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Treating Co-Occurring Substance Use Disorders and Hepatitis CChronic infection with the hepatitis C virus (HCV) is frequently complicated by the presence of co-existing substance use disorders and mental illnesses. It is important to find improved ways to address barriers to care, and to provide effective and humane care to patients suffering from HCV infection.
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How About a Game of Chess?A psychiatrist's chess game with his patient didn't go the way he expected.
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Psychiatric Emergency StrategiesHere we present how to assess safely patients who become oppositional or menacing in a clinic or office.
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Psychiatric Ramifications of the COVID-19 PandemicJeffrey A. Lieberman, MD, and Mark Olfson, MD, speak from the epicenter of the COVID-19 disaster, New York City.
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Meeting the Mental Health Challenge of the COVID-19 PandemicThe public is gripped by fear of COVID-19 and by worry over whether the health system will be able to treat them or their loved ones should they become ill. Consequently, clinical and public health efforts have focused on acute medical care needs of those who are severely affected, while containing the virus’s spread in the population.
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Research Review: Treating Major Depressive Disorder With MAOIs: Effect of Delivery System on Cardiovascular EventsResearch Review: Treating Major Depressive Disorder With MAOIs: Effect of Delivery System on Cardiovascular Events
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Tipsheet: Physician Substance Abuse in the WorkplaceMany barriers can prevent physicians who have a substance use disorder from obtaining the help they need. However, in many states, all is not lost for physicians who willingly participate in treatment. Here, signs, symptoms, and intervention steps.
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Beyond Terminal Illness: The Widening Scope of Physician-Assisted Suicide in the USPhysician-assisted suicide is now legal in 11 jurisdictions in the US. To this, several clinicians say: “We must care for the dying, not make them dead.” Learn more in our June cover story.
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The New Historical Trauma StudiesRecent decades have seen an outpouring of publications about psychological trauma. With its formal diagnostic category of posttraumatic stress disorder (PTSD), Western psychiatric medicine has led the way in opening up this field of study. Many other disciplines of inquiry, including sociology, anthropology, legal studies, and literary studies, also have contributed their distinctive approaches and methodologies to the subject. Most recently, professional historians in Britain, Germany, Austria, Australia, Canada, and the United States have researched the origins of PTSD to great effect. These “new historical trauma studies” draw heavily on pioneering medical research from earlier places and periods. In addition, empirical findings from and analytical insights into humanity’s troubled, traumatic past provide ideas, observations, and insights that may be useful for mental health practitioners today.
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How Business Pressures Shape the Social Evolution of Modern Private Practice--A Case StudyAll of the forces affecting and influencing my professional life thunder through my day like these footsteps on the bridge. So many times we hear that private practitioners are "dinosaurs" in today's managed health care environment. At times, I admit, I do feel like a hanger-on in some evolutionary cul-de-sac. Yet, as referrals keep coming in, I find myself feeling more and more fit to survive the Darwinian challenges facing psychiatry. Sharing daily life with colleagues I trust and respect better enables me to live with or ignore the "footsteps on the bridge," which in my more optimistic moments I imagine to be the sound of the real "dinosaurs" rumbling off into the mist.
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Instrument Measures for Behavioral Symptoms in Patients With DementiaPsychiatric disorders, such as primary sleep disturbances, depression, substance abuse, mania, sexually inappropriate behaviors, and psychosis, can complicate the care of patients with dementia.
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Improving Medication Adherence: How to Talk With Patients About Their MedicationsImproving Medication Adherence: How to Talk with Patients About Their Medications, by Shawn Christopher Shea, is a slim and excellent primer on the verbal strategies and interviewing tips that clinicians can use to improve medication adherence.
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Faith Is Not Enough: Self-Administered Questionnaire Screening for Bipolar DisorderBipolar disorder screening scales have modest sensitivity; thus, a negative result does not preclude a clinical evaluation.
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The Changing Face of Alcoholism TreatmentAt the core of alcoholism is the pathologically increased motivation to consume alcohol at the expense of natural rewards with disregard for adverse consequences. naltrexone and acamprosate represent the first generation of modern pharmacotherapies that target this pathology.
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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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Psychiatry and the Menopausal Transition: Clinical CaveatsThe menopausal transition is characterized by sex hormone variability and a vulnerability to depressive symptoms and major depressive episodes. The rate of new-onset major depressive episodes is increased during the menopausal transition, as is the experience of depressive symptoms.
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Inpatient Psychiatry: The Interpretation of Changing SceneryRecently our inpatient psychiatric unit moved into a brand new facility. In the months and weeks preceding “the move,” there was much preparation and nervous energy. We had been preparing our patients and ourselves for this day. “
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Utopia: The Transition From Inpatient to Outpatient PsychiatryOutpatient psychiatry is a critical experience in becoming an independent psychiatrist.
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Treat the Whole Patient: Bring in the PsychiatristBehavioral problems “masquerade” as physical symptoms. The time has come to treat the whole patient and to make psychiatry part and parcel of primary care.
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Suicide in Older Adults: How Do We Detect Risk and What Can We Do About It?Older adults have higher rates of suicide than younger adults in many industrialized nations.
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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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Epidemiology and Treatment of Substance Use and Abuse in AdolescentsThis article covers the spread of substance use problems in adolescents and some of the currently available scientifically proven behavioral treatments for these conditions.
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Recognizing Resistance in the Therapeutic EnvironmentDespite the proliferation of competing psychoanalytic theories in the past three decades, for most analysts the recognition and interpretation of resistance (as well as transference) remains at the core of psychoanalytic technique. While resistance has been defined as encompassing all of a patient's defensive efforts to avoid self-knowledge (Moore and Fine), operationally it means those behaviors that help the patient ward off disturbing feelings such as anxiety, anger, disgust, depression, envy, jealousy, guilt and shame.
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Migraine-Preventive Medications: Guidelines for SuccessMigraine-Preventive Medications:Guidelines for Success
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A CASE REPORT: Prepartum or Postpartum Psychosis?Did this woman have (untreated) postpartum psychosis when she became pregnant a second time-- or was this a separate, rare case of prepartum psychosis?
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Psychiatric Conditions Affecting Physicians With Disruptive BehaviorThis study highlights the need to consider a holistic approach when discussing the problem of disruptive behavior in health care settings.
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Treatment Adherence: Strategies and Best PracticesTreatment nonadherence in psychiatric patients contributes to increased suicide rates, illness exacerbation, hospitalization, and mortality. This Special Report countdown highlights the psychiatrist’s role in addressing barriers to treatment in a number of scenarios.
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Psychiatric Comorbidity Associated With Pathological GamblingGambling has become a major recreational activity in the United States. Formerly confined to a few states such as Nevada and New Jersey, legal gambling opportunities have exploded across the nation in the past 2 decades.
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Neurotransmitters, Pharmacologic Synergy, and Clinical StrategiesAlthough studies now suggest that some psychotropic medication regimens have a somewhat higher success rate than the one-third rule would have predicted, psychiatrists are still left with the problem of why it is that only one third to one half of patients who are treated get better, and why fewer still sustain that improvement over time
