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.
The FDA recently approved iloperidone (Fanapt, Vanda Pharmaceuticals) for the treatment of schizophrenia, reversing a July 2008 determination that the New Drug Application (NDA) was “not approvable.” An FDA spokesperson explained in an interview in Forbes (May 8), “Vanda provided the FDA with additional data and arguments that led us to reinterpret results of several of their studies.”
The process of adapting to prison life, or “prisonization,” exerts a dehumanizing effect that may result in feelings of hopelessness and alienation.
Strategies for Recognizing Schizophrenia and Treating to Remission
A National Academy of Sciences (NAS) report urging a more coordinated approach to prevention and treatment of depression in parents-because of its impact on children-hit the streets just as Congress began considering legislation to reform the US health insurance system. The NAS report made a number of recommendations for changing the approach of both public and private health insurers toward depression, although the front-line troops expected to deal with the problem are primary care physicians, who already treat 70% of patients with depression.
As a standing member of the Editorial Board of Psychiatric Times, I read with particular interest the front-page story in the March issue, “Pharmonitor: Reality-Checking and Journalistic Integrity” by Editor in Chief Ronald Pies, MD. In it, Dr Pies pointed out that “disclosures do not guarantee scientific or journalistic objectivity and accuracy.” He set out the critical scientific questions that ought to be asked, and he promised that “Pharmonitor” would be “a reader-driven commentary . . . focusing on articles and reports in Psychiatric Times that the reader considers biased.”
Although the onset of psychotic symptoms before the age of 13 years is exceedingly rare, the incidence of schizophrenia rises sharply after the onset of puberty.1 Only 1% of the population has schizophrenia and 30% of these patients experience an onset of psychotic symptoms by age 18 years.2-8 The period that precedes the onset of frank psychotic symptoms (ie, the prodromal phase) has not been well characterized in early-onset schizophrenia-spectrum disorders (EOSS), but retrospective reports have shown that symptoms include high levels of depression and anxiety, emerging cognitive and social deficits, unusual thought content, and (not infrequently) school failure.
I had intended not to reply to the silly suggestion made by the DSM-V leadership that I wrote my critique out of financial motivations. I had expected that we would be conducting a useful discourse on the concrete issues and was surprised by the unenlightening personal exchange. Unfortunately, the DSM-V leadership refuses to discuss any of the substantive questions I have raised and instead, I am told, persists in the shallow rationalization that whatever I say is about royalties.
What the New Mind-Body Science Tells Us About the Pathophysiology of Major Depression-Focus on Treatment
For pharmaceutical companies, off-label use of a drug represents a substantial “gray market,” to which the company is unable to sell their product directly, yet may be a significant revenue stream. Some drugs have been used more for off-label purposes than for originally approved indications.1
In a shot recently fired around the online world, commentary about the DSM-V process by Allen Frances, MD, has sparked heated debate that continues to reverberate around the psychiatric world.
Historically, borderline patients were considered “help-rejecting complainers.” Clinicians should actively treat both mood/anxiety symptoms and BPD symptoms.