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Dangerously Paranoid?Overview and Strategies for a Psychiatric Evaluation of a Highly Prevalent SyndromeThe term “paranoia,” derived from the Greek &lduo;para” (beside) and “nous” (mind), was coined as a descriptor of psychopathology by Heinroth in 1818.1 By the end of the 19th century, 50% to 80% of patients in asylums in German-speaking countries had received a diagnosis of paranoia.1 Beginning in 1899, Kraepelin’s efforts to define paranoia more precisely resulted in a decrease in diagnoses of paranoia in favor of dementia praecox and, later, schizophrenia.1,2 This narrowing of the definition of paranoia is reflected in current nosology and practice. In DSM-IV-TR, the prevalence of delusional disorder is estimated at 0.03% of the general population and accounts for 1% to 2% of psychiatric admissions. The prevalence of paranoid personality disorder is 0.5% to 2.5%; this condition accounts for 10% to 30% of psychiatric admissions.3
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Secondary Traumatization in Mental Health Care ProvidersWhat is secondary traumatization? The authors discuss current research and implications for this controversial and emerging field of study.
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Using Telehealth to Enhance Access to Evidence-Based CareFindings suggest that telemental health is not only effective for diagnosis and assessment across many populations and disorders in many settings, but it appears to be comparable to face-to-face care.
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How Many Psychiatrists Does it Take to Change a DSM - - or Rowing Backwards Into the Future . . . The DSM ProcessIt used to be that the answer to the above question was: “One . . . but he or she must really want to change.” Now that we are in the DSM process, many other things must be considered. We have watched as the Board assembled the Task Force and Work Groups for almost 2 years, choosing among expertise, years in the field, academic appointments, geographic distribution and freedom from excessive attachments to pharmaceutical and medical device manufacturers, etc, to complete what appears to be a very scientific, secret recipe for “DSM stew.”
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Top Research Findings That Can Change Clinical PracticeFour studies sprang from the TORDIA trial on treatment-resistant depression in children and adolescents and showed that several factors influence treatment efficacy following treatment resistance.
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Religion, Spirituality, and PsychiatryHistorically, there has been conflict between psychiatry and religion.
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Religious/Cultural Heritage and Patient Perceptions of Psychotropic DrugsOne of the major concerns of health professionals working in the area of psychiatry is understanding the conditions under which patients adhere to prescribed treatments. While adherence is linked to some extent to the patients' comprehension of their illness, it is also a function of their social and demographic characteristics, such as age, social milieu, or sex. Another attribute also merits our attention, however: the patient's cultural affiliation and in particular, his or her religious background.
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The Person of the Psychotherapist: Let’s Hear Not the Song but the SingerWhen we write about psychotherapy, we usually write about the patients and their cognitions and psychodynamics; or we talk about the techniques of psychotherapy, schools of psychotherapy, and efficacy studies. These are all songs of psychotherapy.
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Providing Culturally Competent Care: Understanding the Context of PsychosisCulture-the way people make meaning and live their lives in particular social worlds-matters in psychosis. The authors explore how a patient's cultural background should influence the way clinicians think about treatment and care.
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STEPPS: A Viable Supplement to Treatment of Borderline Personality DisorderTwo randomized controlled trials have shown the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program to be effective in reducing the intensity of core aspects of borderline personality disorder (BPD), Dr Donald Black and social worker Nancee Blum announced at the annual meeting of the American Psychiatric Association held recently in San Francisco. Black summarized, “Data from several studies show that STEPPS reduced global severity as rated by clinicians and patients, borderline personality disorder symptoms, and depressive symptoms.”
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The Evil HoursA Q&A with David J. Morris, author of The Evil Hours, a moving biographical book based on a young veteran’s experience with PTSD.
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A Spectrum Approach to Mood DisordersBravely enter territory that academia has largely neglected-the nebulous region between full bipolar disorder and major depression.
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Trauma and Violence in Childhood: A U.S. PerspectiveThis article reviews the Adverse Childhood Experiences (ACE) Study that examined the association between multiple childhood traumas and health outcomes in adults. These findings have significant public health implications for individuals exposed to childhood trauma, and the authors present a vision for a children's mental health care and wellness infrastructure in the United States derived from the Report of the Surgeon General's Conference on Children's Mental Health.
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Pediatric Major Depressive Disorder: Questions to ConsiderWhat are the options for treating major depressive disorder in children and adolescents? This case offers readers a chance to give their feedback and to interact with the authors, who will present teaching points based on your comments.
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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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Violence in Bipolar DisorderWhat is the association between bipolar disorder, trauma, and violence? Here: a guide to assessing violence potential in bipolar patients.
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Psychosis and Suicidality in AdolescentsInformation from studies on adolescents with psychosis and a review of the evidence about the risk of suicide and suicidal behavior in this patient population.
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Natural Supplements and Vitamins for Treatment and Prevention of Dementia and Cognitive DeclineHere: a look at several natural products used to improve cognitive impairment or cognitive symptoms of dementia.
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Drug Safety Oversight: Before and After FDA ApprovalCongress and the Bush Administration are wrangling over how to strengthen the drug safety oversight activities at the FDA in the wake of the recent controversies over cyclooxygenase-2 inhibitors and pediatric antidepressants. The White House intends to create an independent Drug Safety Oversight Board (DSB) within the FDA. Several key senators like the idea but insist that the DSB be separate from the FDA to keep it from being "under the thumb" of that agency.
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Psychocutaneous DisordersPsychological problems are often manifest in the skin. In fact, it is estimated that between 20% and 30% of all skin disorders have some psychological component. Many patients who have psychocutaneous disorders-which are often direct evidence of or secondary to psychological abberations-drift from one physician to another, trying to find one savvy enough to cure their “skin condition.” Furthermore, although they have sought many medical opinions already, patients afflicted with psychocutaneous disorders almost always present as “an emergency.” While pharmacological intervention may benefit such patients, traditional mental health interventions are almost always required if the aberrant behavior is to cease.
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Giving Valproic Acid a Higher Priority in Bipolar PatientsIs valproic acid dismissed out of hand? Three doctors discuss its potential as a treatment.
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Postpartum Psychosis: Updates and Clinical IssuesThe authors focus on the epidemiology of postpartum psychosis, its clinical presentation, etiology, treatment, and strategies to prevent its recurrence.
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Health and Psychiatric Issues in Children of Rural Methamphetamine Abusers and ManufacturersMany abusers of methamphetamine in rural areas manufacture the drug for their personal use. These "mom-and-pop cooks" produce methamphetamine in and around homes where children are also living. This article provides an overview of the mental health of children whose parents abuse methamphetamine.
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Postpartum Psychosis: Updates and Clinical IssuesThe authors focus on the epidemiology of postpartum psychosis, its clinical presentation, etiology, treatment, and strategies to prevent its recurrence.
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Telepsychiatry for Vulnerable and Underserved PopulationsWhen timely psychiatric care or consultation is difficult or impossible to obtain, telepsychiatry may be an acceptable, economical, and effective alternative.
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Understanding the Role of Sigma-1 Receptors in Psychotic DepressionSelective serotonin reuptake inhibitors have been shown effective in the treatment of depression with psychosis. This efficacy appears to correlate with the SSRIs’ level of affinity at the sigma-1 receptors in the brain. What role does the sigma-1 receptor play in psychotic depression? Based on this role, are there implications for other treatments?
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A Crisis in the Public Service Psychiatric WorkforceHere's what's known about the growing shortage of psychiatrists -- why it's happening-- and possible solutions.
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The Anti-Youth Pill? Alprazolam Toxicity Can Add Years to Brain Age and AppearanceHere's a case that illustrates the potential for alprazolam to create a dementia-like appearance-not to mention a premature aging of the patient.
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The Role of Mental Health Consultants on Hostage Negotiation TeamsHostage and barricade situations occur frequently in law enforcement practice. Commonly, police deal with hostage/barricade subjects whose motivation is influenced by psychiatric illness, substance abuse or extreme emotional states. It has been argued that mentally ill people comprise 50% of all hostage/barricade subjects. How can psychiatrists assist in defusing these intense situations?
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Eating Disorders in MalesThe article focuses on eating disorders in males and presents information on similarities and differences between males and females as they relate to risk factors, clinical presentation, and treatment.
