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Epileptic or Nonepileptic Seizure?A right-handed woman aged 19 years is referred for intractable clinical events. The patient's medical history is remarkable for anxiety, depression, and attention-deficit/hyperactivity disorder; migraine headache; and Lyme disease for which she received 6 months of intravenous antibiotic therapy.
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Fat, Food, and Mood: Beyond Omega-3sPotential benefits and benign safety profile of omega-3s indicate a promising intervention.
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Does Evidence-Based Medicine Discourage Richer Assessment of Psychopathology and Treatment?The paradigm for modern psychiatry is evidence-based medicine (EBM)-it represents proven treatments for defined diagnoses. But there are major problems with this position, starting with the fact that while they are superior to placebo, evidence-based treatments too often are ineffective.
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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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E-Cigarettes, Vaping, and Other Electronic Nicotine Products: Harm Reduction Pathways or New Avenues for Addiction?This article summarizes data on e-cigarettes, provides recommendations and resources to learn more, and emphasizes the evidence for treating tobacco (traditional cigarettes) addiction in people with mental illness.
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5 Key Issues About Comorbidity in Geriatric Bipolar DisorderClinicians need to consider and manage multiple medical and cognitive comorbidities when working with the elderly population. This slideshow provides an overview of key points relevant to geriatric bipolar disorder as it relates to comorbidity.
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Cognitive Rehabilitation in SchizophreniaThis article reviews methods to rehabilitate cognition in schizophrenia and suggests strategies for instituting a cognitive remediation program.
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Anxiety Disorders in Children and AdolescentsAnxiety disorders are one of the most common psychiatric disorders in children and adolescents, but they often go undetected or untreated. Identification and effective treatment of childhood anxiety disorders can decrease the negative impact of these disorders on academic and social functioning in youth and their persistence into adulthood.
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Setting Up a Neurology-Based Infusion Center: Rationale and Guidelines"No longer a pipe dream," is the suggestive lead-in of a widely distributed press release issued last October touting the potential benefits of cannabinoid compounds in the treatment of Parkinson disease (PD), Lou Gehrig disease-or amyotrophic lateral sclerosis (ALS)-and a number of other debilitating conditions, as reported during last fall's 2004 annual meeting of the Society for Neuroscience. According to Daniele Piomelli, PhD, an expert in cannabinoid research and professor in the Department of Pharmacology at the University of California, Irvine, certain cannabinoid compounds can be harnessed to "provide select benefits to patients while avoiding some of the unwanted effects" associated with marijuana use. Compounds of greatest interest have been WIN 55212-2, delta(9)-tetrahydrocannabinol (THC), and anandamide.
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The Challenges and Rewards of Rural PsychiatryDespite its many challenges, rural psychiatry can be particularly rewarding because it allows an opportunity to provide much-needed care and the ability to be at the forefront of helping to close gaps in health care disparities.The privilege of being a true community resource and the ability to improve overall community mental health give meaningful purpose to the work of a rural psychiatrist.
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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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Considering PTSD in the Treatment of Female Victims of Intimate Partner ViolenceThe distress and functional impairment associated with PTSD may make it difficult for IPV victims to benefit from interventions to increase their safety and reduce their exposure to violence. Empirically supported PTSD treatments include pharmacotherapy and cognitive behavioral therapy. Incorporating these treatments into interventions to improve victims' safety and reduce exposure to violence may improve their effectiveness in protecting women from IPV.
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Managing the Suicidal College Student: Advice for Community ProvidersAlthough college students are in many ways similar to any patient in their age group, their environment and stressors differ in significant ways. The authors identify issues to consider in assessing and managing suicidality in this population.
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An Elderly Woman Who Refuses TreatmentMrs E, who is 80 years old, lives in the community with the help of a 24-hour-a-day home health aide. She is forgetful and requires assistance with many activities of daily living.
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Traditional Healing Concepts and Psychiatry: Collaboration and Integration in Psychiatric PracticeThe authors share a model for psychiatrists interested in collaborating with traditional healing and medicine.
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The Paradox of PsychopathyThe clinical management of patients with psychopathy and other psychopathic disorders presents a vexing challenge for mental health professionals. The issues of hospital treatment and civil commitment can be especially confusing.
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A Delicate Brain: Ethical and Practical Considerations for the Use of Medications in Very Young ChildrenEffective, early intervention and appropriate support for and treatment of the caregivers of these vulnerable children will improve short-term outcomes and also may provide positive lifelong benefits.
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Sleep Deprivation, Psychosis and Mental EfficiencyToday, average young adults report sleeping about seven to seven and one-half hours each night. Compare this to sleep patterns in 1910, before the electric lightbulb, the average person slept nine hours each night. This means that today's population sleeps one to two hours less than people did early in the century.
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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.
