Psychiatric Times Vol 24 No 8

Book review

Alejandro Gonzales's Babel is a meditation on the barriers to communication in a world divided by class, culture, and language. Although his vision is dark, he never surrenders to cynicism. His Babel, unlike the Bible story, holds out the promise of a universal language of the human heart. Psychiatrists know this language as empathy--the wordless connection that is the art form of every caring profession.

Democratic control of Congress may result in the dislodging of a long-stuck bill authorizing an unspecified amount of additional federal funding for research into postpartum depression. But in hearings in a House subcommittee recently, Republicans voiced an intention to add postabortion depression to the bill's focus.

To assist in meeting the daunting challenge of medication management, the Clinical Manual of Geriatric Psychopharmacology is a valuable, up-to-date resource for any clinician who prescribes for elderly patients.

From our Readers

Medication adherence is a particular challenge for patients with first-episode schizophrenia. In addition to physician and patient concerns about adverse effects of antipsychotics, many patients at this stage are particularly resistant to continuing medications over the long term.

Dr. Harvey Roy Greenberg briefly discusses the inaccuracies of psychiatry in today's movies and television shows.

Poetry of the Times

From our Readers

From our Readers

Homelessness rates in both Canada and the United States have increased dramatically over the past 10 years. Among the homeless, there is a high prevalence of mental illness and substance use disorders.

More than any other branch of medicine, the profession of psychiatry is unable to coexist with business because the suffering of mentally ill persons is deeper and darker and more pervasive and powerful than any other form of human anguish, whether biological or social.

Improving Medication Adherence: How to Talk with Patients About Their Medications, by Shawn Christopher Shea, is a slim and excellent primer on the verbal strategies and interviewing tips that clinicians can use to improve medication adherence.

Figures from the US Department of Justice indicate that more than half of prison and jail inmates have a mental health problem. Mental health courts (MHCs) were designed to divert mentally ill persons convicted of nonviolent crimes to supervised treatment instead of incarceration, but while the number of MHCs has grown substantially over the past decade, limited information has been available about outcomes and costs.

The results of two recent studies suggest that antidepressant medication may have an expanded role in the management of stroke patients. Prophylactic use of antidepressants following stroke appeared in a meta-analysis to be effective in fending off depression, and a short course of antidepressants in a placebo-controlled study was associated with long-term restoration of executive function, independent of depressive symptoms.

Numerous studies have documented the increasing prevalence of mental health and substance abuse issues in youths nationwide. As many as 1 in 5 children and adolescents in the United States have a behavioral or emotional disorder.

This article examines the risks involved in prescribing psychotropic medication and offers suggestions for managing those risks to ensure the best possibility for a favorable outcome.

Psychiatrists who work in inpatient units are faced with daily decisions about predicting which patients will be violent, both in the hospital and after discharge. These decisions are often made using unstructured clinical judgment based on the clinician's experience and knowledge of the literature. How long such judgment stays the standard of care remains to be seen, because psychiatric researchers have produced a number of assessment and management tools to improve the accuracy and use of violence risk assessment. This article briefly outlines 3 tools: the Brøset Violence Checklist (BVC), the Classification of Violence Risk (COVR), and the Historical Clinical Risk-20 (HCR-20).

While many of the claims at improving cognition are dubious (eg, the "Mozart effect"), there is now ample reason to suspect that parental involvement in children's brain development occurs much earlier than the first 3 years. Data now suggests that maternal cues are critical to proper brain development long before birth.

The role of no-suicide contracts is but a small tactical piece of the larger strategic approach to the assessment and prevention of suicide. Its many obvious limitations-to some degree in assessment, but primarily in suicide prevention-should have driven serious discussion of no-suicide contracts out of consideration as a practical measure in clinical practice and a legal talking point in the courtroom.

A recently published study examined the impact of publicity regarding the pediatric suicidality data on the prescribing practices of physicians in the United States. The researchers focused on the period from June 2000 to March 2005.

This article briefly reviews the federal standards regarding S/R and methods of reducing the risk associated with their use. CMS standards that went into effect February 6, 2007, will be emphasized; however, some of these standards vary from JCAHO standards.

The goal of this article is to further assist psychiatrists in tackling some of the more difficult financial issues in hopes of managing and reducing risk.