Addiction & Substance Use

Excellence in psychopharmacology demands sensitivity to the associated ethical considerations. The key considerations of psychiatry are both complex and dynamic, and psychiatrists who develop and refine their ethics skill set will be in a better position to anticipate and respond to ethical dilemmas as they arise in their practice.

Like every drug or technology that has therapeutic value, MDMA (3,4-methylenedioxymethamphetamine) has potential risks and benefits. Unlike most other drugs under clinical investigation, MDMA has a complex and controversial history that has delayed dispassionate scientific investigation into its therapeutic use.

The only question is whether Congress will cut the mental health block grant again, in 2012-and by how much.

Rape is always a heinous, ugly, violent, and cruel crime. But the violence and cruelty that are part of all rapes should not be confused with the specifically motivated violence and cruelty that distinguish sexual sadism...

Anyone working in the mental health field will recognize that in patients with extreme irritability, explosive behavior, or quick mood changes, bipolar disorder (BD) is often unquestionably diagnosed.

Deliberate self-harm (DSH) is a behavior in which a person commits an act with the purpose of physically harming himself or herself with or without a real intent of suicide.

Antidrug vaccines represent an exciting area of development in the pharmacological treatment of chemical dependency. In addition to the clinical trials being conducted on vaccines for cocaine and nicotine dependence, preclinical development of vaccines for methamphetamine and heroin is ongoing.

The focus of this Special Report is on some future-oriented aspects of psychopharmacology. First, it is an eclectic set of articles that cover treating resistant depression, using currently illegal drugs to treat psychiatric problems, and finally the potential of using vaccines to treat substance use disorders.

The NIMH Research Domain Criteria (RDoC) project raises many questions about DSM-5 and future DSMs.

ECT is making something of a comeback because it remains a paragon of efficacy amidst other relatively disappointing treatments.

Digital technology is a valuable tool, but if it dazzles us with its speed and control, there is the risk that we may forget the old way of connecting.

As experts in neurobiology, we can conduct and critically evaluate research to identify the short- and long-term risks and benefits of neuroenhancers for patients without recognized clinical indications.

Dr Weissman discusses psychiatric residency recruitment by looking at the forces that affect a student’s selection of a psychiatric career rather than at what the influences have been during the past 5 years.

This article reviews methods to rehabilitate cognition in schizophrenia and suggests strategies for instituting a cognitive remediation program.

The New York Times of February 14 carries the disturbing news of an alarming increase in deaths from accidental overdose among our active duty military personnel and our war veterans.

Apart from the lack of evidence supporting their use, is there any reason not to use patient opioid agreements and urine drug testings?

I recently shared a research article on “no-suicide contracts” with a colleague who is very knowledgeable about suicide. That article concluded--as virtually all the previous literature had-that use of suicide prevention contracts (SPC) remains a questionable clinical practice intervention.

In a recent Psychiatric Times blog, Allen Frances engaged a debate with Andrew Hinderliter over the question of change in the diagnostic categories of DSM-5.

On January 24, Dr Ronald Pies posted a thoughtful piece titled “Who Can Forgive Jared Loughner?” which advocates the importance of relinquishing hatred in cases like the ones in Tucson and transforming “our revulsion and rage into something higher and nobler.”

Major mood disorders have been associated with increased suicidal behavior. This is especially true in patients with a mixed, manic-depressive, or dysphoric-agitated state.

Expansion of age-appropriate developmental psycho-therapeutic services must become a top public health priority to make these treatments more widely available to young children and to capture the potential greater benefit of the earliest possible intervention for mental disorders.

Pushing the edge of our understanding into the murky world of association cortex only means that future experiments will be trickier to interpret.

Is violent behavior a proxy indicator for the relationship between severity of substance abuse and suicide risk? What has the strongest influence in promoting doubt about a delusion in a patient with schizophrenia? These questions and more.

I would like to start off this blog with two stories that happened many years ago.

What goes on in the minds of those who attempt suicide? Here: a psychologist who explores the myths that surround suicide notes "We need to get it in our heads that suicide is not easy, painless, cowardly, selfish, vengeful, self-masterful, nor rash."

Erroneous conclusions, and medical harm, can come from accepting any hypothesis uncritically, and growing evidence indicates that treatments based on disorder hypotheses for depression do cause harm.

Recently, the Substance Use Disorder Work group of the DSM-5 announced the inclusion of “craving” in the diagnostic criteria for all substance use disorders despite its lack of empirical support from the very analyses conducted by that Workgroup. In addition, no detailed literature review supports the decision to make “craving” a core symptom of Substance Use Disorder syndromes.

Recently, NARSAD presented its achievement awards for 2010-awards given to physicians and scientists doing cutting-edge work to better understand the mechanisms and causes of mental illness.

Forensic psychiatrists expressed near-unanimous opposition to 3 controversial new sexual diagnoses after a spirited debate at a recent conference of the American Association of Psychiatry and Law (AAPL).

Sometimes, when I recommend an antidepressant, patients will ask if it will make them happy. No, I usually eventually answer. I try to gently and empathically point out that what we have are called antidepressants. They are not called happy pills for a good reason.