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The Neurobiological Development of AddictionSelf-administration of drugs of abuse often causes changes in the brain that potentiate the development or intensification of addiction. However, an addictive disorder does not develop in every person who uses alcohol or abuses an illicit drug. Whether exposure to a substance of abuse leads to addiction depends on the antecedent properties of the brain.
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Prescription Digital Therapeutics and the Hunger for New TreatmentsHere's why the next step in mental health treatment is digital.
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Lessons Learned From the International Society for Bipolar Disorders Task Force on SuicideWhat is the actual risk of suicide attempts or suicide death in people with bipolar disorder? How does a BD diagnosis affect short-term and long-term suicide risk? How should a BD diagnosis help guide us toward the most effective suicide prevention strategies?
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Keys to Success in ADHD TreatmentClinicians who treat children with ADHD face a challenging conundrum. Although our understanding of ADHD and its evidence-based treatments has increased significantly in recent years, the number of successful treatment outcomes has not.
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Treatment-Resistant Depression: An Alternative Approach to ManagementIn this podcast, B. Andrew Farah, MD, looks at shortcomings of current therapy that make treatment-resistant depression so common, offers insights into the genetic underpinnings of TRD, and focuses on a new treatment paradigm.
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Eating Disorders: Research and Future DirectionsWhat do we know about eating disorders and what are the next steps in treatments and research? More in this podcast.
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Interatrial Communications, Stroke, and Migraine HeadacheThis review will familiarize physicians with the embryology, types, and incidence of various interatrial communications; summarize and highlight the potential association of interatrial communications with stroke, platypnea-orthodeoxia syndrome, neurologic decompression sickness in divers, and migraine headaches; discuss various therapeutic modalities available for closure of interatrial communications; and outline future directions in this rapidly evolving field.
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Reducing Risk Associated With Seclusion and RestraintThis article briefly reviews the federal standards regarding S/R and methods of reducing the risk associated with their use. CMS standards that went into effect February 6, 2007, will be emphasized; however, some of these standards vary from JCAHO standards.
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Hypersexuality in Children With Mania: Differential Diagnosis and Clinical PresentationThe diagnosis of bipolar disorder in children remains controversial. One of the more disturbing facets of its presentation in such young patients is the presence of hypersexual behavior. How can these behaviors be differentiated from the effects of abuse and other psychiatric disorders?
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The Book of Ethics: Expert Guidance for Professionals Who Treat AddictionFewer than a handful of books have been published on the ethical dimensions and challenges in treating and helping persons living with an addiction. Therefore, this book is a welcome contribution to the literature almost from the start. The contributors in this 9-chapter text range from community- and hospital-based professionals to behavioral program directors to ethics center directors and researchers to psychology, neurology, and psychiatry professors and fellows. The book aims to provide general advice on central issues encountered routinely by those experienced in addiction services and research. Contrary to the book’s rather biblical and authoritative title, the editors “offer this work modestly,” given the relative newness of focused ethical analysis in addiction treatment and care.
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The Medication Check as Psychotherapeutic OpportunityThis article explores the use of functional analytic psychotherapy (FAP)-a behavioral, evidenced-based approach to psychotherapy that can add psychotherapeutic benefit to your existing brief approaches during medication checks.
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Panic-Focused Psychodynamic PsychotherapyBoth cognitive-behavioral and pharmacological treatments for panic disorder have been found to be effective over the short term. Not all patients, however, can tolerate or fully respond to these approaches, and the effectiveness of these interventions over the long term remains unclear.
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Special Issues in Menopause and Major Depressive DisorderA risk to benefit ratio of treatment must be established to determine the optimal treatment for perimenopausal depression. Untreated depression during the perimenopause exacerbates heart disease, diabetes, and osteoporosis. Details about management options here.
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My Patient Lost Their Job…Now What?Unemployment is associated with an array of social and psychological complexities, directly affecting patients' self-esteem and perceptions of self-worth. When a patient loses their job, the psychiatrist has 4 tasks.
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Serotonin Reuptake Inhibitor and Bleeding Risk, Part 2: Gastrointestinal (GI) Bleeding, Malignancy, Pregnancy, and Surgical ConsiderationsIn this CME article, review literature on SRI-related bleeding complications in patients with GI bleeding, malignancy, perioperative settings, pregnancy, and hormonal therapy.
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Exploring Affect-Focused Psychotherapies for LGBTQ+ Patients With PTSD at APA 2023Experts discuss findings from a new trial exploring affect-focused psychotherapies for LGBTQ+ patients with PTSD at the 2023 APA Annual Meeting.
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Love, Alzheimer Disease, and Medical Aid in DyingApproximately 6.5 million Americans are living with Alzheimer disease today, and that number is projected to rise to about 13 million by 2050.
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Suicidal Self-Injurious Behavior in People With BPDUnlike other forms of self-injury, suicidal self-injury has special meaning, particularly in the context of borderline personality disorder. How is suicidal self-injury differentiated from non-suicidal self-injury in these patients, and how can their behavior be properly assessed and treated?
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Dr John C. Whitehorn: A Wise and Gentle ManDr John C. Whitehorn shaped mental health policy at the national level, and his influence is still alive in his former residents and the young psychiatrists we have trained.
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Combining Psychopharmacology, Psychotherapy and PsychoanalysisThe advent of safer psychopharmacological agents with less troublesome side effects, along with increasing knowledge of the broad array of syndromes treatable with medication, have led to a vast expansion in treatment options available to the psychiatrist. Studies and clinical experience demonstrate that employing psychotropic medication in combination with psychoanalysis or psychodynamic psychotherapy now occurs with increasing frequency.
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Psychotic Depression: Underrecognized, Undertreated-and DangerousHere: the history of psychotic depression for the Study of the Pharmacotherapy of Psychotic Depression (STOP-PD), a summary its epidemiology, significance, diagnostic complexity, and treatment, as well as case vignettes.
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The Psychiatrist's Role in Choosing a Nursing HomeFor elders confronted with the necessity of living in a nursing home, the choice of facility is a decision with profound consequences-for their health, their quality of life and their family finances. Nursing home care may cost $50,000 a year or even more, and more than half of all elders begin their nursing home stays by paying the costs out of pocket. That imposing sum can purchase excellent care, or can pay the rent for a place that is literally "worse than death" for the unfortunates who live there.
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Computers in the Consulting RoomComputerized information resources are being introduced into psychiatric practice settings, but some psychiatrists question whether they are really needed.
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Vision Loss and Depression in the ElderlyThe emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).
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An Update on Pica: Prevalence, Contributing Causes, and TreatmentIn this overview of pica, we review its causes and prevalence. In addition, we discuss some of the associated complications as well as current treatment strategies.
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Assessment of Decisional CapacityVoluntary informed consent is, with rare exceptions, a necessary, albeit not sufficient, defining precondition of ethical clinical treatment, and it is essential for enrollment in clinical research trials.
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Crossing the Blood-Brain Barrier: Integrating Scientific Innovation With Socio-Ethical Reflection in Predictive MedicineIn this article, we discuss recent advances in drug transporters and nutrient-transporter interactions that can impact drug bioavailability in the systemic circulation and the brain. We also present emerging research strategies that may facilitate the discovery and clinical development of predictive diagnostic tests to identify patients at risk for treatment resistance.
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The Assessment and Management of Depression in Children With AsthmaAsthma is one of the most impairing diseases of childhood, affecting more than 6% of children. Each year, it is responsible for 14 million lost school days and $3 billion in treatment costs.
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Witchcraft or Mental Illness?I don’t believe in witches or ghosts or things that go bump in the night. I’ve always thought that the Salem witch trials were a result of mass hysteria (on the part of the persecutors) rather than a phenomenon of dark forces at work. And seeing Arthur Miller’s The Crucible a few years ago, only confirmed my suspicions. So I was gratified to see Dr Quintanilla’s poster at this year’s meeting of the American Psychiatric Association. As a physician and researcher, she factually explains the fallacy of witchcraft. Looking at historical documents dating back to the 15th century, Dr Quintanilla was able to match the symptoms of people condemned as witches with associated neurological and psychiatric disorders, such as epilepsy and hysteria. [Editor’s Note: Natalie Timoshin]
