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Introduction: The State of Addiction PsychiatryThe articles in this Special Report provide a broad, cross-cutting perspective on the current state of addiction psychiatry, insofar as it may pertain to your own clinical practice.
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Assessing the Violent Patient: An Additional Case of Legal ImplicationsAssessing the Violent Patient: An Additional Case of Legal Implications
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Cognitive Complaints: Their Role in Detecting MCI and DementiaShort of mass screening of the elderly using a neuropsychological test or some yet-to-be-determined biomarker, persons with cognitive disorders come to the attention of the health care system only when symptoms are recognized. Occasionally, physicians identify cognitive deficit on routine examination or when they notice patients having trouble following instructions (eg, taking medications properly)
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Comfortably Numb: How Psychiatry Is Medicating a NationIn Comfortably Numb, author Charles Barber reports that in 2002, 16% of the inhabitants of Winterset- a quintessentially American town in Iowa-had an antidepressant prescribed for them and asks, “Why did Winterset want to get numb?” With this question, Barber begins a journey through the world of psychiatry and psychopharmacology that spans most of the book.
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Chronic Disease Self-Management Programs in PsychiatryThrough patient self-management, mental health clinicians can transfer the focus from managing symptoms to allowing patients to live well in the context of their mental illness and medical comorbidities.
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Introduction: The Challenges of Treating Older AdultsWith more and more baby boomers turning 65 every day, there will be an enormous increase in elderly patients needing psychiatric care over the next 20 years.
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PTSD in the Emergency SettingThe following 3 cases illustrate the diagnostic challenges related to differentiating brain injury and posttraumatic stress disorder (PTSD) in patients presenting to the emergency department (ED) in the acute period following a traumatic injury. Such patients pose a dilemma for ED clinicians because of the interplay between head injury and PTSD in the clinical presentation of cognitive impairments in the aftermath of trauma.
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Forensic Evaluations: Testamentary CapacityThis article focuses primarily on the issues facing a psychiatrist who has been retained as an expert witness in a will or trust contest involving claims of a lack of capacity.
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The Neuroscience of Psychotherapy: Healing the Social Brain, Second EditionCozolino reveals how much those “givens” have strong scientific underpinnings and underlines the urgency of re-integrating them into the training and the minds of 21st century therapists.
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Opportunities and Challenges in Treating Adolescents and Young Adults With Major Depressive DisorderHalf of all mental health disorders occur by age 14. Early interventions may mitigate progression to more serious and persistent mental health concerns.
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Commentary: The Moral High (Low?) Ground of Assisted SuicideThere is and has been much debate about the issue of assisted suicide as physicians, lawyers and lay people argue the pros and cons of assisting in someone's death. The physician who agrees to participate in this endeavor points out that his or her concern is to alleviate suffering. Notwithstanding that, painkillers are notoriously prescribed in inadequate, understrength doses; people with serious illness who are depressed are considered unlikely candidates for treatment of their depression because, sayeth the physician: "It is only natural, understandable, to be depressed with that kind of terrible illness."
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Understanding PharmacogeneticsThe idea that drug response could be based on a patient's genetic background first surfaced over 100 years ago. Since then, technology has advanced to the point where prescribing medications based on a patient's genetic makeup no longer seems like science fiction. This article looks at the latest research on the pharmacogenetics of psychotropic medications and shows how far we still have to go.
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Managing the Psychiatric Manifestations of Parkinson Disease: An UpdateParkinson disease (PD) is a progressive neurodegenerative disorder affecting 1% of people 65 years and older. The core symptoms include the motor manifestations of tremor, bradykinesia, and rigidity.
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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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Posttraumatic Stress Disorder and MemoryTrauma, by definition, is the result of exposure to an inescapably stressful event that overwhelms a person's coping mechanisms. Since it would be immoral to expose laboratory subjects to the sort of overwhelming stimuli that give rise to the dissociated sensory reexperiences characteristic of posttraumatic stress disorder (PTSD), we are uncertain to what degree the vast literature involving laboratory studies of less stressful events is relevant to understanding how people process traumatic memories.
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A Novel Approach to Morbidity and Mortality Analysis in Psychiatry ResidencyRegulatory bodies that oversee hospitals and graduate medical education have begun to place an ever growing importance on patient safety and quality improvement, from which psychiatry is not immune. More in this case study.
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Treating Complex Trauma SurvivorsThis CME outlines distinguishing features of PTSD, complex trauma, and the dissociative subtype of PTSD (DPTSD), with an explanation of the distinctive neurobiological subtype of DPTSD.
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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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Preparing an Advanced Beneficiary NoticeAn ABN is a written communication given to a Medicare beneficiary by a physician prior to providing a service that is expected to be denied by Medicare Part B.
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15 Steps to Helping Psychiatric Patients Achieve and Maintain a Healthy WeightWhile psychotropic medications for schizophrenia, bipolar disorder, and other psychiatric disorders can cause weight gain, patients can take small steps to improve their health.
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Strategies to Reduce and Prevent Restraint and Seclusion in Pediatric PopulationsHere's compelling reason for judicious use of restraint and seclusion, and a review of various alternative approaches.
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Mini Quiz: Alcohol and SleepWhich sleep parameters are increased in alcohol use disorders? Take the quiz and learn more.
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Group Visit CodesBilling 99213 for individual patients seen together in a group visit is fraud.
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Troubleshooting Delirium in Elderly InpatientsDelirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. Approximately 15% of elderly patients admitted to the hospital have delirium as a presenting or associated symptom. Delirium will develop in another 15% of elderly patients during hospitalization.
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The Interplay of Mood Disorders and Eating DisordersA 20-year-old college sophomore with “depression and anxiety,” who is exercising ferociously and who is literally dying to lose more weight sets the stage.
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Borderline Personality Disorder in AdolescentsBPD appears to be a neurodevelopmental disorder, influenced by the person’s genetics and brain development and shaped by early environment, including attachment and traumatic experiences.
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Debate: Is It Worth Saving the Bereavement Exclusion in DSM-5?Ringing the Bell to Save the Bereavement Exclusion.
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Can You Be Forced to Buy Burial Insurance?Tuesday's oral arguments on the Affordable Care Act produced at least one truly riveting exchange.
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Cross-National Research: Caregiver ConsequencesComparing the consequences of caregiving across countries for a person with a serious mental illness needs to take into account not only different languages, but also different cultures, quality of mental health services and standards of living. So far, one questionnaire has shown the most validity and become the exemplar in cross-national research; yet it is still not free from possible cultural bias or criticism from its creators who acknowledge that much more research needs to be done.
