The Blue Mask: Uncovering the Cause of the NightmareFebruary 22nd 2010
Mr V had appeared at our appointment in a panic, after an episode of premature ventricular contractions and a terrifying nightmare. In the dream, he was threatened by a blue, masklike face with white circles for eyes and 2 slits for a nose.
Insanity Defense Evaluations - Basic Procedure and Best PracticesDecember 2nd 2008
The insanity defense represents a prominent symbol of the relationship between law and psychiatry. Despite the fact that it is infrequently raised and seldom successful, the insanity defense is the subject of intense legal and public scrutiny.
Evaluating Capacity to Make a WillPsychological Autopsy and Assessment of Testamentary CapacityDecember 2nd 2008
It is an ancient practice to state instructions for distributing one’s property after death. In Genesis 48, Jacob verbally bequeaths his property to Joseph, Joseph’s siblings, and Joseph’s 2 sons. Wills existed in ancient Greece and Rome, with restrictions.
Cognitive-Behavioral Therapy for Adolescent DepressionProcesses of Cognitive ChangeDecember 2nd 2008
The substantial and often recurrent distress and impairment associated with major depressive disorder (MDD) in youth has prompted increased interest in the identification and dissemination of effective treatment models. Evidence supports the use of several antidepressant medications, specific psychotherapies, and, in the largest treatment study of depressed teenagers, the combination of fluoxetine and cognitive-behavioral therapy (CBT) as effective treatments.1-3 CBT is the most extensively tested psychosocial treatment for MDD in youth, with evidence from reviews and meta-analyses that supports its effectiveness in that population.3-5
Invitation to Disaster: Mutual Attraction Between Therapist and PatientDecember 1st 2008
Even though there was no name attached to the message, I knew instantly who had sent the vague text that left my heart racing. This was the last communication I had with Mr R, a 36-year-old neuroscience researcher with no past psychiatric history.
One minute she's breathing room air and the next you're barking orders at a team wheeling in a crash cart. You review signs and symptoms you missed, the rough rhythm of her heart before she coded. You want to believe your reasoning was as elegant as a glass filled with cabernet, and you want to forget the bottle you imagine resting on a tray table at forty thousand feet, ready to tumble when the captain announces the plane is diving for an unscheduled stop. But I don't need images of air disasters to convince you doctors live somewhere between reason and panic: just flip open your laryngoscope, visualize the vocal chords, and forget you have fifteen seconds to thread the tube before the breathless body on the bed turns blue.
When in Rome . . . Museo della MenteDecember 1st 2008
A revamped museum in Italy is providing a hands-on and heads-on approach to mental illness. The Museo della Mente (Mind's Museum), which originally opened in 2000, is located on the outskirts of Rome in a former psychiatric hospital that closed in 1978
Psychiatric Care: Coming to a Computer Near You?December 1st 2008
Persons who live in rural areas in this country often lack access to adequate mental health care. Psychiatrists from Michigan State University (MSU) are tackling their state’s lack of resources by providing counseling via videoconference for patients with psychiatric disorders who live in remote areas.
Sexually Violent Predator Statutes: The Clinical/Legal InterfaceDecember 1st 2008
Since 1990, many states have instituted sexually violent predator (SVP) or sexually dangerous person (SDP) civil commitment statutes that seek to identify the small group of extremely dangerous incarcerated sexual offenders who would present a threat to public safety if released from custody.
Dangerously Paranoid?Overview and Strategies for a Psychiatric Evaluation of a Highly Prevalent SyndromeDecember 1st 2008
The term “paranoia,” derived from the Greek &lduo;para” (beside) and “nous” (mind), was coined as a descriptor of psychopathology by Heinroth in 1818.1 By the end of the 19th century, 50% to 80% of patients in asylums in German-speaking countries had received a diagnosis of paranoia.1 Beginning in 1899, Kraepelin’s efforts to define paranoia more precisely resulted in a decrease in diagnoses of paranoia in favor of dementia praecox and, later, schizophrenia.1,2 This narrowing of the definition of paranoia is reflected in current nosology and practice. In DSM-IV-TR, the prevalence of delusional disorder is estimated at 0.03% of the general population and accounts for 1% to 2% of psychiatric admissions. The prevalence of paranoid personality disorder is 0.5% to 2.5%; this condition accounts for 10% to 30% of psychiatric admissions.3
End-of-Life Care and the ElderlyDecember 1st 2008
Every life ends with death. For the elderly, death is the end of a long life that has been shaped by personal history and world events, various relationships, well-set personality characteristics and, of course, happenstance. Each of these, in addition to the specific circumstances that herald death, shapes the experience of dying in old age.
Major Depression After Recent Loss Is Major Depression - Until Proved OtherwiseDecember 1st 2008
Suppose your new patient, Mr. Jones, tells you he is feeling “really down.” He meets all DSMIV symptomatic and duration criteria for a major depressive episode (MDE) after having lost his wife to cancer 2 weeks ago. Should you diagnose major depressive disorder?
Update on Pharmacotherapy for ADHDDecember 1st 2008
Youths aged 6 to 16 years with any subtype of ADHD participated in the study. Comorbid bipolar disorder, pervasive developmental disorder, psychotic illness, anxiety disorders, and tic disorders were exclusionary criteria. Patients with other comorbid psychiatric disorders, including major depressive disorder, were allowed to participate if ADHD was the primary diagnosis.
Medical Comorbidities in Late-Life DepressionDecember 1st 2008
Late-life depression is both underrecognized and undertreated, and the impact of medical comorbidity may mask depressive symptoms. Depression further complicates the prognosis of medical illness by increasing physical disability and decreasing motivation and adherence to prescribed medications and/or exercise or rehabilitation programs
Antipsychotics in Children: Experts Report Mixed ResultsDecember 1st 2008
Studies of antipsychotics in child prenpresented at the 48th Annual New Clinical Drugs Evaluation Unit (NCDEU) Meeting, conducted by the NIMH in Phoenix, May 27-30, provide some data where there have been relatively little on the increasing use of these agents.