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Working With Law Enforcement to Provide Health Care for the Acute Mentally IllJails have a much higher percentage of homeless mentally ill than does the general community, and those with psychiatric disorders (eg, schizophrenia) must often fend for themselves. Here are some solutions.
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Intervention Helps Workers With DepressionIn the US, depression ranks fifth in the number of disability-adjusted life years lost due to illness and employment problems often persist, even if help is sought. Helping those who want and/or need to work is part of providing comprehensive, patient-centered care.
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Shedding Light on the 'Black Box': Treating Pediatric DepressionThe FDA has issued a "black box" warning about the use of all antidepressants in the pediatric population due to a 1.8-fold increase in suicidality on drug compared to placebo. Yet these medications can be an effective tool in treating depression. How should parents and patients be educated, considering this information?
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Chronic Opioid Treatment, Addiction and Pseudo-Addiction in Patients With Chronic PainAlthough patients taking opioids for chronic pain may sometimes appear to display addictive behaviors, addiction may not be the case. How can you tell if addiction is the problem or if inadequate pain control is to blame?
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Stress Neurobiology and Corticotropin-Releasing FactorStress Neurobiology and Corticotropin-Releasing Factor
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Pharmacogenomic Screening for Depressed Children and AdolescentsWhile the utilization of clinical genotyping to determine drug response and dosage has been anticipated for many years, the actual utilization of screening for atypical drug metabolizers has only recently become a reality. What is the promise of this technology, as well as the limitations?
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Bipartisan Legislation Seeks to Expand US Approach to Mental HealthLegislation includes a CDC community public health approach to build mental wellness and resilience.
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Best Recent Screen Portrayals of Mental Health IssuesCelebrating accurate representations of psychiatric issues and treatment in film and television from the past year.
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How Clinicians Actually Use the DSM: Psychiatric Times Survey ResultsGiven that one of the primary goals of making DSM revisions is to improve its clinical utility, establishing a baseline of current usage is critical to inform future proposals. For this and other reasons, the authors provide preliminary results from research focused on determining clinicians’ actual use of DSM.
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Common Augmentation Strategies for Depression: Findings Show Lack of EvidenceIt is estimated that at least half of persons who begin antidepressant treatment will not respond to monotherapy.
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Addressing the Youth Mental Health Crisis With Coordinated Systems of CareHow can integrated systems of care help us provide the appropriate level of high-quality care to each individual child?
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The Once-Forgotten Factor in Psychiatry: Research Findings on Religious Commitment and Mental HealthAs previously discussed, new research has made us look much more closely at the influence of religion and spirituality on overall health. Now more than 30 psychiatric residencies including Harvard, Baylor, and Georgetown provide focused training on addressing patients' religious/spiritual beliefs.
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Benefits of Social Media in Mental Health Practices (Part 2)Social media is not a fad. It allows physicians to “get out of the office” in real time, to learn about patients’ concerns, and to connect with others.
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Social Media: A Key Component to the Psychiatrist's PracticeHaving even a basic idea of the potential--as well as of the perils--of social media is therefore not only important to good practice, but it may be essential to good practice.
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Cognitive Impairment in Patients With Bipolar Disorder: Effect on Psychosocial FunctioningThere is growing evidence that individuals with bipolar affective disorder have cognitive impairments, even during periods of symptom remission.
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Diagnoses From Clinical Evaluations and Standardized Diagnostic Interviews Don’t AgreeA recent meta-analysis showed that diagnoses generated from clinical evaluations often do not agree with the results of structured and semistructured interviews-together called standardized diagnostic interviews (SDIs).
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7 Components of Depression EvaluationThe co-occurrence of depression and cognitive impairment doubles every 5 years after the age of 70. Here we present a list of elements in a comprehensive and extended evaluation of depression in the elderly.
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Biopsychosocial Model: Another Reader Weighs InI was Dr George Engel's assistant and associate for 14 years. His biopsychosocial model was a conceptual effort designed to get beyond the reductionistic biomedical model that still prevails. In his letter, Dr Victor Schwartz reads Dr Engel much more closely and to the point than does Dr Waterman "Biopsychosocial Model: Helpful or Hindering?" Psychiatric Times, May 2007).
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Progress in the Treatment of Bipolar Depression: Advances and ChallengesA discussion of the pharmacologic management of bipolar depression, including emerging treatments and expert recommendations.
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The Psychiatry of Work: Is Residency Training Adequate?It has been estimated that depression alone results in a loss of $31 billion per year for employers. This slideshow reports findings from a survey on work psychiatry.
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How Frame Analysis Can Guide the Therapeutic ProcessFrame analysis can not only help us to discern the roots of such standoffs but also to conceptualize specific ways of addressing the conflicts in therapeutic language with the patient, with the goal of forging an integrated approach to treatment.
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Exposure Therapy for Anxiety DisordersExposure-based therapies are highly effective for patients with anxiety disorders, to the extent that exposure should be considered a first-line, evidence-based treatment for such patients. In clinical practice, however, these treatments are underutilized, which highlights the need for additional dissemination and training.
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Psychopharmacology in the Acute Setting: Review and Proposed GuidelinesThere are two goals in the acute treatment setting (e.g., emergency department): initiation of treatment and reducing the symptoms of agitation and aggression that frequently accompany an acute psychotic breakdown. Treatment options and considerations are reviewed.
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Development of a Transdiagnostic Unified Psychosocial Treatment for Emotional DisordersResearch emerging from the field of emotion science suggests that individuals who have anxiety and mood disorders tend to experience negative affect more frequently and more intensely than do healthy individuals, and they tend to view these experiences as more aversive, representing a common diathesis across anxiety and mood disorders.1-5 Deficits in the ability to regulate emotional experiences, resulting from unsuccessful efforts to avoid or dampen the intensity of uncomfortable emotions, have also been found across the emotional disorders and are a key target for therapeutic change.
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Ethics in Psychotherapy and Counseling: A Practical Guide, 3rd ed.It is notoriously difficult to capture in writing the essence of what constitutes ethical practice in contemporary psychotherapy. Authors who take on this daunting task face the potential pit-falls of presenting their ideas in an abstract manner that bores the reader and is clinically irrelevant or risks coming across as overly moralistic and preachy.
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Psychotherapy for Gay and Lesbian ClientsScientific, social or legal redefinition is only slowly reflected in changed practitioners and practices. It is not surprising that surveys continue to report high levels of ignorance and prejudice encountered by homosexuals in their contacts with health care providers. This also contributes to a negative feedback loop in which many homosexuals are reluctant to utilize, inform or confront their care providers, impairing collaboration in treatment.
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Vascular Psychiatry: A New Specialty?Vascular surgeons, internists, and neurologists all exist-but why aren’t there any vascular psychiatrists? There certainly is a need.
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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
