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College Students Under StressEmerging adults in the midst of a tremendous emotional growth spurt and a leap of neurocognitive maturation often need guidance articulating what bothers them.
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Is ECT Appropriate in Old-Old Patients?More patients are reaching the old-old demographic-those age 75 and above-with psychiatric conditions such as treatment-resistant depression. Research has shown that with some careful screening and precautions, ECT is a safe, effective treatment option for these patients.
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Climate Change: No Personal Beliefs Should Increase Children’s AnxietyOne reader believes psychiatrists and mental health clinicians should approach climate change with skepticism.
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Exploring Group TherapiesGroups are important throughout the course of a patient's therapy, especially for patients who have substance use disorders. Group therapy's clinical and cost benefit is evaluated for its efficacy in preventing and treating substance abuse.
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What the Future HoldsThis is both an exciting and challenging time to be a child and adolescent psychiatrist. New findings are changing our knowledge of childhood psychopathology. This Special Report discusses current developments in diagnosis, treatments, and problems for children and adolescents.
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Group Therapy and Cancer Survival-- Where Does the Evidence Lie in 2007?One of the most hotly debated questions within oncology over the past decade has been whether the promotion of psychological wellness can extend survival for patients with advanced cancer. The converse--that psychiatric disorder shortens survival--seems true, with mechanisms of poor self-care and reduced adherence to anticancer treatments resultant from depressive or psychotic disorders explaining this outcome.
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Cognitive Side Effects of Antiepileptic Drugs in ChildrenAntiepilepsy drug use in children presents special challenges because, unlike adults, treatment-emergent neuropsychological deficits occur against the backdrop of cognitive and psychosocial development, with treatment decisions having lifelong implications.
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The Changing Face of Substance Misuse in Older AdultsAddictive disorders are among the leading causes of disability worldwide; however, misuse of and addiction to alcohol and illicit substances is often not appreciated as relevant to the care of older adults.
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PTSD Has Unreliable Diagnostic CriteriaCurrently the Veterans Administration (VA) is the world’s largest recipient of per patient funding for PTSD. The VA treats 200,000 veterans with this diagnosis annually at a cost of $4 billion. But research calls into question the very existence of the “PTSD” syndrome, and its diagnostic formulation remains invalid. We do not minimize the suffering of those who experience trauma or the need for comfort and restitution. We seek only to reexamine research evidence, to clarify the impact of culture on diagnosis, to reevaluate the consequences of trauma, and to ensure optimal allocation of resources.
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Suicide Prevention in Diverse Populations: A Systems and Readiness Approach for Emergency SettingsIn the US, suicide is a leading cause of death, ranking third among youths aged 15 to 24. Rates of suicide attempts and death are highest among US Pacific Island indigenous youths. Emergency departments play a key role in suicide prevention, especially in this and other minority populations.
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Delayed Sleep Wake Phase Disorder in Adolescents: Chronotherapy and Best PracticesHere: suggested strategies for assessment and management of this circadian sleep disorder commonly seen in adolescents.
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Amotivation in Individuals with Schizophrenia: Exciting Research Ideas at ACNP 2023 Annual MeetingExciting research ideas are stirring at the ACNP 2023 Annual Meeting.
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Diagnosis and Assessment Issues in Eating DisordersYou must assess the presenting problem and identify the appropriate diagnostic code needed for insurance billing. But diagnosis is complicated. Help here.
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The Conceptualization and Role of Impulsivity: Bipolar Disorder and Substance AbuseImpulsive behaviors play an important role in both bipolar and substance abuse disorders. However, results of studies investigating this link are often ambiguous, in part, due to the multidimensional nature of the impulsivity construct and the fact that many studies use a single measurement technique. We describe a model of impulsivity characterized by three components: response initiation, response inhibition and consequence sensitivity. How these components differ from one another in terms of their use, behavioral theory and biological function is discussed, along with measurement techniques.
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The “Hard” and “Soft” Phenotypic Boundaries of Bipolar DisorderThere is no substitute for understanding one’s patient as an individual, and treating accordingly, keeping in mind the possibility that not all psychosis is schizophrenia and that moodiness may or may not indicate a place in the bipolar spectrum.
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Rape-Related PTSD: Issues and InterventionsRape is a crime that is defined as an unwanted sexual act that results in oral, vaginal, or anal penetration. Generally speaking, there are 2 major types of rape. Forcible rape involves unwanted sexual penetration obtained by the use of force or threat of force. Drug- or alcohol-facilitated rape occurs when the victim is passed out or highly intoxicated because of voluntary or involuntary consumption of alcohol or drugs. Rape can happen to boys and men as well as to girls and women but this article will focus primarily on women.
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Are Genius and Madness Related? Contemporary Answers to an Ancient QuestionEver since antiquity, thinkers have associated creativity with psychopathology--the classic idea of the "mad genius."
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Clinical Uses and Ethical Implications of Psychiatric Genetic CounselingThe Human Genome project has provided an abundance of genetic information, including identification of many disease-causing genes. Clinical applications, genetic counseling and the potential ethical issues raised by the availability of genetic testing are all areas of concern in gene research. Will genetic counseling in classical genetic diseases help to provide guidelines for behavioral disorders?
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Are Studies Misguiding the Choice of First-Line Treatments?A recently published meta-analysis questions if efficacy data garnered from clinical trials is relevant to everyday clinical practice. The authors ponder if enough patients are being included, if they are being followed long enough afterward, and whether exclusion criteria are too broad?
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Rural Psychiatry's Appeal Increasing as Urban Opportunities DiminishRural psychiatry is on the threshold of an immense transformation. Across the country, each state, faced with mandates to cut budgets and conserve health care spending, is in the complex process of negotiating the changing world of health care reimbursement and the redistribution of ever-shrinking funds. Since the majority of rural psychiatric care is delivered at community mental health centers, which rely heavily on state and federal government funding and initiatives, rural psychiatrists are likely to find themselves battling bureaucratic waves that challenge their resourcefulness and ardor.
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Guest Editorial: The Loss of the Right of ConsentInitially, it seemed that the privacy rule for HIPAA would protect patients' privacy, but in reality it has opened the door for insurance companies and hospitals to view private health care information. How can physicians and patients protect their privacy from further erosion?
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Dispatch From the Repressed-Memory Legal FrontDespite the fact that recent juries have discounted repressed-memory testimony as viable, the emotional cost of such cases still takes its toll. Why are such cases so controversial, and how can psychiatrists avoid their pitfalls?
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Treatment for Eating Disorders and the Path to WellnessPodcast: Experts summarize effective treatment options for patients with eating disorders and discuss common features, medical components of anorexia and bulimia, behavioral features, and psychological symptoms.
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Youth-Led Suicide Prevention in an Indigenous Rural CommunitySuicide is a pervasive public health issue for adolescents in Hawaii. In response, a youth leadership model was initiated to empower young leaders in suicide prevention through evidence-based training, relationship building, and community awareness.
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Sharing the Burden of Intercultural StressThe manner in which a clinician enters the room and approaches and engages with an intercultural patient and family can either set off or relieve “culture shock.”
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The Little Psychotherapy Book: Object Relations in PracticeThis book is recommended for therapy trainees who are interested in relational psychodynamic approaches and concerned with putting these seemingly abstract concepts into “real world” practice.
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An Early Warning Sign for ViolenceBullying and being bullied put adolescents at risk for developing violent behaviors. Depression and anxiety are two of the underlying issues related to this type of behavior. Recognizing the warning signs may help mental health care professionals prevent violence in the adolescent's life.
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Psychiatric Consultation to the Postpartum MotherThe authors examine the potential areas of concern during the postpartum period, as well as practical approaches to differential diagnosis and treatment.
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The Use of Meditation in Children With Mental Health IssuesThis review provides information to assist clinicians who are considering mindfulness meditation for their patients.
