Psychiatric Times Vol 25 No 10

I have been invited to write a clinical article on psychotherapeutic interventions for chronic depression.

A 52-year-old female college professor was referred to a psychiatrist by a nurse practitioner at the college health clinic. The referring diagnosis was “adjustment disorder with depressed mood versus atypical depression with somatization; rule out fibromyalgia.”

Both the American Psychiatric Association (APA) and the Accreditation Council for Continuing Medical Education (ACCME) are embroiled in the widening Senate investigations of pharma’s possible influence on CME in particular and on medicine in general.

Unipolar major depressive disorder is a debilitating condition with a lifetime prevalence of 17%. Recent epidemiological evidence indicates that MDD is the fourth leading cause of disease burden and the leading cause of disability-adjusted life years.

I am writing to correct several inaccurate assertions in the essay, “The American Psychological Association and Detainee Interrogations: Unanswered Questions” (Psychiatric Times, July 2008, page 16), by Kenneth S. Pope, PhD, and Thomas G. Gutheil, MD.

Psychiatrists were among the chief physician beneficiaries of the Medicare bill (HR 6331) that Congress passed in July. The Medicare Improvements for Patients and Providers Act of 2008 included an historic elimination of the discriminatory co-pay for Medicare outpatient mental health services.

ADHD, the most common diagnosis in child psychiatry, appears to be more challenging to diagnose and treat when there is a comorbid depressive disorder.

Regular interval administration of outcome measurement tools has proved to be beneficial in improving the quality of care that we all hope to provide for our patients.

In his review of my book, Doing Psychiatry Wrong: A Critical and Prescriptive Look at a Faltering Profession (Psychiatric Times, June 2008, page 57), S.N. Ghaemi, MD, MPH, citing George Orwell, writes that I “seek to justify an opinion” rather than “seek the truth.” He claims that my “errors are numerous and fundamental.”

I was dismayed by the article by Dr Antonuccio and colleagues (“Common Augmentation Strategies for Depression,” Psychiatric Times, March 2008, page 21), in which they warned us against using augmentation strategies for treatment-resistant depression in the face of a lack of studies that show the efficacy of such strategies. They argued that this is not evidence-based medicine. Far be it from me to be a proponent of “contrary to evidence-based medicine.” I certainly agree that evidence-based controlled studies of each and every reasonable augmentation strategy would be wonderful.

Here I will discuss several examples of recent, reasonable depictions of ECT in the media, and I will suggest how they could represent a shift in the way that this “controversial” therapy is regarded. I use the word “controversial” advisedly, because even on the day I write this, a newspaper article on deep-brain stimulation, in which ECT is described, reads: “New reports this month show that some worst-case patients-whose depression wasn’t relieved by medication, psychotherapy, or even controversial shock treatment-are finding lasting relief.

A recent decision by Pfizer to eliminate all direct funding for continuing medical education/continuing education (CME/CE) programs conducted by commercial providers including medical education and communication companies (MECCs) raises questions about whether it is an isolated action or a signal that MECCs will no longer conduct business as usual

The Golden Gate Bridge in San Francisco has the regrettable distinction of being the number one spot for suicide in the world. There have been more than 1300 known suicides from the bridge, and in 2007 at least 35 people committed suicide by jumping off the Golden Gate Bridge, more than in any other year.

Psychiatrists may encounter patients who present with severe emotional consequences because they are victims of stalking. In addition, psychiatrists themselves are at increased risk for becoming victims of stalking because of the nature of their profession and their interaction with lonely and unhappy individuals.

After I slippedmy finger inside and feltdeath’s rough stoneI knew I should grantthe old man’s wish:“Just cut my toenails.”Down on my kneesI admired them, thickas a silver dollar,long and curved asthe shofar, the ram’s hornJews blow on judgment day.And I was dressed in whitelike Yeshua, Jesus, my favoriteJew, a healer I knewwould have been downon his knees with me,worshipping the beautyof an old man’s body.

In this column, I will discuss new progress on this Internet-boosted line of inquiry. I will begin with a few basics about differential gene expression and microarrays and will then move on to something that researchers are calling “convergent functional genomics.” As you shall see, the clever use of online databases both confirmed and extended the work done at the bench.

The editors of Diagnostic Manual-Intellectual Disability (DM-ID) have set out to complete the difficult task of compiling the evidence base on mental disorders in the field of intellectual disability (ID) into one reference book while modifying DSM-IV diagnostic criteria for use in persons with the disorder who present with mental and behavioral disorders.

Elder abuse is a concern for all practitioners who care for elderly patients or their family members. An elderly person’s fears of aging and dependence may be heightened by stories and news accounts of abuse.

This article focuses on recent innovations in diagnostic issues, tactics, and strategy, and takes a brief look at the future.