Psychiatric Times Vol 25 No 9

Unexplained Physical Symptoms

August 02, 2008

he key manifestations of DSM-IV somatoform disorder are unexplained physical symptoms or complaints that tend to coexist with other psychiatric syndromes or are linked to psychological issues. These symptoms typically lead to repeated medical or emergency department visits; are associated with serious discomfort, dysfunction, and disability; and lead to significant health expenditures.

Polypharmacy to Optimize Depression Outcomes

August 02, 2008

Polypharmacy is used increasingly in the treatment of depression.1 Although it can be beneficial-and at times may even be unavoidable-it can also be overused, resulting in drug-drug interactions, accumulation of adverse effects, reduced treatment adherence, and unnecessary increases in the cost of health care.2 This article describes current trends in psychiatric polypharmacy in the treatment of depression along with ways to use polypharmacy to optimize treatment outcomes.

Reading the Humanities for Humanity

August 02, 2008

Cynthia Geppert has done it again! She has written a timely article that expresses what I have thought for a long time (“Why Psychiatrists Should Read the Humanities,” Psychiatric Times, February 2008, page 10). Recently, I was sitting in a nonscience course for first-year medical students wondering why it was difficult for some of them to respond to the professor’s questions.

Recognizing and Treating Interferon-α–Induced Neuropsychiatric Symptoms

August 02, 2008

The fact that treatment with interferon (IFN)-α has become the world’s foremost human model for studying how the innate immune system promotes depression points to a disturbing clinical truth: patients who elect to receive (IFN)-α therapy for any of the several disease states to which it is applied face a high likelihood of experiencing a multitude of psychiatric symptoms severe enough to affect their social and occupational functioning and overall well-being.1

The Age of Conflicts-of Interest

August 02, 2008

In our own time, many so-called conflicts of interest (COI) boil down to temptation, as James DuBois,3 professor and department chair of health care ethics at Saint Louis University, notes in his excellent chapter on this subject. A physician-researcher is tempted to slant the results of his or her study in order to maintain funding from a medical technology company.

Reconstructing One’s Past

August 02, 2008

Over 55 years ago, I graduated from the then almost new University of Texas Southwestern Medical School in Dallas and went off to Boston and the Brigham to be a straight medical intern. I had been married for 2 years, and my wife was pregnant with our first child-neither of us knew a soul in Boston. I was on duty for 36 of each 48 hours (except for 1 weekend a month) and was of little help to my wife, who was alone in a strange city and was facing the imminent birth of our first child.

A Neuroscientific-Medical Perspective

August 02, 2008

Recent research emphasizes our need for better understanding of the interface between the specialties of psychiatry and medicine. Psychiatrists need to monitor emerging work that highlights the need for both a neuroscientific and medical perspective in the management of complex disorders.

The Defendant Psychiatrist’s Malpractice Deposition

August 02, 2008

After a formal complaint alleging malpractice is made, the discovery phase of the litigation process begins. Discovery is the process in which the parties to a lawsuit go about gathering information before trial. The rationale behind discovery is to reduce surprises at trial and to encourage settlement before trial. Methods of discovery include written interrogatories, requests for documents, and depositions of various witnesses.

From Prevention to Preemption: A Paradigm Shift in Psychiatry

August 02, 2008

Universal prevention has been a focus of psychiatric research for the past 4 decades. Using a public health approach, research has shown that mitigating major risk factors, such as poverty and early life stress, and promoting protective factors can improve behavioral outcomes.

Collaborating With Our Medical Colleagues

August 02, 2008

Ninety percent of patients with psychiatric disorders are seen in the general medical sector. Two-thirds of these patients receive no treatment for their psychiatric illness. Of the one-third that does, only one-tenth is provided minimally adequate treatment.1 Furthermore, nontreatment or nonevidence-based treatment of psychiatric disorders in the primary care setting is associated with at least double the total health care costs for patients, mainly from increased general medical care and nonpsychiatric prescriptions.2,3

Intimate Partner Violence: Practical Issues for Psychiatrists

August 02, 2008

The term “domestic violence” emerged in the United States with the rise of the women’s movement in the 1970s. Before that, violence between partners was considered a private matter. A specific type of domestic violence, intimate partner violence, refers to violence between intimate partners. Public awareness campaigns help us identify one type of intimate partner violence in which one partner, typically the male partner, is the aggressor, and the other partner, typically the female, is the victim.

Oxytocin and the Bottom Line

August 02, 2008

Trust can be a scary proposition. Among other characteristics, trusting someone involves the ability to measurably predict a behavior on the basis of nothing more than a memory, an impression, or a whim. For creatures like us, who spend a ridiculous amount of time with unpredictable strangers, brokering trust is an oddly important survival strategy.

Conflicts Grow Over Conflicts-of-Interest Policies and Practices

August 02, 2008

Debates over conflicts of interest (COIs) in medical research and practice are intensifying with recent proposals to ban industry funding of medical education, to better “manage” industry-physician relationships, and to mandate public disclosure of industry payments to physicians and medical institutions. Caught in the cross fire are prominent psychiatrists accused of underreporting payments received from pharmaceutical companies.

Behavioral Comorbidities in Rheumatoid Arthritis

August 01, 2008

While tremendous therapeutic advancements have been made, patients with rheumatoid arthritis (RA) have a myriad of comorbidities, including fatigue, depression, and sleep disturbances. Data on the comorbidity of psychiatric disorders with arthritis are also striking: according to the NIMH Catchment Area program, the lifetime prevalence of psychiatric disorders among patients with RA is 63%.

Last Minute Drug Approvals Linked to Postmarket Safety Issues

August 01, 2008

Drugs approved by the FDA just before mandated deadlines are more likely to have safety issues after entering the market than those approved at other times, according to a study in the March 27 New England Journal of Medicine.1 Coincidentally, on that date, the FDA announced the first group of marketed medications, including the atypical antipsychotic clozapine (Clozaril), for which it is requiring additional safety plans under the FDA Amendments Act of 2007.

Congress to Avert Drastic Medicare Fee Cut; Psychiatric Copay Reduction Less Clear

August 01, 2008

Congress will undoubtedly set aside, one more time, a scheduled, drastic cut in Medicare fees for psychiatrists and all other physicians sometime this summer based on action in Congress before its Fourth of July recess. The House and Senate almost agreed to replace the 10.6% cut in fees scheduled for July 1 with a 1.1% increase through the end of 2009. But various political difficulties interceded, and the Bush administration stepped in and ordered a 10-day halt to any fee cuts until Congress returned to Washington.

Dynamic Psychotherapy for Cancer Patients and Their Partners

August 01, 2008

The estimated number of patients with cancer in this country is 10.5 million. Close to a million and a half are new cases, and it is estimated that 560,000 people die of cancer each year.1 There is clearly a large group of cancer patients and their families at high risk for serious psychiatric illness. In this article, I focus on the advantages of a psychodynamic approach and address how this approach is helpful in the liaison function and psychotherapy of cancer patients and their partners.

Supreme Court Expands Judicial Discretion With Mentally Ill Defendants

August 01, 2008

The Supreme Court has staked out new legal ground by ruling that a judge has the right to deny a patient with schizophrenia (or anyone with a mental illness) the right to represent himself or herself in a trial-even though the court deemed him mentally qualified to stand trial.

Depression and Cardiovascular Disease

August 01, 2008

Depression is a risk factor for cardiovascular disease and death in many ways, directly and indirectly. It is independently linked to smoking, diabetes, and obesity-all of which are risk factors for coronary heart disease (CHD).1 Depressed patients are more likely to be noncompliant with treatment recommendations, including diet, medications, and keeping appointments, and are more likely to delay presentation for treatment with an acute coronary event.2-4