Psychiatric Times Vol 26 No 4

Cognitive-Behavioral Therapy in Severe Mental Illness

April 17, 2009

Psychotropic treatment can often prevent the relapse of psychotic and mood symptoms. However, many patients take medication intermittently or not at all; or the symptoms may be only partially responsive to medication. Therefore, there is a need for interventions that can supplement the effect of medication and improve treatment outcomes.

Comorbidity: Psychiatric Comorbidity in Persons With Dementia

April 16, 2009

The assessment and treatment of psychiatric symptoms in persons with cognitive dysfunction are becoming increasingly important. Prevalence estimates of dementia in the United States range from 5% in those aged 71 to 79 years to 25% to 50% in those 90 or older.

Cormorbidity: Diagnosing Comorbid Psychiatric Conditions

April 16, 2009

Autism spectrum disorders (ASDs) are a group of 5 neuro developmental conditions (autism, Asperger syndrome, pervasive developmental disorder not otherwise specified [PDD-NOS], Rett syndrome, and disintegrative childhood disorder).1 Once thought to be rare, the incidence of these disorders is now estimated to be 1 in 150 children in the general population.2 Furthermore, the number of recognized cases has increased markedly in recent years.

Comorbidity: Schizophrenia With Obsessive-Compulsive Disorder

April 15, 2009

The co-occurrence of obsessive-compulsive symptoms (OCS) and psychotic illness has been a challenge for clinicians and investigators for more than a century. Over the past decade, interest in this area has burgeoned because of recognition of higher-than-chance comorbidity rates of schizophrenia and OCD.

Off-Label Prescribing

April 14, 2009

Medications cannot be marketed in the United States without an FDA determination that they are safe and effective for their intended use. To obtain such certification, pharmaceutical companies submit their products to rigorous scrutiny (eg, in vitro studies, animal studies, human clinical trials) and present the subsequent data to the FDA, which determines whether the medication in question is safe and effective for a specific purpose.

The Physics of fMRI

April 14, 2009

I almost destroyed the backseat pocket of an airline seat this summer. The vandalism was inadvertent, assuredly, though the anger that fueled it was not. While waiting for my plane to take off, I had read a magazine article claiming to show that fMRI (functional magnetic resonance imaging) studies were “uncovering” the voting preferences of test subjects. An adjacent article announced that researchers could now predict the buying preferences of other test subjects using the same imaging technologies.

Treating the Morally Objectionable Patient: Countertransference Reactions

April 14, 2009

Clinicians who treat patients with strong antisocial traits commonly struggle with the tension between conceptualizing them as either man or beast.2 On one hand, there is the well-intended goal of helping the offender develop into a more functional “human being.” On the other, there are the common emotional reactions of anger, disgust, and even fear of predation.3

A Psychiatrist’s Prayer

April 09, 2009

Lord, protect me from all the institutions that want to guard me from harm-Congress, PhRMA, academics, journal publishers, and even my APA. They fear I will be brainwashed. They fear-heaven forefend- I may use drugs “off-label.” I hesitate to inform you-it’s too late! I already prescribe medications offlabel, and I do it every day.

Pain Management Bill Likely to Pass This Year

April 08, 2009

The debate over physician involvement in assisted suicide has become relatively quiet since the federal courts and the Supreme Court, in a 6 to 3 decision on January 17, 2006, upheld Oregon’s 1997 Death With Dignity Act, which allows assisted suicide under certain conditions. However, that debate gave birth to the related controversy about the management of pain.

When to Avoid Antidepressants in Bipolar Patients

April 08, 2009

Patients with bipolar depression who exhibit even minimal manic symptoms are at heightened risk for switching into mania if they receive antidepressant medication, according to a new report from the Bipolar Collaborative Network.

Forest Under Fire

April 08, 2009

Allegations of suppressed research, promotion of drugs for unapproved uses, payment of kickbacks to physicians, and ghostwriting of a major journal article surfaced recently when the Department of Justice unsealed a civil complaint against Forest Laboratories and Forest Pharmaceuticals, Inc.