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Today when the ground was no longer...

As if psychiatrists didn’t have enough to worry about with regard to complying with upcoming Medicare e-Prescribing dictates, there is now a second layer of complication . . . the interim final rule from the DEA, which prescribes requirements for physicians who want to use electronic prescribing for controlled substances.

Dramatology approaches human encounters, events, and scenes as dramatic enactments of characters in conflict and crisis.

As a psychiatrist who has lymphoma, 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 various forms of cancer. I hope these insights will be useful to psychiatrists as they wrestle with the problems that plague their patients who are coping with cancer.

The risk of breast cancer recurrence related to some SSRI antidepressants interacting with and reducing the effectiveness of tamoxifen was quantified in 2 epidemiological studies published in February.

When I was a grad student-back in the Jurassic Era of molecular manipulations-my lab mates and I were all transfixed by the notion of a new technology: knockout animals (KOAs). This was because of its promise to solve a vexing problem.

After reading Dr Daniel Carlat’s heartfelt piece in the April 19, 2010, New York Times Magazine (“Mind Over Meds”), I was struck by several things. The first was Dr Carlat’s eloquence regarding the dilemmas of psychiatric practice. Second was how his experience may represent a generation of psychiatrists who were trained during an era of drug discovery wrapped in the exciting promise of “Biological Psychiatry.”

Bipolar disorder is recognized as a serious disorder. It has an adverse impact on many areas of a child’s development-including cognitive, emotional, and social functioning. Children with BD are at significant risk for substance use and suicidality. Further identification of effective treatments is a pressing public health concern.

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.

A recent meta-analysis showed that diagnoses generated from clinical evaluations often do not agree with the results of structured and semistructured interviews-together called standardized diagnostic interviews (SDIs).

I sent the letter that begins on page 4 to the Trustees of the APA on April 8, 2010. It contains an urgent plea that the Trustees move immediately to correct the increasingly wayward course of DSM5. The DSM5 Task Force is about to begin a field trial that is a complete mistake:

As an officer of the APA, I was one of the prime movers of the limitations on, and vetting of, potential participants in the preparation of the DSM-5.

Psychiatric Times is pleased to welcome James L. Knoll IV, MD, as Editor-in-Chief. Dr Knoll is an associate professor of psychiatry at the SUNY Upstate Medical Center in Syracuse, where he is director of forensic psychiatry, and director of the forensic psychiatry fellowship at Central New York Psychiatric Center. Dr Knoll provides forensic consults for the criminal justice system and the private sector. He has authored numerous articles and book chapters and is coeditor of the Correctional Mental Health Report. He contributes frequently to Psychiatric Times and previously served as series editor of the column Psychiatry & The Law. He writes a forensic psychiatry blog, The Edge Effect.

A vital consideration we learn in medicine is that continuing life support for a moribund patient past a certain point is harmful to the lives of all concerned.

The discipline of evolutionary psychology views modern human behaviors as products of natural selection that acted on the psychological traits of our ancestors. A subdiscipline, evolutionary psychiatry tries to find evolutionary explanations for mental disorders.

It’s an embarrassment, no doubt about it. For those of you who have been following the intense debate over the DSM-5, it’s high time to ask: how much longer will the public put up with a medical specialty like this?

How regularly do you use outcome measures to assess how well your patients with depression are doing? Research suggests many psychiatrists avoid such measures, believing that they are aren’t trained to use them; that they take too much time; or that they aren’t clinically helpful.1

"A patient I had seen a couple of times in the hospital made a follow-up appointment in the office - that she didn’t show up for. Because she was in the hospital (again)."

Included in this list of disorders are those not currently listed such as hypersexual disorder, paraphilic coercive disorder, sexual interest/arousal disorder in women and in men, and genito-pelvic pain/penetration disorder; those proposed for removal such as sexual aversion disorder; and those proposed to be subsumed under other diagnoses such as hypoactive sexual desire disorder, female sexual arousal disorder, dyspareunia, and vaginismus.

Psychotropic drugs are big business: in 2009, roughly 300,000,000 prescriptions were written for these agents.

My medical school clinical preceptor asked me, during my first year, what specialties (at The University of Chicago, the attitude toward general practice was well represented by the dismissive references to ‘LMDs’-local medical doctors) I was considering.

Transcranial magnetic stimulation (TMS) is noninvasive focused brain stimulation that uses pulsed magnetic fields. The underlying mechanism depends on the principle of electromagnetic induction, the process (discovered by Faraday in 1839) by which electrical energy is converted into a magnetic field and vice versa.1

The issue of self-disclosure in psychotherapy is one of complexity and some evolution.1-16 Most discussions about the practice refer to boundary questions because self-disclosure by the therapist to the patient is a boundary issue. Self-disclosure has, of course, a number of dimensions, including clinical, therapeutic, technical and-in some cases-legal or regulatory. Despite the rich and interesting clinical issues relating to self-disclosure (outlined in Gutheil and Brodsky1), the focus of this article is on the ethical aspects of self-disclosure.1,15,16 Of necessity, the discussion centers on the more exploratory forms of psychotherapy, such as dynamic therapy, rather than on behavioral therapies, co-counseling, substance abuse treatment, or pharmacological treatment.

Bioethicists often debate whether the rapid pace of medical science truly generates new ethical questions or whether what appear to be novel dilemmas are really ancient conflicts presented in modern terms and contexts.1 The valuable essays in this Special Report offer support for each position and, more important, provide clinical wisdom for mental health professionals struggling with ethical issues both profound and prosaic in a variety of practice settings.

Questions have also been raised about the extent of industry influence on the American Psychiatric Association’s diagnostic and treatment guidelines-namely, its DSM and Clinical Practice Guidelines.