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
Drugs approved by the FDA just before mandated deadlines are more likely to have safety issues after entering the market than those approved at other times, according to a study in the March 27 New England Journal of Medicine.1 Coincidentally, on that date, the FDA announced the first group of marketed medications, including the atypical antipsychotic clozapine (Clozaril), for which it is requiring additional safety plans under the FDA Amendments Act of 2007.
Congress will undoubtedly set aside, one more time, a scheduled, drastic cut in Medicare fees for psychiatrists and all other physicians sometime this summer based on action in Congress before its Fourth of July recess. The House and Senate almost agreed to replace the 10.6% cut in fees scheduled for July 1 with a 1.1% increase through the end of 2009. But various political difficulties interceded, and the Bush administration stepped in and ordered a 10-day halt to any fee cuts until Congress returned to Washington.
The estimated number of patients with cancer in this country is 10.5 million. Close to a million and a half are new cases, and it is estimated that 560,000 people die of cancer each year.1 There is clearly a large group of cancer patients and their families at high risk for serious psychiatric illness. In this article, I focus on the advantages of a psychodynamic approach and address how this approach is helpful in the liaison function and psychotherapy of cancer patients and their partners.
The Supreme Court has staked out new legal ground by ruling that a judge has the right to deny a patient with schizophrenia (or anyone with a mental illness) the right to represent himself or herself in a trial-even though the court deemed him mentally qualified to stand trial.
Depression is a risk factor for cardiovascular disease and death in many ways, directly and indirectly. It is independently linked to smoking, diabetes, and obesity-all of which are risk factors for coronary heart disease (CHD).1 Depressed patients are more likely to be noncompliant with treatment recommendations, including diet, medications, and keeping appointments, and are more likely to delay presentation for treatment with an acute coronary event.2-4
Agitation in older adults is frequently associated with multiple psychiatric and medical conditions and comorbidities. It commonly occurs in patients with anxiety, affective illness, psychosis, dementia, stroke, brain injury, delirium, or pain.
We are growing older. In ancient Greece, the expected life span was 20 years. In Medieval Europe, it went up to 30 years. In 1900, people reasonably could expect to live to the ripe old age of 47 years, and 39% of those born at that time survived to age 65 years in the United States. Currently, the average life span in the United States is 78 years, and 86% of those born will survive to age 65 years. The very old-people older than 85 years-are the fastest-growing population group in the country, and there are 120,000 Americans over the age of 100 years. And the trend continues.
Education is a cornerstone for the effective treatment of bipolar disorder. The Bipolar Disorder Answer Book is a recent addition to the resources available for patients and their families. Each of the newly emerging self-help books offers different perspectives and emphasis. This book sets out to cover a broad range of relevant topics. Although it begins with the usual discussion of diagnosis and treatment, it quickly moves on to specific issues, such as securing care (both outpatient and inpatient), relapse prevention, comorbid illnesses, “survival tips” for friends and family, insurance coverage, and disability resources.
A review of targeted treatment strategies for symptom domains when impulsivity and compulsivity become dysfunctional.
Although Demystifying Love: Plain Talk for the Mental Health Professional is economy-sized at 200 pages, the book is a useful attempt by the well-known psychiatrist and sex therapist Stephen Levine to condense a lifetime of knowledge from clinical practice, personal growth, and extensive reading about a complex subject. Not surprisingly, his case vignettes remain uppermost in the memory while the whirlwind tour of the many meanings of love, processes of getting into and out of love, erotic transference, psychological intimacy, and sexual desire gets a bit blurry
Success with new approaches to the psychotherapeutic treatment of borderline personality disorder (BPD) and other DSM-IV personality disorders has been reported in several studies recently, raising hopes that an intractable set of illnesses may not be as hopeless as once thought.
Northwest light, pine trees and open sea,a pair of eagles circling Manana Island,the Laura B gliding into harbor,picking up mail and passengers for the tripinshore, the sound of the sea poundinggranite cliffs, cries of ravens and gulls,one last summer fly buzzing at the window,a room arrayed with easels, drying racks,brushes and brooms, the smell of spirits
The guideline divides the therapies it reviewed into nonpharmacological, nonsurgical, and pharmacological categories. The nonpharmacological category includes a wide range of modalities from treatments that patients can perform themselves, such as yoga and exercise, to psychotherapy, acupuncture, and a variety of physical therapy techniques, including heat and laser treatments.
Depression complicates medical illnesses and their management, and it increases health care use, disability, and mortality. This article focuses on the recent research data on diagnosis, etiopathogenesis, treatment, and prevention in unipolar, bipolar, psychotic, and subsyndromal depression.
This month I will examine the relationship between alcohol use disorder, stress, and a neuropeptide called substance P (SP). The data that led directly to research with human subjects came from the mouse-based genetic manipulation of a gene called neurokinin-1 receptor (NK1R), the receptor for SP. To understand this research thread, I will need to review some basic biology behind a class of biochemicals called tachykinins, of which SP is its most famous member. I begin, however, with an attempt to understand the relationship between the experience of stress, relapse rates in alcohol-dependent populations, and how mouse research ended up helping a cohort of stressed-out patients.
Two recent studies present clinical evidence that the use of stimulants to treat boys with attention deficit hyperactivity disorder (ADHD) does not increase their risk of later substance use disorders. This evidence provides clinicians and families with much needed reassurance.