The increasing complexity and specificity of clinical trials, widely publicized research scandals and major advances in psychopharmacology have created a dilemma for academic institutions and private research organizations alike--how to find appropriate volunteers to participate in clinical drug trials. A major obstacle to patient recruitment is finding patients who are protocol-appropriate, said Nancy Hashim, affiliated with the Feighner Research Institute in San Diego.
Urging psychiatrists and other physicians to stay abreast of "what's going on in the youth culture," social psychologist Lloyd Johnston, Ph.D., explained that one of every 16 students entering high school has tried the potentially neurotoxic MDMA (Ecstasy) and among high school seniors, one-quarter are daily cigarette smokers and nearly one-third are frequent binge drinkers.
After a teenager's suicide attempt, her desperate and bewildered parents dragged her to a mental health clinic. The 16-year-old admitted to drinking nearly every day and using an assortment of other illicit drugs. Only after a month in treatment did the clinician learn that the teenager had been molested when she was 8 years old by an uncle and threatened with death if she ever told her parents.
The law and psychiatry are not disciplines that "fit together very easily," this is the essence of the debate that pervades psychiatry in death penalty cases. Ethical and moral issues faced by doctors practicing medicine clash with society's norms for ethical and moral behavior. At the same time, legal standards for insanity shift-often without regard to scientific advances or mental health advocacy.
The findings are disturbing. The Substance Abuse and Mental Health Services Administration (SAMHSA), in an effort to measure substance use and abuse among women, compiled data from its National Household Survey on Drug Abuse into a new report, Substance Use Among Women in the United States, which was released in September 1997. What they found is a worrisome indicator that substance use in this country is a significant problem for women, particularly among young girls ages 10 to 14.
Learning the Shapes - Poetry of the Times
At stake are not only apprehensions over quality patient care and staff safety, but also worries over what can only be described as zealously guarded turf prerogatives. Put into play are long-simmering disputes over the respective roles psychiatrists and psychologists should play in delivering mental health services. With California often a bellwether for national trends, the outcome of the dispute could have spillover effects throughout the country.
Addicts are people who have learned how to give themselves a quick chemical fix or achieve an emotional high when they either want to or have to change how they feel, and when they want to ignore real-life problems. Most people do that, but the next morning, they feel sick or foolish. They don't do it again because it didn't work for them. What makes addicts different is that they are willing-or feel compelled-to do it again and again even though they "know" that doing so will get them into trouble.
The investigators reported that "all 30 men stated that their sexual desire had decreased considerably and that their sexual behavior had become easily controllable." These self-assessments were given credence by the investigators for not only being consistent with other measures, but because the subjects were voluntary participants who were not required to initiate or continue the treatment study as a condition for leaving jail or avoiding prosecution.
In May 1997, a young Rwandan girl came to a clinic in Kigali reporting nausea and the feeling of insects crawling on her face. She complained of the strong smell of feces and grew increasingly agitated and fearful, describing vivid images of people trying to kill her at that moment. For months she had vomited at the sight of avocados, and for three years she had been unable to tolerate the sight of rice.
Nothing is sacred in America's pop culture. So when it embraces any topic, we've grown used to the relentless distortion that occurs, one that transforms reality into an odd combination of fact and fantasy.
PTSD - Poetry of the Times
In the two years since receiving a $1.5 million private grant from William and Joy Ruane to study the effects of psychiatric medications in children and adolescents, the division of child psychiatry at New York State Psychiatric Institute (NYSPI)-the nation's oldest psychiatric research facility-has opened a pediatric psychopharmacology research unit and established a federally supported research unit in pediatric psychopharmacology (RUPP), one of the first in the United States.
The program, Strong STARTS (Schools Taking Action to Reach Troubled Students), is a model initiative targeting the growing number of adolescents suffering from untreated emotional disorders that impact academic performance, social achievement and positive lifestyle choices. The program's fall kickoff seminar began with a keynote address by Alvin Poussaint, M.D., clinical professor and faculty associate dean for student affairs at Harvard Medical School, and featured focus sessions and panel discussions by national and local experts.
There is a substantial constituency for alternative medicine. Worldwide, 70% to 90% of all health care "ranges from self-care according to folk principles, to care given in an organized health care system based on an alternative tradition or practice." As many as one-third of all Americans are reported to have some belief in alternative medicine or to be actively using nonmainstream remedies.
All families have such belief systems, which include expectations, values, attitudes-the basic assumptions-that govern family interactions. Because they determine the structure and organization of a family, the traditions they follow, the rules they abide by, and the values they hold, these beliefs shape the kinds of problems a family has and how they go about trying to solve them.
My Bosnian psychiatric colleagues reported to me that there was the usual adolescent stew of identity crisis among them: delinquency, drugs and sex; but also much, much more. I asked the students, "What do you suffer from?" Lack of opportunity was mentioned most often. A few said that they wanted someone to talk with when it all got to be too much. They welcomed the new school-based initiative of the adolescent mental health clinic in Sarajevo.
Although adoption dates back centuries, the issue of whether or not adopted children are at risk for psychological maladjustment remains controversial. That this dispute would occur at all is not surprising, since as recently as 1926 laws which liberalized adoptions in England were faced with a widespread objection that adoption would encourage depraved conduct.
Today, average young adults report sleeping about seven to seven and one-half hours each night. Compare this to sleep patterns in 1910, before the electric lightbulb, the average person slept nine hours each night. This means that today's population sleeps one to two hours less than people did early in the century.
Previous research on the effects of early child care had led to controversy and confusion. The most provocative finding was that when infants were in nonmaternal child care 20 or more hours a week, starting in the first year of life, they were less likely than infants without such experience to form a secure emotional attachment to their mothers.
Acyclovir (Zovirax) Amphetamines Anticonvulsants Asparaginase (Elspar) Baclofen (Lioresal) Barbiturates
There is and has been much debate about the issue of assisted suicide as physicians, lawyers and lay people argue the pros and cons of assisting in someone's death. The physician who agrees to participate in this endeavor points out that his or her concern is to alleviate suffering. Notwithstanding that, painkillers are notoriously prescribed in inadequate, understrength doses; people with serious illness who are depressed are considered unlikely candidates for treatment of their depression because, sayeth the physician: "It is only natural, understandable, to be depressed with that kind of terrible illness."
On the surface, mental health parity does not appear to be controversial. Why should insurance companies and government insurance discriminate against patients with psychiatric problems? Making an artificial separation between psychiatric and medical illness makes little clinical sense. It is also clear that the treatment of psychiatric disorders often decreases physical symptoms, resulting in fewer visits to nonpsychiatric physicians. Cost estimates for mandating parity, although widely divergent, have generally been thought to be low. However, many seemingly benign regulations can often result in unforeseen costs and negative effects.
For elders confronted with the necessity of living in a nursing home, the choice of facility is a decision with profound consequences-for their health, their quality of life and their family finances. Nursing home care may cost $50,000 a year or even more, and more than half of all elders begin their nursing home stays by paying the costs out of pocket. That imposing sum can purchase excellent care, or can pay the rent for a place that is literally "worse than death" for the unfortunates who live there.
A lawsuit brought on behalf of the 600,000-member United Seniors Association (USA) and four individual Medicare recipients last December may turn the Washington, D.C., federal court where it was filed into the latest health care battleground. The issue: Does a patient's right to choose a physician outweigh the federal government's efforts to regulate health care provided to the elderly?
The ERISA shield has become a favorite of employers and benefits providers, because its overwhelming effect is to reduce the situations in which they can be held legally responsible for misdeeds. Even in cases where a violation can be established, the statutory penalties are insufficient to make bringing cases to court worthwhile, or are inadequate to deter future improper conduct. Efforts over the years to enact an amendment to ERISA have failed because of powerful lobbying by business and health care interests. re reluctant to utilize, inform or confront their care providers, impairing collaboration in treatment.
This year at the 10th Annual U.S. Psychiatric & Mental Congress, CME LLC honored deserving recipients with the prestigious "Lifetime Achievement Award." The award winners for 1997 were recognized during a presentation ceremony in Orlando, Fla., in November.
Every evening, just when quiet comes, she awakens on the prowl.
It is estimated that 60% to 70% of American people who have health insurance have a plan which falls under the provisions of the Employee Retirement Insurance Security Act of 1974 (ERISA). ERISA was designed to protect and enhance pensions and benefits for employees of nationwide companies, and was heavily lobbied for by business as more and more employers established facilities in multiple states.
Depression, subcortical dementia and normal aging: all three may have similar neurobehavioral manifestations. So how does a clinician make a differential diagnosis?
