI

September 01, 2006

In a study published in the April issue of Archives of Internal Medicine, researchers sought to determine whether young women who were hospitalized with acute MI also had higher rates of depression than other groups.

New Legislative Move in Battle With Psychologists

September 01, 2006

Having lost a few battles over state laws allowing psychologists to prescribe drugs in some cases, organized psychiatry is trying a new tactic--this time at the national level--in order to define professional boundaries in scientifically appropriate ways.

Preventing Rehospitalization in Schizophrenia

September 01, 2006

Interventions addressing symptom education, service continuity, and daily structure are the most effective in avoiding inpatient stays in patients with schizophrenia who have had multiple hospitalizations, a study in the June issue of The Journal of Nervous and Mental Disease reported.

Parents as Part of the Therapeutic Process in a Child and Adolescent Referral

September 01, 2006

While some mental health services for adolescents allow self-referral, many require parental involvement. There is increasing evidence that working with the family and the child is important if only to increase compliance with medication and to tackle any comorbid difficulties.

Infant Psychiatry

September 01, 2006

Infant, or developmental, psychiatry is a subspecialty of child and adolescent psychiatry that focuses on the promotion of mental health in infants, toddlers, preschoolers, and their families through the consultation, assessment, and treatment of clinical problems.

Catatonia in Autism or the Blind Men and the Elephant

September 01, 2006

Current treatments for autistic spectrum disorders (ASD) are useful in some cases, but have little enduring impact. This had lead to many parents seeking nonconventional treatments that often border on quackery.

Novel Methods to Predict Outcome Using Neuroimaging

September 01, 2006

Noninvasive brain imaging methods are providing unprecedented views of the structural and functional development and aging of an individual's brain or state of brain pathology. These exciting new may provide novel information relevant to the enhancement of clinical practice.

Moving Addiction Medications From Lab to Practice

September 01, 2006

Several forums at the May 2006 American Society of Addiction Medicine (ASAM) addressed the issue of the gap between the number of investigational addiction treatment drugs and the few actually available on the market.

ADHD in Girls: Wide Range of Negative Sequelae

September 01, 2006

Attention-deficit/hyperactivity disorder (ADHD) in girls may be more persistent than originally thought and may also be associated with a variety of behavioral and mental health consequences such as eating disorders, depression, and substance abuse.

Rebels Without a Cause? Adolescents and Their Antiheroes

September 01, 2006

Adolescents reject their parents’ icons and seek out and empower their own. Antiheroes seem deliberately provocative, assailing almost every social convention of the adult generation, and parents often fear they are leading youth astray.

New Approaches to Juvenile Delinquency: Psychopathology, Development, and Neuroscience

September 01, 2006

New findings in epidemiology, developmental psychiatry, and neuroscience offer the opportunity for a new perspective on the problems of juvenile delinquency and bring to bear the insights of modern psychiatry in the treatment and successful rehabilitation of juvenile offenders.

The Role of Family Therapy for Adolescents With Anorexia Nervosa

September 01, 2006

The inclusion of parents in their children's treatment for eating disorder is not universally accepted. However, recent studies suggest that families should be included in treatment and that they are often a powerful resource for helping their children recover.

Patients as Friends: Lessons From History

September 01, 2006

Friendship with patients, particularly those with serious mental illness, may seem anathema for a psychiatric ethicist, yet there is a long and rich history of physician-patient friendship in medical ethics.

Psychotherapy for Social Anxiety Disorder

September 01, 2006

While social anxiety disorder (SAD) may cause observable signs of anxiety and social awkwardness in some, many others suffer silently. Cognitive-behavioral therapy can be helpful for most patients with SAD, with alternative therapies such as psychodynamic therapy and interpersonal therapy filling the gaps.

A Case of Pseudosomatization Disorder

September 01, 2006

Particularly because 25% to 50% of patients with conversion disorder eventually have a nonpsychiatric illness that explains their symptoms, it behooves us as psychiatrists to remember that we are physicians too.

Nonconventional Treatments of Cognitive Impairment

September 01, 2006

The numbers of patients with Alzheimer disease (AD), as well as those with severe cognitive impairment caused by traumatic brain injury and stroke, are continuing to increase. This article includes some nonconventional treatment approaches for which the evidence is limited.

Prenatal Antidepressant Use: Time for a Pregnant Pause?

September 01, 2006

A young mother has just learned from her gynecologist that she is 2 months pregnant. She has had 7 major depressive episodes over the past 8 years, 3 of which were accompanied by serious suicide attempts. She is asking you if she should stop taking the antidepressant at this time. What do you advise?

Book Review

August 01, 2006

The publication of a major new textbook is an important event in any discipline, but the arrival of Psychosomatic Medicine is a particularly exciting development for clinicians working in the interface between psychiatry and medicine.

Are Veterans Receiving Adequate Mental Health Care?

August 01, 2006

Questions concerning the adequacy of mental health care for returning Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans continue to capture congressional attention. The latest reminder was a Government Accounting Office (GAO) report issued in May stating that of the 5 percent of returning veterans between 2001 and 2004 who tested as being at risk for posttraumatic stress disorder (PTSD), only 2 percent were referred by Department of Defense (DOD) health care providers for further mental health or combat/operational stress reaction evaluations.

Update on Catatonia

August 01, 2006

Since its initial description by Kahlbaum (1828-1899) over a century ago, catatonia has been associated with psychiatric, neurologic, and medical disorders. Contemporary authors view catatonia as a syndrome of motor signs in association with disorders of mood, behavior, or thought. Some motor features are classic but infrequent (eg, echopraxia, waxy flexibility) while others are common in psychiatric patients (eg, agitation, withdrawal), becoming significant because of their duration and severity.

Assessment and Evaluation of Child and Adolescent Psychiatric Emergencies

August 01, 2006

The incidence of child and adolescent psychiatric emergencies has increased over the past 20 years. This rise in emergency department (ED) mental health visits coincides with an overall increase in ED use from 89.8 million visits in 1992 to 107.5 million visits in 2001. Psychiatric presentations by children and adolescents (often in the absence of medical complaints) account for up to of the total visits to an ED in a given year and, in some reports, such presentations account for as many as 16% of ED visits.

Book Review Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder

August 01, 2006

There are dozens of books on the market aimed at helping the general public recognize depression; there are far fewer that focus specifically on the more subtle forms of bipolar disorder. This disparity has its clinical parallel in the over-diagnosis of unipolar depression among patients who ultimately prove to have a bipolar disorder. Indeed, survey data suggest that there is typically a 7-year delay in the correct diagnosis of bipolar spectrum disorder.

News Brief: ICU Staff May Suffer From Psychiatric Difficulties

May 01, 2006

Caregivers in high-pressure medical settings, such as intenstive care units (ICUs), can suffer from high levels of stress, resulting in emotional exhaustion, diminished empathy for patients, and decreased productivity.

Commercial Influence on Psychiatric Drug Studies

May 01, 2006

A discussion of the evidence that the pharmaceutical industry influences how physicians evaluate drugs in ways that encourage sales of their products and that are not always in the best interests of the patient.