As her patient leaves the consulting room, Susan Roth, M.D., picks up her computer's microphone and begins dictating. "Wake up. Open template recurrent major depression. Patient identification: Mr. Johnson is a 64-year-old married white male. Chief complaint: difficulty sleeping, loss of appetite and depressed mood with suicidal ideation for the last three weeks."
The fact that the Health Care Financing Administration (HCFA) canceled the July 1 start date for implementation of the much-maligned new evaluation and management (E/M) documentation guidelines does not mean that Medicare is relaxing its efforts to root out erroneous physician billing of Medicare.
In more than two dozen programs throughout the United States, telepsychiatry is ushering in a new way of bringing mental health services to thousands of individuals who, in the past, may have gone without. More often than not, however, they are pilot projects or grant-supported endeavors, meaning that these prototypes of the psychiatrist's office of the future have yet to prove themselves in the medical marketplace.
Uncle Joe - Poetry of the Times
Despite threatening skies on a Sunday afternoon in late May, about 2,000 people gathered in New York City's Bryant Park for the fourth annual picnic given by National Picnic for Parity, a broad-based coalition of mental health providers, consumer groups, legislators and other advocates interested in achieving parity for mental illness.
Psychiatrists would fare considerably worse than anticipated if the Health Care Financing Administration (HCFA) sticks with its recently-announced intention to use a 'top-down' methodology in rearranging new practice expense relative value units (RVUs) for 1999. The new methodology would yield a 4% increase over the four years 1999 to 2003, compared with the 'bottom-up' methodology HCFA had previously chosen, where psychiatrists would have received a 19% increase.
In the first study to compare the efficacy and tolerability of mirtazapine (Remeron) and fluoxetine (Prozac) in patients with major depression, David Wheatley, M.D., of The Royal Masonic Hospital, London, and colleagues from throughout Europe showed mirtazapine and fluoxetine to be similar in tolerability, with mirtazapine significantly superior in efficacy.
The strongest selling point for managed medical care-the ability to hold down price increases-may be losing strength as health care costs begin to climb and managed care organizations (MCOs) begin to look for higher premiums.
By many estimates, the health care industry has been a relative latecomer to awareness of the Y2K problem. Databases may be corrupted or destroyed. Billing records may be voided. Births may be treated as future events. Insurance policies may be canceled. Claims may be denied. Thus, the problem may be especially acute in the health care industry.
The psychiatrists' apparent interest in natural medicinals may be driven by the rising popularity and widespread use of the products among the public. At the annual meeting of the American Psychiatric Association, a symposium considered the hazards and benefits of herbal medicines, and, perhaps for the first time since the 1960s era of psychedelic experimentation, reconsidered the therapeutic and research potential of hallucinogenic substances.
In 1995, I noticed that I was spending more and more time playing solitaire on my computer. I was trying to learn a new computer program and was very frustrated by it.
The dramatic series of recent school shootings in nearly every region of the country has forever altered the way American society views its children. Fueled by media accounts that convey the drama of kids out of control, politicians, public policymakers, school administrators and parents now struggle for answers.
In a surprising 7-2 ruling in May, the U.S. Supreme Court held that a condemned inmate was entitled to federal habeas corpus review of his death sentence based on claims of mental incompetence. Writing for the majority, Chief Justice William O. Rehnquist let stand a 9th U.S. Circuit Court of Appeals ruling that delayed the execution of an Arizona prisoner pending a sanity determination in federal court.
While there is broad-ranging support for increased resources for the mentally ill, the degree to which innovations should include mandated care has re-ignited a long-standing debate over whose civil rights are actually being trampled-those individuals who are forced to receive care, or those who are denied care even though they desperately need it.
Nonprofit health maintenance organizations (HMOs) state that their goal is to serve the public, whereas the main goal of for-profit HMOs is profit generation. One might assume, therefore, that the operating procedures of these two types of HMOs would be different from one another. A recent experience of mine, however, suggests otherwise.
Women and their special needs regarding addiction was the topic of a recent two-day conference held at New York University (NYU).
Inside Out
This is the fourth in a series of five articles regarding obsessive-compulsive spectrum disorders. The first three articles ran in the March 1997, June 1997 and January 1998 issues of Psychiatric Times. The first article gave an overview of spectrum disorders, the second discussed obsessive-compulsive disorder and the third examined body dysmorphic disorder.
For reasons researchers are still trying to understand, clinical depression appears to be almost twice as common in women as in men. Why females are more prone to this debilitating disease than their male counterparts is still under investigation, although significant progress has been made.
A New Drug Application was submitted to the U.S. Food and Drug Administration in May for the selective norepinephrine reuptake inhibitor (SNRI) antidepressant, reboxetine. The manufacturer, Pharmacia & Upjohn, has marketed the antidepressant as Edronax in the United Kingdom since July 1997, and in October 1997 received approval through the European Mutual Recognition Procedure to distribute it in 11 other European Union Countries during 1998.
Among the specialized refugee population in the United States, there is little research on the gender differences in psychological distress, which is considerable. Southeast Asian refugee women have been identified as an at-risk group for developing serious psychiatric disorders primarily due to their premigration experiences.
Differences between the sexes regarding the prevalence, psychopathology and natural history of psychiatric disorders have become the focus of an increasingly large number of epidemiological, biological and psychological studies. A fundamental understanding of sex differences may lead to a better understanding of the underlying mechanisms of diseases, as well as their expression and risks.
The department of psychiatry at Columbia-Presbyterian Medical Center (CPMC) in New York City has opened one of the first facilities in the country that brings the techniques of complementary medicine to psychiatry. The Center for Meditation and Healing, which opened this March, emphasizes traditional meditative methods used for thousands of years in Asian cultures, particularly those of India and Tibet.
Just as the first scattered incidents of homicide involving urban children in the early 1980s were not isolated episodes precipitated by "criminally ill" children, the recent episodes of school homicide in nonurban middle-class America, including the massacre in Littleton, Colo., are not isolated incidents of violence involving seriously "mentally ill" children.
The Office for Protection from Research Risks (OPRR), an agency operating under the aegis of the U.S. Department of Health and Human Services, launched an investigation in April aimed at determining whether young boys were endangered during the course of experiments involving the drug fenfluramine (Pondimin).
A leader of a key mental illness patient advocacy group indirectly but pointedly criticized psychiatrists for the care they give schizophrenics. Laurie Flynn, the executive director of the National Alliance for the Mentally Ill (NAMI), said she was "appalled" by the results of face-to-face interviews with over 700 schizophrenics during a 16-month period. The interviews turned up evidence of under- and overdosing of patients and a failure to get patients into effective community treatment plans.
It is now obvious to most knowledgeable observers that managed care will transform the American health care system. Managed care brought competitive market forces into medicine, and demonstrated that the right financial initiatives can reverse a century of rising professional standards and make health care just another lean and mean downsizing industry.
After the U.S. Department of Veterans Affairs shut down research programs in its Greater Los Angeles Healthcare System (GLAHS) in March, the VA's undersecretary of health, Kenneth W. Kizer, realized that, rather than defending the facility's "failure to correct deficiencies," he would need to launch a reform initiative.
Is it appropriate for physicians to accept assisted-death requests at face value, or should they be interpreted as clinical indications of suffering? Should physicians act on patient requests to die, or should they address patient needs through other measures? Such are the difficult questions facing most physicians today.
What has happened to our nation since the 1960s and 1970s? The quest for racial equality appears to be rapidly dissipating. Blatant pre-civil rights racism has been replaced by a more virulent, yet camouflaged, form of racial bigotry.