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What is the single biggest challenge you face as a psychiatrist?

I am a civilian psychiatrist who recently finished 20 months of work as a contractor for the US Army. Going into the job, I expected the degree of combat-related stress I saw in our troops. I was not prepared, however, for the scope of the impact our 2 long wars have had on military children.

In today’s world, we are witnessing a de-emphasis and depersonalization of how the bereaved experience the death of a loved one. In fact, the occasion of death is frequently referred to as a “celebration,” despite the pain and suffering that can occur. Death is not an occasion for a celebration. Death is a time for mourning by family and friends. Death is a loss-not only to the deceased, who lost everything, but to all those who care about the deceased.

While research suggests that cannabis use can induce an acute psychotic state, there is controversy about whether it may precipitate psychotic disorders, such as schizophrenia. These authors offer an update on this important issue and provide clinically useful recommendations.

Every residency class needs its symbolic rebel, an outsider who will risk it all in the fight against inane and superfluous paperwork. When your program is demanding redundant treatment plans, insisting on triplicate no-show notes, or reminding you to complete some tedious log, this resident is the kind of leader who will confront the administration with tough phrases, like “This form is ridiculous.”

We now communicate in ways that are very different from those available just a decade ago. The iPhone, iPad, and similar devices also enable us to observe ourselves as we perform any number of activities. These and other new devices may have an application their designers never considered.

When we work with patients whose experiences don't align with our expectations, we must be careful not to dismiss those experiences simply because they clash with the overriding psychiatric paradigm.

Maybe the “Occupy Wall Street” movement suggests a different kind of protest for this year’s APA meeting. What about “Occupy Medicine” for us psychiatrists?

Through patient self-management, mental health clinicians can transfer the focus from managing symptoms to allowing patients to live well in the context of their mental illness and medical comorbidities.

The designer of the DSM-5 Field Trials has just written a telling commentary in the American Journal of Psychiatry. She makes what I consider to be 2 basic errors that reveal the fundamental worthlessness of these Field Trials and their inability to provide any information that will be useful for DSM-5 decision making.

Patients with bipolar disorder need a great deal of information about the illness. Without this education, adherence to your recommendations is uncertain; with it, outcomes will likely be better (and your job easier).

With appropriate educational strategies, psychiatrists can address and match diverse goals, competencies, preferences, and practical means of access.

For this psychiatrist, group therapy has proved to be an extraordinarily effective treatment for a range of mental disorders.

How often do insomnia and anxiety disorders coexist? And how best to treat patients with comorbid insomnia and anxiety? Answers here..

Simple, standardized protocols ensure that ECT can be provided safely and comfortably in many facilities, with consistent anti-depressant results and a favorable adverse-effect profile.

This essay is a brief update on an earlier Psychiatric Times article by Dr James Phelps. Several major studies have appeared since the publication of the original article, which shed further light on this issue.

The term “pseudocommando” was first used to describe the type of mass murderer who plans his actions “after long deliberation,” and who kills indiscriminately in public during the daytime.

The response of psychiatrists to Medicare’s continued inhospitability to psychiatrists in 2012 is cautious.

The scar on her sternum is a zipper . . . opened once to reveal her heart,. . . . the smooth arc of her breasts

Accurate diagnosis is absolutely crucial in SVP hearings because the potential outcome is so consequential-involuntary incarceration in a psychiatric hospital that may well last a lifetime. In no other clinical or forensic situation does so much ride on the presence or absence of a psychiatric diagnosis.

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