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The program, Strong STARTS (Schools Taking Action to Reach Troubled Students), is a model initiative targeting the growing number of adolescents suffering from untreated emotional disorders that impact academic performance, social achievement and positive lifestyle choices. The program's fall kickoff seminar began with a keynote address by Alvin Poussaint, M.D., clinical professor and faculty associate dean for student affairs at Harvard Medical School, and featured focus sessions and panel discussions by national and local experts.

There is a substantial constituency for alternative medicine. Worldwide, 70% to 90% of all health care "ranges from self-care according to folk principles, to care given in an organized health care system based on an alternative tradition or practice." As many as one-third of all Americans are reported to have some belief in alternative medicine or to be actively using nonmainstream remedies.

All families have such belief systems, which include expectations, values, attitudes-the basic assumptions-that govern family interactions. Because they determine the structure and organization of a family, the traditions they follow, the rules they abide by, and the values they hold, these beliefs shape the kinds of problems a family has and how they go about trying to solve them.

My Bosnian psychiatric colleagues reported to me that there was the usual adolescent stew of identity crisis among them: delinquency, drugs and sex; but also much, much more. I asked the students, "What do you suffer from?" Lack of opportunity was mentioned most often. A few said that they wanted someone to talk with when it all got to be too much. They welcomed the new school-based initiative of the adolescent mental health clinic in Sarajevo.

Although adoption dates back centuries, the issue of whether or not adopted children are at risk for psychological maladjustment remains controversial. That this dispute would occur at all is not surprising, since as recently as 1926 laws which liberalized adoptions in England were faced with a widespread objection that adoption would encourage depraved conduct.

Today, average young adults report sleeping about seven to seven and one-half hours each night. Compare this to sleep patterns in 1910, before the electric lightbulb, the average person slept nine hours each night. This means that today's population sleeps one to two hours less than people did early in the century.

Previous research on the effects of early child care had led to controversy and confusion. The most provocative finding was that when infants were in nonmaternal child care 20 or more hours a week, starting in the first year of life, they were less likely than infants without such experience to form a secure emotional attachment to their mothers.

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There is and has been much debate about the issue of assisted suicide as physicians, lawyers and lay people argue the pros and cons of assisting in someone's death. The physician who agrees to participate in this endeavor points out that his or her concern is to alleviate suffering. Notwithstanding that, painkillers are notoriously prescribed in inadequate, understrength doses; people with serious illness who are depressed are considered unlikely candidates for treatment of their depression because, sayeth the physician: "It is only natural, understandable, to be depressed with that kind of terrible illness."

On the surface, mental health parity does not appear to be controversial. Why should insurance companies and government insurance discriminate against patients with psychiatric problems? Making an artificial separation between psychiatric and medical illness makes little clinical sense. It is also clear that the treatment of psychiatric disorders often decreases physical symptoms, resulting in fewer visits to nonpsychiatric physicians. Cost estimates for mandating parity, although widely divergent, have generally been thought to be low. However, many seemingly benign regulations can often result in unforeseen costs and negative effects.

For elders confronted with the necessity of living in a nursing home, the choice of facility is a decision with profound consequences-for their health, their quality of life and their family finances. Nursing home care may cost $50,000 a year or even more, and more than half of all elders begin their nursing home stays by paying the costs out of pocket. That imposing sum can purchase excellent care, or can pay the rent for a place that is literally "worse than death" for the unfortunates who live there.

A lawsuit brought on behalf of the 600,000-member United Seniors Association (USA) and four individual Medicare recipients last December may turn the Washington, D.C., federal court where it was filed into the latest health care battleground. The issue: Does a patient's right to choose a physician outweigh the federal government's efforts to regulate health care provided to the elderly?

The ERISA shield has become a favorite of employers and benefits providers, because its overwhelming effect is to reduce the situations in which they can be held legally responsible for misdeeds. Even in cases where a violation can be established, the statutory penalties are insufficient to make bringing cases to court worthwhile, or are inadequate to deter future improper conduct. Efforts over the years to enact an amendment to ERISA have failed because of powerful lobbying by business and health care interests. re reluctant to utilize, inform or confront their care providers, impairing collaboration in treatment.

This year at the 10th Annual U.S. Psychiatric & Mental Congress, CME LLC honored deserving recipients with the prestigious "Lifetime Achievement Award." The award winners for 1997 were recognized during a presentation ceremony in Orlando, Fla., in November.

Every evening, just when quiet comes, she awakens on the prowl.

It is estimated that 60% to 70% of American people who have health insurance have a plan which falls under the provisions of the Employee Retirement Insurance Security Act of 1974 (ERISA). ERISA was designed to protect and enhance pensions and benefits for employees of nationwide companies, and was heavily lobbied for by business as more and more employers established facilities in multiple states.

Depression, subcortical dementia and normal aging: all three may have similar neurobehavioral manifestations. So how does a clinician make a differential diagnosis?

Recent headlines in national newspapers declaring that mentally ill patients are often denied care by psychiatric hospitals merely confirmed what most psychiatrists have known for years. A study published last December, however, created a stir when the authors released what they called "the first national analysis of the factors that promote or constrain economically motivated transfers of patients in relation to competitive pressures, hospital ownership, and managed care practices."

Death Sentence, Ethics, Psychiatry, Competency, Execution, Prisoner, Psychiatrists

Approval of the nation's first physician-assisted suicide law last November has proved the adage "be careful what you wish for." In the aftermath of the Oregon initiative that once again endorsed the state's Death with Dignity Act, physicians and government officials throughout the country are now scrambling to make sense of the law and figure out ways to assure that compliance doesn't lead to liability, both criminal and civil.

January Thaw - Poetry of the Times

In its 1986 decision in Ford v. Wainwright, the U.S. Supreme Court found that death row prisoners had a constitutional right not to be executed if they were incompetent (477 U.S. 399 [1986]). Competence for execution-an odd concept, but one whose roots go back to biblical times-usually requires that a prisoner understand the nature of the punishment about to be imposed and why it is being imposed.

In its 1986 decision in Ford v. Wainwright, the U.S. Supreme Court found that death row prisoners had a constitutional right not to be executed if they were incompetent (477 U.S. 399 [1986]). Competence for execution-an odd concept, but one whose roots go back to biblical times-usually requires that a prisoner understand the nature of the punishment about to be imposed and why it is being imposed.

For 17 years, claim federal prosecutors, Theodore Kaczynski terrorized the nation with a string of 16 bombings that killed three people and injured 23 more. On trial now for his life, the alleged Unabomber's case will most likely hinge on the expert testimony proffered by a covey of psychiatrists and psychologists scheduled to be called as witnesses as the case unfolds in U.S. District Court in Sacramento, Calif. this month.

The Association of Gay and Lesbian Psychiatrists (AGLP) is a professional organization of psychiatrists, residents, medical students and supporters, which serves as a voice for the concerns of lesbians and gay men in the professional psychiatric community. AGLP is committed to fostering a more accurate understanding of homosexuality, ensuring well-informed and appropriate treatment for lesbians and gay men, and opposing discriminatory practices against gays and lesbians in our society.

"Hwa-byung" and "ataque de nervios," listed in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) as culture-bound syndromes, can serve as gateways to understanding anger's role in psychiatric morbidity, according to a panel of experts.

In 1997, the National Library of Medicine (NLM) helped initiate a new era in American medicine when it made MEDLINE, its comprehensive online bibliography of published medical information, accessible to the public through the World Wide Web. That event may prove to be a symbolic watershed of 20th century American medicine. It will impact every aspect of medicine, from the manner in which physicians are educated to the way they run their daily practices.

Scientific, social or legal redefinition is only slowly reflected in changed practitioners and practices. It is not surprising that surveys continue to report high levels of ignorance and prejudice encountered by homosexuals in their contacts with health care providers. This also contributes to a negative feedback loop in which many homosexuals are reluctant to utilize, inform or confront their care providers, impairing collaboration in treatment.

Many of the factors purported to influence accessing mental health services by men and ethnic minorities are systemic in nature, ingrained within our culture, and consequently, difficult to change (e.g., gender differences in attitudes toward help-seeking, ethnic differences in the use of alternative healing resources). However efforts have been made within the mental health system to make services more acceptable to men and minority group members who choose to, or are able to, access the system.

What counts as participation in capital punishment? Is it possible for a medical activity to be ethical in one context, but a similar one not ethical in another? Is death different? Are there neat and universal ethical rules that will always guide us wisely, or are there inevitable clashes among various legitimate and important values? Is it ethically possible that a forensic psychiatrist is not a psychiatrist, as Dr. Paul Appelbaum has argued? How strongly should physicians protect their duty to always help and not harm all individual patients in the face of many pressures to do otherwise?