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Mental Health as a Role in Mortality Rates in Peri- and Postpartum Black WomenBlack mothers in the US experience far worse outcomes. Here’s what clinicians need to know.
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Is Redefinition of Psychiatry Underway?Over the past decade, cost containment efforts have pushed psychotherapy patients away from psychiatrists and toward the offices of psychologists, therapists and other less expensive mental health workers. The availability of new drug treatments for psychiatric disorders has shifted many psychiatrists' practices away from a long-term therapeutic focus to that of short-term drug treatment. If psychiatry merely reacts to these economic and political forces, rather than managing them with a plan, the future of the field is highly uncertain.
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Evolving Potential of Mobile Psychiatry: Current Barriers and Future SolutionsHow will mobile mental health technologies change the nature of the psychiatrist-patient relationship? And do these technologies truly deliver what they promise?
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What is the Market Rate for My Specialty?The good news is that several resources provide guidance regarding market compensation. Here’s how that information will help you.
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Psychiatry and Chronic PainAlthough acute pain typically resolves on its own with little need for intervention, for some persons pain persists past the point where it is considered an adaptive reaction to injury.
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4 Myths About Assisted Outpatient TreatmentAfter lounging on the doorstep of respectability for the past decade, assisted outpatient treatment is here to stay. But some still balk at the notion.
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Neuroanatomic AbnormalitiesThe first magnetic resonance imaging studies in schizophrenia began to appear in the literature in 1984. These studies confirmed earlier theories and also contributed new findings such as changes in size of the hippocampus, amygdala, corpus callosum and so on in patients with schizophrenia. What other neuroimaging techniques are being used? What do recent studies show regarding the neuroanatomic abnormalities found in patients with schizophrenia?
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New Risks to Confidentiality in the Modern EraWhile this article highlights some of the modern-era risks to confidentiality that psychiatrists may experience, it does not constitute an exhaustive list of issues to consider and is not a substitute for legal advice.
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Advances and AchievementsWith the increase in child and adolescent patients comes an increase in challenging cases. Dr. Schowalter introduces this Child and Adolescent Psychiatry Special Report and provides perspective on articles discussing approaches to initiating care with a teen-ager, collaborating with pediatricians and other clinical topics.
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The Complex Issue of Attachment DisordersAttachment may be defined as a composite of behaviors in an infant, toddler, or young child that is designed to achieve physical and emotional closeness to a mother or preferred caregiver when the child seeks comfort, support, nurturance, or protection.
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Cognitive-Behavioral Therapy for Adolescent DepressionProcesses of Cognitive ChangeThe substantial and often recurrent distress and impairment associated with major depressive disorder (MDD) in youth has prompted increased interest in the identification and dissemination of effective treatment models. Evidence supports the use of several antidepressant medications, specific psychotherapies, and, in the largest treatment study of depressed teenagers, the combination of fluoxetine and cognitive-behavioral therapy (CBT) as effective treatments.1-3 CBT is the most extensively tested psychosocial treatment for MDD in youth, with evidence from reviews and meta-analyses that supports its effectiveness in that population.3-5
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Treatment Resistance in a Woman With Borderline Personality DisorderPatients with borderline personality disorder or narcissistic personality disorder (or both) can feel entitled to special treatment and often seek only approving forms of attention from those who treat them.
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Psychiatric Issues for Patients With Renal DiseaseCurrently, there are 350,000 Americans who receive maintenance dialysis for renal failure, and this predominantly elderly population with multiple comorbidities is growing.
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Addiction Is a DiseaseAddiction-as-disease or addiction-as-choice may be better defined by delineating initial experimentation with addictive drugs from ongoing drug use. Repeated exposure to addictive substances changes the molecules and neurochemistry of the addict. Addiction-as-disease accepts the responsibility of the health care professional to treat the patient and precludes the stigmatization that addiction is a choice.
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Cobenfy: The Tip of the Spear of A New Class of AntipsychoticsCobenfy: Only the first in a new upcoming class of antipsychotics.
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Neurological Complications of Perinatal AsphyxiaThe degree of asphyxia is best ascertained by measuring the amount of fetal acidosis determined by umbilical arterial blood. An umbilical arterial pH of less than 7.0 is seen in about 0.3% of deliveries.1 It indicates a severity of acidosis that places the fetus at risk for permanent neurological damage because of asphyxia. However, the outcome of infants with umbilical cord pH of less than 7.0 who required neonatal intensive care is relatively good. Eighty-one percent can be expected have a normal examination at discharge.
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Management of Mild Traumatic Brain InjuryA considerable overlap exists between TBI and disorders in cognition, behavior, and personality, which can provide even greater clinical challenges. More than 70% of the cases of TBI are mild, which makes this subgroup of particular clinical interest.
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Clinical Assessment of Dysexecutive SyndromesDysexecutive syndromes result from damage to the anterior regions of the brain and present as a combination of disinhibition, disorganization, or apathy.
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Let’s Talk About CognitionCognitive problems have historically been the last to be recognized and treated in the clinical setting.
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The Molecular Biology of Weight Loss: An Unexpected Linkage Between 2 MoleculesThis article outline a previously undescribed mechanism for understanding the molecular relationships between the hypothalamus and high-fat diets. Do they also hint at the creation of a fat pill?
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The Edifice of ScienceFor much of our 155-year history, the United States has been the global leader in research, including in its provision of funding for education and training in science, to the great advantage of itself and the wider world.
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Posttraumatic Stress Disorder in VeteransThere have been nearly 1.5 million military deployments to the southwest Asian combat zone since the start of the Afghanistan operation and Iraq war in 2001 and 2003, respectively. There have been many casualties, some of which have been highly profiled, such as service members being killed in action, losing limbs, or suffering blast injuries to their brain.
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Assessing Violence Risk in Psychiatric Inpatients: Useful ToolsPsychiatrists 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).
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No Legal Exit: The Fort Hood ShooterArmy psychiatrist MAJ Nidal Hasan sought to get out of the service, but the Army, which had poured hundreds of thousands of dollars into his military and medical training, offered him no legal exit.
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Turning a Negative Into a Positive: Ways to Avoid and Overcome Negative ReviewsThe Internet has transformed the way we get information. It is no surprise that finding health information online is a common activity.
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Psychiatric Malpractice: Basic Issues in Evolving ContextsThis article focuses on 4 issues in psychiatric malpractice: prescribing, liability for suicide, informed consent, and duty to protect under the Tarasoff v Regents of the University of California ruling. Malpractice is a civil wrong actionable by law. There are 2 goals of malpractice suits: the first is to make an injured plaintiff whole by an award of money, and the second is to inform the profession how courts will decide similar cases in the future.
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Elder Abuse and Neglect: Appearances Can Be DeceptiveThe number of persons affected by elder mistreatment and self-neglect is growing-with consequent increases in morbidity and premature mortality.
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Cognitive Issues in Schizophrenia Remain a ChallengeHow does John Kane, MD, address issues of cognition in schizophrenia?
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Marketing Off-Label Uses: Shady Practices Within a Gray MarketFor pharmaceutical companies, off-label use of a drug represents a substantial “gray market,” to which the company is unable to sell their product directly, yet may be a significant revenue stream. Some drugs have been used more for off-label purposes than for originally approved indications.1
