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This commentary suggests how the research community can be instrumental in improving DSM-V and helping it avoid unintended consequences. According to several converging, anonymous (but I think quite reliable) sources to which I have had access, the draft options for DSM-V will finally be posted between mid-January and mid-February 2010. There will then be just 1 month (until mid-March) for collecting comments. The good news is that the products of a previously closed process will finally be available for wide review and correction. The bad news is that there will be only a brief period allotted for this absolutely crucial input from the field.

On October 19, 2009, the Office of the Deputy US Attorney General issued a memorandum, “Investigations and Prosecutions in States Authorizing the Medical Use of Marijuana.”1 The memo announced a federal policy to abstain from investigating or prosecuting “individuals whose actions are in clear and unambiguous compliance with existing state laws providing for the medical use of marijuana.” The memo made clear, however, that it did not “legalize marijuana or provide a legal defense to a violation of federal law.” Rather, it was “intended solely as a guide to the exercise of investigative and prosecutorial discretion.”

I don’t know how many psychiatrists paid much attention to the climate-change conference in Copenhagen last month, but I came away convinced they need our help. Here’s why.

The most rigorous scientific review of “medical marijuana” to date was carried out by the Institute of Medicine in 1999, under the direction of Drs John A. Benson Jr and Stanley J. Watson Jr.1 The institute’s conclusions were considerably more nuanced and qualified than those of the US Drug Enforcement Administration.2 The institute report found that:

The empirical basis for the effectiveness of 12-step recovery and the psychotherapeutic benefits of opioid agonist maintenance were among the topics of several symposia with introspective views of time-tested treatments at the 40th Annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM) in New Orleans.

A study of the adverse effects of 4 second-generation antipsychotics in children and adolescents documented substantial weight gain during 11 weeks of treatment with each agent, with the increased abdominal fat that has been associated with development of metabolic syndrome in adults. Metabolic abnormalities emerged with 3 of the 4 agents, differing in type and severity with the agent and, in some cases, with the dose.

For both depression and anxiety disorders in youths, there is increasing evidence of clinical benefit from cognitive-behavioral therapy (CBT).

The CASE Approach is built to uncover pieces of a puzzle that enhance the likelihood of an accurate clinical formulation of risk.

Hired guns.” “Whores.” “Greedy, insensitive bastards.“ These are some of the more printable epithets used to describe psychiatric physicians who (allegedly) have “sold out to Big Pharma.”

Results of a large study funded by the National Institute of Mental Health showed that electroconvulsive therapy (ECT) might be equally effective in both patients with unipolar depression and those with bipolar depression. The study, led by Samuel H. Bailine, MD, assistant professor in the department of psychiatry and behavioral sciences at Zucker Hillside Hospital, Glen Oaks, NY, showed that the remission rate in both patient groups was higher than 60%.

Hy Bloom provided an expert psychiatric report in a multiple murder case in which the accused, who had schizophrenia and depression, had killed his wife and 2 children. Before the murders, the accused had been seeing a psychiatrist and family physician for treatment of the mental disorders.

The United States Census Bureau projects that by 2010 nearly 13% of the US population will be over the age of 65. The elderly are one of the most rapidly growing segments of the US population and are expected to account for more than 20% of the total population by 2050.1 In 2001, the prevalence of dementia in North America was 6.4%. A 49% increase in the number of people with dementia is expected by 2020, and a 172% increase by 2040.2 Patients with dementia may lack the capacity to consent to treatment. The need to evaluate capacity to consent to treatment will therefore increase as the aging population grows.

Standard of Care in Psychiatric Practice

It is my privilege and pleasure to highlight this Special Report on forensic psychiatry. (The first articles in this series appeared in the November issue and are posted on www.psychiatrictimes.com.) The respected authors provide us with the most recent thought on subjects that should be of interest to every practicing psychiatrist.

Simple but powerful suggestions to get a better night's sleep.

When I was young, I believed

The Medicare program appears to have reversed itself and now is seriously considering removing anti-depressants and antipsychotics from its “protected” status on Part D drug plan formularies.

Descartes’ Error1 can be read in 2 ways. To start, it works as an engagingly written, accurate piece of science journalism (which is something that we need more of; it’s hard to imagine running a democracy without it).

Borderline Intellectual Functioning is rarely included in clinical reports and case/treatment team reviews except indirectly when, as part of the mental status examination, mention is sometimes made that the patient’s intellect appears to fall below average limits.

It is widely accepted that patients with schizophrenia have some degree of cognitive deficiency and that cognitive deficits are an inherent part of the disorder. Historically, there has been less focus on cognitive deficits in patients with bipolar disorder; however, numerous studies of cognition in patients with bipolar disorder, including several comprehensive meta-analyses of bipolar patients who were euthymic at the time of testing, have recently been undertaken.1-4 Each of these analyses found that cognitive impairment persists during periods of remission, mainly in domains that include attention and processing speed, memory, and executive functioning.4

I think I am going to talk about the neurobiology of happiness in my next column. The reason has to do with the nature of our 2-month journey into the biology of eating disorders-a subject that, considering the dearth of explanatory data, is tough to write about. It’s also a bit depressing, considering how difficult it can be to treat. This is the second installment in a 2-part series that focuses on the neurobiology of restricting-type anorexia nervosa (AN).

Obesity has emerged as a significant threat to public health throughout the developed world. The World Health Organization defines overweight as a body mass index of 25.0 to 29.9 kg/m2 and obesity as a BMI of 30.0 kg/m2 or greater.1 Nearly two-thirds of Americans are overweight or obese according to these criteria.2 Numerous health problems, including diabetes, cardiovascular disease, arthritis, and cancer, are associated with obesity. In addition, overweight and obese persons are more likely than their normal-weight peers to have a variety of psychiatric disorders.

New compounds and novel applications for established products were evaluated in many of the clinical trials reported at the recent 49th annual NIMH-sponsored New Clinical Drugs Evaluation Unit meeting.

This commentary will suggest how the research community can be instrumental in improving DSM-V and helping it avoid unintended consequences. According to several converging, anonymous (but I think quite reliable) sources to which I have had access, the draft options for DSM-V will finally be posted between mid-January and mid-February of 2010.

At 47 she was happily married with an 11-year-old daughter and expressed much satisfaction with her work as a masters-level psychotherapist. Her adolescence and young adulthood, however, were different stories, filled with chaos. She described impulsive, promiscuous behaviors beginning at age 13. Heavy drug use began in her late teens, and her parents kicked her out of the house. She fended for herself as a waitress and had a series of relationships with abusive men. As age 30 approached, she began to get herself under control, stopped using drugs, and married a musician she described as “very straight.” With his encouragement, she attended a community college, majored in psychology, and ultimately obtained a masters degree in counseling. Currently she is employed at a public agency for abused women.

Practical approaches to integrating 3 aspects of a suicide assessment have been well delineated for adults and adolescents.

November/December 2009 Special Report: Forensic Psychiatry

Award ceremonies abound, from the Oscars for film to the Clio awards for advertising, but none are as important to mental health and psychiatry as the NARSAD annual awards. NARSAD is a unique organization that is dedicated to mental health research, and the NARSAD awards are considered to be the most prestigious prizes in psychiatric research. On October 30, NARSAD presented its 22nd annual awards for outstanding achievement in mental health research. This year the prizes went to 8 distinguished scientists whose work is making a huge impact on the way psychiatric disorders will be diagnosed and treated.

A number of scholars have criticized contemporary bioethics for its focus on what have been called the “neon issues”-end-of-life care, genetic technology, and resource allocation-rather than on the far less dramatic but much more common dilemmas of everyday practice, such as obtaining adequate informed consent for treatment, respecting confidentiality and privacy, and maintaining sound but reasonable boundaries in the therapeutic relationship.1-3 From the “searching and fearless” fourth step of Alcoholics Anonymous to the rigorous spiritual exercises of the Jesuits, many spiritual traditions have proposed a regular and deliberate period of introspection as an effective means of increasing the understanding of and responsiveness to ethical conscience and conduct.

Low levels of 3-methoxy-4-hydroxyphenylglycol (MHPG) in patients with major depressive disorder (MDD) or bipolar depression were shown to be associated with increased risk of suicide attempts. Hanga Galfalvy, PhD, assistant professor of clinical neurobiology at Columbia University and the New York State Psychiatric Institute, New York, and her colleagues found that patients with the lowest levels of MHPG at baseline were more likely to commit highly lethal suicidal acts.