Psychiatric Times Vol 25 No 4

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.

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.

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.

"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.

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.

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.

Recently, a number of studies have examined the characteristics of early-onset schizophrenia spectrum disorders and medication treatment for youths with schizophrenia.

Why is it that experiencing a new love relationship or coping with a severe crisis has such different outcomes for different persons?

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.

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.

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.

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).

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

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.

Psychiatrists more than any other medical specialists would benefit from regular doses of poetry, art, and fiction.

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.

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.

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).

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.

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.

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