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Marijuana and Madness: Clinical Implications of Increased Availability and PotencyCurrent trends are toward relaxing laws on cannabis, but no one knows the likely outcome. Will legalization mean an increase in consumption? Psychiatrists will be on the front lines if and when problems arise.
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Reducing the Risk of Addiction to Prescribed MedicationsPhysicians are often conflicted regarding prescription medications for pain, especially pain complicated by insomnia and anxiety. Concerns that patients may become addicted to medications, exacerbated by limited time available to get to know patients, can lead to underprescribing of needed medications, patient suffering, and needless surgery. At the other extreme, pressure to alleviate patients' distress can lead to overprescribing, needless side effects, and even addiction.
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Medical Necessity Review: History, Innovation, and Missed OpportunityPsychiatrists experience the impact of managed care perhaps most acutely during the utilization review process, which has become a standard tool for the review of treatment modalities and levels of service in the managed care environment.
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Practice Management: Managing Risks When Practicing in Three-Party Care SettingsFollowing trends in medicine, psychiatry is faced with limited resources and third-party administration of resource allocation. This has affected psychiatric practice in many ways and altered the doc-tor-patient relationship. Trends toward resource-sensitive, third-party–related psychiatric practice may be accelerated by the current social concerns regarding the economy. Thus, an awareness of social context and the growing recognition that autonomy-enhancing alternatives to paternalistic care are fundamental to improve both the effectiveness and accessibility of care in limited-resource environments are each becoming vital for an informed clinical and risk-management practice perspective.1
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The Risk of Cerebrovascular Problems in Patients With Dementia Treated With Atypical AntipsychoticsThe Risk of Cerebrovascular Problems in Patients With Dementia Treated With Atypical Antipsychotics
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Collaborating With Our Medical ColleaguesNinety percent of patients with psychiatric disorders are seen in the general medical sector. Two-thirds of these patients receive no treatment for their psychiatric illness. Of the one-third that does, only one-tenth is provided minimally adequate treatment.1 Furthermore, nontreatment or nonevidence-based treatment of psychiatric disorders in the primary care setting is associated with at least double the total health care costs for patients, mainly from increased general medical care and nonpsychiatric prescriptions.2,3
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NIMH, JAMA Shed Light on Seasonal Affective DisorderThe gloom of winter, more often a literary theme than a medical topic, is a biological reality for an estimated 10 million Americans who suffer from seasonal affective disorder (SAD). For some, however, the depression ushered in by the dark days of winter can be treated simply and with rapid results with 30 minutes to two hours of bright-light therapy per day for a few weeks.
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Brief Psychotherapies: Potent Approaches to TreatmentBrief psychotherapy is not the name of a specific model or theory of treatment. Rather, it describes an approach that attempts to make psychotherapy as efficient and practically helpful as possible within a limited time frame. The aim of brief therapy is to speed up the process of change, amplify patient involvement, and foster more focused psychotherapy sessions. Over the years, several approaches to brief psychotherapy have evolved. Some advocate a handful of sessions; others involve more than 20 sessions (eg, psychodynamic therapy).
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DSM-5: What It Will Mean to Your PracticeUndoubtedly there will be problems with some of the additions to DSM-5, with some of the combinations, with some of the new nomenclature, and with some of the new criteria sets. But practitioners will find most of DSM-5 to be well considered and well written. It is unfortunate, however, that much of its nomenclature is out of sync with the rest of medicine.
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Closing Thoughts on the Treatment of MDDRoger S. McIntyre, MD, FRCPC, and Carmen Kosicek, MSN, PMHNP-BC, discuss the future of MDD treatment and share closing thoughts.
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Beyond 'Handholding': Supportive Therapy for Patients With BPD and Self-Injurious BehaviorCan supportive therapy be modified to successfully treat patients with borderline personality disorder? By using a previously developed model, NIMH-funded researchers have found supportive therapy helpful in engaging patients in treatment, developing a therapeutic alliance and achieving treatment goals. Their outcome data may provide a new treatment approach for this difficult-to-treat population.
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Combining Family Practice and Psychiatry Resident TrainingIn 1995, the American Board of Family Practice and the American Board of Psychiatry and Neurology issued a white paper describing board requirements for residency training programs that combine the specialties of family practice and psychiatry. The first few students of these programs have graduated and are on their career paths. Might this be an opportunity for you?
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Management of Treatment-Refractory SchizophreniaBecause cognitive and negative symptoms have the greatest impact on overall recovery, interdisciplinary strategies that target these symptoms are necessary. This article offers details.
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Nothing Is EasyConcerned about increasing medical costs, Congress began to tinker with physicians' fees under Medicare with the Omnibus Budget Reconciliation Act of 1989. The result, the Resource-Based Relative Value Scale (RBRVS), altered our fees in the Medicare system.
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Introduction to Culture-Bound SyndromesA startled Malay woman with latah mocks the photographer.Source: Simons RC (1983)
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ADHD and Sleep Disorders in ChildrenSleep changes associated with psychotropic drugs are common enough to justify routinely obtaining a baseline sleep diary before beginning treatment, even when the initial screening for sleep disorders indicates that no further investigation is needed.
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What Is Organizational and Occupational Psychiatry?Organizational and occupational psychiatry represents the extension of psychiatric knowledge and skill to the day-to-day functioning of individuals in the workplace and their organizations, with the goal of helping both to function better. To this end, psychiatrists have played an important role both in the treatment of workers and consultation to organizations since the early part of the 20th century.
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No, Psychiatric Diagnoses Do Not Reflect “Circular Logic”Not knowing the pathophysiology of a condition does not mean we have no causal explanation of the patient’s suffering and incapacity.
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Introduction: Cross-Cultural PsychiatryDuring the past 2 decades, there has been enormous growth of interest in and visibility of cultural psychiatry. Much of this is due to the steady increase in migration of the world’s population from low-income to higher-income regions and countries.
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Secondary Traumatization in Mental Health Care ProvidersWhat is secondary traumatization? The authors discuss current research and implications for this controversial and emerging field of study.
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A Critical Moment in Psychiatry: The Need for Meaningful Psychotherapy Training in PsychiatryThe goals of psychotherapy education in medical school should be based on these seven ideals.
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On the Cannabinoid Receptor: A Study in Molecular PsychiatryGiven that cannabis (marijuana, hashish, ganja, dagga, etc.) is the most widely used illicit substance in the Western world, it behooves us as physicians to understand as much about it as possible. The cannabinoid receptor is a good starting point in such a pursuit. Marijuana is not a single substance, but a collection of substances or compounds which become 2,000 on pyrolysis. Numbered among the 400 constituents of the plant Cannabis sativa are some 60 cannabinoids.
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Couples Therapy and PsychopharmacologyPsychopharmacology can be useful in all stages of couples' therapy. Using a high-functioning couple as a case example, the author illustrates how psychopharmacology, together with psychotherapy, can be used to facilitate treatment success.
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8 Distinguishing Features of Primary Psychosis Versus Cannabis-Induced PsychosisThe authors compare the clinical features of idiopathic psychosis (eg, schizophrenia) with cannabis-induced psychosis.
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Introduction: Mental Health Correlates of TraumaOver half of the population is exposed to at least one lifetime traumatic event, yet relatively few of those exposed have lasting psychiatric sequelae. As psychiatrists, we attend to the needs of those who suffer.
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Treatment of Somatic Symptoms in Generalized Anxiety DisorderGeneralized anxiety disorder (GAD) is characterized by excessive or unrealistic anxiety and worries about life circumstances. In the general population, the prevalence of GAD is 2% to 5%. It is the most frequent anxiety disorder seen in primary care, where 22% of patients complain of anxiety problems.1 DSM-IV lists 6 somatic symptoms associated with GAD: restlessness, increased fatigability, difficulty in concentrating, irritability, muscle tension, and sleep disturbance. These symptoms may present with hyperarousal, hypervigilance, and heightened muscle tension; autonomic symptoms are milder than in other anxiety disorders and can be absent.
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Persistent Depressive Disorder, Dysthymia, and Chronic Depression: Update on Diagnosis, TreatmentAn update on the diagnosis, causation, and treatment of chronic depressive problems. The focus is on the recently introduced diagnostic category of persistent depressive disorder.
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7 Medical Illnesses That May Present as AnxietyBeyond psychosocial implications of anxiety disorders, an array of physiological effects may ensue.
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Research Developments and Their Implications for Clinical Care of the ADHD ChildAttention-deficit/hyperactivity disorder (ADHD) has received an extraordinary amount of attention in the popular media over the past eight months. Stories concerning the disorder, and especially its treatment with stimulant medication, have appeared in many major newspapers, news magazines and television news, entertainment and talk show programs.
