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The demands on physicians keep growing-they are not only responsible for assessment, diagnosis, and treatment, they are subject to all manner of related administrative and practice responsibilities. Not surprisingly, physicians are susceptible to burnout.

It has become clear over the last couple of days that Sandy Hook Elementary School and Newtown have become an area of great concern locally, nationally, and internationally. We as a world community need to go through a grieving process that includes this type of sharing, especially for parents out there.

What we know for sure is that for all the young children and adults who were killed in Newtown, their world ended a week ago. Soon after the tragedy, one of the fathers of a child killed tearfully pleaded for society to learn from what happened in order to prevent future mass murders. Here, recommendations from a psychiatrist.

Patients with major depression or bipolar depression have a 20- to 26-fold increase of mortality rate over the general population. Suicidal behavior can be quite complex as well deadly. It should go without saying that psychotherapy is usually necessary in treating patients who have suicidal ideation or who have demonstrated such tendencies or actions. Frequently, it may be combined with medication and sometimes it is the treatment of choice without medication.

James Phelps, MD, Bipolar Disorder Section Editor for Psychiatric Times, is Director of the Mood Disorders Program at Samaritan Mental Health in Corvallis, Ore.Dr Phelps' essay, "Aufheben": A Dialectical Approach to Bipolar Diagnosis," begins an ongoing series on bipolar disorder focused on clinical utility. His Web site, PsychEducation.org, gathers no information on visitors and produces no income for him or others. He is the author of Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder (New York: McGraw-Hill; 2006), from which he receives royalties. Dr Phelps stopped accepting honoraria from pharmaceutical companies in 2008.

Additional Resources

• Federation of State Medical Boards. Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice.

Psychosis can arise from a general medical condition, including endocrine diseases, metabolic diseases, autoimmune diseases, infections, narcolepsy, seizures, space-occupying lesions, strokes, head injury, and more.

The American Psychiatric Association Board of Trustees announced that it has approved the final diagnostic criteria for the DSM-5. According to the board, the APA has passed a “major milestone” on the way to its publication slated for May 2013.