Psychiatric Times Vol 24 No 6

Being an Effective Psychiatric Expert Witness

November 01, 2007

Many psychiatrists feel intimidated by or frightened about courtroom testimony. However, with the proper preparation, the psychiatrist need not have a difficult experience. It is the role of an expert witness to educate the court on matters that are beyond a layperson's understanding.

The Crisis of Overdiagnosed ADHD in Children

July 01, 2007

This commentary arises from my concern about the superficiality that characterizes the process of diagnosing attention-deficit/hyperactivity disorder (ADHD) in children--usually followed by the prescription of one of the most powerful drugs on earth, methylphenidate.

Psychiatric Emergencies in Bipolar and Related Disorders

July 01, 2007

Psychiatric emergencies usually involve some combination of agitation, aggression, impulsivity, psychosis, and risk of destructive behavior, including suicide and homicide. The psychiatrist must ensure the safety of the patient and others while identi- fying and treating immediate medical and psychiatric problems and developing and initiating a strategy for continuing the management of less immediate problems. In the diagnosis of acute behavioral disturbances, it is necessary to determine the role of the patient's primary psychiatric illnesses and any complications or treatments of those primary psychiatric illnesses, as well as the role of other medical or toxic disturbances that may be interacting with the patient's psychiatric illnesses or treatments.

Troubleshooting Delirium in Elderly Inpatients

June 01, 2007

Delirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. Approximately 15% of elderly patients admitted to the hospital have delirium as a presenting or associated symptom. Delirium will develop in another 15% of elderly patients during hospitalization.

Understanding the Mind of Your Bipolar Child

May 01, 2007

Childhood bipolar disorder is a devastating illness that affects emotional, social, and cognitive development. In recent years, increased attention devoted to the study of bipolar disorder in childhood has resulted in greater information regarding the cause, phenomenology, and treatment of the disorder.

The Therapeutic Potential of Neural Stem Cells

May 01, 2007

The following must be one of the strangest comments I have ever heard on television. An Iraqi businessman uttered it shortly after a wave of missile strikes during the Gulf War. "The rocket flew down my street and took a left," he said in English. It had smashed into its target, a nearby building--leaving his adjacent shop completely undisturbed.

Mariella's Eye

May 01, 2007

The call came early one morning. Rich and Christine werevery upset. Their 6-year-old daughter, Mariella, had seena flashing light in her left eye that would not go away. Atrip to the emergency department revealed a smallretinal tear.

Intermittent Explosive Disorder and the Like: Overappreciated?

May 01, 2007

In "Intermittent Explosive Disorder: Common but Underappreciated"(Psychiatric Times,January 2007, page 1), Arline Kaplan wrote that intermittent explosive disorder (IED) "is not just another name for bad behavior." She quoted Dr Coccaro from the University of Chicago as asserting that patients with IED who react with rage to minor irritants have been shown to have reduced down-regulation of certain cortical nuclei that should be reined in by inhibitory stimuli from the frontal cortex.

Biopsychosocial Model: Helpful or Hindering?

May 01, 2007

The points made by Dr G. Scott Waterman in his article, "Does the Biopsychosocial Model Help or Hinder Our Efforts to Understand and Teach Psychiatry?" are right on target. Unfortunately, the biopsychosocial model of psychiatry is not merely conceptual; it is woven into the delivery of care at every level. Institutions of government, insurance, and hospital and outpatient services separate "behavioral" medicine from all other medicine and further separate substance abuse disorders from those deemed "psychiatric."

Psychiatric Evaluations in Emergency Departments

May 01, 2007

In the article by Drs Kunen and Mandry, "Should Emergency Medicine Physicians Screen for Psychiatric Disorders?" (Psychiatric Times, October 2006), no mention was made of formally assessing a patient's mental status to diagnose delirium.

How to Write a Suicide Note: Practical Tips for Documenting the Evaluation of a Suicidal Patient

May 01, 2007

Proper suicide assessment is probably the most important part of a clinician's job; appropriately, heavy emphasis is placed on this in our education. Unfortunately, psychiatrists receive comparatively little practical guidance in documenting the history and physical examination (H&P) of a suicidal patient.

Partners of Combat Vets With PTSD Show Psychological Distress

May 01, 2007

It is not uncommon for combat veterans to exhibit a wide range of psychological conditions, from schizophrenia to depression to posttraumatic stress disorder (PTSD), but how do these disorders affect domestic partners, who often serve as veterans' caregivers?

House and Senate Parity Bills: Differences Complicate Passage Prospects

May 01, 2007

The introduction of a House mental health parity bill in March has scrambled prospects for congressional passage of a bill that President Bush could sign. The introduction of the Paul Wellstone Mental Health and Addiction Equity Act (HR 1424) by Reps Patrick J. Kennedy (D, RI) and Jim Ramstad (R, Minn) threatens to split both the mental health community and the House and Senate.

FDA Approval of Vagus Nerve Stimulation

May 01, 2007

FDA Approval of Vagus Nerve Stimulation I am a triple-boarded, long-practicing psychiatrist and have used vagus nerve stimulation (VNS) in several patients so far. I have followed the controversies within the FDA and articles in the national media and was quite impressed by and appreciative of Dr Daniel J. Carlat's article on the sponsorship issues involved in FDA approval of VNS ("Conflict of Interest in Psychiatry: How Much Disclosure Is Necessary?"

VA Statistics Show Large Number of Vets With Psychiatric Diagnoses

May 01, 2007

An analysis of data on nearly 104,000 veterans of the Afghanistan and Iraq wars who sought help from the Department of Veterans Affairs (VA) system confirms that substantial numbers returned from their tour of duty with psychiatric problems.

Nonconventional and Integrative Treatments of Alcohol and Substance Abuse

May 01, 2007

In the first part of this column (Psychiatric Times, February 2007), I reviewed treatments whose beneficial effects are probably achieved through a discrete biological or pharmacological mechanism of action. These included dietary modifications; supplementation with specific vitamins, minerals, and amino acids; and medicinal herbs. In this part, I will review the evidence for approaches that reduce the risk of relapse, diminish craving, or mitigate withdrawal symptoms but for which there is no evidence for direct biological or pharmacological effect.

Psychiatric Evaluation of Children and Adolescents: It Takes Time

May 01, 2007

Psychiatrists know that it takes longer to interview children and adolescents than adults. Child and adolescent psychiatrists are universally struck by how comparatively easy it is to interview an adult patient, whereas general psychiatrists face the evaluation of a child or adolescent with apprehension.

Quality of Life in Patients With Bipolar Disorder: Defining and Measuring Goals

May 01, 2007

A complex and heterogeneous condition characterized by a variety of symptoms and marked variability in disease course, bipolar disorder is marked by episodes of depression, hypomania, mania, or psychosis and,patients can experience a mixture of emotional states.

To Be or Not to Be: Treating Psychiatrist and Expert Witness

May 01, 2007

It begins with a simple request: a patient asks for help in taking time off from work, obtaining disability payments, or seeking other compensation for his or her diagnosis of posttraumatic stress disorder. The requests may come from patients you have been seeing for long periods or from new patients who are sometimes referred by their attorneys.

Suicide Attempts and Completions in Patients With Bipolar Disorder

May 01, 2007

According to the CDC, in 2004, suicide was the 11th leading cause of death across all age groups and the 10th leading cause of death for persons aged 14 to 64 years; 32,439 people in the United States took their own lives. Women attempt suicide about 3 times more often than men, although men are 4 times as likely to complete suicide. Anderson and Smith3 reported that suicide was the eighth leading cause of death among men in 2001. Of the 24,672 completed suicides among men, 60% involved the use of a firearm (the use of a firearm was the means of suicide in 55% of all cases).

Is Bigotry a Mental Illness?

May 01, 2007

There were only 3 Jewish students in my high school, and I was one of them. In the small, western New York town where I grew up, most people were tolerant. But a small clique of anti-Semites made life tough for us Jewish kids. Most of the time, we just shrugged off the jokes and insults or came right back at these louts with a snappy retort. Sometimes, the bigotry grew more menacing.

Hoarding: Studies Characterize Phenotype, Demonstrate Treatment Efficacy

May 01, 2007

A 79-year-old woman recently died in a fire at her Washington, DC, row house when "pack rat conditions" prevented firefighters from reaching her in time. A few days later, 47 firefighters from 4 cities spent 2 hours fighting a fire in a Southern California home before they were able to bring it under control. Floor-to-ceiling clutter had made it nearly impossible for them to enter the house.

Bipolar Diagnosis: Navigating Between Scylla and Charybdis

May 01, 2007

When a new patient with depression enters your practice, you face a diagnostic dilemma. If you miss bipolar disorder (BD), and prescribe an antidepressant, you can do harm. But if you call a unipolar depression "bipolar," you may also do harm, because lithium, anticonvulsants, and atypical antipsychotics carry significant risk as both short- and long-term treatments. In addition, the label of "BD" currently carries much more stigma than the term "depression."