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Schizophrenic patients treated with olanzapine (Zyprexa) required less health care services and incurred less overall health care costs over a 28-week period than patients treated with risperidone (Risperdal). This was the result of a study presented by Eli Lilly and Company researchers at the European College of Neuropsychopharmacology meeting held in Paris from Oct. 31, 1998 to Nov. 4, 1998.

Other Hormones on Behavior - Poetry of the Times

One day after Eli Lilly and Company researchers reported finding olanzapine (Zyprexa) superior to risperidone (Risperdal) on some measures in a 28-week comparative study presented to the American College of Neuropsychopharmacology (ACNP) meeting in 1996, Janssen Pharmaceutica Inc. issued a press statement critical of the methodology and results of the study. Janssen then announced it would undertake its own comparative trial. The results of this trial's initial eight-week acute treatment phase were presented at the European College of Neuro-psychopharmacology meeting held Oct. 31, 1998, through Nov. 4, 1998, in Paris. They indicate risperidone has an advantage for positive symptoms such as hallucinations and delusions, and for anxiety/depression in patients with schizophrenia and schizo-affective disorder.

For her work in establishing the Dialectic Behavioral Therapy (DBT) model for use with chronically suicidal individuals suffering from borderline personality disorder (BPD), Marsha M. Linehan, Ph.D., is this year's recipient of the annual research award given by the New York City-based American Foundation for Suicide Prevention (AFSP).

Proposed in December 1998, the merger has turned Aetna into a managed care powerhouse providing coverage for about one in 11 Americans and having contracts with some 400,000 physicians, more than half the national total. This concentration of economic power, opponents charge, will substitute profit-driven "minimally acceptable clinical guidelines" for treatment plans determined by physicians operating in their patients' best interests. Mental Health Threatened by Aetna/Prudential Merger

Ownership of the human genome-or, more exactly, access to the tools and databases necessary to make sense out of the millions of bits of information that make up the estimated 100,000 human genes-constitutes one of the hottest scientific debates in the public policy arena. On one hand is the Human Genome Project (HGP), a worldwide consortium of governments and their supported researchers who are mapping the 23 pairs of human chromosomes and are determining the complete nucleotide sequence, involving 3 billion base pairs of DNA.

The benefits of psychotherapy in treating the chronically suicidal patient, as well as strategies that can help the potential suicide patient imagine and reflect others' reactions to this most final of acts, was the subject of a conference by Glen O. Gabbard, M.D., at the 11th Annual U.S. Psychiatric & Mental Health Congress. Gabbard is the Bessie Callaway Distinguished Professor of Psychoanalysis and Education at the Karl Menninger School of Psychiatry and Mental Health Sciences.

Whenever a Stanley Kubrick film opens, it is an event. Kubrick, who is considered by many the cinematic genius of the 20th century, made 15 feature films. The eager anticipation surrounding his last film "Eyes Wide Shut," scheduled to be released this summer, has intensified even further because of Kubrick's unexpected death last March at the age of 70. Although the film is shrouded in standard Kubrickian secrecy, leaks suggest that Tom Cruise and Nicole Kidman play psychotherapists who are sexually involved with their patients.

Tina, a 35-year-old legal secretary, is admitted to the hospital hearing voices that demand she gouge out her own eyes as punishment for having lived a sinful life. She was seen in the local emergency room prior to admission, both for involuntary certification and treatment for corneal damage from having attempted to harm herself. She states to the admitting psychiatrist, "If thine eye offend thee, pluck it out!"

Postcard from Auschwitz - Poetry of the Times

For her work in establishing the Dialectic Behavioral Therapy (DBT) model for use with chronically suicidal individuals suffering from borderline personality disorder (BPD), Marsha M. Linehan, Ph.D., is this year's recipient of the annual research award given by the New York City-based American Foundation for Suicide Prevention (AFSP). Linehan is professor of psychology and adjunct professor of psychiatry and behavioral sciences at the University of Washington.

This article addresses several important theoretical issues related to dynamically oriented psychotherapy. These issues include the therapeutic alliance and transference, the authority of the therapist and neutrality, the stability of the therapeutic environment, countertransference, empathy, and basic strategy. Efforts are made to present these issues in a contemporary context.

Psychiatry residents want and need solid training in psychotherapy in order to best serve their patients and to remain competitive in the mental health marketplace, concluded a March conference sponsored by the American Psychiatric Association's Commission on Psychotherapy by Psychiatrists (COPP). The event, entitled "Integration and Specificity in Psychotherapy Education," drew 120 training directors, residents and faculty from around the country, and represented approximately 40% of U.S. residency training programs.

Until the last half of this century, there were few if any treatments that seemed consistently effective in responding to the clinical needs of individuals who were abusing or dependent upon alcohol. As a result, support or self-help groups emerged. Alcoholics Anonymous is an extraordinary example of these groups.

Even the threat of criminal prosecution didn't dissuade CBS from broadcasting a "60 Minutes II" investigation called "Unsafe Haven," an hour-long report that chronicled alleged abuses committed "in more than 20 Charter Hospitals." A last-minute effort by Charter Behavioral Health Systems, the nation's largest provider of inpatient mental health services, to obtain an injunction against the April airing failed, but not without the judge in the case taking some legal swipes at CBS.

Crossing the Street - Poetry of the Times

In this incredible era of breakthroughs in neuroscience and its applied therapies, psychiatrists have been recognized as leaders and pioneers in battling the previously elusive maladies of the human condition. In the darkness, people instinctively follow the person carrying the lantern. As a consequence, I am not necessarily sure where we're going.

Although the exact etiology of premenstrual syndrome (PMS) remains unknown, it appears to be a chronic mood disorder that continues for many years in reproductive-age women. Approximately 2% to 10% of cycling women report severe symptoms resulting in a disruption of work or relationships.

Only one month after the American Medical Association unveiled a major reorganization of its science and technology departments-one that included the dismantling of its department of mental health-the former director, psychiatrist Larry Goldman, M.D., was fired after he criticized the changes.

Recent advances in the treatment of mental and addictive disorders, along with research findings in basic neuroscience, molecular genetics and molecular biology that contribute to the understanding of such disorders, were discussed at the American College of Neuropsychopharmacology's 37th annual meeting in Puerto Rico. The following are brief reports from selected presentations.

According to one estimate, 42,000 of the 757,000 practicing physicians in the United States-roughly 5.5%-were members of a union by the middle of last year. That number appears to have grown. The union movement is sweeping the medical profession around the country.

More than 80 medications are in development to treat mental illnesses, including 18 for depression, 15 for schizophrenia and 16 for anxiety disorders, according to the Pharmaceutical Researchers and Manufacturers of America (1998). Which ones will most likely come to market in the United States?

Psychogenic excoriation (also called neurotic excoriation, pathologic or compulsive skin picking, and dermatotillomania) is not yet recognized as a symptom of a distinct DSM-IV disorder.

Without clear guidance from government regulators, mistakes are easy to make and, rather than raising concerns in a businesslike fashion, the first notification of a problem often comes when the enforcement action shows up at the door.

Rough Air

Marc Schuckit, M.D., professor of psychiatry at the University of California, San Diego, School of Medicine, examined recent developments in the treatments for alcohol and drug dependence, and examined important changes in DSM-IV's classification of substance use disorder at the 11th Annual U.S. Psychiatric & Mental Health Congress.

This article addresses several practical issues related to beginning psychotherapy: telephone contact, the initial session, referral to another therapist, discussion of arrangements, charging for missed sessions, guidelines for the patient and interactions outside the therapy hours. It takes a question-and-answer form, dealing with with questions a neophyte psychotherapist might ask. Although the article specifically relates to treatment that is dynamically oriented, it is also relevant to other forms of psychotherapy.

Myron Liptzin, M.D., is a respected psychiatrist who specialized in the treatment of university students. Liptzin retired last year as chief of psychiatry of student health at the University of North Carolina at Chapel Hill, where he had earned a reputation as a skillful clinician who was particularly adept at crisis intervention. If Liptzin had hoped to go on to a less hectic and stressful life, his expectations were shattered when he found himself accused of negligence in one of the most unusual cases of psychiatric malpractice of this century. A former patient went on a rampage-killing two people-and then blamed Liptzin. The verdict against the psychiatrist was front-page news, and CBS's "60 Minutes" went to North Carolina to do a story that aired mid-November 1998. Like a bolt out of the blue, Liptzin had gotten his 15 minutes of unwanted fame.

DeAndra's story: I came into the rooms and realized after a while that I had the attitudes and behaviors of an addict way before I ever picked up a drug. I remember growing up and being at my family's parties, [where] my aunts and uncles would give me and my brothers beer. There are pictures in our photo albums of us, all under 6 or 7, with cans of beer in our hands. At an early age I learned to manipulate to get what I wanted.

Psychiatrists, like the rest of America, continue to have trouble with alcoholic and other addicted patients. We are comfortable when patients want to get better, tell us the truth and come to treatment of their own free will, but alcoholics often don't fit this profile. We respond angrily when patients manipulate us. We are surprised when their sincere desire for help evaporates after we suggest a plan that will bring about real change.