Recent headlines in national newspapers declaring that mentally ill patients are often denied care by psychiatric hospitals merely confirmed what most psychiatrists have known for years. A study published last December, however, created a stir when the authors released what they called "the first national analysis of the factors that promote or constrain economically motivated transfers of patients in relation to competitive pressures, hospital ownership, and managed care practices."
Death Sentence, Ethics, Psychiatry, Competency, Execution, Prisoner, Psychiatrists
Approval of the nation's first physician-assisted suicide law last November has proved the adage "be careful what you wish for." In the aftermath of the Oregon initiative that once again endorsed the state's Death with Dignity Act, physicians and government officials throughout the country are now scrambling to make sense of the law and figure out ways to assure that compliance doesn't lead to liability, both criminal and civil.
January Thaw - Poetry of the Times
In its 1986 decision in Ford v. Wainwright, the U.S. Supreme Court found that death row prisoners had a constitutional right not to be executed if they were incompetent (477 U.S. 399 [1986]). Competence for execution-an odd concept, but one whose roots go back to biblical times-usually requires that a prisoner understand the nature of the punishment about to be imposed and why it is being imposed.
In its 1986 decision in Ford v. Wainwright, the U.S. Supreme Court found that death row prisoners had a constitutional right not to be executed if they were incompetent (477 U.S. 399 [1986]). Competence for execution-an odd concept, but one whose roots go back to biblical times-usually requires that a prisoner understand the nature of the punishment about to be imposed and why it is being imposed.
For 17 years, claim federal prosecutors, Theodore Kaczynski terrorized the nation with a string of 16 bombings that killed three people and injured 23 more. On trial now for his life, the alleged Unabomber's case will most likely hinge on the expert testimony proffered by a covey of psychiatrists and psychologists scheduled to be called as witnesses as the case unfolds in U.S. District Court in Sacramento, Calif. this month.
The Association of Gay and Lesbian Psychiatrists (AGLP) is a professional organization of psychiatrists, residents, medical students and supporters, which serves as a voice for the concerns of lesbians and gay men in the professional psychiatric community. AGLP is committed to fostering a more accurate understanding of homosexuality, ensuring well-informed and appropriate treatment for lesbians and gay men, and opposing discriminatory practices against gays and lesbians in our society.
"Hwa-byung" and "ataque de nervios," listed in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) as culture-bound syndromes, can serve as gateways to understanding anger's role in psychiatric morbidity, according to a panel of experts.
In 1997, the National Library of Medicine (NLM) helped initiate a new era in American medicine when it made MEDLINE, its comprehensive online bibliography of published medical information, accessible to the public through the World Wide Web. That event may prove to be a symbolic watershed of 20th century American medicine. It will impact every aspect of medicine, from the manner in which physicians are educated to the way they run their daily practices.
Scientific, social or legal redefinition is only slowly reflected in changed practitioners and practices. It is not surprising that surveys continue to report high levels of ignorance and prejudice encountered by homosexuals in their contacts with health care providers. This also contributes to a negative feedback loop in which many homosexuals are reluctant to utilize, inform or confront their care providers, impairing collaboration in treatment.
Many of the factors purported to influence accessing mental health services by men and ethnic minorities are systemic in nature, ingrained within our culture, and consequently, difficult to change (e.g., gender differences in attitudes toward help-seeking, ethnic differences in the use of alternative healing resources). However efforts have been made within the mental health system to make services more acceptable to men and minority group members who choose to, or are able to, access the system.
What counts as participation in capital punishment? Is it possible for a medical activity to be ethical in one context, but a similar one not ethical in another? Is death different? Are there neat and universal ethical rules that will always guide us wisely, or are there inevitable clashes among various legitimate and important values? Is it ethically possible that a forensic psychiatrist is not a psychiatrist, as Dr. Paul Appelbaum has argued? How strongly should physicians protect their duty to always help and not harm all individual patients in the face of many pressures to do otherwise?
In its 1986 decision in Ford v. Wainwright, the U.S. Supreme Court found that death row prisoners had a constitutional right not to be executed if they were incompetent (477 U.S. 399 [1986]). Competence for execution-an odd concept, but one whose roots go back to biblical times-usually requires that a prisoner understand the nature of the punishment about to be imposed and why it is being imposed.
Peter Penna, Pharm. D. spoke on the future of drug formularies and how he sees them changing. Formularies in managed care evolved out of formularies in hospitals and have been around since drugs became relatively commonly used in patient settings, Penna explained. "Today, formularies are widely used by hospitals, managed care organizations, pharmacy benefit management companies, home health agencies and nursing home services."
Nelson Kull, executive director of Pathways, sees an additional benefit to consumer employment: it provides patients with a first-hand look inside the system, and this can help defuse the sometimes antagonistic relationship between consumers and caregivers. "Some people criticize doctors and pharmaceutical companies for making a lot of money," says Kull, "but they gave me back my life. I once told meeting [attendees] that yes, psychiatry and medical care cost a lot, but your car costs a lot. I can't drive my car without my medications, so which comes first?"
The stakes in the debate over recovered memories therapy ratcheted upward in October with the indictment of five health care professionals, including two psychiatrists, in Houston. Charged in a 60-count indictment-believed to be the first of its kind in the United States-the former staff members of the now defunct dissociative disorders unit at the Spring Shadows Glen Psychiatric Hospital are accused of perpetrating a "scheme to defraud by allegedly falsely diagnosing patients with multiple personality disorder caused by their alleged participation in a secret satanic cult."
Before the Malpractice Suit - Poetry of the Times
As a consultant and educator for various stakeholders in the delivery of managed mental health services, I see confusion, skepticism and demoralization in the mental health professions about the direction health care is taking. Many doubt their ability to achieve the objective of the managed care mantra: Better care at less cost. To the clinician delivering care, it feels as if there is no stable ground to stand on, or, in the words of a 1960s female R & B group: "Nowhere to run to baby, nowhere to hide." Our profession seems to be either frozen in fear or disorganized in struggle, not grounded and coordinated in response to the changes that are upon us.
There is an increasing body of data that suggests there may be relationship between certain forms of childhood-onset OCD and previous Group A beta-hemolytic streptococcal infections. They seem to have early-onset OCD, tic disorder, Sydenham's chorea and family history of tics. Sydenham's chorea, a major manifestation of rheumatic fever and a disorder generally limited to prepubertal children, is thought to be disease of basal ganglia, and the basal ganglia is thought to be involved in both Sydenham's chorea and OCD. Children with Sydenham's chorea frequently present with OCD symptoms.
In the spring of 1997, legalization of physician-assisted suicide seemed inevitable. In the space of a month, two appellate courts had declared a constitutional right to physician-assisted suicide, overturning long-standing state laws in New York and Washington that prohibited the practice. Many observers expected the U.S. Supreme Court to follow suit. Earlier, Oregon had become the first state to legalize physician-assisted suicide. Although that decision was still being contested in the courts, had the Supreme Court recognized and accepted a constitutional right to physician-assisted suicide, Oregon was ready to become the first state in which it was practiced.
It was a bad combination, I'll allow that. The call from the emergency room reached me the Saturday morning after I had finished reading Ayn Rand's Atlas Shrugged. I hadn't gotten a lot of sleep, partly because I finally reached page 1,168 around midnight, partly because I couldn't get my mind off John Galt, Hank Rearden, Francisco d'Anconia, Dagny Taggart and the rest of Rand's characters. Before I drifted off, I was already drawing parallels between the current state of psychiatry and Rand's fictional world in which the mind is denigrated, and autonomy and free will nearly stamped out.
It appears randomly in about one out of one million people. In the United States that means somewhere over 200 people get it, and die from it, each year. We know that they die because no one can survive it-mortality from the disease is 100%. It is Creutzfeldt-Jakob disease (CJD), among the deadliest, and least understood, of all brain diseases.
The goals of National Coalition for Mental Health Professionals and Consumers are to educate the public about the problems of managed mental health care and to develop alternative health delivery models. I think greater media coverage has spawned greater awareness of the difficulties with managed care and has provided legislators with vital information. Certainly sharing their stories has made many people feel less alone and isolated within a system they find frustrating and depriving. I think media advocacy has helped doctors find support for their right to stand up to these abuses and band together in greater numbers to fight for integrity and quality in mental health care delivery.
In 1988 I was working as a general adult psychiatrist with a specialty in addictions. One day, a newly referred patient came to my office accompanied by his mother. Although he was well groomed, he was distinctly "nerdy." When I inquired about his chief complaint, his mother quickly explained that, although he had graduated from community college, he was unable to secure a job interview due to his obsessing on the details of his resume.
Two Portraits of AIDS - Poetry of the Times
Inspired, in part, by the initial success of treating young patients with new atypical antipsychotic medications, the National Mental Health Association (NMHA) has initiated a major consumer campaign to educate the public about schizophrenia. S.O.S. (Signs of Schizophrenia) is designed to help parents and children recognize symptoms and seek treatment, emphasizing the importance of early detection and care.
Only eight weeks after beginning treatment for trichotillomania (hair pulling) at Stanford University Medical Center, Christina Pearson found herself being invited to appear on a local television show in Seattle to discuss the disorder.
Only eight weeks after beginning treatment for trichotillomania (hair pulling) at Stanford University Medical Center, Christina Pearson found herself being invited to appear on a local television show in Seattle to discuss the disorder.
America's pop culture can send a dizzying blur of mixed signals. On the one hand, its massive restaurant and food industries serve up an abundance of calorie laden, often unhealthy processed meals that have turned Americans into the most overweight people in the world.