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Cognitive Difficulties Associated With Depression What Are the Implications for Treatment?Subjective complaints of impaired concentration, memory, and attention are common in people with major depressive disorder (MDD), and research shows that a variety of structural brain abnormalities are associated with MDD.1 These findings have intensified the interest in quantitative assessment of cognitive and neuropsychological performance in patients with mood disorders. Many studies that used standardized cognitive tests have found that mild cognitive abnormalities are associated with MDD and that these abnormalities are more pronounced in persons who have MDD with melancholic or psychotic features
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Consumer Employment: Advocacy Assumes Another FaceThe goals of National Coalition for Mental Health Professionals and Consumers are to educate the public about the problems of managed mental health care and to develop alternative health delivery models. I think greater media coverage has spawned greater awareness of the difficulties with managed care and has provided legislators with vital information. Certainly sharing their stories has made many people feel less alone and isolated within a system they find frustrating and depriving. I think media advocacy has helped doctors find support for their right to stand up to these abuses and band together in greater numbers to fight for integrity and quality in mental health care delivery.
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Mini Quiz: Physicians as PatientsWhen physicians behave disruptively in the workplace, what is the most likely cause?
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Neuropsychiatric Dimensions of Movement Disorders in SleepSleep-associated movement disorders are common in the general population. When patients complain of sleep disturbance, psychiatrists should consider,and question for, features of nocturnal movement disorder.
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Issues in the Recovery of Physicians From Addictive IllnessesWhen physicians struggle with substance use disorders, physician health programs are an important source of information and support. Certain medical specialties are at higher risk for substance use disorders than are others, and drugs of choice vary by specialty. Physician health and patient safety must be considered, but colleagues can help.
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The Making of a Homegrown TerroristThe author applies psychodynamic psychology to understand and recognize so-called "homegrown" terrorists, individuals who are familiar with American culture and thus more difficult to detect.
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Depression and Cardiovascular DiseaseDepression is a risk factor for cardiovascular disease and death in many ways, directly and indirectly. It is independently linked to smoking, diabetes, and obesity-all of which are risk factors for coronary heart disease (CHD).1 Depressed patients are more likely to be noncompliant with treatment recommendations, including diet, medications, and keeping appointments, and are more likely to delay presentation for treatment with an acute coronary event.2-4
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The Adolescent Brain Is DifferentAssessments of partial culpability of adolescents are difficult in individual cases; however, the courts are moving away from mandatory sentencing to individual determinations, even for the most heinous crimes.
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Therapeutic Neurostimulation and SchizophreniaThe authors review the evidence for the use of ECT and other novel neurostimulation techniques in the treatment of schizophrenia.
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Immigration and Post-Adolescent Psychology of Young TerroristsRadicalization by Norwegian converts to the Prophet’s Ummah produced massive and terrible social consequences. The explanations offered may be pertinent to the current attraction that ISIS offers for too many young persons in many countries of the civilized world.
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Outside the Pill Box: The Systems-Based Practice of PsychiatryMeet "Gary," whose case provides an introduction to the value of systems-based practice.
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Alzheimer Dementia and Sleep Disorders: Issues in Diagnosis and TreatmentSleep disorders represent a significant problem in patients with Alzheimer disease. Here: assessment strategies and a review of drug and non-drug interventions.
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The “10 Knows” Psychiatric Clinicians Need to Prepare for a Job InterviewWhat 10 things do you need to know before entering a job interview?
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Trait Stages of Diagnosis for Borderline Personality DisorderThe authors describe an alternative model for BPD diagnosis that is dimensional in nature and requires fulfillment of 4 of 7 personality traits.
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10-Point Clock Test Screens for Cognitive Impairment in Clinic and Hospital SettingsThe obvious sometimes bears repeating: Sick people have trouble thinking. They may be suffering from a delirium, a dementia or a more subtle disturbance of cognition caused by fever, drugs, infection, inflammation, trauma, hypoxemia, metabolic derangement, hypotension, tumor, intracranial pathology, pain and so forth.
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You Say “Yes,” I Say “No,” You Say “Goodbye,” and I Say “Hello”In theory, psychiatrists possess no special skills for determining capacity of a patient to accept or refuse medical care, yet a large percentage of a psychosomatic physician’s work nonetheless involves capacity evaluations.
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Major Changes in the Treatment of Schizophrenia: A Long Time in the MakingIn this Special Report, explore groundbreaking insights on schizophrenia treatment, early intervention strategies, and the impact of childhood trauma on psychosis.
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Intrapsychic Focus Can Have Lasting Benefits for PatientsIn recent years, psychiatry and psychoanalysis have been drifting apart. As has been stated, psychiatry is losing its mind as it concentrates on chemistry and biology. This is a pity, because it is always good to have a mind.
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Geriatric Psychiatry: A Niche in DemandThe ranks of the elderly are swelling, yet fewer and fewer physicians are choosing to practice geriatric psychiatry. What will be the impact on older patients who receive their mental health care from primary care physicians?
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Tough Love of Community: The Citizen Review Committee of the Houston Police DepartmentThe story is decades old, but it reverberates today -- incidents of police brutality and excessive force, sometimes lethal. Here's a psychiatrist's story of serving on a citizen's review committee in Houston back in the day.
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Effects of Stress on Family Caregivers: Recognition and ManagementCaregivers may face years of continuous exposure to physical and psychosocial demands with burdens that can include physical, psychological, social, and financial problems; embarrassment; overload; and resentment.
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Keys to Successfully Working With Primary Care PhysiciansAlthough most major organizations recognize the importance of collaboration, the challenge for psychiatry is how to best integrate different aspects of psychiatric and primary care. Help here.
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The Role of Population and ED Trends in Delirium ManagementIn this issue, Drs Heinrich and Sponagle present a thorough overview of the challenges of detecting and treating delirium in the emergency care setting. They also address the high risks involved when the diagnosis is missed. The difficulties of identifying and appropriately managing delirium are not new. However, the importance of doing so is taking on a greater significance because of certain current and forecasted realities that will affect the nation's emergency departments (EDs).
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What Is Complex Posttraumatic Stress Disorder and How Does It Relate to Borderline Personality Disorder?Whether a patient has a diagnosis of cPTSD, BPD, or some combination of both, treatment should be considered multifaceted and overlapping. Learn more in this Special Report article.
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The Facts About Violence Against Historically Disadvantaged PersonsRacial/ethnic and sexual orientation minorities and women historically have been relegated to social, legal, and economic disadvantage in the United States.
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The Molecular Genetics of ADHD: A View From the IMAGE ProjectNew research into the genetic basis and possible genetic markers for attention-deficit/hyperactivity disorder may open the door for new treatments. There is a clear concordance between twins who have ADHD, as well as siblings. What can genetic mapping tell us about treating ADHD?
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Is Antidepressant Prescribing Associated With Suicide Rates?Since the introduction of the SSRIs in the early 1990s, the rate of antidepressant prescribing has increased dramatically. This look at five national data sets concludes that greater recognition of depression and greater rates of treatment with medication and psychosocial interventions has made a significant contribution to reducing suicide rates.
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The Effects of Age on Cognitive Deficits in SchizophreniaRecent studies have shown that patients with schizophrenia experience a greater decline in cognitive abilities with age. Given the large baby boomer population, how will this influence treatment for aging patients with schizophrenia?
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Update on Bipolar Disorder, Part 2: Bipolar Depression and Cyclothymic DisorderThis article reviews DSM-5 changes to symptom criteria for bipolar disorder with a focus on treatment of bipolar depression and cyclothymic disorder.
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Physician Health and Professional SecrecyHow far can the regulation of medicine extend without becoming Orwellian?
