Refining the Wheel

Psychiatric TimesVol 39, Issue 3

Sometimes it is important to take another look at things to see what can be improved.

Building a better wheel



Nobody wants to reinvent the wheel, but sometimes we recognize the wheel can be improved. Maybe changing the treading will prevent skidding on a wet surface. Or maybe altering its composition will help it last longer. The same seems to be true in psychiatry, where, according to your colleagues, some systems are not performing as well as they could.

For example, let us consider the DSM. In this month’s Letter From the Editor, John J. Miller, MD, looks ahead to the release of the latest editition of the DSM. Although he was disappointed with DSM-5, he anticipates some positive changes in this new release. Nevertheless, he argues there are still issues with the classification and diagnostic system.

Similar issues can be found in consultation-liaison psychiatry, as Jacob M. Appel, MD, JD, MPH, shares frustrations over inappropriate consults. He notes that as many as 30% of patients in medical units have psychiatric disorders, so it makes sense that psychiatrists are in-demand— and nobody disagrees that psychiatric expertise can lead to better outcomes for the patient. Yet, inappropriate consultants—regardless of their cause or reason—can be disruptive and wasteful. Dr Appel shares tips for managing and navigating these situations to refine the process for all.

The potential for improvement also can be found in psychopharmacology. Psychiatric Times™ Section Editor Brian Miller, MD, PhD, MPH, examines new research that looks at dose response of antipsychotics to determine how to optimize antipsychotic dosing during acute illness exacerbations. Similarly, Editorial Board Member David N. Osser, MD, synthesizes research to help make sense of prescribing lithium while monitoring its nephrotoxicity.

The cover stories also share insights into improving status quo. J.J. Rasimas, PhD, MD, and Courtney S. Rasimas, MPH, discuss the complexities surrounding excited delirium as well as the controversies that surround it. As they succinctly put it, “The path forward will need to address the many forms of systemic bias embedded in society and the structures of service professions in order to refine the work in a just way.”

Speaking of bias and stigma, Jake Goodman, MD, MBA, pokes holes in the culture of silence and the myth of the superhero clinician in hopes to improve lives for current and future health care professionals. His brave story shines a light on what needs to happen to improve the fields of psychiatry and medicine.

And we are doing the same here at Psychiatric Times™. We are always looking for more ways to share the stories and clinical pearls that matter most to you, our reader. As the voice of psychiatry, we remain steadfast in providing top quality content from cover to cover. If you have ideas or suggestions to help us refine our wheel, please email us at ❒

Mike Hennessy Jr

Publisher and CEO, MJH Life Sciences®

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