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Effective Note-Writing: A Primer for Psychiatry ResidentsAn overview of various aspects of taking notes and suggestions for effective documentation.
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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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The Diagnosis and Treatment of Substance Abuse/ Dependence and Co-Occurring Social Anxiety DisorderSocial anxiety disorder and drug addiction commonly co-occur in the same individual, complicating the presentation, course and treatment of both disorders. Using drugs or alcohol may be a coping mechanism for social anxiety; however, many treatments for addiction are group-based approaches, which would be especially challenging for people with social anxiety disorder. This article provides a brief overview of what is known about the co-occurrence of these disorders, as well as possible treatment interventions for this population.
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Do Adolescents Mimic Psychiatric Symptoms of Their Virtual Friends?Many adolescents have taken to the Internet to discuss their struggles with psychiatric disorders not ordinarily diagnosed in persons under 18 years old (eg, bipolar disorder).
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Ubuntu and Shalom: An Octogenarian, Psychiatrist Looks Back, and Forward“…Have We really Changed after Lo, these Many Years?”
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Podcast: CPT Coding-When Meeting With Parents of an Adolescent PatientWhich CPT billing codes should you use when working with adolescents if there's a need for a clinician to meet with parents separately? Here to discuss is Dr Saundra Jain.
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Society’s Chemical Noose: A Look at Substance Abuse and SuicideSubstance abuse and addiction are commonly associated with an increased risk of suicide. Alcohol abuse plays a key role in suicide attempts and completions; prescription drugs are a close second. The causes of suicide for men and women are different but the suicide rates are equally staggering.
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Controversies of Using Buprenorphine for Maintenance in Opioid DependencyThe use of buprenorphine for the treatment of opioid dependence is on the rise. However, buprenorphine withdrawal has its own withdrawal symptoms that in many cases can be as severe as symptoms of opioid withdrawal.
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Attending to the “Mental Suffering” of Patients With Progressive Medical IllnessPsychiatrists have found ways to bring their expert skills and knowledge to the care of medically ill patients who are nearing the final phase of life.
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Assessing Violence Risk in Psychiatric Inpatients: Useful ToolsPsychiatrists who work in inpatient units are faced with daily decisions about predicting which patients will be violent, both in the hospital and after discharge. These decisions are often made using unstructured clinical judgment based on the clinician's experience and knowledge of the literature. How long such judgment stays the standard of care remains to be seen, because psychiatric researchers have produced a number of assessment and management tools to improve the accuracy and use of violence risk assessment. This article briefly outlines 3 tools: the Brøset Violence Checklist (BVC), the Classification of Violence Risk (COVR), and the Historical Clinical Risk-20 (HCR-20).
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Irreversible Monoamine Oxidase Inhibitors RevisitedGiven the likelihood that insufficient numbers of patients will be available for a randomized controlled trial of MAOIs in refractory depression or atypical depression, we must still rely on consensus guidelines and expert opinion.
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6 Myths About Integrative PsychiatryAs we shift from treating disease and toward supporting health, medication is merely one possible intervention in a spectrum of possible ones.
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Perinatal Psychiatry: What We Still Don't KnowA number of highly publicized cases in the lay press have underscored the significance of, and dangers associated with, perinatal psychiatric illness. Unfortunately, the field of psychiatry has failed to use these tragic cases to disseminate accurate information and educate the public about the high frequency of perinatal depression and anxiety, as well as the relative rarity of postpartum psychosis and infanticide. Moreover, psychiatrists continue to have difficulty in educating their medical colleagues about the need to screen for these illnesses, so most obstetricians and pediatricians still do not screen for perinatal depression and anxiety, much less manage it effectively. Decisions about appropriate treatment are further complicated by a lack of empiric outcome data.
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Neurostimulation for Mood DisordersWe have medications that can affect serotonin, norepinephrine, and-to a lesser extent-dopamine. Many other neurotransmitters are involved with mood disorders, but we have no medications yet to target them. Neurostimulation offers a non-systemic somatic approach to depression, often with an improved side effect profile. More in this Q&A.
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Drs McGlashan and Woods Respond to Dr FeinbergDr Feinberg takes exception to much of what we wrote, or what he thinks we wrote, in our article “Early Antecedents and Detection in Schizophrenia”. We will do our best to reply to his criticisms of what we did write and try to point out where he is shadowboxing at issues that he has created but that we do not hold or endorse.
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Emergency Psychiatry in an Extraordinary AgeWelcome to the Emergency Psychiatry Special Report.
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SSRIs as Antihypertensives in Patients With Autonomic Panic DisorderThe cardiovascular properties of serotonin (5-HT) have been known for some time-its name reflects its presence in serum and its action in increasing vascular tone. Serotonergic medications are routinely used to treat depressive and anxiety disorders, and the association of depression with cardiovascular disease has become well established.2 Recent studies have confirmed the colloquial wisdom that anxiety (especially panic) and hypertension are linked.
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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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Subtle Nuances in Diagnosis of SchizophreniaAn analysis of symptom severity across domains may enable us to reevaluate how we categorize symptoms within the spectrum of psychotic illness.
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My Patient Lost Their Job…Now What?Unemployment is associated with an array of social and psychological complexities, directly affecting patients' self-esteem and perceptions of self-worth. When a patient loses their job, the psychiatrist has 4 tasks.
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Impulse Control, Impulsivity, and Violence: Clinical ImplicationsThe authors explore ways to address aggression in clinical practice and examine the potentially dangerous impulsivity-violence link across a broad range of conditions.
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Intimate Portrait: Richard M. Berlin, MDA brief psychological portrait of this psychiatrist/poet.
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Are the Media and the Public Still Missing the Clues?It is our responsibility as psychiatrists to educate the media and the public in general.
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The Diagnosis of Psychogenic Nonepileptic SeizuresAbout 25% of patients seen in epilepsy clinics and monitoring units who do not respond to antiepileptic drugs (AEDs) have received a misdiagnosis.1-3 The eventual diagnosis for most of these patients will be psychogenic nonepileptic seizure (PNES)1,4-a somatoform conversion disorder. It is treatable, but diagnosis, delivery of the diagnosis, and management present significant challenges. A major barrier to care has been the stigma associated with the label "psychogenic."
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Treatment-Resistant SchizophreniaStrategies for Recognizing Schizophrenia and Treating to Remission
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Utilization of MRS to Identify Neurochemical Abnormalities in Patients With Bipolar DisorderThe number of magnetic resonance spectroscopy studies that assess the levels of different neurochemicals in bipolar disorder has increased considerably in recent years. Abnormalities were reported mainly in the brain regions implicated in the pathophysiology of BD: the dorsolateral prefrontal cortex, cingulated gyrus, hippocampus and basal ganglia. Although these findings are not diagnostic, future research in this area may help to elucidate the pathophysiology of BD and monitor treatment effects.
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Assessing Suicide Risk in Patients With Borderline Personality DisorderPatients with borderline personality disorder are at a much higher risk for suicide attempts than patients with almost any other mental illness. Here, a case report and examples are presented to help clinicians assess, diagnose and treat patients with BPD who have attempted or are threatening suicide.
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Ethical Issues: The Patient’s Capacity to Make Medical DecisionsThis article provides a practical framework that can guide consultation-liaison psychiatrists through solving problems of capacity and informed consent.
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Psychiatric Comorbidity in Emergency Department PatientsEmergency medicine provides care to a vast number of patients each year. In 2005, 115.3 million people visited emergency departments (EDs).
