News

Caregivers in high-pressure medical settings, such as intenstive care units (ICUs), can suffer from high levels of stress, resulting in emotional exhaustion, diminished empathy for patients, and decreased productivity.

A second opinion on the need for new warnings on attention deficit hyperactivity disorder (ADHD) drugs from the FDA advisory committee contradicts The Pediatric Advisory Committee recommendation.

In many situations, patients--even those who are acutely mentally ill--and physicians agree on a treatment regimen. In some cases, however, patients may disagree with the treatment after the fact or refuse treatment altogether. Although the physician's primary concerns are patient care and safety, the legalities of medicine are ever present and must be kept in mind. The following cases illustrate some of the medicolegal challenges that may arise in the emergency care setting.

The author continues his analysis, begun 25 years ago, of the use of polypharmacy versus monotherapy with an antipsychotic agent. Although antipsychotic polypharmacy has been condemned over the years, the practice nevertheless continues and has shown marked increase with the introduction of atypical antipsychotic agents.

Poetry from Dr Richard M. Berlin, professor of psychiatry at the University of Massachusetts Medical School.

The concept of Primum non nocere ("First, do no harm") is a cornerstone of medical education. This Latin phrase reminds physicians that medical treatments can potentially have both good and bad effects. Sometimes, the ultimate net benefit of an intervention is clear to both the physician and the patient, and treatment proceeds unimpeded by doubt. When the net benefit of a treatment is less certain, in most branches of medicine patient choice and self-determination play a major role in determining which "gray zone" treatments are appropriate. For the most part, this is also true in psychiatry.

An overview of the articles in this Special Report on psychopharmacology.

The search in identifying risk factors affecting cognitive health and longevity, including Alzheimer disease and other dementias, has broadened to include genes and lifestyle factors.

Differences between siblings are affected by internal representations and non-shared environmental influences such as gender, birth rank order, different peer influences, illnesses, and accidents.

Somatoform disorders (disorders that are not fully explained by a medical condition or mental disorder) may require psychiatrists to consult with physicians.

Pediatric psychosomatic research shows that emotional, behavioral, and psychiatric symptoms are found more often in children and adolescents with chronic illnesses than in healthy children.

Delirium must be diagnosed accurately, prevented, and treated because of its pervasiveness and the associated risks of morbidity and mortality.

Damage can take biologic, syndromic, social, and personal form, with correlations among the various levels of damage.

Evidence showing the effectiveness of psychopharmacologic and psychotherapeutic management of functional gastrointestinal disorders over standard medical treatment is increasing.

The perinatal period is a high-risk time for some women to experience a new onset or exacerbation of a mood disorder that may require emergency psychiatric care.

A discussion of the recent research on the use of antidepressants in bipolar disorder (BD), and the methodologic principles that should guide this aspect of psychopharmacology.

A discussion of the evidence that the pharmaceutical industry influences how physicians evaluate drugs in ways that encourage sales of their products and that are not always in the best interests of the patient.

Administering drug dosages that are clinically effective while causing minimal side effects is a challenge for physicians. The latest data on antipsychotics, antidepressants, and other psychotropic drugs in relation to brain occupancy and plasma levels are reviewed here.

There is a tendency to avoid psychiatric medications during pregnancy, but the high prevalence of psychiatric disorders in pregnant women means that women and their physicians must make impromptu decisions regarding the initiation or continuation of drug therapy.

This study examined national patterns in emergency department (ED) treatment of patients aged 7 to 22 years who were seen after episodes of deliberate self-harm. Data were from the 1997-2002 National Hospital Ambulatory Medical Care Survey. Population data from the 2000 US Census Bureau were used to estimate population visit rates for the age group studied.

Medical school graduation usually involves the Hippocratic Oath, in which physicians vow not to intentionally harm their patients. Keeping patients safe is another basic principle of patient care. Physicians are charged with ensuring that their patients are in a safe environment and minimizing risks to their patients by carefully selecting treatment options. In emergency psychiatric settings, patient safety is critical, especially when the patient is a danger to himself or herself or to others.

All physicians need to be aware of the medicolegal aspects of practicing medicine, but because emergency psychiatrists must sometimes treat patients against their will or act as consultants to determine capacity, they must be especially vigilant when dealing with the overlap between law and medicine.

Assessing a patient's capacity to make a decision about accepting or refusing a medical intervention should be performed quickly but systematically. Physicians from the department of psychiatry at the Mayo Clinic in Rochester, Minn, present a 3-dimensional model for evaluating capacity. This model includes the risk of the proposed treatment (high vs low), the benefit level of the treatment (high vs low), and the patient's decision about the treatment (accept vs refuse).

Psychiatric advance directives (PADs) allow persons to authorize proxy decision makers and document advance instructions or preferences about future mental health treatment in the event of a crisis. The intent of PAD legislation is to enhance treatment autonomy for persons with severe mental illnesses (such as schizophrenia, bipolar disorder, and major depression) who anticipate periods of decisional incapacity associated with illness relapse.

Trichotillomania (hair-pulling) was once thought to be rare, but recent estimates indicate that it affects 2% of people.

Dance Lesson - Poetry of the Times

The National Alliance for Research in Schizophrenia and Depression awarded the 2000 Nola Maddox Falcone Prize. A brief description of each recipient's contributions to research with affective disorders is given.

The authors discuss gender differences found in patients with schizophrenia. Their group is the first to explore the possibility that gender differences in schizophrenia are mediated by differences in integrative network activity, reflected in a synchronous phase of high frequency (40 Hz) gamma activity.

What does the new set of U.S. Public Health Service guidelines for treating tobacco dependence say? Should everyone, regardless of mental health status, receive treatment?

The authors argue that adopting a single payer system would be like jumping out of the fire and into the frying pan. They look at three perspectives-the doctor's, the patient's and the health care policy-maker's.