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What effects will the verdict from the murder case against Andrea Yates have on the public's view of the insanity defense?

When I raise my rates he folds his fifty dollar co-pay and slides it up my desk like an enlisted man on leave easing a big bill in a stripper's G-string. He tells me I'm like his war-time whore who loved him on payday and left when his money ran dry. Each week I lead him in our dance, excite him with my offer to listen to his dreams. And I tell myself I do it to ease his suffering, because I get paid, because I took an oath. But every month, when we devour another round of sessions, I fill out forms for insurance pimps who won't pay unless I reveal the private parts.

It is amazing how a psychiatric practice changes over the years including the switch to managed care from fee-for-service, larger caseloads, new medications and new treatment options. Despite all the changes, both for better and for worse, one psychiatrist is enjoying his practice as much today as ever before.

Antidepressant use among children and adolescents is on the rise. What prescribing patterns are being formed? Researchers are suggesting that more research into psychiatric pharmacogenetics may produce better treatment outcomes. Will it one day be possible to predict treatment response?

A case history illustrates the need to consider psychosocial approaches to treating postpartum depression.

Advances in basic behavior and neuroscience research have been stunning, but until quite recently, efforts to encourage the clinical application of new knowledge have not kept pace. To aid in applying new knowledge to important public health issues, the National Institutes of Health has placed emphasis on "translational research," which aims to provide a bridge between basic research and clinical care. Particularly promising areas of study are highlighted.

Personal digital assistants have the ability to make your practice more efficient. What are the choices of PDAs on the market, and which one is best for you?

How has the emphasis on economics and mental health care affected the quality of care? Has it improved under managed care? Implementing prevention strategies and improved quality, although initially costly, may save money in the long term.

Ask me about power and I'll tell you cigar smoke, the way it darkens like a thunderhead

The increased money being spent on marketing pharmaceuticals directly to patients is raising questions. Are patients indeed benefiting by becoming more aware of their health, or are they simply being used as a target market for the latest drug?

Patient Drug Information From Mass Media Sources

New medications for the treatment of various addictions are currently under investigation. However, there are still substantial barriers, on the part of health and social policies and the patients themselves, to patients receiving these new treatments. Many of these issues were explored at the 2001 American Society of Addiction Medicine's State of the Art in Addiction Medicine conference.

Several confounding factors need to be taken into account before labeling a patient as treatment-resistant. What options are available for treating a patient with schizophrenia who has been diagnosed as such?

Although treatment of obsessive-compulsive disorder has improved, a large percentage of patients do not respond to pharmacological therapy. What familial or comorbid factors might influence the outcome for these patients?

For various reasons, up to half of patients stop taking their prescribed antidepressant within three months. Side effects are often the biggest obstacle in maintaining treatment adherence. How can clinicians help patients deal with the sexual dysfunction and weight gain that often accompany psychotropic treatment?

There is a range of meaning that underlies patients' violent acts against themselves. The usefulness of so-called "safety contracts" to actually predict suicidal behavior is questioned.

In warn-torn Afghanistan, refugees continue to struggle to survive in 20-year-old "temporary" shelters, without proper food and suffering from the psychiatric consequences of trauma. What are psychiatrists doing to help?

Dropping the Lamb

Mandatory reporting laws rarely require reporting by psychiatrists. Psychiatrists need to treat the patient, rather than act as mandated reporters, and be knowledgeable about the dynamics and consequences of domestic violence and about available community resources and advocates that can help the patient.

A bill just signed into law by New Mexico's governor will allow psychologists to obtain prescribing privileges. Will this provide more care to underserved populations, or will it simply put patients at risk?

While the public perceives that many criminals escape punishment by pleading insanity, the truth is that very few people are ever found not guilty by reason of insanity. Society has to decide whether they want to lock up everyone who does any bad thing or excuse the behavior of people who are not capable of controlling their own behavior.

What is a psychiatric expert and how does their role differ from that of the clinician? What must you consider before deciding to serve as an expert witness?

Although it may be tempting to say that almost any rewarding activity can become addicting, new research appears to indicate that, at least in the case of Internet use, that may not be the case. In fact, "Internet addiction" may actually be a sign for other psychiatric disorders.

In the 1800s there was widespread concern over the increase in the number of individuals with severe mental illnesses. Evidence from the 20th and 21st centuries is building that shows a similar trend. Why, then, is this increase not being currently addressed?

Despite the fact that recent juries have discounted repressed-memory testimony as viable, the emotional cost of such cases still takes its toll. Why are such cases so controversial, and how can psychiatrists avoid their pitfalls?

Psychiatrists can help employers better understand the effects of personality disorders on employment litigation. This article looks at some of the consequences that personality disorders may have on employees' work conduct and the role of these disorders in settling employment legal claims.

Public perceptions are that the insanity defense occurs far more commonly than records indicate. In fact, the insanity defense is used in less than 1% of criminal proceedings and is successful in approximately one-quarter of those cases. Furthermore, defendants who are found insane spend as much, or more, time in state custody than their criminally convicted counterparts.

Is the Office of the Inspector General unfairly targeting psychiatrists? The OIG recently reported negative findings for Medicare claims filed by psychiatrists. Will it continue to do so in the study planned for this year?

Jose R. Maldonado, M.D., assistant professor of psychiatry and behavioral sciences at Stanford University, was named the 2001 recipient of the Psychiatric Times Teacher of the Year award. The award was presented to Maldonado at the 14th Annual U.S. Psychiatric & Mental Health Congress in honor of his outstanding achievements in and steadfast dedication to psychiatry. For his work with geriatric psychiatry, Dilip V. Jeste, M.D., has been appointed to the endowed Estelle and Edgar Levi Memorial Chair in Aging at University of California, San Diego (UCSD). Jeste is founder and chief of UCSD's division of geriatric psychiatry and Founding President of the International College of Geriatric Psychoneuropharmacology. He focuses his research on schizophrenia and other psychotic disorders in late life and their successful treatment with the use of safer and more effective drug and psychosocial treatments.Helping people of all ages with schizophrenia to reintegrate into society is the focus of the Eli Lilly and Company-sponsored Reintegration Awards. Recognizing both patient advocates and mental health care professionals, these awards provide grants for their recipients' respective reintegration programs. In the Honorary category, the 2001 "Public Eye Recipient" is Elizabeth Baxter, M.D., a Tennessee-based psychiatrist who, while suffering from psychosis herself, is a mental health advocate on the national level. The 2001 Reintegration Awards were also given in the categories of Advocacy (New Jersey Association for Mental Health Agencies Inc. in Manasquan, N.J.), Clinical Medicine (The Whole Person Family Medicine Clinic in Torrance, Calif.), Education (The Guidance Center Supported Education Program in New Rochelle, N.Y.), Housing (Fred Geilfuss, Scott Reithel, Jack Rosenberg in Milwaukee), Occupational (Restoration Project in Acton, Mass.) and Social Support/Rehabilitation (Fountain House in New York City).

A report released by former Surgeon General David Satcher, M.D., outlines the disparity in mental health diagnoses and treatment between majority and minority ethnic groups. The report also discusses ways of closing the gap in mental health treatment.