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Vietnamese Amerasians and Former Political PrisonersVietnamese Amerasians and the former political prisoners of South Vietnam are living legacies of the Vietnam War. Now that many live in the United States, it is important for psychiatrists to have an understanding of their life experiences and be able to recognize psychiatric disorders that are common among them.
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Working Within a Campus Health Service: A Challenge With Many RewardsPsychiatrists can provide significant support and insight to patients who are now coming to campus with a wide array of mental health challenges.
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Research-Based PsychotherapyThe practice of one human being helping another to feel better through the use of talk is as old as humanity itself. As a profession, however, psychiatry has existed for only 100 years.
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Special Populations, Emerging Treatments and Persistent ChallengesOver the past quarter-century, new treatments for depression have emerged that are as effective as original pharmacotherapies but have fewer side effects. Yet, full remission and access to care remain out of reach for so many people. In this introduction to our Depressive Disorders Special Report, Dr. Golden encourages readers to see the glass as half-full.
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Seroconversion: From Unconscious to Conscious and BackThe journey of switching specialties from anesthesia to psychiatry, from OR to office.
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Traumatic Brain Injury and Posttraumatic Stress DisorderOur returning military veterans remind us dramatically of the importance to consider traumatic brain injury (TBI) as a potential comorbid illness in cases of posttraumatic stress disorder (PTSD). The common causes of comorbid TBI and PTSD are assault and battery to the head, head trauma (personal or work-related injuries), civilian or military explosions, inflicted head trauma in children, motor vehicle accidents, and suicide attempts by jumping. Prevalence figures for comorbid TBI and PTSD historically have been lacking
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Pioneering FBI Profiler Answers Questions About Serial KillersHere, Mr Hazelwood answers questions about serial murderers that are commonly posed to him. The term serial murderer (or serial killer) was not even a part of the forensic lexicon until the 1970s . . .
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Comorbidities in Borderline Personality DisorderBorderline personality disorder typically coexists with depression, anxiety, and substance abuse. Symptoms of these conditions may lead the clinician to miss the diagnosis of personality disorder entirely. Careful diagnosis of BPD and comorbid disorders is the first step.
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Adaptation and Implementation of the Integrated Dual Diagnosis Treatment Model Into a Psychiatric Inpatient Facility: A 12-Year PerspectiveAs early as the 1970s, researchers and practitioners became increasingly aware of the necessity for services that would address the varied needs and treatment implications for consumers with the co-occurring disorders of substance abuse and mental illness. High percentages of consumers in substance abuse treatment centers were identified with mental illness disorders, and consumers admitted to psychiatric facilities often were identified as having additional substance use disorders.
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A Letter to the Board of Trustees of the APAWe are delighted that you have appointed a DSM-5 Scientific Review Work Group and charged it with assessing the quality of evidence supporting the DSM 5 proposals.This is great news, probably the last hope to weed out proposals that could do great harm to the Association, our field, and to our patients.
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Race-Based Traumatic StressIn 2001, the US Surgeon General issued a report about the status of mental health with respect to racial and ethnic minority groups, which stated that ethnic and racial disparities were likely due to racism and discrimination. Empiric investigations have linked racism to poor mental health and have shown that racism is stressful and compromises the mental health of persons of color.
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Clinical Manual of Sexual DisordersThis 3-part manual on sexual disorders is edited by 2 psychiatrists who have been engaged for more than 20 years in clinical treatment of patients with sexual problems.
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Neuropsychiatric Abnormalities: A New Vista From Studies on Fundamental Properties of Neural CommunicationPostmortem studies indicate that neural circuit abnormalities in schizophrenia could be reflected in gamma-band synchrony. We review findings of recent studies that demonstrate abnormal synchrony in the gamma band of the EEG in chronic schizophrenia patients, and point to links between gamma oscillations and some of the core symptoms of schizophrenia.
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Helping Primary Care Teams Provide Culturally Appropriate Care for Diverse PatientsPsychiatrists may wish to engage the primary care team to conduct a comprehensive case formulation that takes cultural factors into account.
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The DSM-5 Cultural Formulation Interview and the Evolution of Cultural Assessment in PsychiatryThis evidence-based tool is composed of a series of questionnaires that assist clinicians in making person-centered cultural assessments to inform diagnosis and treatment planning.
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A Practical Update on Neuroimaging for Psychiatric DisordersWhich neuroimaging test for which psychiatric patient-and when? What to ask the neuroradiologist?
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One More Thing to Worry AboutA new study recently posted online by researchers at Kaiser Permanente in Oakland, Calif, offers prospective parents one more reason to worry. The study showed that pregnant women who have symptoms of depression are at increased risk for giving birth prematurely.1
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Vision Loss and Depression in the ElderlyThe emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).
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Cyber BullyingWhen most people think of bullying, they envision the schoolyard thug verbally or physically threatening hapless victims on the playground or on the school bus. The past few years, however, have witnessed a new type of bullying-cyber bullying-also known as electronic bullying or online social cruelty.
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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.
