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When The New York Times decided to run a story in July about refractory depression, the article was entitled "Some Still Despair in a Prozac Nation." Even after a decade on the market, and despite the availability of a host of competing drugs, the headline exemplifies the extent to which Eli Lilly and Company's popular antidepressant remains a pop culture icon. So when the Indianapolis-based pharmaceutical manufacturer launched a 30-minute program that featured Prozac (fluoxetine) in May-it avoids using the term infomercial-the cutting edge direct-to-consumer (DTC) ad naturally raised questions and a few eyebrows as the company sought to gain even wider exposure for the drug.

Among psychiatrists who treat patients with HIV/AIDS, the question of how psychosocial distress effects the progression of HIV disease is likely to arise. Even for healthy individuals, we are only beginning to clarify the complex pathways by which thoughts and emotions impact immune function. Due to the bidirectionality of the communications of the brain and the immune system, this is a complicated scenario. The fact that HIV alters the function of the immune system during the course of its progression creates greater confounds to the understanding of these systems. We will address the rationale that progression from HIV infection to AIDS may be modulated by psychosocial factors, discuss possible reasons for conflicting findings and posit some clinically relevant recommendations drawn from research findings.

In the 1950s and 1960s, researchers found that mice and rats subjected to stressful stimuli were more likely to develop viral infections and tumors than nonstressed animals (Miller, 1998). Today, that once-pioneering research in psychoneuroimmunology (PNI) has burgeoned into sophisticated clinical studies that look at, for example, how caregiving can affect the immune system, how stress may delay wound healing and how pretreatment with an antidepressant prevents cytokine-induced depression in therapy for cancer.

As chief of the division of sleep and chronobiology in the department of psychiatry at the University of Pennsylvania School of Medicine, David F. Dinges, Ph.D., focuses on ways sleep and the endogenous circadian pacemaker interact to control wakefulness and waking neurobehavioral functions such as physiological alertness, attention, cognitive performance, fatigue, mood, neuroendocrine profiles, immune responses and health. In an interview with Psychiatric Times, Dinges discussed neurobehavioral consequences of sleep loss, factors that impair sleeping, the pervasiveness of sleepiness and new ways to manage sleepiness.

Mood-stabilizing drugs slipped into the vocabulary of psychiatrists during the last 15 years without a proper discussion of their definition. Consequently, these medications have been used in ways that have no empirical justification.

"You really have to prepare patients for group treatment and have to compose your groups and select patients for that particular group with some care."

Several incidents of serious violence, including the death of one woman, have pushed the issue of involuntary commitment of the noncompliant mentally ill higher on the priority list of the government of New York State.

Developmental traumatology research is the systemic investigation of the psychiatric and psychobiological impact of overwhelming and chronic interpersonal violence on the developing child.

Children whose parents have been diagnosed with affective disorders are far more likely to be diagnosed with a mental illness-especially affective disorder-than their peers whose parents do not have mood disorders (Beardslee, 1998; Burge and Hammen, 1991; Downey and Coyne, 1990).

As traditional unions successfully expand the ranks of organized physician employees, and as the U.S. Congress considers an antitrust exemption so that all doctors can collectively bargain, the American Medical Association decided to unionize. Doing nothing would have been tantamount to leaving the bargaining table even before the negotiations began.

The Hotseat - Poetry of the Times

America's teaching hospitals are facing an unprecedented financial crisis that could leave more than one-third of the most respected institutions operating at a loss within the next five years, according to leaders in academic medicine. In addition to reducing their traditional educational programs, teaching hospitals may have to eliminate a wide variety of community health projects, poison control centers, safety programs and indigent care programs if budget cuts imposed by third-party payers are not reversed.

Present-day psychiatry has fallen into crisis because of the severe limitations of its conception of the person and, as a result, its conception of the patient. It objectifies the patient in a number of ways. Because of this reductionism, psychiatry fails to distinguish between healthy and pathological features of human life. It fails to consider adequately the psychological and social factors that cause and maintain each patient's problems.

The most common psychiatric sequelae following trauma include major depressive disorder, somatoform pain disorder, adjustment disorder and posttraumatic stress disorder (PTSD). In law, trauma that precipitates PTSD is viewed as a tort, which stems from the root word "torquere" (to twist), as does the word torture. In a sense, plaintiffs do allege torture in personal injury cases. A tort constitutes a civil or private wrong, as opposed to a criminal wrong, and rests on the general principle that every act of a person causing damage to a legally protected interest of another obliges that person, if at fault, to repair the damage (Slovenko, 1973).

With less than five months before an irrevocable and unavoidable deadline, major questions still remain about the ability of the health care industry to cope with the so-called Y2K problem

Planning for the turn of the century is a little bit like defensive driving: You have to watch out for the other guy and pay close attention to what you're doing.

Lobster Alchemy - Poetry of the Times

With the end of the Cold War, there is a new dimension to America's military entanglements. The demise of the Soviet bloc has opened the door for the U.S. military to take a more active role in political hot spots, with the result being an increasing willingness to engage in peacekeeping and humanitarian operations throughout the world.

More than 430 psychiatrists, research donors and others gathered in late October for the National Alliance for Research on Schizophrenia and Depression (NARSAD)'s awards dinner in New York City. The black-tie fundraising event was held in conjunction with the organization's 10th annual scientific symposium at which 15 selected NARSAD grantees presented their ongoing research over two days of sessions devoted to basic science, schizophrenia and depression.

Psychological testimony is required in more than half the civil trials that unfold each year in the nation's courtrooms, and it is a rare criminal case that doesn't include a psychiatric evaluation during some stage of the proceedings. Yet despite the significant number of interactions between lawyers and forensic psychiatric experts that occur daily, there is still a fault line that separates them.

When do therapists legally owe a duty of care to persons other than their patients? It is an axiom that good medical care involves consideration not only of the patient but also of others. In law, the general principle is that the risk which may result from one's behavior, as reasonably perceived, determines the duty of care.

It is relatively recent that boundary issues in clinical practice have attained professional awareness, although some early concepts portended the issue. Several decades ago, for example, the term boundary violations referred almost exclusively to what we now term sexual misconduct.

Let us begin with an example. Suppose I am traveling from the United States to Switzerland, anticipating skiing with my son in the Alps. My anticipation becomes vivid and lively. I recall excitement mixed with joy at rapidly soaring down the mountainside, and I am now quite anxious to re-experience this thrilling adventure with my son-eager to be heading down the mountain with him. Later, as we stand on the crest of a deep and winding slope, the speed, thrill and admixture of danger and adventure will infuse my being.

Income increased for psychiatrists in 1997, although it dropped for the combined all-physicians category. Dissemination of physician income data became a controversial issue at the AMA House of Delegates meeting last year (Baldwin, 1999; Booth, 1999). Angered by media reports of rising physician income without consideration of hours worked or differences between demographic groups of physicians, delegates voiced concern with the AMA's collection and release of physician income data.

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.