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Psychiatric Malpractice: Basic Issues in Evolving ContextsThis article focuses on 4 issues in psychiatric malpractice: prescribing, liability for suicide, informed consent, and duty to protect under the Tarasoff v Regents of the University of California ruling. Malpractice is a civil wrong actionable by law. There are 2 goals of malpractice suits: the first is to make an injured plaintiff whole by an award of money, and the second is to inform the profession how courts will decide similar cases in the future.
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Cognitive Behavioral Treatment for Obsessive-Compulsive DisorderPatients with OCD generally respond best to cognitive-behavioral therapy (CBT). At the core of the behavior therapy program is a technique known as exposure and ritual prevention (ERP).
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Introduction: Why Does Psychiatry Need the Humanities?Bringing the arts and humanities to psychiatry requires bringing these areas of study into our education, our research and our practice models.
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The Bipolar Handbook: Real-Life Questions With Up-to-Date Answers by Wes BurgessBipolar disorder is often seen as a perplexing illness by patients and clinicians alike. In recent years, there has been a growing appreciation in psychiatric circles of the disorder's prevalence. This increased attention has filtered its way down to the general public, which, in turn, has produced sometimes sensationalistic media portrayals of manic depression, a number of speculative books about historic figures and noted artists who purportedly had the illness, and an array of self-help books marketed to individuals (and their families) afflicted with the disorder.
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Mentalization-Based Treatment: A Common-Sense Approach to Borderline Personality DisorderMBT presents a compromise to bridge the valuable history of psychoanalytic ideas to both modern psychiatric research as well as present public health needs and practice.
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4 Warning Signs of Illness FalsificationMedical, psychiatric, and/or developmental disorders can be falsified in a variety of ways. Know the warning signs often missed by clinicians.
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Bipolar Disorder: Increasing the Effectiveness and Decreasing the Side Effects of TreatmentStudies have shown that many pharmacologic agents are effective in the treatment of acute mania and bipolar relapse education.
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A New Approach: Using Virtual Reality Psychotherapy in Panic Disorder With AgoraphobiaWith the advent of computer technology, new forms of therapy have emerged that can help patients. How can a virtual reality environment enable patients to overcome panic disorder and agoraphobia, and what are the advantages to such forms of therapy?
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Depression Management in Cancer PatientsDepressive disorders and symptoms are common in cancer patients (up to 58% have depressive symptoms and up to 38% have major depression), worsen over the course of cancer treatment, persist long after cancer therapy, recur with the recurrence of cancer, and significantly impact quality of life.
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Let’s Ask the Right Questions About Medical Aid in DyingSome patients are intractably and maybe even irredeemably ill. What should be done for them?
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Dementia: The Epidemic of Our TimeIf we don't find a cure or adequate treatments, the number of individuals impacted by dementia could skyrocket to nearly 14 or 15 million Americans by 2050.
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PTSD in Late Life: An Update on Clinical IssuesTrauma-related psychiatric disorders such as PTSD and grief often go undetected and untreated in older adults. Here's how to help.
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CBT for PsychosisHow to make cognitive behavioral therapy for psychosis feasible in a busy practice with limited resources.
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Is Pathological Gambling Really a Problem?-You Bet!With more and more Americans engaging in gambling activities, odds are high that psychiatrists may see patients who have some sort of gambling problem. What can be done about this problem, and how can these patients best be treated?
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Measures To Take After Diagnosis of Violence or DangerOnce the potential for violent behavior has been identified in a patient, how should it be dealt with? What steps can the clinician take to ensure the physical and legal safety of themselves and their patients? Furthermore, what are the clinician's legal and ethical responsibilities if the patient does commit a violence act?
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Adolescent Nonsuicidal Self-Injury: Evaluation and TreatmentIn working with adolescents, mental health care professionals often draw on their own developmental experiences to help guide their patients; however, nonsuicidal self-injury (NSSI) is not likely to be a personal experience that psychiatrists can often draw on.
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Preparing for the Graying of the World: Meeting the Needs of Older AdultsHow will economic development influence management of population aging so that the dignity and rights of older persons are respected and protected, particularly those who are vulnerable because of mental illness, social isolation, or physical debility? Insights here.
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Reducing the Risk of Addiction to Prescribed MedicationsPhysicians are often conflicted regarding prescription medications for pain, especially pain complicated by insomnia and anxiety. Concerns that patients may become addicted to medications, exacerbated by limited time available to get to know patients, can lead to underprescribing of needed medications, patient suffering, and needless surgery. At the other extreme, pressure to alleviate patients' distress can lead to overprescribing, needless side effects, and even addiction.
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Ethical Issues in Disclosing to Patients: Should Patients Be Allowed to Read Their Charts?Federal law now strongly supports a patient’s right to view his or her psychiatric record on request. Here: a look at the ethical and legal issues.
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Impulse Control Disorders: Clinical Characteristics and Pharmacological ManagementImpulse control disorders are common psychiatric conditions in which affected individuals typically report significant impairment in social and occupational functioning, and may incur legal and financial difficulties as well.
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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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Assessing Violence Risk in Psychiatric Inpatients: Useful ToolsPsychiatrists who work in inpatient units are faced with daily decisions about predicting which patients will be violent, both in the hospital and after discharge. These decisions are often made using unstructured clinical judgment based on the clinician's experience and knowledge of the literature. How long such judgment stays the standard of care remains to be seen, because psychiatric researchers have produced a number of assessment and management tools to improve the accuracy and use of violence risk assessment. This article briefly outlines 3 tools: the Brøset Violence Checklist (BVC), the Classification of Violence Risk (COVR), and the Historical Clinical Risk-20 (HCR-20).
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rTMS for Antidepressant NonrespondersAdjunctive rTMS for antidepressant nonresponders? Researchers performed a randomized comparison with current antidepressant treatment approaches.
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Social Media and DepressionMore social media use was associated with more depression in this study. Findings suggest that clinicians need to ask about social media use by people who are depressed.
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The Practice of Nonsuicidal Self-injury in Adolescents-Part 3In this final of a 3-part podcast series, Brian Smith, MD, discusses the how’s, the why’s, and the treatment options for adolescents who harm themselves.
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The Facts About Violence Against Historically Disadvantaged PersonsRacial/ethnic and sexual orientation minorities and women historically have been relegated to social, legal, and economic disadvantage in the United States.
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The Dynamics of Psychosis: Therapeutic ImplicationsContemporary ideas about psychotic conditions and clinical approaches for treatment.
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Custody DisputesCustody disputes often produce anxiety for all involved. Whether you are a treating child psychiatrist or custody evaluator, it is imperative to have a clear idea of your role.
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Treating Tobacco Dependence in Patients With Psychiatric ComorbiditiesWhat does the new set of U.S. Public Health Service guidelines for treating tobacco dependence say? Should everyone, regardless of mental health status, receive treatment?
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Traumatic Brain Injury Among Veterans Returning From Afghanistan and IraqThis article addresses the epidemiology, diagnosis, and treatment of mild TBI among combat veterans, with a particular focus on blast injury and the presence of comorbid posttraumatic stress disorder (PTSD).
