Psychiatric Times Vol 25 No 4

Washington Report

April 02, 2008

The congressional debate over expansion of the landmark 1996 Mental Health Parity Act (MHPA) rounded the bend on March 5 when the House passed a bill (HR 1424) that is considerably different from one passed last year by the Senate (S 558).

Integrative Treatment for Adult ADHD: A Practical, Easy-to-Use Guide for Clinicians

April 02, 2008

Although there is evidence in the research literature from as far back as 40 years showing that the symptoms of attention-deficit/hyperactivity disorder (ADHD) often persist into adulthood, it has been only in the past decade or so that integrative treatment models designed specifically for adult ADHD have been developed.

Mental Health Services for Survivors of Mass Violence

April 02, 2008

Nearly one sixth of the world's population has experienced mass violence, be it abducted Ugandan children who are forced to commit atrocities against their families and serve as child soldiers or Iraqi civilians who daily live with bomb blasts, killings, and sectarian violence.

Task Force Proposes New Bipolar Guidelines

April 02, 2008

An international team of experts recently proposed expanding the diagnostic criteria for several subtypes of bipolar disorder, adding a pediatric bipolar disorder category and eliminating the schizoaffective disorder category.

Accountable but Not Responsible

April 02, 2008

"Jack" has been in our emergency department at least 100 times in the 4 years I have worked at the Veterans Affairs Hospital. I first encountered him in the medical ICU, where he was hospitalized multiple times with chest pain and ECG changes after cocaine binges.

Prevention of Boundary Violations

April 01, 2008

Prevention of professional boundary violations in psychotherapy is a matter of crucial importance for the mental health field. Patients are damaged by boundary violations. Psychotherapists' careers are ended. Families of therapists and patients alike are devastated.

Intimate Partner Violence Among Women With Severe Mental Illness

April 02, 2008

The 1994 death of Nicole Brown Simpson and the subsequent highly publicized murder trial of her ex-husband, O.J. Simpson, brought increasing national attention to the problems of domestic violence and intimate partner murder. In 2000, there were 1247 female victims of intimate partner murder in the United States.1 Fully one third of female murder victims were killed by an intimate partner.1 On the positive side, rates of female victimization by intimate partner violence and murder appear to have decreased in the recent past.

Boundary Concerns in Clinical Practice

April 02, 2008

In the historical context of American psychiatry, the concept of boundaries is a relatively recent development.1 Freud reportedly analyzed some patients while walking along the river Danube, gave patients gifts, and was known to share a meal with a patient.

Prevention and Treatment of Addiction

April 02, 2008

In 2006, substance dependence or abuse was diagnosed in about 22.6 million persons in the United States.1 Addiction-related morbidity and mortality pose a major burden to society, costing our economy more than $500 billion annually: about $181 billion for illicit drugs,2 $168 billion for tobacco,3 and $185 billion for alcohol.4

Why Evidence-Based Medicine Can, and Must, Be Applied to Psychiatry

April 02, 2008

In the second century ad, a brilliant physician had a powerful idea: 4 humours, in varied combinations, produced all illness. From that date until the late 19th century, Galen's theory ruled medicine. Its corollary was that the treatment of disease involved getting the humours back in order; releasing them through bloodletting was the most common procedure and was often augmented with other means of freeing bodily fluids (eg, purgatives and laxatives).

Why Evidence-Based Medicine Cannot Be Applied to Psychiatry

April 02, 2008

Evidence-based medicine (EBM) is rapidly becoming the norm. It is taught in medical schools and is encouraged by both government agencies and insurance plan providers. Yet, there is little proof that this model can be adapted to fit psychiatry.

DSM5: Pandora Replies to Dr Frances

February 22, 2010

In his recent David Letterman-like Top-19 list of DSM5 issues, Dr Allen Frances targeted a proposed revision of the DSM-IV diagnosis of Pedophilia, and 2 proposed new diagnoses: Hypersexual Disorder and Paraphilic Coercive Disorder.

Study Faults Selective Publication of Antidepressant Trials

April 02, 2008

Medical journals have a unique image in the US health care system. Because most of them adhere to a strict system of critical peer review, they are often seen as unimpeachable sources of accurate information about the safety and efficacy of new medications.

Boundary Violations and Malpractice Litigation

April 01, 2008

Disregard of professional boundaries is a leading cause of malpractice litigation. Boundary violations take many forms. Sexual involvement is a recurring problem that can cause serious damage. Even without erotic physical contact, material boundary crossings can, at least, destroy or interfere with therapy, and at most, injure the patient and lead to litigation. Generally, boundaries are violated by any act that alters or blurs the contours of the professional relationship.

Rehabilitation of Sexual Boundary Transgressors

April 02, 2008

In my work in sexual boundary violations, now spanning almost 25 years, there are 2 things that have not changed. One is the prevalence or the frequency of at least one type of sexual boundary transgression.

Psychiatric Testimony and the Insanity Defense

April 02, 2008

The Supreme Court's 2006 decision in Clark v Arizona1 was one of the most unexpected defeats the American Psychiatric Association (APA) has had since it began regularly submitting amicus briefs to the Court 35 years ago.

Sleep Disorders in the Elderly

April 02, 2008

A variety of conditions may account for the sleep difficulties experienced by many older adults, including specific sleep disorders, circadian rhythm disturbances, and medical and psychiatric comorbidities.