Psychiatric Times Vol 26 No 9

Diagnosis and Treatment of Restless Legs Syndrome in Psychiatric Practice

September 08, 2009

Restless legs syndrome (RLS) is a neurosensory disorder first described by Sir Thomas Willis in 1672. As early as the 19th century, Theodor Wittmaack observed the comorbidity of RLS with depression and anxiety. He termed this condition “anxietas tibiarum” and believed it to be a form of hysteria.

Primary Care Bonus Could Give Psychiatrists Boost

September 07, 2009

The congressional drive to reform health care could result in a 5% Medicare bonus for psychiatrists because of a provision in a prospective bill that would also have an impact on private insurance payment. As the House and Senate struggle to turn concepts into legislative language, one thing Democrats and Republicans agree on is that primary care physicians should be better compensated, probably with money taken out of the pockets of some specialties.

Deconstructing the “Med Check”

September 03, 2009

A graduating resident recently told me that a psychiatric group attempting to recruit him informed him that he would have 10 minutes for medication appointments and 30 minutes for new patient evaluations. He was horrified. (So was I.)

The Teenaged Brain: Part 2

September 03, 2009

In our last installment, we discussed a familiar finding from the National Comorbidity Survey Replication (NCS-R): the peak age of onset for any mental health disorder is about 14 years. In an attempt to explain these data, we are exploring some of the known developmental changes in the teenaged brain at the level of gene, cell, and behavior.

Risk Management for the Supervising Psychiatrist

September 03, 2009

The need for expert supervision of residents and other health professionals by psychiatrists is growing as a result of the increased demand for accountability by third parties and the expanded number of clinical specialists seeking supervision in psychiatry. The Accreditation Council for Graduate Medical Education has placed professional competency of graduating residents in the national spotlight, and insurers are increasingly scrutinizing patient care provided by trainees and oversight provided by their supervisors.

Poetry of the Times Is 10!

September 01, 2009

My life as a poet changed dramatically in 1999 when Psychiatric Times founder John L. Schwartz, MD, and editor Christine Potvin decided to include my poems as a monthly column in Psychiatric Times. With the creation of “Poetry of the Times,” I experienced a tremendous jolt of artistic energy, a sense of affirmation, and a huge boost in confidence. Writing the column continues to propel my poetry 10 years later.

Psychiatrist on the Road: Encounters in Healing and Healthcare

September 01, 2009

After 18 years as a senior clinical psychiatrist at a New England inner-city mental health clinic, Dr Lawrence Climo was understandably surprised and saddened when he was given 2 weeks’ notice that his services were no longer needed. Financial constraints meant the clinic was replacing him with a nurse. Although his wife told him it was an opportunity, he remembers thinking that health care reform made him feel that his professional skills were “almost irrelevant or at least unmarketable.”

Psychocutaneous Disorders

August 30, 2009

Psychological problems are often manifest in the skin. In fact, it is estimated that between 20% and 30% of all skin disorders have some psychological component. Many patients who have psychocutaneous disorders-which are often direct evidence of or secondary to psychological abberations-drift from one physician to another, trying to find one savvy enough to cure their “skin condition.” Furthermore, although they have sought many medical opinions already, patients afflicted with psychocutaneous disorders almost always present as “an emergency.” While pharmacological intervention may benefit such patients, traditional mental health interventions are almost always required if the aberrant behavior is to cease.

Measurement-Based Care for the Treatment of Depression

August 30, 2009

As clinicians, we routinely make critical decisions for our patients with depression. Because of the uncertainty of factors that affect diagnosis and treatment, clinicians may find an objective, quick measurement tool helpful. Measurement-based care (MBC) provides specific and objective information on which to base clinical decisions and should therefore enhance quality of care and treatment outcomes.1-3

The Neurobiological Development of Addiction

August 28, 2009

Self-administration of drugs of abuse often causes changes in the brain that potentiate the development or intensification of addiction. However, an addictive disorder does not develop in every person who uses alcohol or abuses an illicit drug. Whether exposure to a substance of abuse leads to addiction depends on the antecedent properties of the brain.

Successful Treatment of Physicians With Addictions

August 28, 2009

Physicians generally display better health and have lower rates of all-cause mortality than the general population. However, their education, nutrition, and lifestyle do not offer similar protection from substance abuse and dependence.

Farewell-and Welcome

August 27, 2009

The editorial board and staff of Psychiatric Times wish to announce, with much regret, the retirement of Max Fink, MD, from our journal’s editorial board. Dr Fink-who is emeritus professor of psychiatry and neurology at the State University of New York at Stony Brook-has been a valued member of our board since 2002, and a regular contributor to the journal for many years before that.

Pathological Gambling: Update on Assessment and Treatment

August 27, 2009

Surveys show that approximately 60% of the general population has gambled within the past 12 months.1 The majority of people who gamble do so socially and do not incur lasting adverse consequences or harm. Beyond this, approximately 1% to 2% of the population currently meets criteria for pathological gambling.2 This prevalence is similar to that of schizophrenia and bipolar disorder, yet pathological gambling often goes unrecognized by most health care providers.

From Our Readers

August 25, 2009

I found the American Psychiatric Association’s response (“Setting the Record Straight”) to the commentary by Allen Frances, MD, (“A Warning Sign on the Road to DSM-V”) outlining concerns about the DSM-V to be an embarrassing black mark against the association.* As president of an organization supposedly devoted to scientific objectivity, Dr Alan Schatzberg’s (lead author of the response) ad hominem attack and use of unprovable innuendos to discredit Dr Frances reflects an approach I want nothing to do with.

“Abortion Trauma Syndrome”

August 25, 2009

Abortion trauma syndrome is a fabricated mental disorder conceived by anti-abortion activists to advance their cause and is not a scientifically based psychiatric disorder. So said 2 psychiatrists at the American Psychiatric Association’s recent annual meeting in San Francisco.