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Psychosurgery. For some, the word connotes all the promising therapeutic applications of modern neuroscience; for others, it connotes all the baneful excesses of unregulated pseudoscience.

The press reported it in various ways-either as a “brutal gang rape” or, more forensically, as a “21/2-hour assault” on the Richmond High School campus. Any way you look at it, the horrendous attack on a 15-year-old girl raises troubling questions for theologians, criminologists and, of course, psychiatrists. How do we understand an act as brutal as rape? What factors and forces in the rapist’s development can possibly account for such behavior? And how on earth do we explain the apparent indifference of the large crowd that watched the attack in Richmond, Calif, and allegedly did nothing to stop it-or even, to report it?

The debate within the medical profession over “conflicts of interest” (COIs) has often been shrill, and sometimes seems to be based on misunderstandings or myths about what COIs entail. In this psychiatrist’s view, it is helpful to step back from confident proclamations, acknowledge that the issues involved are complex, and aspire to some semblance of humility. Nobody has cornered the market on “the right way” to deal with COI in the realms of medical research, publication, and education.1 At the same time, as Alan Stone, MD, has noted (personal communication, August 27, 2009), ethical considerations lie at the heart of any debate on COI-in particular, the ancient dictum, “Do no harm.” Indeed, ethicist James M. DuBois has pointed out a direct connection between some types of COI and harm to the general public: “Mental health consumers are at risk when studies that involve questionable scientific and publication practices are translated into therapeutic practice.”1(p205)

The NIMH-sponsored New Clinical Drugs Evaluation Unit (NCDEU) meeting is a favored venue for reports and reviews of NIH-funded psychopharmacological studies, and this was true of the recent annual meeting in Hollywood, Fla. The meeting included a workshop on new investigations of antidepressant use in Alzheimer disease and a panel session on the safety of pharmacotherapy in older adults.

Virtual reality (VR)-facilitated exposure therapy for posttraumatic stress disorder (PTSD), recently evaluated under combat conditions in Iraq, appears to be safe and effective, according to LCDR Robert McLay, research director for mental health with the US Naval Medical Center San Diego (NMCSD). Speaking at the 17th Annual Medicine Meets Virtual Reality (MMVR-17) Conference in Long Beach, Calif, McLay said that military providers need to make PTSD treatments available in such military theaters as Iraq and Afghanistan, as well as stateside. (McLay was speaking as an individual, not as a US Navy or Department of Defense representative.)

Because an increasing number of patients pay for care out-of-pocket, marketing has become an essential part of any practice, said David Sprague, chief operating officer at Physicians’ Ally, Inc, Denver. In a presentation at the US Psychiatric and Mental Health Congress in Las Vegas, he provided tips to help physicians market their practice and avoid common pitfalls.

Four simple steps can help you reduce missed patient appointments and boost profitability. So said Mark Rosenberg, MD, PhD, president of Behavioral Health Management, PC, in St Louis, who spoke at the US Psychiatric and Mental Health Congress in Las Vegas. Not only do missed appointments result in lost revenue, said Rosenberg, but also they “interrupt the flow of patient care and impede clinic productivity.”

The following medical and behavioral health providers were killed or wounded during the November 5 Fort Hood shooting rampage that left 13 dead and 29 wounded.

Many patients with HIV/AIDS experience numerous challenges beyond those posed by the physical effects of their disease-including poverty, mental illness, drug addiction, social alienation, racism, and homophobia. Counseling patients who face these issues can be difficult, but a careful risk assessment along with patient education can improve a patient’s ability to cope and lead to better outcomes, said Marshall Forstein, MD, associate professor of psychiatry, Harvard Medical School, Cambridge, Mass, in a presentation at the US Psychiatric Congress in Las Vegas. On the basis of his extensive experience in treating patients with HIV/AIDS, he said it is also important to provide hope and to encourage treatment adherence.

It is usually traumatic when parents learn that their child has an autism spectrum disorder (ASD). Be clear about the diagnosis and let families know that treatment will begin as soon as possible, said Doris Greenberg, MD, associate clinical professor of pediatrics at Mercer University School of Medicine, Savannah, Ga. In her presentation at the US Psychiatric and Mental Health Congress in Las Vegas, Dr Greenberg discussed strategies for talking to the families of children with ASDs. “Don’t talk around the diagnosis-identify the elephant in the room and get on with it,” she said.

Of the screening tools available to help identify early symptoms of Alzheimer’s disease, which is best?

Current guidelines for the management of bipolar depression are outdated because they are based on the definition and treatment of unipolar depression, according to Eduard Vieta, MD, PhD, director of the bipolar disorders program at the University Clinic Hospital of Barcelona, Spain. Dr Vieta led a study to create new definitions and algorithms for the management of treatment-resistant bipolar I and bipolar II depression.

Researchers have found evidence that the placebo effect is not all “in your mind.” This study, recently published in Science, suggests that the spinal column-specifically, the dorsal horn-may be involved in blocking pain after placebo has been administered. Eippert and colleagues1 examined pain reactions in 13 young, healthy men (21 to 30 years old) after applying 2 types of cream on their forearms. The participants were told that one cream was a highly effective analgesic (“lidocaine”) and the other was a control cream. In reality, both creams were identical and pharmacologically inactive; the one labeled lidocaine was used to measure the placebo response.

Smoking cessation services should be integrated into substance use disorder treatment programs, according to David Kalman, MD, Department of Psychiatry, University of Massachusetts, and colleagues, in their recent review of tobacco dependency among patients who sought treatment for alcoholism.1

Some would ask whether the psychiatric system at Ft. Hood adequately assessed the mental state of Army Maj Nidal Malik Hasan, the man accused of yesterday's shooting rampage on the base.

Although rapid-cycling bipolar disorder has been linked to the use of antidepressants, these treatments may still have a role in the management of patients with bipolar depression, said Stephen V. Sobel, MD, clinical instructor at the University of California, San Diego School of Medicine, in a presentation at the U.S. Psychiatric and Mental Health Congress in Las Vegas.

Repetitive transcranial magnetic stimulation (rTMS) may be an effective therapy for treatment-resistant bipolar depression, according to the results of a recent pilot study led by Guohua Xia, MD, PhD, assistant clinical professor of psychiatry at the University of California, Davis.

Major depressive disorder is common during childbearing. Depression that interferes with function develops in an estimated 14.5% of pregnant women. Some statistics are troubling in that only 13.8% of pregnant women who screen positive for depression actually receive treatment.

A few simple steps can enhance your assessment of a patient’s suicide risk-and thereby reduce your own risk for liability if the patient does commit suicide. Phillip J. Resnick, MD, professor of psychiatry and director of forensic psychiatry at Case Western Reserve University in Cleveland, described those measures in a lecture today at the US Psychiatric Congress in Las Vegas.

Information transmission, such as blogs, RSS feeds, and podcasts, have emerged as common forms of communication. The exponential growth of medical knowledge and the increasingly rapid pace of scientific discovery have made it nearly impossible for the print medium to keep abreast of new developments.

A clinic for patients with bipolar disorder at Massachusetts General Hospital (MGH) was the scene of yet another attack by a patient on a psychiatrist.

With billions of dollars for electronic health record (EHR) technology purchases hanging in the balance, psychiatrists need to be paying attention to the Department of Health and Human Services (HHS) deliberations on the definition of “meaningful use.”

Hans Asperger considered the disorder a personality factor rather than a developmental issue. How things have changed.

I have elsewhere summarized the problems caused by the excessive and misdirected ambitions of the DSM-V effort.1 My purpose here is to suggest a different, more useful and attainable ambition for DSM-V-namely trying to integrate DSM-V and ICD-11 into one system. If successfully achieved, this would be by far the biggest accomplishment possible in this round of revision.

Appetite regulation is made up of complex interlocking, incentive-driven motivational hormonal and neuronal circuitries . . . that can be pulled in many directions, especially where food is cheap and readily available.

The article “Mental Health Professionals in the ‘Enhanced’ Interrogation Room” on the cover of this issue provides an invaluable service. It documents psychologists’ and physicians’ involvement in enhanced interrogation programs.

Notwithstanding the personal implications and its centrality to mental health professionals, in my 30 years of teaching and writing about the intersection of psychiatry and law, I had managed to avoid that rite of passage. I was not comfortable and found it difficult to say something original on a topic that has been so extensively explored.

Patients who exaggerate, feign, or induce physical illness are a great challenge to their physicians. Trained to trust their patients’ self-reports, even competent and conscientious physicians can fall victim to these deceptions.