Psychiatric Questions, Queries, and Quarrels

More Dives and Intellectual Jujitsu. Almost everything about the psychiatric profession has been doubted-our assumptions about the nature of psychiatric disorders from psychoanalysis to neuropsychiatry, and our interventions from ECT to CBT. Scroll through the slides for hot discussions affecting psychiatry today. In this overview of the DSM diagnostic system, the medicalization of normal variants of human behavior, and physician-assisted suicide, Special Report Chair, Cynthia Geppert, MD, introduces this collection and puts it into context, getting to the heart of what makes psychiatry so fascinating.

Medical Marijuana and Mental Health: Cannabis Use in Psychiatric Practice. The authors discuss the 2 compounds in herbal cannabis that have received the most research attention and have also been of greatest clinical interest: THC and CBD. There are, however, numerous other compounds that are unique to cannabis. Patients may feel stigmatized not only by their mental disorder, but also by their cannabis use, and may be reluctant to discuss it with their provider for fear of being denied treatment or labeled a substance abuser in need of rehab. Open discussions between psychiatrist and patient about the patient’s cannabis use can potentially be beneficial, especially if the psychiatrist is receptive to learning about the perceived benefits of using cannabis. This is one reason psychiatrists and other mental health professionals need to understand the relationship between cannabis and mental disorders.

Are We Overdiagnosing and Overtreating ADHD? Many claim psychiatric disorders are overdiagnosed in an effort to medicalize and medicate normal variants in human behavior. Psychiatric detractors give a variety of rationales-some suggestive of conspiracy theories-for this tendency. Rahil R. Jummami, MD, Emily Hirsch, and Glenn Hirsch, MD, take on one of the most heated topics-the diagnosis and treatment of ADHD in children. Mining the epidemiological data field, they draw interesting, and at times opposing, conclusions as befits a Special Report dedicated to dissension. Readers can decide after reading the article whether ADHD is really over-or perhaps even under-diagnosed as well as parse out the logical fallacy that a diagnosis leads ineluctably to medication management. This article speaks to the care with which ADHD must be diagnosed and managed to reduce the significant negative impact of the disorder on the individual, family, and society.

Diagnosis of ADHD depends on phenomenology, subjective reports, and clinical observations of symptoms. Further, overdiagnosis may cause medicalization of normal variants and lead to unnecessary treatments with little or no benefit and with unacceptable risks. The Table summarizes DSM and ICD diagnostic criteria. For a mobile-friendly view, click here.

From “Delete Your Account” to “Delete Yourself”: Legislated Suicide and the Role of Psychiatry. Physician-assisted suicide (PAS) is now legal in several states. But none of the state statues mandates a mental health evaluation by a psychiatrist or psychologist before the writing of a lethal prescription by an attending physician. PAS has been legal and ethical not only in Europe for years but more contemporaneously in our neighbor to the north-Canada. No other issue in this collection of debates has aroused such polarized and powerfully held opinions, and this is not surprising given that PAS or PAD (physician-assisted dying), depending on your view, goes to the heart of the ethical commitment of psychiatry as a profession.