Addiction & Substance Use

The stakes in the debate over recovered memories therapy ratcheted upward in October with the indictment of five health care professionals, including two psychiatrists, in Houston. Charged in a 60-count indictment-believed to be the first of its kind in the United States-the former staff members of the now defunct dissociative disorders unit at the Spring Shadows Glen Psychiatric Hospital are accused of perpetrating a "scheme to defraud by allegedly falsely diagnosing patients with multiple personality disorder caused by their alleged participation in a secret satanic cult."

The goals of National Coalition for Mental Health Professionals and Consumers are to educate the public about the problems of managed mental health care and to develop alternative health delivery models. I think greater media coverage has spawned greater awareness of the difficulties with managed care and has provided legislators with vital information. Certainly sharing their stories has made many people feel less alone and isolated within a system they find frustrating and depriving. I think media advocacy has helped doctors find support for their right to stand up to these abuses and band together in greater numbers to fight for integrity and quality in mental health care delivery.

In 1988 I was working as a general adult psychiatrist with a specialty in addictions. One day, a newly referred patient came to my office accompanied by his mother. Although he was well groomed, he was distinctly "nerdy." When I inquired about his chief complaint, his mother quickly explained that, although he had graduated from community college, he was unable to secure a job interview due to his obsessing on the details of his resume.

Only eight weeks after beginning treatment for trichotillomania (hair pulling) at Stanford University Medical Center, Christina Pearson found herself being invited to appear on a local television show in Seattle to discuss the disorder.

Only eight weeks after beginning treatment for trichotillomania (hair pulling) at Stanford University Medical Center, Christina Pearson found herself being invited to appear on a local television show in Seattle to discuss the disorder.

Over 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.

Proponents 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.

A 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?

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."

In 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."

Annick Hollister has always loved to paint. Her parents, Hal and Patsy, remember that ever since the age of 3, art was a way for her to express herself when she couldn't convey her feelings in words.

How 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.

Detoxification 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.

In 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.

Because 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.

To 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?

Despite the public's growing acceptance of addiction as a biopsychosocial disease from which recovery is possible, an ideological chasm persists between psychiatry AA.

Is 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.

The 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."

Although 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.

This 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).

A 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.

Causal Explanations that Suggest How to Change

Orally 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.

During 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.