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When a patient dies and my pager goes off, and a nurse brings in a family member who needs to talk, and my pager cries again, my heart rate jumping to 120, my skin twitching like a racehorse, I hide in a fifth floor bathroom no larger than a closet with an old toilet, rust stained sink, and a mirror the size of my face. I look myself in the eye, to be sure my pupils are equal and react to light, measure my pulse until the beats begin to slow, run cold water on my wrists, stuff paper towels under my arms to absorb the sweat, and make cool compresses to hold on my forehead like a wounded soldier. And I turn off the pager and think about my colleagues, who stand here as alone as me believing no one else knows where they hide.

Many options exist for the pharmacological treatment of anxiety disorders. Are some more appropriate under certain conditions or for some patients? Mechanisms and efficacy of medicinal treatments, as well as some common herbal remedies, are reviewed.

Anxiety disorders are highly prevalent and potentially debilitating psychiatric conditions. Is heredity linked to anxiety disorders? The importance of early identification and management of children at risk for anxiety disorders is emphasized.

Women are more vulnerable to anxiety and depression, which are linked with the development and progression of heart disease. What has been discovered about the specific psychological outcomes for women with heart disease?

Compared with Caucasians, African Americans receive an excess of schizophrenia-spectrum diagnoses. Potential explanations for the ethnic differences in clinical assignment of psychiatric diagnoses are reviewed.

Social anxiety disorder, the third most common mental disorder, is often underdiagnosed and undertreated. A leading expert on SAD provides an overview, including highlights of the barriers to diagnosis, a differential diagnostic approach and treatment options for social anxiety disorder.

A recently published meta-analysis questions if efficacy data garnered from clinical trials is relevant to everyday clinical practice. The authors ponder if enough patients are being included, if they are being followed long enough afterward, and whether exclusion criteria are too broad?

While there is still time before memory begins its long revision, I want to preserve the way you looked the night of my fiftieth birthday when the band played Not Fade Away. You stood with your hand held tight on the center pole of the tent and leaned toward me on stage, your body dying and rocking to the music, your round face creased in that generous smile I always loved, lips curled high at the corners, eyes narrowed to sharpen he focus of your joy.

As the field of addiction psychiatry continues to evolve, researchers and clinicians are looking at old problems with new vision.

Will insurance coverage for mental health care ever equal that of physical health care? Until the federal government takes a stand, many states are implementing new laws or revising old ones to help level the grounds. However, with the states' options ranging from full parity to mandated offering and the option to base coverage on type of mental illness, equal mental health care coverage is still left on shaky grounds.

Psychiatrists are being marginalized in this current era of managed care and treatment teams. What can be done to secure the psychiatrist's role in the diagnosis and treatment of patients?

While progress in identifying the specific genetic variations that help determine an individual's vulnerability to addiction has been slow, a great deal has been uncovered about delineating the role that numerous genes and their protein products play in mediating the development of addiction.

Contingency management provides tangible reinforcement to modify patients' behaviors and has been found to reduce substance abuse across a number of clinical populations and settings. What types of tangible reinforcements are most effective?

Although there are numerous media accounts of the detrimental effects of the drug Ecstasy, there may also be some clinical uses in the treatment of PTSD. The U.S. Food and Drug Administration has approved the first-ever clinical trial of MDMA since it was banned in 1988. An expert in the field discusses what psychiatrists need to know about the popular "rave" drug and the compound's use as a therapeutic tool.

Psychodynamic concepts such as the Self and the collective unconscious are helpful in understanding "our millennial event"3/4Sept. 11, 2001. Because it aims to help patients become aware of and free themselves from social contexts, psychotherapy may be more useful than ever.

Treating traumatized patients requires special care so that both therapist and patient can benefit from the relationship. How can therapists facilitate this care, and what can they do to keep themselves healthy while treating such patients?

Neurofeedback, a way for patients to learn to create and maintain desirable brainwaves, may be an affective adjunct therapy for many psychiatric disorders. Which procedures are most effective, and what are the benefits and risks?

Contingency management rewards good behaviors, thereby modifying behaviors of substance abusers in a positive and supportive manner.

Neurofeedback, also called electroencephalogram (EEG) biofeedback or neurotherapy, is an adjunctive treatment used for psychiatric conditions such as attention-deficit/hyperactivity disorder, generalized anxiety disorder, posttraumatic stress disorder, phobic disorder, obsessive-compulsive disorder, bipolar disorder, depression and affective disorders, autism, and addictive disorders (Moore, 2000; Rosenfeld, 2000; Trudeau, 2000).

The question of whether a clinically significant marijuana (cannabis) withdrawal syndrome exists remains controversial. In spite of the mounting clinical and preclinical evidence suggesting that such a syndrome exists, the DSM-IV does not include marijuana withdrawal as a diagnostic category.

On Feb. 12, New Mexico's Senate passed House Bill 170, "Prescriptive Authority to Psychologists," with a 29-9 vote, and Governor Gary Johnson (R), will soon decide the bill's fate. According to Gov. Johnson's office <www.governor.state.nm.us>, the estimated date for the final decision is March 6.

Two new reports, released by the Institute of Medicine and the World Health Organization, examine the issue of mental health care in Third World countries. In those areas that have limited medical resources, how can mentally ill patients best be served?

I've known him since my first days as a doctor,and now he wants to quit.

Whether for free or for a fee, many states are now offering public Internet access to information regarding physicians. Much of this information is benign -- specialty certification, years of practice, medical school and so on. However, some Web sites are including more controversial information such as malpractice suits and settlements. Is this going too far?

The following are case studies discussing the impact of proper evaluation of comorbid psychiatric illness and medical disorders. To read more case studies and find out how to effectively recognize and treat patients with these disorders, please see the January 2002 issue of Psychiatric Times.

New Law Allows Consideration of Mental History for Involuntary Hospital Admission

E. Fuller Torrey, M.D., explores the battle for control of the state asylums in the late 1800s. Using everything from rational arguments to blatant defamation of character, William Hammond's neurologists and John Gray's psychiatrists duked it out in New York as other states watched carefully in pursuit of what might follow.

Although incomplete, the link between thyroid function, bipolar affective disorder, and lithium has been acknowledged for many years. This article provides an overview of the relationship and recent literature.

Diabetes doubles the likelihood of comorbid depression, which impairs functioning and quality of life. This mood disorder has a unique importance in diabetes because of its associations with treatment noncompliance, insulin resistance, hyperglycemia and an increased risk for diabetes complications.

Asthma is a serious health condition that can be exacerbated by emotional triggers. Furthermore, depression in these patients can affect treatment compliance, thus worsening prognosis. What role does psychiatry play in treating these patients?