More than any other branch of medicine, the profession of psychiatry is unable to coexist with business because the suffering of mentally ill persons is deeper and darker and more pervasive and powerful than any other form of human anguish, whether biological or social.
Psychiatric emergencies usually involve some combination of agitation, aggression, impulsivity, psychosis, and risk of destructive behavior, including suicide and homicide. The psychiatrist must ensure the safety of the patient and others while identi- fying and treating immediate medical and psychiatric problems and developing and initiating a strategy for continuing the management of less immediate problems. In the diagnosis of acute behavioral disturbances, it is necessary to determine the role of the patient's primary psychiatric illnesses and any complications or treatments of those primary psychiatric illnesses, as well as the role of other medical or toxic disturbances that may be interacting with the patient's psychiatric illnesses or treatments.
Improving Medication Adherence: How to Talk with Patients About Their Medications, by Shawn Christopher Shea, is a slim and excellent primer on the verbal strategies and interviewing tips that clinicians can use to improve medication adherence.
Figures from the US Department of Justice indicate that more than half of prison and jail inmates have a mental health problem. Mental health courts (MHCs) were designed to divert mentally ill persons convicted of nonviolent crimes to supervised treatment instead of incarceration, but while the number of MHCs has grown substantially over the past decade, limited information has been available about outcomes and costs.
The results of two recent studies suggest that antidepressant medication may have an expanded role in the management of stroke patients. Prophylactic use of antidepressants following stroke appeared in a meta-analysis to be effective in fending off depression, and a short course of antidepressants in a placebo-controlled study was associated with long-term restoration of executive function, independent of depressive symptoms.
Numerous studies have documented the increasing prevalence of mental health and substance abuse issues in youths nationwide. As many as 1 in 5 children and adolescents in the United States have a behavioral or emotional disorder.
This article examines the risks involved in prescribing psychotropic medication and offers suggestions for managing those risks to ensure the best possibility for a favorable outcome.
Psychiatrists who work in inpatient units are faced with daily decisions about predicting which patients will be violent, both in the hospital and after discharge. These decisions are often made using unstructured clinical judgment based on the clinician's experience and knowledge of the literature. How long such judgment stays the standard of care remains to be seen, because psychiatric researchers have produced a number of assessment and management tools to improve the accuracy and use of violence risk assessment. This article briefly outlines 3 tools: the Brøset Violence Checklist (BVC), the Classification of Violence Risk (COVR), and the Historical Clinical Risk-20 (HCR-20).
While many of the claims at improving cognition are dubious (eg, the "Mozart effect"), there is now ample reason to suspect that parental involvement in children's brain development occurs much earlier than the first 3 years. Data now suggests that maternal cues are critical to proper brain development long before birth.
The role of no-suicide contracts is but a small tactical piece of the larger strategic approach to the assessment and prevention of suicide. Its many obvious limitations-to some degree in assessment, but primarily in suicide prevention-should have driven serious discussion of no-suicide contracts out of consideration as a practical measure in clinical practice and a legal talking point in the courtroom.
A recently published study examined the impact of publicity regarding the pediatric suicidality data on the prescribing practices of physicians in the United States. The researchers focused on the period from June 2000 to March 2005.
This article briefly reviews the federal standards regarding S/R and methods of reducing the risk associated with their use. CMS standards that went into effect February 6, 2007, will be emphasized; however, some of these standards vary from JCAHO standards.
The goal of this article is to further assist psychiatrists in tackling some of the more difficult financial issues in hopes of managing and reducing risk.
One of the most common symptoms of autonomic neuropathy is orthostatic hypotension (OH). It is treatable; however, the only FDA-approved therapeutic agent for OH, midodrine, causes supine hypertension. This hypertension occurs to a greater degree and for a longer period than bouts of OH, explained Philip A. Low, MBBS, MD, during a plenary session at the 59th Annual Meeting of the American Academy of Neurology (AAN), held in Boston, April 28 to May 5.
The temporary withdrawal of natalizumab (Tysabri) from the market in February 2005 in response to 3 cases of progressive multifocal leukoencephalopathy (PML) among clinical trial participants was a wake-up call for the neurology community about the risks of therapies for multiple sclerosis (MS). Although natalizumab returned to the market under a restricted distribution program in June 2006, the impact of the withdrawal remains evident in the more guarded optimism now being expressed by clinicians and researchers about the agent and about other immunosuppressive therapies for relapsing- remitting MS (RRMS) in the absence of longterm safety data.
Multiple sclerosis (MS) is the most commoninflammatory demyelinating disease of theCNS and the most frequent cause of nontraumaticneurological disability in young andmiddle-aged adults.1 Women are twice as likelyto be affected as men, and onset typicallyoccurs between the ages of 20 and 40 years.
Although the strongest risk factor for multiple sclerosis (MS) is a family history, which is not modifiable, there is compelling evidence that environmental factors also are at play in MS development. Addressing these risks may potentially result in reduction of disease incidence, reported Alberto Ascherio, MD, DrPH, associate professor of nutrition and epidemiology and director of the Neuroepidemiology Group at Harvard University in Boston.
A 32-year-old left-handed woman presented with a 4-week history of progressive left hand numbness, tingling, and clumsiness. Symptoms worsened until she found it difficult to write and perform fine motor tasks. She reported having no transient neurological symptoms in the past. Her medical history was significant only for Dengue fever acquired several years ago while on a visit to Southeast Asia. She was taking no medications, and a review of systems was noncontributory.
In 2005, the aim of the National Multiple Sclerosis (MS) Society Promise 2010 Initiative was to raise $30 million and distribute it to research teams. "Our goal has been to foster collaboration across various disciplines," said Patricia O'Looney, MD, director of biomedical research programs at the National MS Society.
Hypertonicity in plantar flexion is a frequent complication of traumatic brain injury (TBI), which affects more than 1.5 million persons in the United States.
Early treatment of clinically isolated syndrome (CIS) with subcutaneous interferon beta 1b (IFN-b-1b; Betaseron) may reduce disability at 3 years, according to the latest news from the Betaferon/Betaseron in Newly Emerging MS For Initial Treatment (BENEFIT) study. The data were presented by Mark Freedman, MD, director of the Multiple Sclerosis Research Unit at the University of Ottawa, in Ontario, at the recent Annual Meeting of the American Academy of Neurology (AAN), held April 28 to May 5 in Boston.
An imbalance in blood levels of oxytocin may be associated with certain forms of autism spectrum disorders (ASDs).
Poetry of the Times
Early intervention in psychiatric disorders such as schizophrenia can have a wide range of effects on patient symptoms and outcome. A recent study published in the Journal of Clinical Psychiatry reported improvements with antidepressants and atypicals in adolescents in the "prodromal" stage of schizophrenia, although a psychotic disorder later developed in a quarter of the adolescents treated with atypicals.
States will come under new pressure to provide mental health data to the FBI gun purchase check system if Congress passes a bill being touted as a response to the Virginia Tech catastrophe in which a student gunman with previous mental health problems shot and killed 32 people. The National Instant Criminal Background Check System (NICS) Improvement Act (HR 297) now seems destined to pass Congress this year. It would provide grants to states to help them provide a variety of data to the FBI’s NICS on whether a person has been convicted of a misdemeanor crime of domestic violence or has been the subject of court orders, mental health adjudications, or commitments.
Although there are many treatments and interventions available for drug abuse and dependence, few persons with substance use disorders actually use them, a new survey reports. The National Epidemiologic Survey on Alcohol and Related Conditions, conducted by scientists from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, was published in the May 2007 issue of the Archives of General Psychiatry. The survey used face-to-face interviews with over 43,000 US adults aged 18 years or older.
The FDA has ordered the addition of a "black box" warning to antidepressant labeling of increased suicide risk in adults aged 18 to 24 years. The labeling will also note that no increased risk has been seen in older adults and that, in fact, the incidence of suicidal thoughts and behavior has been found to decrease during antidepressant therapy in patients 65 years and older.
In 1980 DSM-III created a new diagnostic entity-posttraumatic stress disorder (PTSD). Although this condition had been described for centuries, it was always within the context of a particular stressor, most often war. The term shell shock was applied to World War I soldiers who seemed to have been struck senseless in the heat of battle. The horrors of World War II produced not only robust psychiatric morbidity in its combatants but also devastating emotional symptoms in the civilian victims of concentration camps and atomic bombs.
I grew up with a neighborhood kid who was a nice guy but burst into tears at even the tiniest of scrapes--heck, even if he fell down--so we always called him a crybaby. He seemed to be very tuned to his sensory environment--in our gang's perspective, overly tuned--hence the epithet for his behavior. The many unjust cruelties of childhood notwithstanding, was that really a fair accusation? There is growing evidence that may supply a solid molecular answer to this question. It may reveal the accusation to be not only emotionally unkind but also biologically unsound.
There are important distortions in the article "Substance Abuse in Women: Does Gender Matter?" (Psychiatric Times, January 2007, page 48). My concerns regard the political assumptions made (rather than those based on science) that put a spin on data rather than letting the data stand alone.