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Integrating Psychosocial Treatment for PTSD and Severe Mental IllnessPatients with severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to have experienced trauma in childhood, adolescence, and throughout their adult lives than the general population. This high exposure to traumatic events such as physical and sexual abuse and assault takes a heavy toll.
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Boundary Violations and Malpractice LitigationDisregard of professional boundaries is a leading cause of malpractice litigation. Boundary violations take many forms. Sexual involvement is a recurring problem that can cause serious damage. Even without erotic physical contact, material boundary crossings can, at least, destroy or interfere with therapy, and at most, injure the patient and lead to litigation. Generally, boundaries are violated by any act that alters or blurs the contours of the professional relationship.
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Is ECT Appropriate in Old-Old Patients?More patients are reaching the old-old demographic-those age 75 and above-with psychiatric conditions such as treatment-resistant depression. Research has shown that with some careful screening and precautions, ECT is a safe, effective treatment option for these patients.
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The Meaning of Addiction: DSM-5 Gives the Lie to Addiction as a Chronic Brain DiseaseAlthough Charles O’Brien, MD, who heads the substance-related disorders work group, is a vigorous proponent of the notion of addiction as a disease, nothing about the proposed DSM-5 substance-related disorders section supports the idea that the syndrome is best understood as a chronic brain disease.
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The Patient’s Son Is Normal"You just never think people like that can have normal children.” And then I I think of when I was 14 years old and answered a late-night phone call at home.
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Identifying Predictors of Drug Response in Patients With OCDAlthough treatment of obsessive-compulsive disorder has improved, a large percentage of patients do not respond to pharmacological therapy. What familial or comorbid factors might influence the outcome for these patients?
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Strategies for Treatment-Resistant OCDThe clinician's role is to “translate” symptoms of OCD and understand the dysfunctional circuits at play to decide on the most appropriate treatment for each patient.
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The Impact of Antipsychotics on Cognitive Functioning in SchizophreniaCognitive deficits, which play a crucial role in the pathogenesis and prognosis of schizophrenia, can lead to noncompliance and poor outcomes. New treatment options need to be tested that may offer surplus effects on neurocognition.
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FDA Nominees Have Psychiatrists as ParentsPresident Obama’s 2 nominees for the top positions at the FDA have 3 psychiatrists as parents between them. Both Margaret Hamburg, nominated as commissioner of the FDA, and Joshua Sharfstein, nominated as deputy commissioner, are medical doctors and have held top public health positions: Hamburg in New York and Sharfstein in Baltimore. Both of Hamburg’s parents are psychiatrists, according to Neal L. Cohen, MD, director of the Center for Public Mental Health at Hunter College in New York, who knows Hamburg from her days in the early 1990s when she served for 6 years as commissioner of health for the City of New York.
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Learning to Do Psychotherapy With Psychotic Patients: In Memory of Elvin Semrad, MDDr Elvin Semrad was a much-loved psychiatrist and psychotherapy supervisor who had a profound influence on hundreds of psychotherapists and psychoanalysts in the Boston area. One of his unique qualities was his ability to connect empathically with even the most psychotic patients. He supervised at Boston State Hospital and then for 4 decades at the Massachusetts Mental Health Center (MMHC) in Boston, where he conveyed his strong conviction that psychotic and other seriously men-tally ill patients could benefit from long-term psychoanalytically oriented psychotherapy.
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Youth-Led Suicide Prevention in an Indigenous Rural CommunitySuicide is a pervasive public health issue for adolescents in Hawaii. In response, a youth leadership model was initiated to empower young leaders in suicide prevention through evidence-based training, relationship building, and community awareness.
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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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Culture as a Factor in Adherence: Learning From Latino ExperiencesSuccessful culturally adapted interventions to improve adherence among Latino patients with depression and schizophrenia confirm how important it is to understand a patient’s entire sociocultural environment.
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Treating Comorbid Anxiety Disorders in Patients With Schizophrenia: A New PathwayIdentifying comorbid anxiety disorders as potential treatment targets may contribute to more positive outcomes for patients with schizophrenia. Details here.
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Psychiatric Disorders During PregnancyTreatment with psychopharmaceuticals may prove problematic for pregnant women. The decision to discontinue medications or to adjust dosages to minimize the risk to the fetus has to be addressed. The dynamic balance of treatment options, maternal concerns and practitioner responsibility depends upon staying abreast of the latest research in psychopharmacology and pregnancy.
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Illuminate Life Processes by Taking a Sexual HistorySexual life is not just about sexual identity and sexual behavior.
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Medicare to Drop Antidepressants as Part D “Protected Class”Starting in 2015, psychiatrists will have to juggle antidepressant selections for Medicare patients. What might this mean for your patients?
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Detainee Interrogations: American Psychological Association Counters, but Questions RemainI am writing to correct several inaccurate assertions in the essay, “The American Psychological Association and Detainee Interrogations: Unanswered Questions” (Psychiatric Times, July 2008, page 16), by Kenneth S. Pope, PhD, and Thomas G. Gutheil, MD.
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Clinical Issues and Strategies Associated With Smoking CessationHere: assessment approaches, treatment options, and potential risks inherent in treating tobacco dependence in individuals with major mental illnesses and substance use disorders.
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Psychological Aspects of Human Reproductive Clones: What Can We Infer From the Clone-Like?The world began to face the prospect of human cloning when the journal Nature published Dolly the sheep's "birth announcement" in the form of a letter authored by Wilmut and colleagues. But despite all the attention given the issue, including two presidential commissions, the psychological consequences of cloning have been little addressed.
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Changing Healthcare Practices are Hard, Changing Culture HarderIt seems that all the changes in the healthcare system over recent decades have been top down, and without a lot of input from the folks at the delivery end.
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Areas for Future ResearchElderly patients are a heterogeneous population with myriad issues facing them. The group of articles in this Special Report should stimulate thinking, discussion and future research in a variety of areas.
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Psychopharmacology for Medically Ill PatientsThe prescription of psychotropic medications for patients with complex comorbid medical and psychiatric conditions is a cornerstone of psychosomatic medicine (PM) practice.
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Delirium: Emergency Evaluation and TreatmentDelirium is a disorder that lies at the interface of psychiatry and medicine. It is an acute organic syndrome caused by an underlying medical condition and is defined clinically by disturbances in cognitive function, attention, and level of consciousness.1 Delirium is considered a syndrome because of the constellation of signs and symptoms associated with the disorder, coupled with a wide variety of potential etiologies.
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A Clinician’s Guide to Statistics and Epidemiology in Mental Health: Measuring Truth and UncertaintyIs A Clinician’s Guide to Statistics and Epidemiology in Mental Health what we have been waiting for? Yes and no. It contains solid descriptions of concepts such as the P value and confidence intervals, and it has extensive discussions of the history of modern statistical methods. Perhaps its greatest strength involves critiques of the interpretations of several studies that have mistakenly become cornerstones of clinical lore.
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The Four Categories of Elder Abuse: Evaluation ApproachesThis article reviews the different categories of elder abuse, emphasizing the role and requirements for psychiatrists, with a focus on financial elder abuse.
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Clinical Service Delivery and Benefits in General Medical Care of Psychosomatic IllnessThe renaming of consultation-liaison psychiatry as psychosomaticmedicine, a new formal subspecialtyof psychiatry, may require someadjustment in our understanding ofthese terms. Both consultation-liaisonpsychiatry and psychosomatic medicinehave focused on treatment and researchof illnesses with mind-body interactions.Despite considerable overlap,consultation-liaison psychiatry hastraditionally been associated with treatmentand clinical research of comorbidmental disorders of the medicallyill, while psychosomatic medicine hasbeen associated with research into thephysiologic mechanisms underlyingmind-body interactions and classicalpsychosomatic diseases such as hypertension,asthma, and ulcerative colitis.
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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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Informed Consent and Civil Commitment in Emergency PsychiatryMedical school graduation usually involves taking the Hippocratic oath, in which physicians vow not to intentionally harm their patients. Keeping patients safe is another basic principle of patient care. Physicians are charged with ensuring that their patients are in a safe environment and minimizing risks to their patients by carefully selecting treatment options.
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The Rise of Cranial ElectrotherapyCranial electrotherapy devices, soon to be only home-use device approved to treat depression, can be an essential adjunctive treatment to standard modalities of care for soldiers and veterans, says this psychiatrist.
