April 11th 2024
Take a look back at our recent coverage relating to our April content theme.
The Missing Risk/Benefit Analyses For DSM5
May 7th 2010DSM5 first went wrong because of excessive ambition; then stayed wrong because of its disorganized methods and its lack of caution. Its excessive and elusive ambition was to aim at a “paradigm shift.” Work groups were instructed to think creatively, that everything was on the table. Accordingly, and not surprisingly, they came up with numerous pet suggestions that had in common a wide expansion of the diagnostic system-stretching the ever elastic concept of mental disorder. Their combined suggestions would redefine tens of millions of people who previously were considered normal and hundreds of thousands who were previously considered criminal or delinquent.
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The DSM5 Draft: Can The Poor Writing Be Salvaged?
May 7th 2010The recently posted criteria sets for DSM5 are a mess. The writing is unclear, inconsistent, and imprecise. Unless they are edited and drastically improved, any field testing based on them will be a waste of time, effort, and money- and DSM5 may not be usable.
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Hallucinations, Self Monitoring-and an Historical Injustice
April 21st 2010I am writing to commend Flavie Waters, MD, for her recent article on auditory hallucinations in psychiatric illness.1 She covers the topic well. Her article is timely and I hope it will contribute to a badly needed reorientation of our field toward the positive symptoms of schizophrenia. However, I am compelled to point out an error of citation that is not the author’s fault.
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Psychiatrists, Physicians, and the Prescriptive Bond
April 16th 2010Almost the first memory I have of a physician is our family doctor at my bedside, leaning over to press his warm fingers against my neck and beneath my jaw. I’m 5, maybe 6 years old. I have a fever and a sore throat, and Dr Gerace is carefully palpating my cervical and submandibular lymph nodes. In my family, Dr Gerace’s opinion carried a lot of weight. It was the 1950s, and my mother did not quite trust those new-fangled antibiotics. She usually tried to haggle with the doctor over the dose-“Can’t the boy take just half that much?”-but even my mother would ultimately bow to Dr Gerace’s considered opinion.
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ADHD and Comorbid Substance Use Disorder
April 7th 2010Epidemiological studies show that, 4% to 5% of the general population have severe ADHD. Of this number, half have a comorbid substance use disorder. The aim of this article is to help physicians understand and manage this challenging combination of comorbidities.
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“Prescribing Psychologists:” Practicing Medicine without a License?
March 30th 2010Dateline: Portland, Oregon, April, 2011[From the office notes of Prescribing Psychologist, R.X. Sciolus, PhD]“Ms Malfortuna is a 60-year-old white female with a recent history of significant depressive symptoms, including insomnia, poor appetite, decreased energy, anhedonia, and lack of motivation. . .
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In a study of 3801 young adults that was just published in the Archives of General Psychiatry, Australian researchers have concluded that early and prolonged use of marijuana is associated with psychosis-related outcomes in young adults. They found a “dose-response” relationship: the longer marijuana was used, the higher the risk was out eventual psychosis.
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An Alternative Approach To The Suicidal Patient: Crisis Intervention
March 18th 2010There are currently several disturbing phenomena in the field of suicidology: •Many papers are describing risk assessment and suggesting the need for high-risk patients to be hospitalized. •Emergency department (ED) staff are complaining about spending much of their time trying to find beds for patients. •Programs are claiming “crisis intervention” when, in fact, they only provide triage.
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Psychiatric Symptoms Associated With Parkinson Disease
March 7th 2010Parkinson disease (PD) is the second most common neurodegenerative illness in the United States, affecting more than 1 million persons. Disease onset is usually after age 50. In persons older than 70 years, the prevalence is 1.5% to 2.5%.1 While the primary pathology involves degeneration of dopaminergic neurons in the substantia nigra, circuits important in emotion and cognition-such as the serotonergic, adrenergic, cholinergic, and frontal dopaminergic pathways-are also variably disrupted.
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Depression is a Thief, Even When You Learn From It
March 5th 2010Writer Jonah Lehrer caused quite a stir with his recent article in the New York Times Magazine, with the unfortunate title, “Depression’s Upside.” I have a detailed rejoinder to this misleading article posted on the Psychcentral website.
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Treating Child and Adolescent Mental Illness: A Practical, All-in-One Guide
February 26th 2010Treating Child and Adolescent Mental Illness: A Practical, All-in-One Guide is just what its title promises: a clinically relevant, encompassing yet concise guide to child and adolescent mental health care. Dr Shatkin’s book serves as a useful primer for medical and mental health clinicians who do not specialize in the treatment of children and adolescents but who find themselves faced with the growing demand to provide mental health services to this sector. It is also a handy refresher for child and adolescent clinicians called on to treat disorders seen less often in their practices, as well as a reference for nonphysicians less familiar with psychopharmacological interventions.
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Offspring of Parents With Bipolar Disorder
February 8th 2010It is generally held that the offspring of parents with bipolar disorder (BD) are at risk for BD. The degree of risk is an important question for both clinicians and parents. A recent study of bipolar offspring by Birmaher and colleagues1 sheds light on this issue.
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New Recommendations for Treatment of Schizophrenia
February 6th 2010Newly published recommendations for pharmacological and psychosocial treatments from the Schizophrenia Patient Outcomes Research Team (PORT) are the first to address related treatments, such as smoking cessation, substance abuse, and weight loss, and they are the first update since 2003.
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Learning to Do Psychotherapy With Psychotic Patients: In Memory of Elvin Semrad, MD
February 5th 2010Dr Elvin Semrad was a much-loved psychiatrist and psychotherapy supervisor who had a profound influence on hundreds of psychotherapists and psychoanalysts in the Boston area. One of his unique qualities was his ability to connect empathically with even the most psychotic patients. He supervised at Boston State Hospital and then for 4 decades at the Massachusetts Mental Health Center (MMHC) in Boston, where he conveyed his strong conviction that psychotic and other seriously men-tally ill patients could benefit from long-term psychoanalytically oriented psychotherapy.
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The Mythology of Evidence-Based Medicine
February 5th 2010Medical training is awash in catch phrases and shibboleths. Some can be useful (“When you hear hoofbeats, think horses not zebras”); others, perhaps overly simplistic (“If it’s not in the chart, it didn’t happen”). A current divination clinging to medical consciousness is the concept of evidence-based medicine (EBM).
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Cultural Considerations in Child and Adolescent Psychiatry
January 11th 2010The onset of psychiatric illness in a child is a life-changing event for families. Families from immigrant and ethnocultural communities often must come to an understanding of their child’s psychiatric difficulties while simultaneously interacting with an unfamiliar health care system and its practitioners.
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Religion, Spirituality, and Mental Health
January 10th 2010Until the early 19th century, psychiatry and religion were closely connected. Religious institutions were responsible for the care of the mentally ill. A major change occurred when Charcot1 and his pupil Freud2 associated religion with hysteria and neurosis. This created a divide between religion and mental health care, which has continued until recently. Psychiatry has a long tradition of dismissing and attacking religious experience. Religion has often been seen by mental health professionals in Western societies as irrational, outdated, and dependency forming and has been viewed to result in emotional instability.3
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What to Make of CATIE: Are We Better Off With Atypical Antipsychotics?
January 9th 2010CATIE can be viewed as a switch study. Switches offer both opportunity and risk. Data from CATIE demonstrate differences in overall effectiveness, but these differences depend on the individual patient context.
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After formulating and signing “Melancholia: A Declaration of Independence,” an international cadre of psychiatrists recently launched a campaign to have the upcoming DSM-V recognize melancholia as a distinct syndrome rather than as a specifier for the mood disorders of major depression and bipolar disorder.
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Alert to the Research Community-Be Prepared to Weigh In on DSM-V
January 7th 2010This commentary suggests how the research community can be instrumental in improving DSM-V and helping it avoid unintended consequences. According to several converging, anonymous (but I think quite reliable) sources to which I have had access, the draft options for DSM-V will finally be posted between mid-January and mid-February 2010. There will then be just 1 month (until mid-March) for collecting comments. The good news is that the products of a previously closed process will finally be available for wide review and correction. The bad news is that there will be only a brief period allotted for this absolutely crucial input from the field.
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Medical Marijuana: The Institute of Medicine Report
January 6th 2010The most rigorous scientific review of “medical marijuana” to date was carried out by the Institute of Medicine in 1999, under the direction of Drs John A. Benson Jr and Stanley J. Watson Jr.1 The institute’s conclusions were considerably more nuanced and qualified than those of the US Drug Enforcement Administration.2 The institute report found that:
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Addictions Conference Assesses Treatments
December 30th 2009The empirical basis for the effectiveness of 12-step recovery and the psychotherapeutic benefits of opioid agonist maintenance were among the topics of several symposia with introspective views of time-tested treatments at the 40th Annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM) in New Orleans.
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Medical Decision-Making Capacity of Patients With Dementia
December 14th 2009The United States Census Bureau projects that by 2010 nearly 13% of the US population will be over the age of 65. The elderly are one of the most rapidly growing segments of the US population and are expected to account for more than 20% of the total population by 2050.1 In 2001, the prevalence of dementia in North America was 6.4%. A 49% increase in the number of people with dementia is expected by 2020, and a 172% increase by 2040.2 Patients with dementia may lack the capacity to consent to treatment. The need to evaluate capacity to consent to treatment will therefore increase as the aging population grows.
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