September 23rd 2024
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September 20th 2024
Patient Advocacy-and a Deadly Outcome
October 1st 2008William Bruce, a young man with symptoms of paranoid schizophrenia, was released from Maine’s state-run Riverview Psychiatric Center in April, 2006. Two months later, he killed his mother with a hatchet. Bruce subsequently was found not criminally responsible by reason of insanity and was recommitted to Riverview.
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Substance Abuse in Women With Bulimia Nervosa
October 1st 2008The high rate of comorbid substance abuse in women with bulimia nervosa (BN) has remained consistent in the literature. This article reviews the prevalence of substance abuse in BN and summarizes treatment approaches for persons with BN and comorbid substance abuse.
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Medicare Bill Brightens Mental Health Outlook for Psychiatrist
September 2nd 2008Psychiatrists were among the chief physician beneficiaries of the Medicare bill (HR 6331) that Congress passed in July. The Medicare Improvements for Patients and Providers Act of 2008 included an historic elimination of the discriminatory co-pay for Medicare outpatient mental health services.
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Doing Psychiatry Wrong Author Responds to Critique
September 2nd 2008In his review of my book, Doing Psychiatry Wrong: A Critical and Prescriptive Look at a Faltering Profession (Psychiatric Times, June 2008, page 57), S.N. Ghaemi, MD, MPH, citing George Orwell, writes that I “seek to justify an opinion” rather than “seek the truth.” He claims that my “errors are numerous and fundamental.”
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Collaborating With Our Medical Colleagues
August 2nd 2008Ninety percent of patients with psychiatric disorders are seen in the general medical sector. Two-thirds of these patients receive no treatment for their psychiatric illness. Of the one-third that does, only one-tenth is provided minimally adequate treatment.1 Furthermore, nontreatment or nonevidence-based treatment of psychiatric disorders in the primary care setting is associated with at least double the total health care costs for patients, mainly from increased general medical care and nonpsychiatric prescriptions.2,3
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Intimate Partner Violence: Practical Issues for Psychiatrists
August 2nd 2008The term “domestic violence” emerged in the United States with the rise of the women’s movement in the 1970s. Before that, violence between partners was considered a private matter. A specific type of domestic violence, intimate partner violence, refers to violence between intimate partners. Public awareness campaigns help us identify one type of intimate partner violence in which one partner, typically the male partner, is the aggressor, and the other partner, typically the female, is the victim.
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he key manifestations of DSM-IV somatoform disorder are unexplained physical symptoms or complaints that tend to coexist with other psychiatric syndromes or are linked to psychological issues. These symptoms typically lead to repeated medical or emergency department visits; are associated with serious discomfort, dysfunction, and disability; and lead to significant health expenditures.
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Dynamic Psychotherapy for Cancer Patients and Their Partners
August 1st 2008The estimated number of patients with cancer in this country is 10.5 million. Close to a million and a half are new cases, and it is estimated that 560,000 people die of cancer each year.1 There is clearly a large group of cancer patients and their families at high risk for serious psychiatric illness. In this article, I focus on the advantages of a psychodynamic approach and address how this approach is helpful in the liaison function and psychotherapy of cancer patients and their partners.
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Current Knowledge and Future Direction
July 2nd 2008We are growing older. In ancient Greece, the expected life span was 20 years. In Medieval Europe, it went up to 30 years. In 1900, people reasonably could expect to live to the ripe old age of 47 years, and 39% of those born at that time survived to age 65 years in the United States. Currently, the average life span in the United States is 78 years, and 86% of those born will survive to age 65 years. The very old-people older than 85 years-are the fastest-growing population group in the country, and there are 120,000 Americans over the age of 100 years. And the trend continues.
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Personality Disorder: “Untreatable” Myth Is Challenged
July 2nd 2008Success with new approaches to the psychotherapeutic treatment of borderline personality disorder (BPD) and other DSM-IV personality disorders has been reported in several studies recently, raising hopes that an intractable set of illnesses may not be as hopeless as once thought.
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Of Stress and Alcoholism, Of Mice and Men
July 2nd 2008This month I will examine the relationship between alcohol use disorder, stress, and a neuropeptide called substance P (SP). The data that led directly to research with human subjects came from the mouse-based genetic manipulation of a gene called neurokinin-1 receptor (NK1R), the receptor for SP. To understand this research thread, I will need to review some basic biology behind a class of biochemicals called tachykinins, of which SP is its most famous member. I begin, however, with an attempt to understand the relationship between the experience of stress, relapse rates in alcohol-dependent populations, and how mouse research ended up helping a cohort of stressed-out patients.
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Risk of Substance Abuse Not Increased by ADHD Drugs
July 2nd 2008Two recent studies present clinical evidence that the use of stimulants to treat boys with attention deficit hyperactivity disorder (ADHD) does not increase their risk of later substance use disorders. This evidence provides clinicians and families with much needed reassurance.
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Substance Use With Comorbid Obesity in Patients With Bipolar Disorder
July 2nd 2008The rising prevalence and dispersion of obesity in North America in the past decade is analogous to a communicable disease epidemic. Longitudinal and cross-sectional associations between major depressive disorder, schizophrenia, and obesity have been established. Existing evidence also indicates that there is an association between bipolar disorder and obesity.
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Bereavement-Related Depression
July 1st 2008The loss of a loved one is one of the most traumatic events in a person’s life. In spite of this, most people cope with the loss with minimal morbidity. Approximately 2.5 million people die in the United States every year, and each leaves behind about 5 bereaved people.
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Anxiety Disorders in Later Life
July 1st 2008Older adults can present with anxiety or worries about physical health (illness, changes in vision or hearing), cognitive difficulties, finances, and changes in life status (widowhood, care-giving responsibilities, retirement). Clinicians need to be aware that older adults may deny psychological symptoms of anxiety (fear, worry) but endorse similar emotions with different words (worries, concerns).
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Recent Clinical Findings From Longitudinal Studies
June 2nd 2008There is substantial comorbidity with oppositional defiant disorder (ODD) and conduct disorder (CD) in children with attention-deficit/hyperactivity disorder (ADHD). It is important to determine the effect of comorbid ODD and CD on the clinical course in youth with ADHD. Biederman and associates1 recently published clinical findings from a 10-year prospective, longitudinal study of boys with ADHD, following them into early adulthood.
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Violent Attacks by Patients: Prevention and Self-Protection
June 2nd 2008The brutal murder of New York psychologist Kathryn Faughey and attempted murder of psychiatrist Kent Shinbach this past February has provoked warnings to psychiatrists about personal safety and overreliance on clinical judgment. David Tarloff, a person with schizophrenia, was indicted for the attacks. According to press reports, Tarloff blamed Shinbach for having him institutionalized in 1991. While he was wait-ing to see Shinbach, Tarloff allegedly entered Faughey's nearby office and slashed her to death with a meat cleaver and knives. Shinbach heard her screams, tried to rescue her, and was assaulted and robbed.
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Pathological Lying: Symptom or Disease?
June 1st 2008Mr A was desperate. He was about to lose yet another job, not because he was at risk for being fired, but because his lying behavior had finally boxed him into a corner. He had lied repeatedly to his colleagues, telling them that he had an incurable disease and was receiving palliative treatment. . .
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Mood and Anxiety Disorders Following Traumatic Brain Injury
June 1st 2008Traumatic brain injury (TBI) is the major cause of death and disability among young adults. In spite of preventive measures, the incidence of a TBI associated with motor vehicle accidents, falls, assault, and high-contact sports continues to be alarmingly high and constitutes a major public health concern. In addition, the recent military operations in Iraq and Afghanistan have resulted in a large number of persons with blast injuries and brain trauma. Taking into account that cognitive and behavioral changes have a decisive influence in the recovery and community reintegration of patients with a TBI, there is a renewed interest in developing systematic studies of the frequency, mechanism, and treatment of the psychopathological alterations observed among these patients.
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Nonconventional Approaches in Psychiatric Assessment
June 1st 2008Everyone is unique at the level of social, cultural, psychological, biological, and possibly "energetic" functioning. By extension, in every person, the complex causes or meanings of symptoms are uniquely determined. The diversity and complexity of factors that contribute to mental illness often make it difficult to accurately assess the underlying causes of symptoms and to identify treatments that most effectively address them.
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Doing Psychiatry Wrong: A Critical and Prescriptive Look at a Faltering Profession
June 1st 2008Psychiatry has gone wrong by being too symptom-focused, too brain-oriented, and riddled with misdiagnoses. It should go back to seeking the "meaning" of things in patients' subjective experiences. This is the main theme of this short polemic based on case studies. The author selectively cites studies or opinions to make his point rather than trying to get at the truth by offering other perspectives. As George Orwell pointed out, books are of 2 types: those that seek to justify an opinion and those that seek the truth.
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