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From Cinderella to Straw Man?We are living in an evidence-based era in all fields of medicine, including psychiatry. For the most part, this represents progress because clinicians can start to base their interventions on treatments that have been supported by the results of research studies.
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Setting the Record Straight: A Response to Frances Commentary on DSM-VThe commentary “A Warning Sign on the Road to DSM-5: Beware of its Unintended Consequences” by Allen Frances, M.D., submitted to Psychiatric Times contains factual errors and assumptions about the development of DSM-V that cannot go unchallenged. Frances now joins a group of individuals, many involved in development of previous editions of DSM, including Dr. Robert Spitzer, who repeat the same accusations about DSM-V with disregard for the facts.
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Antipsychotic Combination Strategies in Bipolar Disorder:Strategies to Maximize Treatment AdherenceOptimal management of bipolar disorder (BD) includes the careful selection and regular ingestion of appropriate medication to stabilize mood. Unfortunately, between 40% and 50% of patients with BD in routine clinical settings take breaks or forget to take their medication or even discontinue the drug altogether.1-3 Treatment nonadherence is associated with mood relapse, hospitalization, and suicide.4,5
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Behavioral and Pharmacologic Treatment of Aggression in Children With AutismThis article will provide an overview of treatment modalities, with emphasis on the future direction of interventions targeting aggression in children with autism.
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Psychiatric Aspects of the Impending Avian Flu PandemicI was taken ill with the flu. They gave me up. The paper had my obit set in type. . . . My hair turned white and then it fell out. The first time I tried to rise to a sitting position I fell and broke an arm. I had phlebitis in one leg and they said I'd never walk again.
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PNIPs, SNPs, and PhenotypesHow can we get even better at customizing treatment for our patients and thereby achieve improved outcomes? How do we avoid becoming relegated to mere brokers of psychopharmacologic commodities? A few thoughts in this brief communication.
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Anxiety in the Medical PatientAnxiety is a ubiquitous, natural affective state that is essential for evolutionary survival. Nearly as common, however, are experiences of anxiety that exceed social, psychological, or physiological needs, leading to functional impairment. Indeed, primary anxiety disorders, including panic disorder, social phobia, and generalized anxiety disorder (GAD), represent the most common category of mental illness in the United States. Secondary, or reactive, anxiety is also widespread and can arise not only from numerous medical causes but also from the psychological process of coping with illness.
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Commentary: Against Biologic PsychiatryAs a practicing psychiatrist, I have watched with growing dismay and outrage the rise and triumph of the hegemony known as biologic psychiatry. Within the general field of modern psychiatry, biologism now completely dominates the discourse on the causes and treatment of mental illness, and in my view this has been a catastrophe with far-reaching effects on individual patients and the cultural psyche at large. It has occurred to me with forcible irony that psychiatry has quite literally lost its mind, and along with it the minds of the patients they are presumably supposed to care for. Even a cursory glance at any major psychiatric journal is enough to convince me that the field has gone far down the road into a kind of delusion, whose main tenets consist of a particularly pernicious biologic determinism and a pseudo-scientific understanding of human nature and mental illness.
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Cognitive-Behavioral Therapy in Severe Mental IllnessPsychotropic treatment can often prevent the relapse of psychotic and mood symptoms. However, many patients take medication intermittently or not at all; or the symptoms may be only partially responsive to medication. Therefore, there is a need for interventions that can supplement the effect of medication and improve treatment outcomes.
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Pinpointing the Cause of Non-Alzheimer DementiaMany physicians, including psychiatrists, may shy away from seeing elderly patients with symptoms of dementia because they imagine that there are a large number of alternative diagnoses and that differential diagnosis is complicated. In fact, however, the number of possible diagnoses in most situations is relatively small and the diagnosis of dementia in older patients is certainly feasible in primary care psychiatry.
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Can the Efficacy of Psychotropic Drugs Be Measured?Dr Fogelson discusses how science has refined research designs to measure the efficacy of psychotropic drugs.
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Music Therapy With Emotionally Disturbed ChildrenUsing music as a form of therapy for emotionally disturbed children seems quite natural, given children's innate love of music. How can this form of creativity be used as therapy to help children better communicate feelings and emotions?
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Posttraumatic Stress Disorder: Neurobiology, Psychology, and Public HealthIn recent years, we have learned a great deal about posttraumatic stress disorder (PTSD) and its public health implications. From 9/11 to Katrina and the present Iraq war, PTSD has been in the forefront of health concerns and public policy.
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Club Drugs and Their TreatmentThe most common club drugs or party drugs are MDMA, ketamine and GHB. How dangerous is continued use of these substances? Can they cause real damage to the brain?
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Update from the American Society of Addiction Medicine: New CriteriaHere, a psychiatrist certified by the American Board of Addiction Medicine discusses new treatment criteria for addiction.
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Melatonin: The Dark Side of the HormoneOur own melatonin plays an important role in regulating our sleep-wake cycle. Recent evidence raises questions about whether we should be taking extra doses to try to improve our sleep.
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A Skeptical Look at MDMA From a PTSD ExpertSome clinicians are skeptical about the potential of MDMA-assisted therapy...
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The Elderly DriverOf concern is the safety of our roadways as the effects of aging take their toll upon drivers nationwide. Are there accurate ways to test the cognition and response ability of elderly drivers?
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Sleep Disturbances After Traumatic Brain InjurySleep-related problems are among the most disabling consequences of TBI, with multiple influences: impairment of neuronal plasticity, metabolomic alterations, loss of vascular homeostasis, and disruption of the blood-brain barrier. The authors take a close look.
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A New Screening Measure for Detecting 'Hidden' Domestic ViolenceOrgan donation from brain-dead patients has become a psychiatric issue in Japanese transplant medicine. Brain death is recognized as human death only in the context of organ transplantation in Japan. Since many Japanese physicians deny that brain death constitutes the death of an individual, there is no solid, general consensus in Japan about what constitutes brain death.
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Issues in Psycho-Oncology: What Clinicians Need to KnowAn overview of select topics in clinical psycho-oncology, including assessment and management of delirium and brain lesions, mood and anxiety disorders, medication adverse effects, and existential death anxiety.
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The Prevalence of Schizophrenia in the USMight a lower prevalence suggest that it is less a problem?
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Brain Stimulation Therapies for Treatment-Resistant DepressionEvidence for Use of Neurostimulating Techniques
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Psychoneuroimmunology and HIV Disease ProgressionAmong psychiatrists who treat patients with HIV/AIDS, the question of how psychosocial distress effects the progression of HIV disease is likely to arise. Even for healthy individuals, we are only beginning to clarify the complex pathways by which thoughts and emotions impact immune function. Due to the bidirectionality of the communications of the brain and the immune system, this is a complicated scenario. The fact that HIV alters the function of the immune system during the course of its progression creates greater confounds to the understanding of these systems. We will address the rationale that progression from HIV infection to AIDS may be modulated by psychosocial factors, discuss possible reasons for conflicting findings and posit some clinically relevant recommendations drawn from research findings.
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Update on Mood Disorders: Implications for PracticeHow generalizable are the results of depression treatment studies? Which factors predict readmission and length of stay in inpatients with mood disorders?
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Road Rage: Are Our Patients Driving Angry?Road rage is well known in popular culture and to many people it is a common and dangerous experience. Alcohol problems, illicit drug use and general psychiatric distress are associated with road rage perpetration. Road rage incidents may also result in psychiatric distress. Although treatment for road rage has received little research attention, encouraging results have been reported from specialized programs.
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Introduction: The Art of PsychopharmacologyThis Special Report presents an important set of articles that considers controversial issues relevant to the practice of psychiatry. These articles demonstrate that what we do as practitioners is often based on incomplete evidence and/or reliance on experience and the art of psychopharmacology. There are considerable limitations to “evidence-based medicine” as applied to the issues considered and also to what can be said officially about “off-label” uses of medications. All that said, these articles represent a very interesting set of perspectives on important and, to date, unresolved problems for which our science falls quite short of giving us definitive answers.
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Racial Profiling in Psychiatry: Does It Help Patients?Should psychiatrists follow these leads and use a patient's race or ethnicity to guide treatment decisions? In this article, I will describe the evidence that supports racial profiling in psychiatry and will explore some of the relevant concerns.
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CounterpointThe psychologists appear to believe that large numbers of untreated mentally ill would get better if their psychologists could prescribe medication for them, thereby making up for a resource-poor and underfunded mental health system. There is no lack of prescribers. Psychiatrists know that the biggest problem for the mentally ill isn't a lack of medication, it is the dearth of supportive services available to augment, among other treatments, the taking of medication. So why are psychologists fleeing the duties they have long been mandated to provide? The answer is simple: Money.
