Splitting, archetypally imbedded in a patient's psychic structure, acts as a powerful unconscious force to protect against the ego's perception of dangerous anxiety and intense affects. Rather than providing real protection, splitting leads to destructive behavior and turmoil in patients' lives.
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What does the term “polypharmacy” actually mean? Dr Pies likens polypharmacy to fire: just as the latter may either heat your house or burn it down, polypharmacy may either help or harm the patient.
A discussion of the pharmacologic management of bipolar depression, including emerging treatments and expert recommendations.
Patients with OCD generally respond best to cognitive-behavioral therapy (CBT). At the core of the behavior therapy program is a technique known as exposure and ritual prevention (ERP).
While the ban on same-sex marriage is hotly debated between conservative groups and lesbians and gay men, several psychiatrists are researching and discussing how denial of same-sex marriage impacts mental health.
A look at how to use the spectrum concept to promote understanding and acceptance of bipolar II and soft bipolar diagnoses. In this article, you will find 5 tools for fostering what has been called “concordance” or, more simply, “buy-in.”
Can sociodemographic and clinical variables predict outcome in cases of schizophrenia? Results from studies related to prognostic variables for schizophrenia have yielded interesting yet inconsistent results.
Although psychosis is rare in adolescent patients with anorexia nervosa restricting type, the possibility should be explored because it may be the underlying cause of the eating disorder.
Could the content of television shows give you a common platform for discussing interests and experiences with your patients?
There are still many questions about how to develop useful guidelines, introduce them into clinical practice, and measure their effectiveness. What does it mean to use a guideline in practice?
The past few years have seen substantial progress in recognizing and treating several of the subtypes of bipolar disorder. This Special Report addresses the diagnostic challenges and the different strategies for managing these subtypes.
A review of the diagnosis and treatment of complex regional pain syndrome (CRPS).
A discussion of the many difficulties in treating patients with the rapid-cycling subtype of bipolar disorder, along with a history of the condition and the author’s treatment approach.
A report from the Government Accountability Office supports an earlier accusation in the New England Journal of Medicine that the FDA is failing to protect the public from unsafe drugs.
New ways to address medication adherence problems in patients with schizophrenia offer the hope of better treatment outcomes. Two new and promising approaches for individuals with schizophrenia are the use of environmental supports and cognitive adaptation training and cognitive-behavioral therapy.
The connection between social policy and the treatment of addiction was the topic of several symposia at the 37th annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM).
Three issues of current concern in bipolar II disorder include: diagnostic criteria for hypomania, diagnosis of mixed depression, and management of mixed depression.
Bipolar disorder I and II have the highest association with substance use disorder, compared with any other major psychiatric disorder. Treatment requires an integrated approach that includes specific psychotherapy as well as the use of medication.
A discussion of the development of the brain and whether neurobiology of the brain can play a role in predicting risk for future bipolar disorders and substance use disorders SUDs.
With an application to certify its use in depression before the FDA, transcranial magnetic stimulation (TMS) has become a hot topic in the expanding field of device-based treatment modalities.
The publication of a major new textbook is an important event in any discipline, but the arrival of Psychosomatic Medicine is a particularly exciting development for clinicians working in the interface between psychiatry and medicine.
Questions concerning the adequacy of mental health care for returning Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans continue to capture congressional attention. The latest reminder was a Government Accounting Office (GAO) report issued in May stating that of the 5 percent of returning veterans between 2001 and 2004 who tested as being at risk for posttraumatic stress disorder (PTSD), only 2 percent were referred by Department of Defense (DOD) health care providers for further mental health or combat/operational stress reaction evaluations.
According to the Substance Abuse and Mental Health Services Administration, emergency department (ED) visits related to medical and psychiatric complications of methamphetamine use increased nearly 75% between 1999 and 2002. Because methamphetamine can be manufactured locally from common household ingredients, users and producers are often one and the same. Users can experience various injuries to multiple body systems as well as psychiatric symptoms, since methamphetamine is a neurotoxin; producers are also at risk for injuries from fires and explosions that result when volatile chemicals are combined.
When I was young, we had a neighbor named Frank. A proud father of 5 and a trusted employee at the local mill, Frank lived an apparently peaceful and happy life together with his wife, Kay. Frank had a secret, however.
Electronic medical records (EMRs) are becoming increasingly common in health care. Many hospitals use computer systems for some aspects of patient care, including gathering demographic and insurance information, posting laboratory results or radiology reports, providing access to transcribed dictations, and listing currently prescribed medications.
Since its initial description by Kahlbaum (1828-1899) over a century ago, catatonia has been associated with psychiatric, neurologic, and medical disorders. Contemporary authors view catatonia as a syndrome of motor signs in association with disorders of mood, behavior, or thought. Some motor features are classic but infrequent (eg, echopraxia, waxy flexibility) while others are common in psychiatric patients (eg, agitation, withdrawal), becoming significant because of their duration and severity.
The incidence of child and adolescent psychiatric emergencies has increased over the past 20 years. This rise in emergency department (ED) mental health visits coincides with an overall increase in ED use from 89.8 million visits in 1992 to 107.5 million visits in 2001. Psychiatric presentations by children and adolescents (often in the absence of medical complaints) account for up to of the total visits to an ED in a given year and, in some reports, such presentations account for as many as 16% of ED visits.
