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Behavioral Comorbidities in Rheumatoid ArthritisWhile tremendous therapeutic advancements have been made, patients with rheumatoid arthritis (RA) have a myriad of comorbidities, including fatigue, depression, and sleep disturbances. Data on the comorbidity of psychiatric disorders with arthritis are also striking: according to the NIMH Catchment Area program, the lifetime prevalence of psychiatric disorders among patients with RA is 63%.
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Discussing and Assessing Capacity for Sexual ConsentHere: basic concepts behind sexual consent capacity and guidance on how to pursue capacity assessments.
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Managing Treatment-Resistant OCDObsessive-compulsive disorder is a prevalent, disabling and chronic illness. Serotonin reuptake inhibitors are the first-line of treatment; however a large proportion of patients will have either a partial or nonresponse. This review outlines the strategies for treatment-resistant OCD, including augmentation agents, alternative monotherapies, intravenous strategies and newer nonpharmacologic somatic treatments under development.
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PTSD Is a Valid Diagnosis: Who Benefits From Challenging Its Existence?PTSD filled a nosological gap by providing a way to characterize the long-lasting effects of trauma exposure.1 This led to a plethora of previously lacking scientific observations. Now the existence of PTSD is being called into question because some of the original assumptions that helped make the case for it have proved to be incorrect.2-4 However, it is possible to update some of the flawed assumptions of PTSD without rescinding the diagnosis. There is no reason to throw the baby out with the bathwater.
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Novel Methods to Predict Outcome Using NeuroimagingNoninvasive brain imaging methods are providing unprecedented views of the structural and functional development and aging of an individual's brain or state of brain pathology. These exciting new may provide novel information relevant to the enhancement of clinical practice.
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What Role Does Serotonin Play in PTSD?As many as 90% of Americans are exposed to at least one traumatic event in the course of their lives. Many more are exposed to more than one traumatic event. Short- and long-term sequelae of traumatic exposure vary greatly and range from complete recovery, to severe and debilitating PTSD.
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Defining Intellectual Disability: The Case of Hall Versus FloridaIn March, the Supreme Court will need to set a national standard for the definition of intellectual disability. In doing so they will inevitably have to address a number of complications that arise when clinical constructs, such as intellectual disability, are used in the courtroom.
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Comorbidity: Schizophrenia With Obsessive-Compulsive DisorderThe co-occurrence of obsessive-compulsive symptoms (OCS) and psychotic illness has been a challenge for clinicians and investigators for more than a century. Over the past decade, interest in this area has burgeoned because of recognition of higher-than-chance comorbidity rates of schizophrenia and OCD.
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Shrink Rap: Three Psychiatrists Explain Their WorkStructured around fictional case vignettes, this book presents the different pathways through which one enters the mental health system. Patients can better judge whether they are being offered the optimal treatment modality and can more effectively assess the stylistic match between themselves and their therapist.
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Veterans Struggle to Adjust to Family LifeOf the 3.6 million military personnel deployed to Operation Iraqi Freedom and Operation Enduring Freedom, over half are married and about 53% are parents. As these veterans return home, the process of reintegration can have a variety of effects.
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Therapeutic Alliance in the Aftermath of an Emergency Crisis VisitA therapeutic alliance can serve to build a trusting relationship between clinician and patient and increase the patient’s feelings of agency and autonomy.
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Mini Quiz: Impulsivity Risk FactorsImpulsivity has long been thought to be an important risk factor for depression and suicide. But recent research suggests that the reality might actually be counterintuitive.
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The Body Clock and Its DiscontentsCircadian components are profound in depressive disorders, such seasonal affective disorder. This article introduces a course to be given at this year’s APA Meeting in Toronto, on melatonin and light treatment.
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Commentary: The Doctor's Dilemma: A Conflict of LoyaltiesArguing that participation in any aspect of death penalty cases is an ethical conflict for physicians-and specifically psychiatrists-Dr. Freedman calls for physicians' organizations to join the American Bar Association's goal of a moratorium on executions. The author himself opposes the death penalty.
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Commentary: The Prescription JihadThe great debate over whether to allow psychologists to have prescribing privileges continues. What is ultimately the best for the patient's well-being? Ali Hashmi, M.D., a practicing psychiatrist from Arkansas, tells both sides to this story, and offers his opinion on the matter.
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Theoretical Models of Health BehaviorMedication adherence, especially in children and adolescents, is a complex problem that is poorly understood and underresearched, yet it is a clear barrier to effective treatment and is frequently encountered in everyday clinical practice.
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Neurobiology of Eating Disorders: Clinical ImplicationsNew insights into neural pathways that play a role in anorexia nervosa, bulimia nervosa, and binge eating disorder.
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Parent Project Muscular Dystrophy: Advocacy and SupportThe diagnosis of Duchenne muscular dystrophy (DMD) is devastating for patients and their families. There is no standardized treatment and no cure, and boys with this disorder typically die by age 25 years because of respiratory failure or failure of the heart muscle. Until 13 years ago, parents of boys with DMD had nowhere to turn for support and no concerted efforts in clinical research were being made. This changed in 1994 with the founding of Parent Project Muscular Dystrophy (PPMD), a grassroots organization started by parents with the goal of creating awareness of DMD and generating interest and funding for research.
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Cognitive Remediation for Psychiatric PatientsImproving Functional Outcomes for Patients With SchizophreniaMany people assume that it is the emotional and psychotic symptoms that make it difficult for a person with schizophrenia to function in everyday life. In fact, research indicates that cognitive impairment is a major reason why functional outcome is so poor.1
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Treatment-Resistant Depression: Strategies for ManagementDespite advances in our understanding of depression therapy, many patients with depression remain unresponsive to treatment. As many as 50% of patients who begin treatment with an antidepressant do not respond.
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When the Psychiatrist Has PTSDFor PTSD in psychiatrists and other mental health care providers to be addressed, a major shift in medical culture and thinking is needed.
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The NICHD Study of Early Child CarePrevious research on the effects of early child care had led to controversy and confusion. The most provocative finding was that when infants were in nonmaternal child care 20 or more hours a week, starting in the first year of life, they were less likely than infants without such experience to form a secure emotional attachment to their mothers.
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Confidentiality and the Family: 5 Guidelines for Better OutcomesFamily involvement is often misunderstood as being a hindrance to individuation, when in fact family-oriented interventions can improve patient functioning, agency, and autonomy.
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Surveying Attitudes Towards Digital Mental Health68% of Americans reported their mental health could be improved.
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Intimate Partner Violence: Practical Issues for PsychiatristsThe term “domestic violence” emerged in the United States with the rise of the women’s movement in the 1970s. Before that, violence between partners was considered a private matter. A specific type of domestic violence, intimate partner violence, refers to violence between intimate partners. Public awareness campaigns help us identify one type of intimate partner violence in which one partner, typically the male partner, is the aggressor, and the other partner, typically the female, is the victim.
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Psychiatric Diagnosis and Treatment of Somatizing Neuropsychiatric DisordersAlthough the somatizing disorders cover a vast array of symptomatic domains across many medical specialties, this article addresses the broad topic conceptually.
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The Role of Cortisol and Depression: Exploring New Opportunities for TreatmentsAfter reading this article, you will be familiar with:The function of the hypothalamic-pituitary-adrenalaxis and the significance of cortisolin the etiology of depression.
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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.
