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.
In addition to their use in the management of epilepsy, anticonvulsants are indicated for management of bipolar disorder, mania, neuralgia, migraine, and neuropathic pain.
Other disorders include those not currently listed such as complex somatic symptom disorder; those proposed for reclassification such as body dysmorphic disorder; and those proposed to by subsumed under other diagnoses such as somatization disorder, pain disorder associated with psychological factors, and hypochondriasis.
Included in this list of disorders are those proposed for possible reclassification such as obsessive-compulsive disorder; those proposed for removal such as agoraphobia without a history of panic disorder; those proposed to be subsumed under other diagnoses such as panic disorder with or without agoraphobia; and those not currently listed such as substance-induced tic disorder, hoarding disorder, olfactory reference syndrome, and skin picking disorder.
I never wanted to go to New Orleans-I thought it would be hot and muggy and very crowded. But, life takes you on unexpected journeys and one day I found myself at a conference in New Orleans, and I was charmed.
I just finished reading Dr Zucker’s retort to Dr Frances’ critique of proposed categories for paraphilias in DSM5, as well as Dr Frances’ reply.
Among other things, the Work Group for this class of disorders is examining whether premenstrual dysphoric disorder should classify as a separate disorder from mood disorders or a specifier for mood disorders.
The health insurance reform bill Congress passed and President Obama signed has a number of small, psychiatric-targeted provisions, but their significance probably pales beside the first-time insuring of somewhere above 30 million Americans-some of whom will visit psychiatrists for the first time in their lives.
Hear the story of wood...
The recently posted draft of DSM5 makes a seemingly small suggestion that would profoundly affect how grief is handled by psychiatry.
My “most important achievement to date” is that I’m capable of even the simplest forms of basic cognition. I can remember, perceive, speak, feel, think, solve, and-sometimes-pay attention.