April 19th 2024
This first update in 20 years is contained in a recent rule issued by SAMHSA.
Is Redefinition of Psychiatry Underway?
October 1st 1997Over the past decade, cost containment efforts have pushed psychotherapy patients away from psychiatrists and toward the offices of psychologists, therapists and other less expensive mental health workers. The availability of new drug treatments for psychiatric disorders has shifted many psychiatrists' practices away from a long-term therapeutic focus to that of short-term drug treatment. If psychiatry merely reacts to these economic and political forces, rather than managing them with a plan, the future of the field is highly uncertain.
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Interim Hearing Next Step in Proposed "Prescription Privileges" Bill
October 1st 1997Proponents of SB 694 argue that the doctoral-level training undertaken by psychologists qualifies them to deal with mental illness more so than most physicians. More than 75% of mental health prescriptions are written by general practitioners who have limited training in treating mental illness. They say it makes good sense to set up a system in which psychologists who meet additional educational requirements would be given the authority to prescribe medication. Opponents contend that the training provided for in the bill is inadequate. Many feel that as time brings new and significantly more powerful drugs for the treatment of mental disorders to the market, the arguments against psychologists prescribing will increase.
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Psychiatrists: Shortage or Surplus?
October 1st 1997A number of parameters determine how many psychiatrists our nation needs. First is the incidence and prevalence of mental disorders. Second is the kind of clinical care individuals with mental disorders will need, and who will provide that care. Individuals with mental disorders require a thorough diagnostic assessment. Does this need to be provided by a psychiatrist? Obviously, some individuals will need medications as an aspect of their care. These medications must be prescribed by a physician. Does that physician need to be a psychiatrist? Some individuals with mental disorders will need psychotherapy. Does the psychotherapy need to be provided by a psychiatrist?
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There's such an enormous need, said Renshaw, noting that a study of 100 white, middle-class, well-educated couples revealed that more than 70% of the women and 50% of the men reported they had sexual problems. "Ours is a small clinic, in no way able to meet the demand for treatment or training from all who request it. About 80 couples a year are treated. The waiting list is much too long. Couples wait between three and 10 months to come in for therapy, a far from ideal situation."
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Sexual Predator Ruling Raises Ethical, Moral Dilemma
August 1st 1997In Kansas v. Hendricks, the Supreme Court upheld by a narrow 5-4 margin a Kansas law that permits the civil commitment of individuals who, due to a "mental abnormality" or "personality disorder," are likely to engage in "predatory acts of sexual violence." Justice Clarence Thomas said the Kansas statute "comports with due process requirements and neither runs afoul of double jeopardy principles nor constitutes an exercise in impermissible ex post facto lawmaking."
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Physician Fills Niche With Self-Administered Psychotherapy Programs
August 1st 1997How can the simple act of forgetting become the impetus for a psychiatrist to develop his own series of self-administered psychotherapy computer programs? According to John Greist, M.D., it began when he forgot to ask his patients important information during the interview process. He also became aware that the very way he formed the question would lead to different responses from the patient, depending on the person he was speaking with or their frame of mind.
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Outpatient Detoxification Strategies at ASAM
July 1st 1997Detoxification from alcohol and drugs can be safely accomplished in outpatient settings. Careful selection of appropriate patients and frequent monitoring are key elements of successful detoxification. The success of outpatients withdrawing from alcohol without serious medical complications and continuing in recovery programs is comparable to success rates of inpatients when there is careful selection of patients, a good triage process and good nursing and medical assessments.
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Gold Forecasts and Describes Cocaine Vaccine, Smoking Addiction Research
July 1st 1997In 1962, fewer than 4 million Americans had ever tried illegal drugs. By 1983, that number had risen to 80 million. Drug use peaked in 1985 and dropped until 1992. Since then, use has been increasing steadily, particularly among teenagers. This increase is partially a result of a trend back toward glorification of drug experimentation and legalization, and also because there's a general resurgence of smoking. Whether it's marijuana, tobacco, opiates or cocaine, it's still smoking.
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Steps to Accurate Diagnosis of Substance Abuse
July 1st 1997Because alcohol- and drug-dependent patients tend to develop high rates of symptoms usually associated with common psychiatric syndromes, practitioners often fail to diagnose substance dependence and instead jump to treat more familiar disorders. The risk that such circumstances will occur is understandable given statistics that two of every three alcohol- or drug-dependent individuals meet the criteria for psychiatric disorders and one of every three such individuals meets the criteria for anxiety or depressive disorders.
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Drugs On Our Minds: Historical, Social Perspectives on 'Modifiers of Affect'
July 1st 1997To understand our fascination with drugs in the first place, we need to ask some basic questions, such as "Why do we like to take poison in small quantities?" The truthful answer is always some variation of "To feel better." How does this come about, and why do we have so much trouble with it?
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Psychoanalysis and Pharmacotherapy - Incompatible or Synergistic?
June 1st 1997Is the rising use of psychotropic medication to treat anxiety and mood disorders incompatible with the psychoanalytic approach? As a psychopharmacologist and psychoanalyst who frequently provides consultation to analysts regarding medication for their patients, Steven P. Roose, M.D., has studied this question and presented his findings and opinions in various scientific papers, books and meetings.
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EEOC Issues ADA Guidelines for Mentally Disabled
June 1st 1997The guidance answers the most commonly asked questions about how ADA affects persons with psychiatric disabilities, said EEOC chairman Gilbert F. Casellas. "It provides practical instruction to employers and persons with psychiatric disabilities on their respective rights and responsibilities."
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Violence and Survival: Denial and the Ultimate Threat
June 1st 1997Although recent news portrays general violence as on the decline, the Centers for Disease Control still rank health care providers only one notch below convenience store clerks and taxi drivers at risk for homicide. Mental health personnel are exposed to these ultimate threats in emergency rooms, on home visits, walking through lonely hospital corridors or hotel corridors during conventions, as well as on the street and at home.
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Vitamin E for Alzheimer's Report Cautiously Interpreted
June 1st 1997This two-year study of 341 patients is the largest controlled trial conducted in a population with moderately severe Alzheimer's. The primary end points, assessed quarterly, were the onset of severe dementia (clinical dementia rating of 3); death; institutionalization; and loss of ability to perform at least two of three basic daily activities (eating, grooming and toileting).
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Ex-Profs Charged in Psych Department Research Scam
April 1st 1997A scandal-rocked Medical College of Georgia has announced tightened compliance controls for clinical studies in the wake of a 172-count indictment that charged two former professors with diverting more than $10 million in research funds. Richard L. Borison, M.D., the former chair of MCG's department of psychiatry and health behavior, and Bruce I. Diamond, Ph.D., once a professor in the department, were jailed in February.
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Pill Stimulates CNS Neurons' Regrowth
April 1st 1997Orally active compounds called neuroimmunophilins were demonstrated to protect and to stimulate the regeneration of brain cells in animal models with Parkinson's disease, according to a study published in the March 4 issue of the Proceedings of the National Academy of Sciences.
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A Model of Psychotherapy for the 21st Century
April 1st 1997During this first century of Western psychotherapy, arguments among and between the schools of psychotherapy have dominated discourse. The psychotherapy of the next century is likely to place theory and associated techniques in their appropriate, practical places in the psychotherapy outcome puzzle.
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Psychodynamic Treatment of Panic Disorder
March 1st 1997Panic disorder is a prevalent, debilitating illness associated with high utilization of multiple medical services, poor quality of life and a high incidence of suicide. Short-term efficacy of time-limited cognitive-behavioral and medication treatments has been demonstrated in many studies. Evidence for long-term efficacy of these treatments, however, is sparse and less convincing.
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Recognizing Resistance in the Therapeutic Environment
February 1st 1997Despite the proliferation of competing psychoanalytic theories in the past three decades, for most analysts the recognition and interpretation of resistance (as well as transference) remains at the core of psychoanalytic technique. While resistance has been defined as encompassing all of a patient's defensive efforts to avoid self-knowledge (Moore and Fine), operationally it means those behaviors that help the patient ward off disturbing feelings such as anxiety, anger, disgust, depression, envy, jealousy, guilt and shame.
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Guidelines for Clinicians Working with Gifted, Suicidal Adolescents
January 2nd 1997Adolescents are among the most difficult populations with whom to work therapeutically. Giovacchini (1985) wrote that they possess a "propensity for creating problems within the treatment setting [including]...their reticence about becoming engaged or their inclination to express themselves through action rather than words and feelings."
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The state of North Carolina has relatively liberal policies regarding petitions for involuntary commitment. If such documents bear words like "dangerous" or "mentally ill," even in the most nebulous sense imaginable, the police will surely locate the relevant individuals and dutifully bring them to the emergency department. This generosity of interpretation produces some sticky situations for the lucky ED resident of the day.
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Intrapsychic Focus Can Have Lasting Benefits for Patients
December 1st 1996In recent years, psychiatry and psychoanalysis have been drifting apart. As has been stated, psychiatry is losing its mind as it concentrates on chemistry and biology. This is a pity, because it is always good to have a mind.
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When Natalie Rogers was very young, she would enter the living room of her home where her parents, renowned psychotherapist Carl Rogers and artist Helen Elliott Rogers, sat reading. She'd turn on some music, look over at them and say, "Please don't watch me." Then she would begin to dance, describing this blissful experience as "the music flowing through me." Little did she know these impromptu rituals would set the stage for her own important work that would expand on the humanistic principles of her father, yet encompass elements of the creative process itself.
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Psychoanalytic Method and the Mischief of Freud-Bashers
December 1st 1996Psychotherapy is as old as civilization. Literally soul therapy, the term is a misnomer, since soul is a mystical notion and what is meant is the whole person. The misnomer also survives in the name psychiatry, literally soul medicine. Yet nobody is crusading against psychiatry and psychotherapy because soul is unscientific. What is important is that psychotherapy and psychiatry are job descriptions that refer to what we actually do when as providers or recipients of the service called psychotherapy, we use words to convey meaningful messages to each other, or to evoke desirable acts from each other.
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NIMH Team Links Tourette's Severity with Supersensitive Receptors
November 1st 1996In 1885, Georges Gilles de la Tourette, M.D., described in the Achives of Neurology a neuropsychiatric disorder characterized by chronic motor and vocal tics that begin in childhood. During the next century, researchers demonstrated that the disorder, which came to be called Tourette's syndrome (TS), is probably inherited as a dominant gene that expresses with widely varying symptoms, even within monozygotic twin pairs.
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