Addiction & Substance Use

Organizational and occupational psychiatry represents the extension of psychiatric knowledge and skill to the day-to-day functioning of individuals in the workplace and their organizations, with the goal of helping both to function better. To this end, psychiatrists have played an important role both in the treatment of workers and consultation to organizations since the early part of the 20th century.

Adults who are severely mentally ill are over-represented in U.S. jails and prisons, leading to an interface between the mental health and criminal justice systems. New intervention strategies involving both systems, such as mental health courts and forensic assertive community treatment, could divert patients away from the criminal justice system and promote engagement in community-based treatment and support services.

Many psychiatrists limit the application of their skills to individuals whose discomfort matches the phenomenological criteria of DSM-IV-TR. Can psychiatry transcend the concept of "objective cure" and include "subjective perfection" as a goal? Is there a logical reason why the concept of "treatment pills" cannot coexist with that of "lifestyle pills" on the psychiatric prescription pad? Dr. Giannini reflects on whether there can be both "cosmetic" as well as "reconstructive" psychiatry and if a disease is needed in order to be treated.

Hollywood has had a long-standing love affair with psychiatry and its portrayals of electroconvulsive therapy reflect and influence public attitudes toward the treatment. One-third of medical students decreased their support for the treatment after being shown ECT scenes from movies, and the proportion of students who would dissuade a family member or friend from having ECT rose from less than 10% prior to viewing to almost 25% afterward. So what is the legacy of portrayals that have been so abhorrent, and are there any exceptions to the rule?

What are some of the pitfalls of treating patients from varying cultural backgrounds, what cultural issues should psychiatrists be aware of and how can they fit varying culturally based psychiatric disorders into a proper diagnostic framework? Using case studies, Dr. Moldavsky explores the clinical implications of culture in psychiatric practice.

What are the qualities of forensic psychiatry? In reviewing the basis on which forensic psychiatry is defined as a specialty or, more accurately, a subspecialty of psychiatry, the author discusses the altered relation between physician and "subject," the consultative role in relation to the legal system, and the areas of specialized knowledge and skills that attend the field.

According to a large international study, BD-II mixed depression can easily be misdiagnosed as major depressive disorder. Proper assessment and treatment of mixed depression in BD-II could have a positive impact on outcomes in bipolar disorder.

Headache is a frequent somatic complaint in childhood and adolescence, and its prevalence has increased over the last few decades. The presence of a comorbid psychiatric disorder tends to worsen the course of headache by increasing attack frequency and severity, making the headaches less responsive to treatment, and increasing the risk of chronification. Identification and treatment of comorbid psychiatric conditions is, therefore, important for the proper management of headache, especially in children and adolescents.

While the symptoms of somatoform and dissociative disorders are influenced by the patient's culture, these syndromes are heterogeneous and may have overlapping features. Although more frequently reported in non-Western cultures and thought of as exotic and culture-bound, multiple personality disorder may be a North American example of one such disorder.

One of the spin-offs of the consensus statement is a study of the risk for metabolic disorders with antipsychotic use in children and adolescents. Here, the lead researcher discusses some of the group's initial findings.

Community awareness of traumatic events and their effects on individuals has increased in the last decade. The articles in the special report section of Psychiatric Times enhance our appreciation of the divergent research and clinical efforts being made assist those who have suffered from the consequences of trauma and its aftermath.

For decades, personal essays on ECT highlighted pain and discomfort, a dismaying loss of memory, and an indifference of practitioners who forced the treatment on unwilling patients. The attacks on ECT by popular writers in the press and in film drowned out the voices that described its benefits. However, the public testimony has slowly changed toward a greater acceptance of ECT; it is time to hearken to the testimony of these witnesses and roll back the unethical restrictions that commit our most disadvantaged citizens to unnecessary chronic illness, prolonged hospital care and even death.

In the wake of the Columbine school shootings, it is of utmost importance for psychiatrists to be aware of the role they can play in preventing violence and bullying in our schools. What programs have been tried and how have they fared? What are the elements for a successful program?

A new consensus statement has been issued regarding the high risk of diabetes and associated disorders with use of atypical antipsychotics. Several of the major pharmaceutical companies have responded negatively to this statement.

Will the most effective treatments be available for your patients? Atypical antipsychotics and antidepressants that are being marketed or developed worldwide are reviewed.

How is it that anti-anxiety drugs can cause anxiety and insomnia, sometimes within the first day or two of treatment? These are not the soothing qualities we expect for anti-anxiety medications.

What role might cognitive functioning play in suicidal ideation in elderly patients? How can psychiatrists determine the cognitive functioning skills of older patients who express suicidal thoughts?

Euthanasia is a word coined from Greek in the 17th century to refer to an easy, painless, happy death. In modern times, however, it has come to mean a physician's causing a patient's death by injection of a lethal dose of medication. In physician-assisted suicide, the physician prescribes the lethal dose, knowing the patient intends to end their life.

Patients who use or abuse alcohol and other substance are at high risk for insomnia and present unique challenges for treating this debilitating disease. The three avenues of treatment--behavioral, OTC medications and prescription medications--are reviewed and future trends are outlined.

Studies have shown that children of divorced parents may suffer more mental health problems, particularly conduct disorders. What programs might be effective in helping these children deal with the stress of their parents' divorce? Are there effective programs to teach parents better coping skills?

Reported by two out of every five college students nationally, heavy episodic or binge drinking may be the most frequently reported and researched mental health problem among college youth. Effective prevention and treatment should reflect the heterogeneity of binge drinking, as it can cause substantial and serious harms.

espite the fact that about 30% of our life is spent sleeping and decades of research have been spent on sleep, we still do not know its real function. What we do know is lack of sleep can have serious implications, such as increased risk of depressive disorders, impaired breathing and heart disease. On the other hand, nighttime sleep disturbance is usually followed by excessive daytime sleepiness that is associated with delayed problems like memory deficits and impaired social and occupational function, and immediate consequences such as car accidents (Kupfer and Reynolds, 1997; Roehrs and Roth, 1995).

Chronic infection with the hepatitis C virus (HCV) is frequently complicated by the presence of co-existing substance use disorders and mental illnesses. It is important to find improved ways to address barriers to care, and to provide effective and humane care to patients suffering from HCV infection.

This year marks the 70th anniversary of the first use of induced seizures to treat mental disorders. Read about the career of Ladislas Meduna, M.D., the Hungarian neuropathologist who pioneered this treatment method. Although his theory that convulsive therapy is effective because it increases glial cell function was disproved, it remains one of the

Women with schizophrenia may benefit from hormone replacement therapy. A new study measured the efficacy of estrogen, progesterone, Prolactin, luteinizing hormone, follicle stimulating hormone and testosterone on women with the disorder.

The current climate of managed care has dramatically changed how psychiatrists deal with the issue of suicide. What should clinicians know, both about the safety and welfare of their patients and to protect themselves legally, when dealing with managed care companies in cases of potential suicidality?

Can PET scans show differences in suicide risk among depressed patients? What are the risk factors for high-lethality suicide attempts versus low-lethality attempts?

Unlike other forms of self-injury, suicidal self-injury has special meaning, particularly in the context of borderline personality disorder. How is suicidal self-injury differentiated from non-suicidal self-injury in these patients, and how can their behavior be properly assessed and treated?

Assessing and treating suicidal behavior in the elderly can be difficult. What are the risk factors and how can this population best be treated?

This summary of the special report looks at various new ways to assess and treat for suicidal ideation, risk and behavior.