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Understanding and Managing Adolescent Disruptive BehaviorThe words attributed to Socrates resonate with the perspectives of many contemporary parents and clinicians.1 The endurance of the concern suggests something fundamental about the psychopathology of deviant, disruptive behavior of youth. Yet clinicians struggle to understand its origins, to help parents control their children, and to help the children control themselves. Clinically, this manifests in failed pharmacological treatments, incompleted courses of individual therapy, problems in engaging families in treatment, and controversies over which therapy is most effective.
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The Arts and Humanities in Psychiatry . . . A DebutCreativity should not be seen as “optional” in psychiatry. Rather, it helps us to approach clinical problems in new ways.
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Treatment Resistance: Anorexia Nervosa in a Middle-Aged WomanEating disorders like anorexia nervosa are resistant to treatment. This case briefly outlines a treatment approach using a community-based, patient-centered model of care.
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This Is the Water: The Social Determinants of Mental Health and the Future of PsychiatryHere's why we need more effective training, practice, and advocacy regarding the social determinants of mental health.
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Depressive Symptoms After LossTo improve validity, we proposed extending the current MDD bereavement exclusion-which excludes “uncomplicated” (relatively brief, lacking certain severe symptoms) depressive bereavement from diagnosis-to also exclude uncomplicated reactions to other major stressors, such as romantic breakups, job loss, and serious medical diagnoses.
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Mini Quiz: Pharmacotherapy for Eating DisordersSSRIs are effective for the treatment of eating disorders, but what treatment is best for which disorder? More in this quiz.
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Stages of Change Common to All PsychotherapiesDespite their differences, all psychotherapies have these things in common—and are important to consider.
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Factitious Disorder: Detection, Diagnosis, and Forensic ImplicationsFew phenomena in medicine aremore confounding than the diagnosesinvolving deception:malingering, Munchausen syndrome,Munchausen by proxy (MBP), and factitiousdisorder.
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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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Management of ICH, Part IIThe prognosis for patients with intracerebral hemorrhage (ICH) is poor. The 30-day mortality rate is 25% to 50%, and half of these deaths occur within the first 48 hours.
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EEG Neurofeedback for Treating Psychiatric DisordersNeurofeedback, a way for patients to learn to create and maintain desirable brainwaves, may be an affective adjunct therapy for many psychiatric disorders. Which procedures are most effective, and what are the benefits and risks?
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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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Overcoming Challenges Associated With TBI, Intellectual Disability, and Developmental DisabilityYour patient walks in with signs of traumatic injury, or intellectual or developmental disability. What special considerations are necessary in assessing and treating this patient?
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The Clinical Management of Amyotrophic Lateral SclerosisAmyotrophic lateral sclerosis (ALS) is a progressive, debilitating, fatal disease that involves degeneration of upper and lower motor neurons. Patients often initially present with limb or bulbar weakness, atrophy, and spasticity, followed by progressive loss of ambulation and, ultimately, respiratory failure, which is the most common cause of death.
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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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Coaching Families to Address Addiction"He'll just have to hit bottom." That bit of outdated advice can be terrifying. How do clinicians trying to help the person with an addiction who refuses to set foot in our office render assistance?
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Psychodynamic Psychiatry: A Case ReportThe author presents a fictionalized case based on a real patient to encourage colleagues to pursue psychodynamic psychiatry.
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Autism Spectrum Disorders, Down Syndrome, and 22q Deletion SyndromeWith aging, a multitude of medical conditions can occur and/or existing conditions can be exacerbated, contributing causally to or amplifying neuropsychiatric comorbidities.
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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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We Journey OnA poem written by a psychiatrist: "A faith in human kindness lost, abandonment with lasting cost."
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Brain Imaging Data of ADHDThe past two decades have ushered in a new era of methodological advances in tools for noninvasive imaging of the living brain. The information gleaned from advances in neuroimaging have been used to provide insights into ADHD's etiology, diagnosis and treatment.
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The Correlation Between Sleep-Disordered Breathing and PsychiatrySleep-disordered breathing is common in patients with mood and anxiety disorders. This article explores the implication for practicing psychiatrists whose patients have sleep disorders.
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Commercial Influence on Psychiatric Drug StudiesA discussion of the evidence that the pharmaceutical industry influences how physicians evaluate drugs in ways that encourage sales of their products and that are not always in the best interests of the patient.
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Knee pain in an 81-year-old manAn 81-year-old man presented to an urgent care facility with a 1-year history of pain in his right knee.
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Instrument Measures for Behavioral Symptoms in Patients With DementiaPsychiatric disorders, such as primary sleep disturbances, depression, substance abuse, mania, sexually inappropriate behaviors, and psychosis, can complicate the care of patients with dementia.
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Radio as a Public Health InterventionA Q&A with a board-certified psychiatrist, whose radio show has become a vehicle for hundreds of hidden experiences to be brought into the light and transformed into inspiring narratives.
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Assessment and Evaluation of Child and Adolescent Psychiatric EmergenciesThe incidence of child and adolescent psychiatric emergencies has increased over the past 20 years. This rise in emergency department (ED) mental health visits coincides with an overall increase in ED use from 89.8 million visits in 1992 to 107.5 million visits in 2001. Psychiatric presentations by children and adolescents (often in the absence of medical complaints) account for up to of the total visits to an ED in a given year and, in some reports, such presentations account for as many as 16% of ED visits.
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The State of the Evidence on Pediatric Bipolar DisorderPediatric bipolar disorder (PBD) is a serious psychiatric illness that impairs children’s emotional, cognitive, and social development. PBD causes severe mood instability that manifests in chronic irritability, episodes of rage, tearfulness, distractibility, grandiosity or inflated self-esteem, hypersexual behavior, a decreased need for sleep, and behavioral activation coupled with poor judgment. While research in this area has accelerated during the past 15 years, there are still significant gaps in knowledge concerning the prevalence, etiology, phenomenology, assessment, and treatment for PBD.
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SolaceMy patient allowed me a glimpse into the suicidal mind. And, in that way, she taught me a lot.
