My first exposure to electronic medical records (EMRs) was when I saw my own primary care physician about 3 years ago. I didn't like it. Neither did he. For me, it seemed like he had to pay as much attention to the computer as to me. We spent less time talking. He laughed as he typed, joking that once everything was in the computer, it should save time and make for better care. I responded that we heard the same promise with managed care.
In his recent David Letterman–like Top 19 list of DSM5 issues, Allen Frances1 targeted a proposed revision of the DSM-IV diagnosis of Pedophilia, and 2 proposed new diagnoses: Hypersexual Disorder (HD) and Paraphilic Coercive Disorder. He protests the inclusion of pubescent teenagers in the definition of the proposed revision of Pedophilia (including the renaming of it as Pedohebephilic Disorder) and criticizes the quality of writing of these criteria.1 As the chair of the DSM5 Work Group responsible for those draft criteria, I need to address his poorly reasoned claims.
Antidepressants effectively combat depression in people who are physically healthy. But how effective are these agents for depressed patients who are physically ill?
Two events occurred last week that will have significant ramifications for psychiatry. On March 23, The Physician Payments Sunshine Act was signed into law by President Obama. The act was embedded in the larger healthcare reform package, so it didn’t receive a lot of fanfare, but it is huge.
Electroconvulsive therapy (ECT) devices are undergoing FDA scrutiny and could become subject to new requirements and restrictions that affect their use by psychiatrists. The FDA is considering whether to keep ECT devices in their current Class III category or drop them to Class II.
DSM-IV provides separate categories for Substance Abuse and Substance Dependence. The typical substance abuser is someone who gets into recurrent, but intermittent, trouble as a consequence of recreational binges. This is in contrast to the continuous and compulsive pattern of use that is typical of DSM-IV Substance Dependence.
Dateline: Portland, Oregon, April, 2011[From the office notes of Prescribing Psychologist, R.X. Sciolus, PhD]“Ms Malfortuna is a 60-year-old white female with a recent history of significant depressive symptoms, including insomnia, poor appetite, decreased energy, anhedonia, and lack of motivation. . .
Neuroscientists are exploring ways to erase bad memories in patients who have experienced traumatic events. This possibility raises ethical concerns: Is it ethical to erase a memory or flashback and the feelings associated with that moment to alleviate suffering, or should clinicians focus on therapies such as CBT and EMDR (Eye Movement Desensitization and Reprocessing) to help patients cope with a trauma?
Many European-born Israelis who lived through the Holocaust were subject to severe starvation, extreme mental stress, exposure to a variety of infectious agents, and hypothermia. Perhaps it is no coincidence that these Jews now have higher rates of all types of cancers-especially breast and colon cancer-than other Jewish or non-Jewish ethnic groups who currently live in Israel. The authors of a study recently published in the Journal of the National Cancer Institute comment that experiences during WWII appear to have had a direct impact on the long-term health of survivors.
Your Mother Was Right . . .A new study appears to add a new dimension to mothers’ sage advice. Researchers in Austria have found that fish oil with omega-3 polyunsaturated fatty acids reduced the risk of progression to psychotic disorder in young people who had subthreshold psychotic symptoms-with none of the adverse effects associated with drug treatment.
“I just threw him in the lake and expected him to die. . . My only regret is that he lived.”
There are 2 very different methods of describing people with a mental health problem. A typical psychiatrist will give the mental disorder a name. Many psychologists would prefer to give it a number on a rating scale. The first “categorical” approach is the simplest and most natural way people sort things. It is the method used throughout medicine (with just a few exceptions like hypertension). The second “dimensional” approach works best to describe phenomena that are continuous, lacking in clear boundaries, and reducible to numerical measurement.
In a study of 3801 young adults that was just published in the Archives of General Psychiatry, Australian researchers have concluded that early and prolonged use of marijuana is associated with psychosis-related outcomes in young adults. They found a “dose-response” relationship: the longer marijuana was used, the higher the risk was out eventual psychosis.
The proposal for a "Psychosis Risk Syndrome" aims to solve a pressing problem in psychiatry-- the need for early identification and preventive treatment.
I have been closely following the discussions of the proposed DSM5 in Psychiatric Times. Your publication of this discourse is a significant contribution to our field. As a research psychiatrist who has published over 150 peer-reviewed papers, I strongly support Allen Frances’ emphasis on the importance of continuity in diagnostic criteria for DSM5.
There are currently several disturbing phenomena in the field of suicidology: •Many papers are describing risk assessment and suggesting the need for high-risk patients to be hospitalized. •Emergency department (ED) staff are complaining about spending much of their time trying to find beds for patients. •Programs are claiming “crisis intervention” when, in fact, they only provide triage.
A new study appears to add a new dimension to mothers’ sage advice. Researchers in Austria have found that fish oil with omega-3 polyunsaturated fatty acids reduced the risk of progression to psychotic disorder in young people who had subthreshold psychotic symptoms-with none of the adverse effects associated with drug treatment. Click here for more details.
I have been a member of our American Psychiatric Association (APA) for over 30 years. I've also been a Fellow for many years, served on the Assembly 3 different times, served on the Managed Care Committee twice, and was once asked if I would consider running for President. On the other hand, I did resign from a request to run for District Branch President because of some unexpected (and what I and some others thought was unethical) collegial conflict.
It is safe to say that few authors of mental health–related books would introduce themselves by presenting these credentials:
A major general problem in the preparation of DSM5 is that the various Work Groups have been given far too little guidance and support. This explains why: 1)most of the criteria sets are written so obscurely and inconsistently; 2) the rationales for change vary so widely in depth and quality across Work Groups,and; 3) so many suggestions that should have no chance at all have made it this far without being tossed.
The recently posted draft of DSM5 makes a seemingly small suggestion that would profoundly impact how grief is handled by psychiatry. It would allow the diagnosis of Major Depression even if the person is grieving immediately after the loss of a loved one. Many people now considered to be experiencing a variation of normal grief would instead get a mental disorder label.
Due to decreasing revenue, the APA Assembly has been forced to reduce its budget by $200,000 and and many of the APA Components have been eliminated or significantly changed.
I had lunch with Death some 12 or so years ago, as a chief resident in psychiatry. He was a bit hard to converse with. In fact, the exact opposite of how he had been when presenting grand rounds just an hour before.
Our country is in the midst of a 15-year "epidemic" of Attention Deficit Disorder (ADD). There are 6 potential causes for the skyrocketting rates of ADD-- but only 5 have been real contributors. The most obvious explanation is by far the least likely -- that the prevalence of attention deficit problems in the general population has actually increased in the last 15 years. Human nature is remarkably constant and slow to change, while diagnostic fads come and go with great rapidity. We don't have more attention deficit than ever before. . . we just label more attentional problems as mental disorder.
There are a lot of temperamental Jerome Kagan moments in my friend’s household-an observation that will require this entire column to explain. What exactly is a temperamental moment? And who exactly is Jerome Kagan?
An overview of the characteristics of auditory hallucinations in people with psychiatric illness, and a brief review of treatment options.
Traumatic brain injury (TBI) affects approximately 2 of every 1000 persons per year. Persons vulnerable to mental illness (eg, persons with alcohol abuse or antisocial personality disorder) are particularly at risk.
Six months after the deadline for a final rule, 3 federal departments published an interim final rule that leaves a number of questions open about the application of the expanded mental health parity law passed by Congress in October 2008. But the penultimate version of the implementing regulations won mostly praise from psychiatrists and psychiatric hospitals.
Given the potential for a significant role in recognition of neurologically complex disorders, psychiatrists should become familiar with diagnostic criteria and appropriate therapeutic option.