Authors
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‘What I Didn’t Learn in Residency’Pediatrician Sandy L. Chung on getting schooled in the business of medicine during her first year of practice.
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Update on Diagnosis and Treatment of Alzheimer DiseaseAlzheimer disease (AD) affects between 6% and 8% of Americans older than 65 years. As the population of older adults increases, the number of persons with AD is expected to rise from 4.5 million in 2000 to 13.2 million by 2050.1 This disease is important not only because of the number of patients affected but also because it leads to significant physical and emotional burdens on families and caregivers.
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Management of Antipsychotic-Induced Weight GainIndividuals with schizophrenia are at greater risk for weight gain than the general population. From recent research, it appears that some of the second-generation antipsychotics may be more likely to cause weight gain than others. Recommendations for treatment strategies are provided.
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Revisiting the Hallucinogenic Potential of KetamineAn exploration of findings from contemporary research that hint at the unexplored hallucinogenic potential of ketamine and considerations for future investigation.
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Mini Quiz: Capital PunishmentThe 1990s can be considered a high-water mark for support of the death penalty, as well as for imposing it. Where does that figure stand now? Take the quiz and learn more.
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Psychiatric Care of Patients With Hepatitis C: A Clinical UpdateThe prevalence of chronic hepatitis C virus infection is among the highest in patients with severe underlying mental illness. Here: clinical information on the interface of HCV infection and psychiatric disorders.
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Atypical Antipsychotics for Children and Adolescents With Schizophrenia-Spectrum DisordersAlthough the onset of psychotic symptoms before the age of 13 years is exceedingly rare, the incidence of schizophrenia rises sharply after the onset of puberty.1 Only 1% of the population has schizophrenia and 30% of these patients experience an onset of psychotic symptoms by age 18 years.2-8 The period that precedes the onset of frank psychotic symptoms (ie, the prodromal phase) has not been well characterized in early-onset schizophrenia-spectrum disorders (EOSS), but retrospective reports have shown that symptoms include high levels of depression and anxiety, emerging cognitive and social deficits, unusual thought content, and (not infrequently) school failure.
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Treating Adolescent Depression With Psychotherapy: A QuizEmpirically supported psychotherapeutic treatments have been shown to reduce symptoms of depression and build problem-solving skills in adolescents. Three of those treatments are discussed in this 10-question quiz.
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Perspectives on Consultation-Liaison in Child and Adolescent PsychiatryChild and adolescent psychosomatic medicine, usually in the realm of the pediatric psychiatric consultation-liaison service, seeks to address the complex relationship between a child's physical illness and affective state with the goal of improving the child's emotional well-being.
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Using the Internet to Increase Access to Evidence-Based Treatment for Obsessive-Compulsive DisorderInternet-based CBT has shown promise to improve access to therapy for patients with OCD, which is associated with a profoundly diminished quality of life and social isolation.
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A Case of Pseudosomatization DisorderParticularly because 25% to 50% of patients with conversion disorder eventually have a nonpsychiatric illness that explains their symptoms, it behooves us as psychiatrists to remember that we are physicians too.
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The Case of a Female Teacher Who Sexually Abuses Her StudentIn treating a female who sexually abuses a minor, what should the clinician keep in mind? Is the treatment plan different for a female offender than a male?
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Cognitive-Behavioral Therapy for Adolescent DepressionProcesses of Cognitive ChangeThe substantial and often recurrent distress and impairment associated with major depressive disorder (MDD) in youth has prompted increased interest in the identification and dissemination of effective treatment models. Evidence supports the use of several antidepressant medications, specific psychotherapies, and, in the largest treatment study of depressed teenagers, the combination of fluoxetine and cognitive-behavioral therapy (CBT) as effective treatments.1-3 CBT is the most extensively tested psychosocial treatment for MDD in youth, with evidence from reviews and meta-analyses that supports its effectiveness in that population.3-5
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Complementary Therapies for Schizophrenia: Expanding the Clinician’s ToolboxGiven the burdens of living with schizophrenia, and the increasing focus on patients' quality of life, it’s no wonder clinicians are seeking other treatment options for the disorder. Here, a discussion of the most promising nonconventional therapies and how to use them.
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Psychiatric Manifestations of HIV Infection and AIDSPatients with HIV infection are at risk of developing psychiatric symptoms and disorders similar to those seen in the general population. What unique biological, psychological and environmental factors are involved in treating this population?
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Between Stoned and a Hard Place? Navigating Cannabis Medicolegal IssuesGiven the significant variation in medical cannabis laws amongst states and the continually shifting legal landscape regarding its use, medical cannabis presents a unique challenge for medical professionals who consider recommending it to their patients
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Promising Strategies for Treatment-Resistant DepressionIn this CME, review novel, currently available, and promising pharmacological treatment options for treatment-resistant depression.
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Sexualized Transference in Older AdultsOf all the transferences that emerge in the consultation room, sexual feelings are by far the least talked about and the most challenging for therapists to manage. This author talks about erotic transferences here.
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Sexuality in Older Adults: Addressing the Elephant in the RoomRecognition, management, and understanding of the broad range of sexual feelings in older adults is a key component to providing humane and competent care. More in this expert Q&A.
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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).
