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New Biologic Tools in PsychiatryThe psychiatric community has a need for diagnostic and predictive tests. Some recent techniques have just become available for clinical care.
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Diabetic Polyneuropathy: Definitive DiagnosisDiabetic polyneuropathy (DPN) has a major impact on quality of life and can contribute to significant morbidity and mortality. In the United Kingdom, the prevalence of distal symmetrical polyneuropathy, as seen in specialty care, is about 28.5%, and prevalence increases with age.
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Coming Along With the DSM-5: Hybrid Models of Psychiatric DiagnosisDo not be surprised if you hear more about hybrid models of psychiatric diagnoses included in DSM-5. The categorical and dimensional model approaches are 2 sides of the same coin as you look at the same patient from 2 different angles.
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Prevention and Treatment of AddictionIn 2006, substance dependence or abuse was diagnosed in about 22.6 million persons in the United States.1 Addiction-related morbidity and mortality pose a major burden to society, costing our economy more than $500 billion annually: about $181 billion for illicit drugs,2 $168 billion for tobacco,3 and $185 billion for alcohol.4
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Psychiatric Issues in the Somali Refugee PopulationThis article highlights several features of medical and social importance that are somewhat unique to the Somali refugee community in the US.
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OCD in Egyptian Adolescents: The Effect of Culture and ReligionHow does the role of culture affect disease presentation? The author reviews the impact of religion, ideology and upbringing on the epidemiology of OCD in Egypt.
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Psychiatric Medicine: The Psychiatrist’s Guide to the Treatment of Common Medical IllnessesMost, if not all, psychiatrists have cared for psychiatric patients with common but sometimes complex medical illnesses.
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Multiple Medication Use in General Practice and Psychiatry: So What?The incidence of polypharmacy is on the rise, and with the increase comes a greater risk of drug-drug reactions. One survey estimated that patients seeing a psychiatrist may be six times more likely to receive multiple psychotropic medicines compared to patients seen by a primary care physician. This article provides an overview of the extent of polypharmacy, the factors driving the phenomenon and issues clinicians should consider when treating patients who are already taking medicines for other illnesses.
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A Literature Review of Videophone Use in Mental HealthIn our survey, we found videophones a surprisingly understudied and underutilized tool in spite of the fact that they are easy to use and do not require any technical support.
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Placebo Effects on Pharmacotherapy Outcomes in Major DepressionIf clinical trials data are any indication, the potential impact of placebo treatment on depression outcomes may be potent. Placebo response rates in clinical trials for depression average approximately 30%, with a top range beyond 50%-and the trend is upward.
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Neurotechnology's New Wave, Part II: Value, Acceptance, and Clinical ApplicationsNeurotechnologic devices are proving themselves in clinical medicine. Many of these devices offer several distinct advantages over traditional pharmaceutical-based therapies: their effects are reversible, they are often cheaper than pharmaceuticals, and they solve therapy adherence issues. "If a problem occurs, you can turn off the device; or if the disease evolves over time, you can dynamically adjust the device," explained Ali R. Rezai, MD, chairman of the Center for Neurological Restoration at the Cleveland Clinic.
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A New Adaptation of Integrated Psychological Treatment for Patients With SchizophreniaIntegrated psychological treatment (IPT)--which was developed by a research group in Bern, Switzerland, for patients with schizophrenia--is a distinctive and practical approach to rehabilitation.
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When Your Child Is SickOne is reminded as one reads this book of Emerson’s well-known quote, “Common sense is genius dressed in work clothes.”
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Biofeedback and AnxietyConsidered a "fringe" therapy 25 years ago, biofeedback has matured today to a modality much closer to mainstream treatment. Its value is accepted by a growing number of professionals, and it is covered by Medicare for some conditions, as well as by most health insurers.
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Psychiatric Emergencies in Bipolar and Related DisordersPart 1 of this article, discussed a general approach to treating psychiatric emergencies in patients with bipolar and related disorders, as well as the assessment and management of agitation and impulsive aggression. Part 2 focuses on psychosis, suicidality, and specific treatments relevant to patients in emergency settings who are agitated or have bipolar disorder.
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Levodopa-Induced Dyskinesia: Medical and Surgical ManagementIn the 1960s, the treatment of Parkinson disease (PD) was revolutionized by the introduction of levodopa. Soon after its discovery, however, it was observed that continuous treatment was complicated by the emergence of choreoathetoid movements and off episodes.
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Setting the Record Straight: A Response to Frances Commentary on DSM-VThe commentary “A Warning Sign on the Road to DSM-5: Beware of its Unintended Consequences” by Allen Frances, M.D., submitted to Psychiatric Times contains factual errors and assumptions about the development of DSM-V that cannot go unchallenged. Frances now joins a group of individuals, many involved in development of previous editions of DSM, including Dr. Robert Spitzer, who repeat the same accusations about DSM-V with disregard for the facts.
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Chronic Fatigue SyndromeJohn Medina's column, "Chronic Fatigue Syndrome-A Lesson in Big Science", focuses on recent research by the CDC on the genetic aspects of chronic fatigue syndrome (CFS) as reported in Pharmacogenetics and Nature.
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Marijuana Withdrawal Syndrome: Should Cannabis Withdrawal Disorder Be Included in DSM-5?DSM-IV, published in 1994, did not include a cannabis withdrawal disorder diagnosis. DSM-IV-TR clearly stated the reason for the omission: “Symptoms of possible cannabis withdrawal . . . have been described in association with the use of very high doses, but their clinical significance is uncertain.”1
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The Treatment of Persons With Mental Illness in Prisons and Jails: An Untimely ReportThe recent 2014 Joint Report of the Treatment Advocacy Center and the National Sheriffs’ Association could have been a most useful and timely report on the woefully inadequate access to appropriate levels of mental health services for incarcerated seriously mentally ill persons. This author believes the report will only make the problem worse.
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Prenatal Risk Factors in SchizophreniaSignificant research developments in the etiopathogenesis of schizophrenia have occurred during the past several years. One such advance is the "neurodevelopmental" hypothesis that events during early brain development, especially the prenatal and perinatal periods, may play an important causal role in at least some, and perhaps many, cases of schizophrenia.
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Understanding and Treating DeliriumThis CME article reviews the pathophysiology and epidemiology of delirium and provides strategies for assessment, prevention, and management of this syndrome.
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Ground Lost: The False Memory/Recovered Memory Therapy DebateThe recovered memory debate has been the most acrimonious, vicious and hurtful internal controversy in the history of modern psychiatry. From its very beginning in the late 1980s, it has been more an "ad hominem" war, appealing to feelings and prejudices, rather than a matter of reasoned professional disagreement.
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Childhood Obesity and PsychopathologyThe continuation of the epidemic of childhood obesity and overweight has major implications and consequences for future research in psychopathology.
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Understanding the Neurobiological Basis of Drug Abuse: Comorbidity in SchizophreniaIt is clear that the prognosis for schizophrenia is much better when patients achieve drug abstinence, including in the domains of depression, quality of life, and community integration.
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Albert Ellis, PhD (1913 - 2007)What follows is an adaptation of Dr Ellis’s response to a volunteer who took part in a live public workshop demonstration of the Rational Emotive Behavior Therapy approach.
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Exploring the Psychosis-Depression Interface: Clinical ImplicationsA review of the distinction between depressive and psychotic symptom domains, current knowledge about the etiology and neurobiology of depression and psychosis, and how this knowledge can inform the treatment of patients with features of both.
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Understanding and Evaluating Mental DamagesUnlike a pure psychiatric disabilityevaluation, mental and emotionaldamage claims require anassessment of causation. Today, treatingpsychiatrists are increasingly asked toprovide this assessment, since mentaland emotional damages are widelyclaimed in the United States as a remedyin legal actions.
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Telepsychiatry-Based Culturally Sensitive Collaborative TreatmentTelepsychiatry-based Cultural Sensitivity Collaborative Treatment is a promising and effective model to improve treatment of depression in underserved racial and ethnic minority populations. Details here.
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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.
