With 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.
Attachment 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.
The 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
Patients 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.
Currently, there are 350,000 Americans who receive maintenance dialysis for renal failure, and this predominantly elderly population with multiple comorbidities is growing.
Addiction-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.
Experts discuss groundbreaking insights on ketamine's role in treating depression, highlighting its rapid effects and potential to transform psychopharmacology.
The 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.
A 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.
Dysexecutive syndromes result from damage to the anterior regions of the brain and present as a combination of disinhibition, disorganization, or apathy.
Cognitive problems have historically been the last to be recognized and treated in the clinical setting.
This 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?
Learn more about how serum drug levels enhance psychiatric treatment by providing critical insights into medication efficacy and patient outcomes.
There 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.
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).
Army 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.
How many apps do you use on your phone? John Luo, MD, a technology expert shares his thoughts on their usefulness at the 2025 APA Annual Meeting.
This 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.
The number of persons affected by elder mistreatment and self-neglect is growing-with consequent increases in morbidity and premature mortality.
How does John Kane, MD, address issues of cognition in schizophrenia?
For 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
After reading Dr Daniel Carlat’s heartfelt piece in the April 19, 2010, New York Times Magazine (“Mind Over Meds”), I was struck by several things. The first was Dr Carlat’s eloquence regarding the dilemmas of psychiatric practice. Second was how his experience may represent a generation of psychiatrists who were trained during an era of drug discovery wrapped in the exciting promise of “Biological Psychiatry.”
Advances in basic molecular research of alcoholism await translation into important new clinical insights.
This is the last installment in a 3-part series discussing the behavioral, cellular, and molecular characteristics of posttraumatic stress disorder (PTSD). In Part 1, I described some basic clinical observations of PTSD and the challenges these observations pose to researchers attempting to understand underlying biological substrates.1 Part 2 examined progress on addressing these challenges at the level of the tissue and cell.2 In Part 3, I will discuss efforts to understand PTSD at the level of DNA, including potential genetic underpinnings and heritable risk factors.
Research conducted over the past 30 years leads to the conclusion that televised violence does influence viewers' attitudes, values and behavior.
Identification of atypical features is important in the treatment of depression for both treatment selection and prognosis, especially when initial measures prove ineffective. The concept of atypical depression has evolved over many years, and now it appears timely for a further revision.
It is important to recognize and document the abilities and deficits of a patient in order to determine capacity.
What is the effectiveness (if any) of antidepressants in bipolar depression? What is the risk of manic switching? How effective are antidepressants in preventing relapse of bipolar depression? Insights here.
Further arguments opposing MAID.