Mr 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. . .
Prognostication is a major part of what physicians do in many fields of medicine, and it is particularly relevant when a treatment or procedure is controversial or anxiety-provoking. Being able to accurately tell a prospective ECT patient how likely he or she is to respond would be helpful.
When historians try to understand why psychiatric diagnosis abandoned validity for the sake of reliability in the years surrounding the millennium, they will rely on The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder.
The Supreme Court's 2006 decision in Clark v Arizona1 was one of the most unexpected defeats the American Psychiatric Association (APA) has had since it began regularly submitting amicus briefs to the Court 35 years ago.
From Our Readers
A Public Health Approach to Intervening With Youth in Schools
Dr Jeffrey Metzner's brief article, "Evolving Issues in Correctional Psychiatry" (Psychiatric Times, September 2007) related many of the difficulties and complexities of the corrections world; however, it did not mention the greatest problem of all--"deinstitutionalization," which, over the past half century, has resulted in the wholesale diversion of patients with chronic mental illnesses--many of whom cannot be managed as outpatients--from hospitals to jails and prisons.
Paraphilias and paraphilia-related disorders (nonparaphilic sexual compulsivity or sexual addiction) are sexual disorders that predominantly afflict men.
The role of the forensic psychiatrist frequently requires straddling a fence. On the one side lie the standard function and commensurate ethics of a physician; on the other are the needs of the legal system calling for objectivity, truth, and justice.
Virtual games, such as World of Warcraft, The Sims, and Second Life, are played by thousands every day, allowing people, worldwide, to connect and share information. In fact, the virtual "worlds" that can be created in these games are now being used to make money (through buying and selling virtual objects), to form partnerships and friendships, and even to conduct business; it is easy to see how many become engrossed in this alternative life.
Many psychiatrists feel intimidated by or frightened about courtroom testimony. However, with the proper preparation, the psychiatrist need not have a difficult experience. It is the role of an expert witness to educate the court on matters that are beyond a layperson's understanding.
The clinical management of patients with psychopathy and other psychopathic disorders presents a vexing challenge for mental health professionals. The issues of hospital treatment and civil commitment can be especially confusing.
How time flies! It has been more than a year since my last column, when I staked my claim in psychiatry. I planned to eschew the medical rat race and find my own little piece of medicine as it used to be, when doctors were doctors, nurses were nurses, and insurance salespeople were . . . salespeople. Should one read anything into the long delay between that column and this one? Absolutely! But I'll get to that.
Whether or not sexual offending behavior-or the predisposition to such-is a mental illness, there are patients with traditional mental illnesses who also present with sexually inappropriate and even sexual offending behavior.
There is no disputing that the rapidly escalating rate of incarceration during the past decade in the United States has been associated with an increasing number of imprisoned individuals with a mental illness. Research indicates that as many as 20% of inmates in jail or prison are in need of psychiatric care, frequently because of a serious mental disorder.
Figures from the US Department of Justice indicate that more than half of prison and jail inmates have a mental health problem. Mental health courts (MHCs) were designed to divert mentally ill persons convicted of nonviolent crimes to supervised treatment instead of incarceration, but while the number of MHCs has grown substantially over the past decade, limited information has been available about outcomes and costs.
Psychiatrists who work in inpatient units are faced with daily decisions about predicting which patients will be violent, both in the hospital and after discharge. These decisions are often made using unstructured clinical judgment based on the clinician's experience and knowledge of the literature. How long such judgment stays the standard of care remains to be seen, because psychiatric researchers have produced a number of assessment and management tools to improve the accuracy and use of violence risk assessment. This article briefly outlines 3 tools: the Brøset Violence Checklist (BVC), the Classification of Violence Risk (COVR), and the Historical Clinical Risk-20 (HCR-20).
The goal of this article is to further assist psychiatrists in tackling some of the more difficult financial issues in hopes of managing and reducing risk.
Patients with severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to have experienced trauma in childhood, adolescence, and throughout their adult lives than the general population. This high exposure to traumatic events such as physical and sexual abuse and assault takes a heavy toll.
Rape is a crime that is defined as an unwanted sexual act that results in oral, vaginal, or anal penetration. Generally speaking, there are 2 major types of rape. Forcible rape involves unwanted sexual penetration obtained by the use of force or threat of force. Drug- or alcohol-facilitated rape occurs when the victim is passed out or highly intoxicated because of voluntary or involuntary consumption of alcohol or drugs. Rape can happen to boys and men as well as to girls and women but this article will focus primarily on women.
In "Intermittent Explosive Disorder: Common but Underappreciated"(Psychiatric Times,January 2007, page 1), Arline Kaplan wrote that intermittent explosive disorder (IED) "is not just another name for bad behavior." She quoted Dr Coccaro from the University of Chicago as asserting that patients with IED who react with rage to minor irritants have been shown to have reduced down-regulation of certain cortical nuclei that should be reined in by inhibitory stimuli from the frontal cortex.
Fliege H, Grimm A, Eckhardt-Henn A, et al. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics. 2007;48:60-64.
An analysis of data on nearly 104,000 veterans of the Afghanistan and Iraq wars who sought help from the Department of Veterans Affairs (VA) system confirms that substantial numbers returned from their tour of duty with psychiatric problems.
"There must be some way out of here," said the joker to the thief."There's too much confusion, I can't get no relief. . . .""No reason to get excited," the thief, he kindly spoke,"There are many here among us who feel that life is but a joke.But you and I, we've been through that, and this is not our fate,So let us not talk falsely now, the hour is getting late."From "All Along the Watchtower," Bob Dylan
The following cases highlight some of the challenges clinicians face when treating patients in whom malingerling is suspected. One key aspect of these evaluations is not overlooking signs or symptoms that point to serious illness.
