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A First-Episode Psychosis Treatment Program: “The Disease Doesn’t Define Me”The Psychiatric Transition Program at the Naval Medical Center in San Diego is a specialized first-episode psychosis program that provides coordinated specialty care to active-duty service members with serious mental illness.
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Addiction Psychiatry: Clinical InsightsThis brief communication highlights clinically applicable information and take-home points presented at the American Academy of Addiction Psychiatry Annual Meeting.
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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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Parenteral Antidepressants: Is America Ready?In spite of the enormous success of antidepressants, there are surprisingly few that are available in other than oral form. There is now substantial evidence that intravenous administration is well tolerated and may accelerate onset of therapeutic effect. With the possibility of transdermal delivery3/4a noninvasive and painless route of administration requiring no technical support3/4parenteral antidepressants may become more acceptable in this country and warrant further clinical investigation.
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Assessing Risk of QTC ProlongationMonitoring patients for possible QTC prolongation with psychotropic use can be difficult--even more so in children or adolescents. What screening and treatment techniques should be used for maximum therapeutic benefit with minimum cardiac risk?
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Optimizing ADHD TreatmentWeight-based dosing strategies have been used in psychostimulant studies for ADHD in children between the ages of 6 and 12 years. The efficacy of weight-based psychostimulant doses changes throughout early childhood and into adolescence in ways that are not in keeping with weight-based dosing practices. Future treatment and research must explore new possibilities in order to afford patients the most benefit for the least amount of effective drug intervention.
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Pathology and Management of Treatment Resistance in Bipolar DisorderThe problem of treatment resistance in bipolar disorder begins with its definition. Characterizing the phases of bipolar disorder as manic, mixed, hypomanic, or depressed does not do justice to the reality for many persons with this disorder.
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Intellectual Disability and Psychiatric Comorbidity: Challenges and Clinical IssuesIntellectual disability affects an individual’s functioning in everyday life. The risk for a psychiatric disorder is greater in persons with ID than in those with intelligence in the normal range. Here: the latest information on ID.
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Stress Neurobiology and Corticotropin-Releasing FactorStress Neurobiology and Corticotropin-Releasing Factor
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Bioethical Challenges for Psychiatrists: Determination of Decisional CapacityThe authors parse myths and facts about decisional capacity, with the goal of preserving patients' dignity and autonomy and helping you mediate conflicts, meet bioethical challenges, and provide compassionate resolutions.
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The Dizzy Patient: How You Can HelpPainstaking elucidation of a patient's symptoms is the key component of the diagnostic workup for dizziness and vertigo. A rational, straightforward, and cost-effective approach that uses minimal, selective diagnostic testing can get to the root of an individual's specific problem.
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The Outlook for Mental Health Services: A Perfect Storm on Our HandsFunding for mental health services has never achieved top legislative priority, and reforms requiring parity succeeded only after years of hard-fought battles.
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Ms. L, Delirious ManiaTo this day, I fiercely debate whether I would want to remember such an experience if it had happened to me. How tortured would I feel?
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Why Do Psychiatrists Select or Switch an Antipsychotic?The increase in diagnostic and therapeutic options has made the selection of the best medical strategy more complex. Physicians are often forced to work and make decisions under time pressure, which complicates matters.
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Psychiatric Consultant's Role Continues to Grow at Life Insurance CompanyI find expertise is best defined by the attending psychiatrist. I usually ask them whose opinion they respect in the community, whether that person is acceptable to them to do the evaluation and if their conclusions about disability would be acceptable. If the attendings have no one in mind, I have developed a network of excellent forensic psychiatrists around the country from which I can draw. In this case, I make a suggestion, and ask the attending if the particular provider is acceptable.
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Q&A: Addiction MedicineIn this podcast, Dr Michael Miller, Director of the American Board of Addiction Medicine, discusses addiction medicine, including the new ASAM, patient placement criteria, and DSM-5 changes.
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An Army of ChildrenI am a civilian psychiatrist who recently finished 20 months of work as a contractor for the US Army. Going into the job, I expected the degree of combat-related stress I saw in our troops. I was not prepared, however, for the scope of the impact our 2 long wars have had on military children.
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5 Classic Hallucinogens Studied in the Treatment of AddictionsThis slideshow provides information about the compounds, clinically relevant attributes, approximate dose, and data under study.
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Helping Children Hospitalized for RagesRages are part of a syndrome of severe mood dysregulation, which is defined by markedly increased and frequent reactivity to negative emotional stimuli.
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Exploring OCD Subtypes and Treatment ResistanceObsessive-compulsive disorder (OCD) is a heterogeneous disorder with a variety of phenotypic expressions. Delineation of clinically distinct subtypes of the disorder may be valuable in predicting treatment response and resistance.
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Behavioral Comorbidities in Rheumatoid ArthritisWhile tremendous therapeutic advancements have been made, patients with rheumatoid arthritis (RA) have a myriad of comorbidities, including fatigue, depression, and sleep disturbances. Data on the comorbidity of psychiatric disorders with arthritis are also striking: according to the NIMH Catchment Area program, the lifetime prevalence of psychiatric disorders among patients with RA is 63%.
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Black Boxes, Xboxes, and Other Current ConcernsThe articles in this Special Report, although far from comprehensive, address an intriguing sample of the many key topics in child and adolescent psychiatry today.
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10 Hallmarks of a Great PsychiatristA great psychiatrist knows the disease, the person with the disease, and the way the two interact. Here are tips from a clinician who has devoted his career to treating psychiatric disorders.
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Measuring Up on Mental Health?Tracking and measuring the nation’s health is no easy undertaking. How are we doing?
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Reactivation of PTSD Symptoms Resulting From Sandy Hook Media ExposureCombat veterans who have suffered a moral injury in the past may be predisposed to a recurrence of the painful memories associated with previous trauma after exposure to similar traumatic events with moral overtones.
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Multi-Modal Integrated Treatment for Youth With Bipolar DisorderBipolar disorder in children is particularly difficult to treat. A treatment algorithm combining pharmacology with psychotherapy in order to get optimal results is presented.
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Eating Disorders in SchizophreniaEating disorders in patients with schizophrenia have been underappreciated and poorly studied. Profiling characteristic phenotypic patterns will help clarify the distinctions among eating behaviors that are part of the spectrum of schizophrenia, those that represent distinct coexistent entities, and those that represent overlapping comorbidity.
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Management of Acute Ischemic Stroke: Reviewing the OptionsDespite the significant progress in stroke prevention and treatment over the past 10 years, stroke remains the third leading cause of death in the United States.1 Approximately 700,000 strokes occur every year; the majority are ischemic.1 In 1996, the FDA approved the use of intravenous tissue-type plasminogen activator (t-PA).
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Obesity in Patients With Psychiatric ConditionsObesity is one of the most common physical health problems in individuals with psychiatric conditions and contributes to excess medical morbidity and mortality. Several classes of psychotropic medications, particularly atypical antipsychotics, cause weight gain. While these issues pose challenges to optimal health, the good news is that there are solutions and emerging strategies.
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Stalkers and Their Victims"Stalking" is defined as repeated and persistent unwanted communications and/or approaches that produce fear in the victim. The stalker may use such means as telephone calls, letters, e-mail, graffiti and placing notices in the media. A stalker may approach or follow the victim, or keep their residence under surveillance.
