Psychiatric Times Vol 26 No 5

Psychiatrists failed to get privacy protection for an expanded version of their psychotherapy notes in the stimulus bill Congress passed last February. But the American Recovery and Reinvestment Act (ARRA) did authorize a study on the issue and made other pro-privacy improvements to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Social anxiety disorder (SAD), also referred to as social phobia, is a chronic and potentially disabling anxiety disorder characterized by the intense and persistent fear of being scrutinized or negatively evaluated by others. At its core, people with this disorder fear and/or avoid the scrutiny of others. Symptoms may occur only in circumscribed situations, such as a fear of speaking in formal or informal situations, or eating or drinking in front of others.

For many antidepressants, the issue of brand-name versus generic has no practical significance. Elavil was first marketed almost a half century ago, and its patent has long expired. It lives on, however, but as generic amitriptyline. Today, only a few antidepressants are still fully protected by patents, namely, Cymbalta (2010), Lexapro (2012), and Pristiq (2022) for major depressive disorder (MDD); and Seroquel (2011) and Symbyax (2017) for bipolar depression.

Several classes of hypnotic medication are available: the older barbiturates and their derivatives; benzodiazepines; chemically distinct “z-compounds”; antihistamines and antihistaminic antidepressants; and melatoninergic compounds. The use of hypnotic medications continues at a high rate. However, some switching to the shorter-acting benzodiazepines has occurred. The z-compounds-eszopiclone, zolpidem, and zaleplon-have become popular; they seem to have fewer residual effects than the benzodiazepines. Even so, care is needed in prescribing such hypnotics for the elderly.

This Special Report presents an important set of articles that considers controversial issues relevant to the practice of psychiatry. These articles demonstrate that what we do as practitio­ners is often based on incomplete evidence and/or reliance on experience and the art of psychopharmacology. There are considerable limitations to “evidence-based medicine” as applied to the issues considered and also to what can be said officially about “off-label” uses of medications. All that said, these articles represent a very interesting set of perspectives on important and, to date, unresolved problems for which our science falls quite short of giving us definitive answers.

Child murder by parents is an upsetting topic for both the public and clinicians. It is even more distressing when a mother kills her child than when a father does because we expect mothers to love and protect their children at all costs.

Lecturing around the country has left us with the powerful impression that both psychiatrists and primary care physicians are hungry for new ways to think about and manage depression and the myriad symptoms and syndromes with which it is associated-including attention deficit disorder, insomnia, chronic pain conditions, substance abuse, and various states of disabling anxiety.

For Allen, that film was the measure of Bergman’s genius, and it reached aesthetic heights that he conceded his own films would never attain. Bergman, like his Knight, Allen observed, could not put off the ultimate checkmate nor would his great art secure for him a personal afterlife as intellectuals wanted to believe. Allen was sure that Bergman would barter each great film he had made for another year of life so he could go on making films.

In Comfortably Numb, author Charles Barber reports that in 2002, 16% of the inhabitants of Winterset- a quintessentially American town in Iowa-had an antidepressant prescribed for them and asks, “Why did Winterset want to get numb?” With this question, Barber begins a journey through the world of psychiatry and psychopharmacology that spans most of the book.

Anew study shows that the rate of remission in adolescents treated for depression for 36 weeks was more than double that of adolescents treated for 12 weeks, whether treatment was with an antidepressant, cognitive-behavioral therapy, or a com­bination of both.1

In a highly charged environment in which reports of potential conflicts of interest between physicians and pharmaceutical companies dominate the headlines almost daily, we want to point out that the supplements that were mailed with this month’s issue of Psychiatric Times were based on meetings funded by drug companies. The supplement on treatment-resistant depression, which was sponsored by Lilly USA,includes an article that focuses on the company’s drug Symbyax.

The financial tsunami that has hit the United States and most of the rest of the globe is causing unparalleled misery for hundreds of millions. In America, millions of jobs have been lost, and it appears that millions more will be lost. In a nation where home ownership is a cherished expectation and goal, millions are losing their homes. The GNP is shrinking, the value of nearly all investments has plummeted, and the retirement plans of millions have been decimated.

President Obama’s 2 nominees for the top positions at the FDA have 3 psychiatrists as parents between them. Both Margaret Hamburg, nominated as commissioner of the FDA, and Joshua Sharfstein, nominated as deputy commissioner, are medical doctors and have held top public health positions: Hamburg in New York and Sharfstein in Baltimore. Both of Hamburg’s parents are psychiatrists, according to Neal L. Cohen, MD, director of the Center for Public Mental Health at Hunter College in New York, who knows Hamburg from her days in the early 1990s when she served for 6 years as commissioner of health for the City of New York.

Thanks to the recently passed stimulus package, as much as $44,000 over 5 years will be available to those physicians who become “meaningful users” of electronic health records (EHRs). Physicians who meet the adoption standards in the bill, which have to be ironed out by the Department of Health and Human Services, will qualify for the payments from Medicare. However, physicians who balk run the risk of being docked a tiny portion of Medicare payments starting in 2015.

His hand is a farmer’s hand, nails outlined with crescents of black earth, skin calloused, tough as a paw.

The FDA recently released its long-awaited but highly controversial final guidance permitting drug and device manufacturers to distribute medical journal articles and medical or scientific texts that discuss off-label uses of approved products.

Lecturing around the country has left us with the powerful impression that both psychiatrists and primary care physicians are hungry for new ways to think about and treat depression and the myriad symptoms and syndromes with which it is associated-including attention deficit disorder, insomnia, chronic pain conditions, substance abuse, and various states of disabling anxiety. Primary care physicians also seem especially excited to learn that depression is not just a psychiatric illness but a behavioral manifestation of underlying pathophysiological processes that promote most of the other conditions they struggle to treat-including cardiovascular disease, diabetes, cancer, and dementia.1,2