News

There has always been controversy over what consitutes a psychiatric disorder and the best treatment options for a specific disorder.

DSM5 suggests 2 changes that would make it much easier for an adult to get a first time diagnosis of Attention Deficit Disorder (ADD): 1) reducing the number of symptoms required for adults from 6 to 3; and 2) relaxing the requirement that the onset of symptoms must have occurred before age 7 (by allowing the onset to be up to age 12).

As a psychiatrist who has cancer, I have developed a deep understanding of the ways in which our training can help us help patients who find themselves forced to deal with the complicated emotional aspects that accompany this disease. My hope is that my insights will help psychiatrists as they wrestle with the problems that plague their patients who are coping with this difficult disease.

A recently published a meta-analysis showed that diagnoses generated from clinical evaluations often do not agree with the results of structured and semi-structured interviews-together called standardized diagnostic interviews (SDI).1 Such a study could easily be overlooked as another dry and “methodological” investigation. Nevertheless, the implications of this meta-analysis are enormous

Almost the first memory I have of a physician is our family doctor at my bedside, leaning over to press his warm fingers against my neck and beneath my jaw. I’m 5, maybe 6 years old. I have a fever and a sore throat, and Dr Gerace is carefully palpating my cervical and submandibular lymph nodes. In my family, Dr Gerace’s opinion carried a lot of weight. It was the 1950s, and my mother did not quite trust those new-fangled antibiotics. She usually tried to haggle with the doctor over the dose-“Can’t the boy take just half that much?”-but even my mother would ultimately bow to Dr Gerace’s considered opinion.

There is a difference of opinion among psychiatrists whether it is time to restructure the APA to a “leaner and meaner” organization where activities and functions by necessity have to be cut back because of reduced income.

The first drafts of DSM5 were posted 2 months ago, allowing the field and the public a first glimpse into what had previously been an inexplicably secretive process. Today is the last day for public comment on these drafts. This is a plea for continued openness and iterative interchange in the next steps in the preparation of DSM5.

DSM5 first went wrong because of excessive ambition; then stayed wrong because of its disorganized methods and its lack of caution. Its excessive and elusive ambition was to aim at a "paradigm shift.”

Oregon’s Governor Kulongoski has vetoed a bill that would have allowed psychologists to practice clinical medicine without adequate training-otherwise known by the euphemism of "prescribing." The Governor's rationale was precisely the one opponents of the bill, such as myself, had advocated.

Dr Seeman makes a compelling case for using web-based communications to connect with your patients in real time. She outlines 10 practice tips to help you avoid liability and security risks.

Help in Clinical Decision Making

There are limited data on clinical and biological predictors of antipsychotic drug response. The ability to identify those patients who will respond well to psychotropic drug treatment or who will be at a higher risk for adverse effects could help clinicians avoid lengthy ineffective drug trials and limit patients’ exposure to those effects. Moreover, better predictability of treatment response early in the course of a patient’s illness can result in enhanced medication adherence, a significant predictor of relapse prevention.

Pilots will no longer be banned from flying if they are taking an SSRI antidepressant.

Mark Twain observed that "the past may not repeat itself, but it sure does rhyme." An unfortunate rhyme in psychiatric history is the recurrence of fad diagnoses. Childhood Bipolar Disorder is the most dangerous current bubble, with a remarkable forty-fold inflation in just one decade.

Avoid Surprises and Unintended Consequences

Available treatments are so robust that nearly one-third of patients with major depression will achieve full clinical remission with monotherapy.

Diagnostic Dilemmas-Effective Treatment Approaches

Epidemiological studies show that, 4% to 5% of the general population have severe ADHD. Of this number, half have a comorbid substance use disorder. The aim of this article is to help physicians understand and manage this challenging combination of comorbidities.

They read sonnets for patients...

Is A Clinician’s Guide to Statistics and Epidemiology in Mental Health what we have been waiting for? Yes and no. It contains solid descriptions of concepts such as the P value and confidence intervals, and it has extensive discussions of the history of modern statistical methods. Perhaps its greatest strength involves critiques of the interpretations of several studies that have mistakenly become cornerstones of clinical lore.

The impact of FDA alerts and label warnings was examined in 2 recently published studies of antipsychotic drug use. In one study, researchers gauged physician response to the 2005 warning of increased mortality with antipsychotic use in elderly patients with dementia, and in the other study, researchers determined whether recommended safeguards were implemented following the 2003 advisories on adverse metabolic effects of second-generation antipsychotics.

My parents lived in 2 different worlds together. One, the outside world, was where they sparkled. Their business was so successful, and they were urbane, sophisticated, and very smooth. At home, the inside world was very different. They were competitive with each other, more critical than affectionate; there was none of the togetherness they presented to the outside world.

Overly sensitive, aversive reactions to stress seem to run in families. The literature abounds with reports of relatives in these populations predisposed to depression, anxiety, and even suicide. Some family members present with glucocorticoid levels notched abnormally high, and in curiously deregulated concentrations. Behaviorally, they seem to exist at a permanent state of high alert.

As a fellow Oregonian, I concur with Dr Jim Phelps that the topic of psychologist prescribing is highly complex, and that even balanced opinions generate “affective discharge” approaching “invective."

Oregon’s legislature has passed the bill: should the governor sign it? Most opinions on this issue are strong, and many have reached the point of invective. Even such a cool mind as Ronald Pies' has weighed in with an emotionally charged editorial.1 To speak in favor when so many are opposed seems only to invite more affective discharge. On the other hand, editorial views thus far may be moving us toward extremes on an issue that is highly complex. Perhaps a dialectic approach -– what value can we find in an opposing view? -- would be wise at this point. In that spirit, here are 4 considerations that I hope will be useful.