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Some Concerns Regarding DiagnosisThe mental health professions are currently awaiting the American Psychiatric Association’s newest version of the Diagnostic and Statistical Manual. The need for a fifth revision underscores the lack of satisfaction within the professions with our diagnostic schema
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Neoplasm or Demyelinating Lesion?A 32-year-old left-handed woman presented with a 4-week history of progressive left hand numbness, tingling, and clumsiness. Symptoms worsened until she found it difficult to write and perform fine motor tasks. She reported having no transient neurological symptoms in the past. Her medical history was significant only for Dengue fever acquired several years ago while on a visit to Southeast Asia. She was taking no medications, and a review of systems was noncontributory.
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Assessing Malingered Voice-HearingMalingering in clinical settings is usually motivated by an attempt to obtain care or social services (eg, hospital admission, medication, disability income) and often co-occurs with real mental illness, hence the dilemma.
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Antecedents of Personality Disorders in Young AdultsPersonality disorders are characterized by the presence of inflexible and maladaptive patterns of perceiving oneself and relating to the environment that result in psychosocial impairment or subjective distress. The enduring nature of the behaviors, their impact on social functioning, the lack of clear boundaries between normality and illness, and the patient's perception of the symptoms as not being foreign make this group of conditions more difficult to conceptualize than the more typical, episodic mental disorders.
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Telepsychiatry: The Perils of Using SkypeWhat Skype does not offer is a means of communication clearly suitable for clinical services-especially in mental health and psychiatry.
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Hemicraniectomy for Massive Basal Ganglia Hemorrhageintracerebral hemorrhage, hemicraniectomy, stroke, neurosurgery, traumatic brain injury
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Psychiatric Problems in Patients Who Survive Critical Illnesses (Part 2)The psychiatric aftermath of critical illness can involve emerging from the ICU with horrifying memories (of being tortured, raped, assaulted, or imprisoned).
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What’s New in Our Understanding of SchizophreniaDuring the past 5 years, new insights into the pathophysiological processes that underlie schizophrenia have been revealed. Here's a quick update.
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The State of the Mental Health SystemThe federal government must realize that decades of allowing mental health care to go begging leaves a very weak chance of detecting or treating those who need help.
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Progress in the Treatment of Bipolar Depression: Advances and ChallengesA discussion of the pharmacologic management of bipolar depression, including emerging treatments and expert recommendations.
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Correctional Psychiatry: Challenges and RewardsPracticing psychiatry in a correctional environment differs from traditional outpatient and inpatient venues and presents unique challenges. It can be a rewarding choice of workplace.
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The OPTICS Project: An Open-Science Framework for the Analysis of Clinical Trial DataA report of initiatives that have raised awareness of and promoted data sharing and data transparency in order to advance science and improve public health and health care.
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From Our ReadersThe totalitarian system as we know it today may also be called 'managerial capitalism' since the decisions dictated by technical and economic considerations are no longer hampered by the rights of ownership and title holders. Yet it should be emphasized, speaking of 'managers,' that the true technical directors have nowhere acquired the disposing power of technocrats; the real power rests mainly with economic and business managers. This was written by H. Bruggers in 1941 in his "Stages of Totalitarian Economy," in the publication Living Marxism.
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Career Q&A With Joseph Weiner, MD, PhD (Part 2)During a presentation at a past Psychiatric Times Virtual Career Expo, Dr Joseph Weiner answered questions submitted by attendees, offered here in this brief Q&A.
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Borderline Personality Disorder and Bipolar Disorder-Distinguishing Features of Clinical Diagnosis and TreatmentSince the inclusion of the borderline personality disorder (BPD) diagnosis in DSM, there have been multiple efforts to recast the disorder as part of an Axis I illness category. While the initial focus was on the schizophrenia spectrum, more recent authors have attempted to link BPD to mood disorders.
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Special Risk Management Issues in Child and Adolescent PsychiatryNumerous studies have documented the increasing prevalence of mental health and substance abuse issues in youths nationwide. As many as 1 in 5 children and adolescents in the United States have a behavioral or emotional disorder.
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Comorbidity and Psychiatric Disorders: Support or Hindrance for Psychiatric Care?The revolution inherent in the move from DSM-II to DSM-III primarily involved a growing emphasis on comorbidity. For several decades before DSM-III, the emphasis had been on diagnostic economy: fewer diagnoses were considered more elegant, more accurate, and more useful in guiding care.
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Light Treatment for Nonseasonal DepressionDaniel F. Kripke, M.D. has studied the relationship between biological rhythms and depression since the early 1970s. He states that seasonal responses in many mammals are controlled by the photoperiod. Therefore, it seemed that depression might be analogous to winter responses and that light might be an effective treatment.
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Polypharmacy to Optimize Depression OutcomesPolypharmacy is used increasingly in the treatment of depression.1 Although it can be beneficial-and at times may even be unavoidable-it can also be overused, resulting in drug-drug interactions, accumulation of adverse effects, reduced treatment adherence, and unnecessary increases in the cost of health care.2 This article describes current trends in psychiatric polypharmacy in the treatment of depression along with ways to use polypharmacy to optimize treatment outcomes.
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Loss and Managing the Crisis at HandIf we acknowledge our feelings of grief and loss over the pandemic, we can begin to come together, encourage hope, find meaning, and stay connected. Dr Morganstein talks on this.
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Confounding Factors in Treatment-Resistant Depression (Part 2): Comorbidities and Treatment ResistanceThe role of subtyping and bipolarity in TRD was discussed in Part 1 of this 2-part article. Here we review a number of the most common confounding factors of TRD but limit our scope to comorbidities that can be directly addressed and treated by psychiatrists.
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Psychotherapy for Social Anxiety DisorderWhile social anxiety disorder (SAD) may cause observable signs of anxiety and social awkwardness in some, many others suffer silently. Cognitive-behavioral therapy can be helpful for most patients with SAD, with alternative therapies such as psychodynamic therapy and interpersonal therapy filling the gaps.
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Detox Diagnosis--Keeping Medicine in PsychiatryThe following are case studies discussing the impact of proper evaluation of comorbid psychiatric illness and medical disorders. To read more case studies and find out how to effectively recognize and treat patients with these disorders, please see the January 2002 issue of Psychiatric Times.
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COUNTERPOINT: Gun Control and the Second AmendmentWe are told that we must allow the massacre of innocent Americans--including children--with easily obtained firearms because "it is the price we must pay for freedom."
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Edema Associated With Infarct . . . Or Something Else?A sharp decrease in visual acuity affecting both eyes developed in a 35-year-old man 3 days after elective abdominal surgery. Six months earlier, acute B cell-type lymphoblastic leukemia was diagnosed in the patient for which he received bone marrow transplantation (BMT). Following BMT, graft-versus-host disease developed in the patient. It was treated with cyclosporine, mycophenolate mofetil (CellCept), sirolimus (Rapamune), and prednisone.
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How Serious Are We About Psychiatric Disease?Psychiatric treatment requires primary intervention and solid follow-up care, like diabetes, hypertension, and other medical conditions. More in this commentary by a resident in psychiatry.
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Treating Complex Trauma SurvivorsThis CME outlines distinguishing features of PTSD, complex trauma, and the dissociative subtype of PTSD (DPTSD), with an explanation of the distinctive neurobiological subtype of DPTSD.
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A Visit to Auschwitz: Reflections on Biology and the Psychiatric Sequelae of Political ViolenceIf I closed my eyes, it would have been easy to imagine that I was visiting a peaceful city park. The sounds of birdsong and children’s laughter rang in the air, and the odor of freshly cut grass filled my nostrils. But the sweet smells and soothing sounds belied the horror of the place where I actually stood-inside the wrought iron gates of Auschwitz-Birkenau, the Holocaust’s most infamous concentration camp. Today the camp is a museum, and there is an eerie dissonance between the tranquility of its sprawling grounds and the mass murders that were carried out here almost 70 years ago. Like many visitors to Auschwitz, I experienced powerful emotions-a mixture of revulsion, anger, and a deep empathy for the millions of souls who suffered and perished there. I also felt a discomfiting sense of doubt about the goodness of humanity, including my own.
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Sexual Harassment and Alcohol UseSince the 1990s there has been an increase in research on sexual harassment and its mental health consequences. These researchers discuss the use of alcohol to self-medicate harassment-engendered distress and the need for greater attention to potential alcohol-related consequences of harassment experiences.
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The Trauma-Focused CBT and Family Acceptance Project: An Integrated Framework for Children and Youth"Well-meaning" behavior by parents or guardians could be contributing to high levels of depression, suicidality, substance use, and other adverse outcomes in their child.
