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Then he fell silent and moments passed. I knew, of course, about his father’s recent death and their stormy relationship. I was moved by his sadness-could feel it within. I found myself thinking about my own father’s death. The silence between us continued, and finally I said, “It is so sad.” His crying intensified; he did not look at me. I felt a teary mist in my eyes and thought, “Now what?” Should I try to stay inside where he was and reflect again on his sadness, or should I back away by offering him a more cognitive level of dialogue? This question-whether to move in or out or, perhaps more accurately, to offer him the choice of where he feels most safe-is at the heart of some forms of psychotherapy. However, as we shall see, this is not the case in all forms.

“Is it wise to stay on my pill?I know the question may seem inane.”I’ll answer since you’ve paid your bill.

Make no mistake: Dr Torrey is on the side of the patient. He is enraged by the plight of the seriously mentally ill in the postinstitutional era, and he takes aim at a troika of villains-deinstitutionalization, the civil liberties bar, and the antipsychiatry movement. These 20th-century forces have conspired to relegate citizens with mental illness to a deplorable state of neglect that puts us all at risk. The Insanity Offense threads a needle of making us fear the violent mentally ill without stigmatizing them as a group.

We at Psychiatric Times wish to note, with great sadness, the passing of our colleague and editorial board member, Dr Gene Usdin, at the age of 87.

A collaborative effort of prominent medical leaders seeking to wean professional medical associations (PMAs) from pharmaceutical and device industry funding serves as a major step toward building best practice models for managing conflicts of interest (COI), said the president of the Institute on Medicine as a Profession (IMAP).

Depression is an insidious, ugly beast, creeping into the mind over time until one is engulfed and powerless, feeling only a sense of futility and heaviness. In my case it came some months after I had had to retire from a fruitful and enjoyable academic neurodevelopmental pediatrics practice, because of onset of a degenerative neuromuscular disease. My depression was manifested mainly by weight loss, poor affect, anger and irritability, fitful sleep, and thoughts of suicide. Luckily, my primary physician recognized the signs immediately and recommended both pharmacotherapy and psychotherapy. For both therapies and for this physician, I am extremely grateful. However, in this essay, I will speak of the ways I experienced psychodynamic psychotherapy and its ramifications into many parts of my life.

Anger is an emotion that is familiar to everyone. An episode of anger may dissipate quickly and harmlessly or evolve into a murderous rage. Between the benign and malignant end points in this spectrum, a seething, chronic anger may come to dominate a person’s thinking, feeling, and behavior.

Following the recommendations of a working group set up to examine the American Psychiatric Association’s (APA) relationship with the pharmaceutical industry, the Board of Trustees has voted to phase out industry-sponsored educational programs and industry-supplied meals at annual meetings and educational symposia.

Forest Laboratories recently set aside $170 million in anticipation of eventually settling a federal government complaint about the company’s marketing and promotional practices.

Mr A is a 73-year-old resident of a nursing home, where the irate aides describe him as “a liar and a troublemaker.” Mr A’s “stories” were regarded by the staff as deliberate mischief on his part.

The molecular events that accompany drug abuse and addiction are different for women than for men, according to new studies presented at the annual meeting of the American Psychiatric Association (APA). As yet, little if any of this knowledge has made its way into gender-based differences in pharmacological and behavioral treatments for addiction. But according to some of the speakers, it could and it should.

Kia Faridi MD, a psychiatrist at McGill University in Montreal, discusses the results of his study on the impact of marijuana use in patients with psychotic symptoms.

Christopher Janish, BA and Melanie Buskirk, BS, students at the Mayo Clinic in Rochester, Minn, discuss the results of their study on representations of homicide portrayed in dramatic television series compared with US homicide data from the CDC’s National Violent Death Reporting System.

Despite their severe physical impairment, disability, and frequent medical complications, tetraplegic patients reported a very positive outlook on life, according to a recent study. In another, 63% of major lottery winners chose to con­tinue working full-time at their same jobs.

As transgender activists protested outside the American Psychiatric Association meeting, speakers at the meeting were presenting on the same topic: gender identity disorder. Some of their words would add clinical weight to the political slogans.

For almost 10 years, studies have shown that advanced paternal age may be a risk factor for schizophrenia in offspring. However, the risk of schizophrenia may also be higher in male offspring of fathers who are younger than 25 years, according to the results of a study presented at the 2009 American Psychiatric Association annual meeting.

Cognition” has more than one meaning. Cognitive-behavioral therapy refers to therapies that work on changing automatic thoughts and resulting schemas.

Over spring break, my daughter Tess went to visit a friend in San Francisco. Because he was working and Tess was left to her own devices for some of the time, Alex put together some itineraries for her that included places to go, what to do when she got there, great places to eat, and recommendations on what to eat. To be included in Alex's list, the outings had to be easily accessible, fun, not touristy, and inexpensive.

Is it ethical for a psychiatrist to Google a patient? There are no established policies about this, and perhaps there should be, contends Damir Huremovic, MD, co-chair of a session on cyberspace at the American Psychiatric Association meeting.

Why do Drs Pies, Wakefield, and Horwitz feel that “blue” feelings after a major loss (such as death of a spouse) or, for that matter, any loss have to be either “grief” or “major depression”?

In “Major Depression After Recent Loss Is Major Depression-Until Proved Otherwise” (Psychiatric Times, December 2008, page 12), Dr Pies highlights one of the more provocative questions encountered when we train in clinical psychiatry: “Suppose your new patient Mr Jones, tells you he is feeling ‘really down.’ He meets all DSM–IV symptomatic and duration criteria for a major depressive episode (MDE) after having lost his wife to cancer 2 weeks ago. Should you diagnose MDD?”

The polemics between Drs Pies and Wakefield and Horwitz (“An Epidemic of Depression,” Psychiatric Times, November 2008, page 44) have validity, but their commentaries did not touch on the real bone of contention. Dr Pies does not believe that just because psychosocial precipitators of a depression-specifically, bereavement-are known, somehow the significance of the depression should be viewed differently.

“An Epidemic of Depression” by Wakefield and Horwitz (Psychiatric Times, November 2008, page 44) raised the issue that DSM does not take into account the context in which symptoms arise for the diagnosis of MDD. The authors opine that the diagnosis should require that symptoms be “excessive” or “unreasonable” relative to the context in which they arise, and that “the efficacy of these medications for the treatment of normal sadness is often overstated.”

To improve validity, we proposed extending the current MDD bereavement exclusion-which excludes “uncomplicated” (relatively brief, lacking certain severe symptoms) depressive bereavement from diagnosis-to also exclude uncomplicated reactions to other major stressors, such as romantic breakups, job loss, and serious medical diagnoses.

Social anxiety disorder (SAD), also referred to as social phobia, is a chronic and potentially disabling anxiety disorder characterized by the intense and persistent fear of being scrutinized or negatively evaluated by others. At its core, people with this disorder fear and/or avoid the scrutiny of others. Symptoms may occur only in circumscribed situations, such as a fear of speaking in formal or informal situations, or eating or drinking in front of others.

Acupuncture is associated with an increase in the level of neurobiologically active substances, such as endorphins and enkephalins. There are also data indicating that acupuncture induces the release of norepinephrine, serotonin, and dopamine.

For many antidepressants, the issue of brand-name versus generic has no practical significance. Elavil was first marketed almost a half century ago, and its patent has long expired. It lives on, however, but as generic amitriptyline. Today, only a few antidepressants are still fully protected by patents, namely, Cymbalta (2010), Lexapro (2012), and Pristiq (2022) for major depressive disorder (MDD); and Seroquel (2011) and Symbyax (2017) for bipolar depression.

Several classes of hypnotic medication are available: the older barbiturates and their derivatives; benzodiazepines; chemically distinct “z-compounds”; antihistamines and antihistaminic antidepressants; and melatoninergic compounds. The use of hypnotic medications continues at a high rate. However, some switching to the shorter-acting benzodiazepines has occurred. The z-compounds-eszopiclone, zolpidem, and zaleplon-have become popular; they seem to have fewer residual effects than the benzodiazepines. Even so, care is needed in prescribing such hypnotics for the elderly.

This Special Report presents an important set of articles that considers controversial issues relevant to the practice of psychiatry. These articles demonstrate that what we do as practitio­ners is often based on incomplete evidence and/or reliance on experience and the art of psychopharmacology. There are considerable limitations to “evidence-based medicine” as applied to the issues considered and also to what can be said officially about “off-label” uses of medications. All that said, these articles represent a very interesting set of perspectives on important and, to date, unresolved problems for which our science falls quite short of giving us definitive answers.

Child murder by parents is an upsetting topic for both the public and clinicians. It is even more distressing when a mother kills her child than when a father does because we expect mothers to love and protect their children at all costs.