Psychiatrists were among the chief physician beneficiaries of the Medicare bill (HR 6331) that Congress passed in July. The Medicare Improvements for Patients and Providers Act of 2008 included an historic elimination of the discriminatory co-pay for Medicare outpatient mental health services.
ADHD, the most common diagnosis in child psychiatry, appears to be more challenging to diagnose and treat when there is a comorbid depressive disorder.
Regular interval administration of outcome measurement tools has proved to be beneficial in improving the quality of care that we all hope to provide for our patients.
In his review of my book, Doing Psychiatry Wrong: A Critical and Prescriptive Look at a Faltering Profession (Psychiatric Times, June 2008, page 57), S.N. Ghaemi, MD, MPH, citing George Orwell, writes that I “seek to justify an opinion” rather than “seek the truth.” He claims that my “errors are numerous and fundamental.”
I was dismayed by the article by Dr Antonuccio and colleagues (“Common Augmentation Strategies for Depression,” Psychiatric Times, March 2008, page 21), in which they warned us against using augmentation strategies for treatment-resistant depression in the face of a lack of studies that show the efficacy of such strategies. They argued that this is not evidence-based medicine. Far be it from me to be a proponent of “contrary to evidence-based medicine.” I certainly agree that evidence-based controlled studies of each and every reasonable augmentation strategy would be wonderful.
Here I will discuss several examples of recent, reasonable depictions of ECT in the media, and I will suggest how they could represent a shift in the way that this “controversial” therapy is regarded. I use the word “controversial” advisedly, because even on the day I write this, a newspaper article on deep-brain stimulation, in which ECT is described, reads: “New reports this month show that some worst-case patients-whose depression wasn’t relieved by medication, psychotherapy, or even controversial shock treatment-are finding lasting relief.
A recent decision by Pfizer to eliminate all direct funding for continuing medical education/continuing education (CME/CE) programs conducted by commercial providers including medical education and communication companies (MECCs) raises questions about whether it is an isolated action or a signal that MECCs will no longer conduct business as usual
The Golden Gate Bridge in San Francisco has the regrettable distinction of being the number one spot for suicide in the world. There have been more than 1300 known suicides from the bridge, and in 2007 at least 35 people committed suicide by jumping off the Golden Gate Bridge, more than in any other year.
Psychiatrists may encounter patients who present with severe emotional consequences because they are victims of stalking. In addition, psychiatrists themselves are at increased risk for becoming victims of stalking because of the nature of their profession and their interaction with lonely and unhappy individuals.
After I slippedmy finger inside and feltdeath’s rough stoneI knew I should grantthe old man’s wish:“Just cut my toenails.”Down on my kneesI admired them, thickas a silver dollar,long and curved asthe shofar, the ram’s hornJews blow on judgment day.And I was dressed in whitelike Yeshua, Jesus, my favoriteJew, a healer I knewwould have been downon his knees with me,worshipping the beautyof an old man’s body.
In this column, I will discuss new progress on this Internet-boosted line of inquiry. I will begin with a few basics about differential gene expression and microarrays and will then move on to something that researchers are calling “convergent functional genomics.” As you shall see, the clever use of online databases both confirmed and extended the work done at the bench.
The editors of Diagnostic Manual-Intellectual Disability (DM-ID) have set out to complete the difficult task of compiling the evidence base on mental disorders in the field of intellectual disability (ID) into one reference book while modifying DSM-IV diagnostic criteria for use in persons with the disorder who present with mental and behavioral disorders.
Elder abuse is a concern for all practitioners who care for elderly patients or their family members. An elderly person’s fears of aging and dependence may be heightened by stories and news accounts of abuse.
This article focuses on recent innovations in diagnostic issues, tactics, and strategy, and takes a brief look at the future.
The fact that treatment with interferon (IFN)-α has become the world’s foremost human model for studying how the innate immune system promotes depression points to a disturbing clinical truth: patients who elect to receive (IFN)-α therapy for any of the several disease states to which it is applied face a high likelihood of experiencing a multitude of psychiatric symptoms severe enough to affect their social and occupational functioning and overall well-being.1
In our own time, many so-called conflicts of interest (COI) boil down to temptation, as James DuBois,3 professor and department chair of health care ethics at Saint Louis University, notes in his excellent chapter on this subject. A physician-researcher is tempted to slant the results of his or her study in order to maintain funding from a medical technology company.
Over 55 years ago, I graduated from the then almost new University of Texas Southwestern Medical School in Dallas and went off to Boston and the Brigham to be a straight medical intern. I had been married for 2 years, and my wife was pregnant with our first child-neither of us knew a soul in Boston. I was on duty for 36 of each 48 hours (except for 1 weekend a month) and was of little help to my wife, who was alone in a strange city and was facing the imminent birth of our first child.
Recent research emphasizes our need for better understanding of the interface between the specialties of psychiatry and medicine. Psychiatrists need to monitor emerging work that highlights the need for both a neuroscientific and medical perspective in the management of complex disorders.
After a formal complaint alleging malpractice is made, the discovery phase of the litigation process begins. Discovery is the process in which the parties to a lawsuit go about gathering information before trial. The rationale behind discovery is to reduce surprises at trial and to encourage settlement before trial. Methods of discovery include written interrogatories, requests for documents, and depositions of various witnesses.
Universal prevention has been a focus of psychiatric research for the past 4 decades. Using a public health approach, research has shown that mitigating major risk factors, such as poverty and early life stress, and promoting protective factors can improve behavioral outcomes.
Ninety percent of patients with psychiatric disorders are seen in the general medical sector. Two-thirds of these patients receive no treatment for their psychiatric illness. Of the one-third that does, only one-tenth is provided minimally adequate treatment.1 Furthermore, nontreatment or nonevidence-based treatment of psychiatric disorders in the primary care setting is associated with at least double the total health care costs for patients, mainly from increased general medical care and nonpsychiatric prescriptions.2,3
The term “domestic violence” emerged in the United States with the rise of the women’s movement in the 1970s. Before that, violence between partners was considered a private matter. A specific type of domestic violence, intimate partner violence, refers to violence between intimate partners. Public awareness campaigns help us identify one type of intimate partner violence in which one partner, typically the male partner, is the aggressor, and the other partner, typically the female, is the victim.
Trust can be a scary proposition. Among other characteristics, trusting someone involves the ability to measurably predict a behavior on the basis of nothing more than a memory, an impression, or a whim. For creatures like us, who spend a ridiculous amount of time with unpredictable strangers, brokering trust is an oddly important survival strategy.
Debates over conflicts of interest (COIs) in medical research and practice are intensifying with recent proposals to ban industry funding of medical education, to better “manage” industry-physician relationships, and to mandate public disclosure of industry payments to physicians and medical institutions. Caught in the cross fire are prominent psychiatrists accused of underreporting payments received from pharmaceutical companies.
he key manifestations of DSM-IV somatoform disorder are unexplained physical symptoms or complaints that tend to coexist with other psychiatric syndromes or are linked to psychological issues. These symptoms typically lead to repeated medical or emergency department visits; are associated with serious discomfort, dysfunction, and disability; and lead to significant health expenditures.
Polypharmacy is used increasingly in the treatment of depression.1 Although it can be beneficial-and at times may even be unavoidable-it can also be overused, resulting in drug-drug interactions, accumulation of adverse effects, reduced treatment adherence, and unnecessary increases in the cost of health care.2 This article describes current trends in psychiatric polypharmacy in the treatment of depression along with ways to use polypharmacy to optimize treatment outcomes.
Cynthia Geppert has done it again! She has written a timely article that expresses what I have thought for a long time (“Why Psychiatrists Should Read the Humanities,” Psychiatric Times, February 2008, page 10). Recently, I was sitting in a nonscience course for first-year medical students wondering why it was difficult for some of them to respond to the professor’s questions.
This review provides an overview of the efficacy, safety, and mechanisms of action in the treatment of depression.
While tremendous therapeutic advancements have been made, patients with rheumatoid arthritis (RA) have a myriad of comorbidities, including fatigue, depression, and sleep disturbances. Data on the comorbidity of psychiatric disorders with arthritis are also striking: according to the NIMH Catchment Area program, the lifetime prevalence of psychiatric disorders among patients with RA is 63%.
When I started out in medicine,before I married and beforeI had written a single poem,I read your poetry like a hiker