While managed care generally has limited inpatient care and contained short-term costs for mental health and substance abuse services, significant questions remain about how these changes in health care delivery affect the quality of care patients receive.
To understand how mental health law is changing, one must begin with a sense of its traditional orientation. The underlying principle of the law that governs psychiatric practice has been that patients require protection from unjustified restrictions on their liberty, especially at the hands of the state.
Meeting the mental health needs of the millions of immigrants from diverse cultural backgrounds and homelands who now live in the United States may require more than a thorough knowledge of psychiatry or psychology, according to a number of cultural psychiatric practitioners.
The advent of the new millennium has stimulated many discussions about what changes can-and should-occur in the world. For social psychiatry, there could not be a more fortuitous time to review and reaffirm our role in this country's health care.
Breaking the News - Poetry of the Times
The passage of the Mental Health Parity Act of 1996, which took effect Jan. 1, 1998, came amid dire warnings from edgy business groups that it would cause exorbitant cost increases in health insurance premiums or prompt a dramatic reduction of medical and surgical benefits. But a recently released report emphasized the affordability of mental health insurance coverage.
This month establishes a milestone for CME LLC Not only is it the company's 11th annual U.S. Psychiatric & Mental Health Congress, it also marks the 20th anniversary of the company's first conference. CME LLC grew out of a desire to reach and educate more people regarding psychiatric issues. One way to do this was by developing high-quality continuing education opportunities.
Apology - Poetry of the Times
The Health Care Financing Administration (HCFA), the agency responsible for administering the burgeoning Medicare program for the elderly, announced a nationwide crackdown on community mental health care centers (CMHCs) in September, signaling increased efforts to curtail fraud, error and abuse.
The dynamically informed psychotherapies can be thought to occur on a continuum, with the most insight-oriented and exploratory types at one end and the most supportive types at the other. Psychoanalysis proper stands at the end of this continuum, followed by analytically oriented psychotherapy, then dynamically oriented psychotherapy. Within this classification, analytical oriented psychotherapy and dynamic oriented psychotherapy are two quite distinct, yet related, forms of therapy.
Organ donation from brain-dead patients has become a psychiatric issue in Japanese transplant medicine. Brain death is recognized as human death only in the context of organ transplantation in Japan. Since many Japanese physicians deny that brain death constitutes the death of an individual, there is no solid, general consensus in Japan about what constitutes brain death.
The poet must remember that it is his poetry which bears the guilt for the vulgar prose of life, whereas the man of everyday life ought to know that the fruitlessness of art is due to his willingness to be unexacting and to the unseriousness of the concerns to his life. The individual must be answerable through and through: all of his constituent moments must not only fit next to each other in the temporal sequence of his life, but must also interpenetrate each other in the unity of guilt and answerability-M.M. Bakhtin, 1919
An investigational compound that blocks the neurokinin "substance P" has demonstrated robust antidepressant effect in preliminary clinical testing against paroxetine (Paxil) and placebo. This finding has been described by as "a breakthrough discovery" in mental health care.
Only in recent years has the widening scope of domestic violence achieved such national prominence. Highly publicized cases like the Nicole Brown Simpson murder have brought the issue of domestic violence to worldwide attention. Overall rates of violence against women, including both lethal and nonlethal violence, are much higher.
Psychotherapy as a sole treatment for noncoerced opioid addicts in outpatient settings has been shown to have little patient interest and low chances for success. However, when integrated into a treatment plan that includes methadone maintenance and drug counseling, it can be associated with additional benefits for patients who have moderate to severe levels of psychiatric symptoms.
In view of the fact that support is an important aspect of all models of psychotherapy, it is remarkable that beginning practitioners are not taught how to be supportive. Only limited attention has been paid to discussion of the principles underlying supportive interactions. It seems to be taken for granted that good sense, kindness, innate empathy and life experience will enable psychotherapists-and physicians in general-to meet their patients' needs for support by communicating interest, liking and understanding. Just as the literature on psychoanalysis is a source for much of what we know about the expressive component of therapy, the limited literature on supportive psychotherapy is a source for ideas pertinent to the supportive component.
A popular slang definition of the verb to split is "to depart," or "to leave." In this context, to split describes the occasional wish of a psychiatrist who may be mired in the chaos created by the behavior of a patient diagnosed with borderline personality disorder. The primary definition of to split is "to divide sharply or cleanly."
Dissociative identity disorder (DID), known as multiple personality disorder until renamed in the DSM-IV (American Psychiatric Association, 1994), is a controversial diagnosis.
The obvious sometimes bears repeating: Sick people have trouble thinking. They may be suffering from a delirium, a dementia or a more subtle disturbance of cognition caused by fever, drugs, infection, inflammation, trauma, hypoxemia, metabolic derangement, hypotension, tumor, intracranial pathology, pain and so forth.
Wallowing in $1.3 billion in debt, and after losing about a million dollars a day for the past year, the Allegheny health system-a conglomeration of hospitals, physician medical practices and academic institutions-went down for the count in July, leaving Philadelphia's health care system in a financial snarl that may take years to untangle.
Consultation-Liaison (C-L) psychiatric services are generally not profit-making enterprises. Indeed, they are hard-pressed to demonstrate that they break even. Some attention has been paid to this issue in the recent literature, and specific recommendations of a most helpful nature have been made. The C-L service at Lehigh Valley Hospital (LVH) in Allentown, Pa., is an example of recommendations that have been put in place for C-L.
Atypical antipsychotic treatment for borderline personality disorder (BPD) and augmentation therapy with olanzapine (Zyprexa) or estrogen replacement therapy (ERT) for patients with mood disorders were among the research questions addressed at the American Psychiatric Association's annual meeting in Toronto. Following are some brief reports of selected presentations.
The future is both bright and dark for consultation-liaison (C-L) psychiatry. It is a paradox created by a still-evolving health care system that affords unique opportunities for innovation, while simultaneously placing seemingly insurmountable obstacles in the way of access to quality care. Striving to navigate these systemic contradictions, C-L psychiatry can be seen as on the verge of either a breakthrough or a breakdown-only time will tell how things will work out for this as yet uncertified subspecialty.
William - Poetry of the Times
As health care continues to shift in the United States from fee-for-service to managed care, and away from specialist-driven care to the primary care gatekeeper, it is necessary to re-examine psychiatric training and the psychiatric services that are being provided.
When Sigmund Freud gave his epochal lectures at Worcester's Clark University in the early 20th century, a young Harvard student named Alan Gregg was in the audience. Upon completion of his medical education and training as an internist, he would become a great visionary of psychiatry's role in the practice of medicine.
New methods of conducting and evaluating research were as intriguing as their results at the National Institute of Mental Health (NIMH)-sponsored New Clinical Drug Evaluation Unit Program's (NCDEU) 38th annual meeting in Boca Raton, Fla., June 10-13. The meeting has grown from a forum of NIMH-funded researchers reporting on their progress into a convention of approximately 1,000 clinicians, industry and regulatory personnel, and investigators marking the progress in psychopharmacology.
The diagnostic criteria for sexual addiction are derived from the behaviorally nonspecific criteria for addictive disorder that were presented in Part 1 (Goodman, 1998b), by replacing "behavior" with "sexual behavior".
Because of the very prominent physical symptoms of panic disorder, many see their primary care doctor or a specialist, such as a pulmonologist, first.
A gene variant in the CYP2A6 enzyme may help protect some individuals from nicotine addiction, according to a new study funded in part by the National Institute on Drug Abuse of the National Institutes of Health.