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Since the time of Homer, warriors have returned from battle with wounds both physical and psychological, and healers from priests to physicians have tried to relieve the pain of injured bodies and tormented minds.1 The soldier’s heartache of the American Civil War and the shell shock of World War I both describe the human toll of combat that since Vietnam has been clinically recognized as posttraumatic stress disorder (PTSD).2 The veterans of Operation Iraqi Freedom (OIF) and of Operation Enduring Freedom (OEF) share with their brothers and sisters in arms the high cost of war. As of August 2009, there have been 4333 confirmed deaths of US service men and women and 31,156 wounded in Iraq. As of this writing, 796 US soldiers have died in the fighting in Afghanistan.3

Synecdoche, New York, screenwriter Charlie Kaufman’s directorial debut, was greeted with Best Film of the Year from critics and catcalls from moviegoers. It is a film that only someone like Psychiatric Times’ Editor in Chief, Dr Ron Pies, could fully understand (ie, a psychiatrist who knows about arcane neuroscience and literature). The problems start with the title. Most people have no idea what “synecdoche” means or how to pronounce it. Looking it up is not much help. The Oxford English Dictionary defines it as “a figure [of speech] by which a comprehensive term is used for a less comprehensive or vice versa, as whole for part or part for whole, genus for species or species for genus, etc.” The commentary adds to the confusion: “Formerly sometimes used loosely or vaguely, and not infrequently misexplained.” No matter. Most critics did not explain it anyway, emphasizing instead its pronunciation-si-NECK-doh-kee-which sort of rhymes with Schenectady (sken-ECK-tuh-dee), where the film “seems” to be set. They outdid each other, too, in their praise of the film, while being surprisingly candid about their inability to explain it. Roger Ebert called it “Joycean,” with the richness of literature. He enthused, “It’s about you. Whoever you are,” even though he conceded that he had not fully understood it. As for the ambiguity of the title, he advised readers to “get over it.”

This is the third and final installment in a series on biophysical mechanisms of functional magnetic resonance imaging (fMRI) technologies. My overarching goal has been to explain why great care must be exercised when interpreting data derived from these magnets. The inspiration for the series came as I was reading a magazine article while waiting for a plane to take off-my reaction to what I read may have resulted in a bit of trauma to the seat pocket in front of me.

Dr Stone’s Pharmonitor essay justly skewers drug promotion hubris disguised as a CME article.

Why do people get addicted? Of the countless books that have been published on this topic, this is the first that focuses on the self-medication hypothesis (SMH). Understanding Addiction as Self Medication is largely based on the experiences of the authors and other clinicians with individuals who struggle with addiction.

I just read and enjoyed “Treatment-Resistant Bipolar Disorder”1 at www.PsychiatricTimes.com, and wanted to thank the author for pulling together a great deal of useful information in a succinct and lucid format.

Restless legs syndrome (RLS) is a neurosensory disorder first described by Sir Thomas Willis in 1672. As early as the 19th century, Theodor Wittmaack observed the comorbidity of RLS with depression and anxiety. He termed this condition “anxietas tibiarum” and believed it to be a form of hysteria.

The congressional drive to reform health care could result in a 5% Medicare bonus for psychiatrists because of a provision in a prospective bill that would also have an impact on private insurance payment. As the House and Senate struggle to turn concepts into legislative language, one thing Democrats and Republicans agree on is that primary care physicians should be better compensated, probably with money taken out of the pockets of some specialties.

The validity of any study involves the sequential assessment of confounding bias, followed by chance, followed by causation.

This book is well-written and concise. It provides an overview of ECT that is evidence-based yet understandable by the average person. The author effectively uses clinical anecdotes to provide a “face” for the science. The book is organized in a user-friendly way.

A graduating resident recently told me that a psychiatric group attempting to recruit him informed him that he would have 10 minutes for medication appointments and 30 minutes for new patient evaluations. He was horrified. (So was I.)

In our last installment, we discussed a familiar finding from the National Comorbidity Survey Replication (NCS-R): the peak age of onset for any mental health disorder is about 14 years. In an attempt to explain these data, we are exploring some of the known developmental changes in the teenaged brain at the level of gene, cell, and behavior.

The need for expert supervision of residents and other health professionals by psychiatrists is growing as a result of the increased demand for accountability by third parties and the expanded number of clinical specialists seeking supervision in psychiatry. The Accreditation Council for Graduate Medical Education has placed professional competency of graduating residents in the national spotlight, and insurers are increasingly scrutinizing patient care provided by trainees and oversight provided by their supervisors.

Poetry of The Times September 2009

My life as a poet changed dramatically in 1999 when Psychiatric Times founder John L. Schwartz, MD, and editor Christine Potvin decided to include my poems as a monthly column in Psychiatric Times. With the creation of “Poetry of the Times,” I experienced a tremendous jolt of artistic energy, a sense of affirmation, and a huge boost in confidence. Writing the column continues to propel my poetry 10 years later.

“Do poets need to be mentally ill to produce great work? Is creativity heightened by treatment, or does treatment reduce emotional pain to the extent that the poet no longer has anything to say?”

After 18 years as a senior clinical psychiatrist at a New England inner-city mental health clinic, Dr Lawrence Climo was understandably surprised and saddened when he was given 2 weeks’ notice that his services were no longer needed. Financial constraints meant the clinic was replacing him with a nurse. Although his wife told him it was an opportunity, he remembers thinking that health care reform made him feel that his professional skills were “almost irrelevant or at least unmarketable.”

This text provides an excellent overview of mood disorders during older adulthood. Chapter 1 deals with diagnosis and includes helpful diagnostic tools and pertinent laboratory values. Chapter 2 addresses nonmajor depressive syndromes-a much-needed area of discussion-and provides a literature review in an easy-to-read table. Chapter 3 includes very good information about epidemiology and a most useful table of information. Another strength is a discussion of potential reasons for low rates of depressive disorders.

Psychological problems are often manifest in the skin. In fact, it is estimated that between 20% and 30% of all skin disorders have some psychological component. Many patients who have psychocutaneous disorders-which are often direct evidence of or secondary to psychological abberations-drift from one physician to another, trying to find one savvy enough to cure their “skin condition.” Furthermore, although they have sought many medical opinions already, patients afflicted with psychocutaneous disorders almost always present as “an emergency.” While pharmacological intervention may benefit such patients, traditional mental health interventions are almost always required if the aberrant behavior is to cease.

As clinicians, we routinely make critical decisions for our patients with depression. Because of the uncertainty of factors that affect diagnosis and treatment, clinicians may find an objective, quick measurement tool helpful. Measurement-based care (MBC) provides specific and objective information on which to base clinical decisions and should therefore enhance quality of care and treatment outcomes.1-3

Unlike other handbooks, such as the Clinical Handbook of Couple Therapy (Guilford, 2002) and the Handbook of Couples Therapy (Wiley, 2005), which give considerable attention to specific theoretical approaches for treating couples, this handbook addresses clinical issues only. There are no chapters on cognitive-behavioral couple therapy, emotion-focused couple therapy, or the like. Instead, this handbook’s 18 chapters cover biological and physiological issues, traumatic issues, divorce and remarital issues, sociological issues, primary prevention issues, and training issues.

Self-administration of drugs of abuse often causes changes in the brain that potentiate the development or intensification of addiction. However, an addictive disorder does not develop in every person who uses alcohol or abuses an illicit drug. Whether exposure to a substance of abuse leads to addiction depends on the antecedent properties of the brain.

Physicians generally display better health and have lower rates of all-cause mortality than the general population. However, their education, nutrition, and lifestyle do not offer similar protection from substance abuse and dependence.

The editorial board and staff of Psychiatric Times wish to announce, with much regret, the retirement of Max Fink, MD, from our journal’s editorial board. Dr Fink-who is emeritus professor of psychiatry and neurology at the State University of New York at Stony Brook-has been a valued member of our board since 2002, and a regular contributor to the journal for many years before that.

Surveys show that approximately 60% of the general population has gambled within the past 12 months.1 The majority of people who gamble do so socially and do not incur lasting adverse consequences or harm. Beyond this, approximately 1% to 2% of the population currently meets criteria for pathological gambling.2 This prevalence is similar to that of schizophrenia and bipolar disorder, yet pathological gambling often goes unrecognized by most health care providers.

An overview of the critical issues involved in overcoming personal and organizational barriers to help substance abusers quit smoking.

>I greatly enjoyed Dr Ron Pies’ editorial “What Should Count as a Mental Disorder in DSM-V?”1 in which he encouraged framers of DSM-V to critically examine the boundaries of mental illness and to more carefully distinguish between diseases, disorders, and syndromes. As I have noted elsewhere, current plans to integrate a “spectrum” approach into DSM-V require a careful consideration of these issues that must be defensible to critics of diagnostic expansion within psychiatry.2

There is no magic moment when it becomes clear that the world needs a new edition of the DSM. With just one exception, the publication dates of all previous DSM’s were determined by the appearance of new revisions of the International Classification of Diseases (ICD). Thus, DSM-I appeared in conjunction with ICD-6 in 1952; DSM-II with ICD-8 in 1968; DSM-III with ICD-9 in 1980; and DSM-IV with ICD-10 in 1994. The lone exception was DSM-IIII-R, which appeared in 1987-out of cycle only because it was originally meant to be no more than a minor revision. The official publication date for DSM-V is May 2012. That date was picked to be consistent with an earlier, no longer correct, expectation that ICD-11 would be published in that same year.

I found the American Psychiatric Association’s response (“Setting the Record Straight”) to the commentary by Allen Frances, MD, (“A Warning Sign on the Road to DSM-V”) outlining concerns about the DSM-V to be an embarrassing black mark against the association.* As president of an organization supposedly devoted to scientific objectivity, Dr Alan Schatzberg’s (lead author of the response) ad hominem attack and use of unprovable innuendos to discredit Dr Frances reflects an approach I want nothing to do with.

Abortion trauma syndrome is a fabricated mental disorder conceived by anti-abortion activists to advance their cause and is not a scientifically based psychiatric disorder. So said 2 psychiatrists at the American Psychiatric Association’s recent annual meeting in San Francisco.