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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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Glucose DysregulationThe atypical antipsychotics have become the treatment of choice for patients with psychotic and other behavioral disorders. However, case reports, retrospective studies and epidemiological data suggest that these medications may be associated with new-onset type 2 diabetes and diabetic ketoacidosis.
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The Diagnosis and Treatment of Substance Abuse/ Dependence and Co-Occurring Social Anxiety DisorderSocial anxiety disorder and drug addiction commonly co-occur in the same individual, complicating the presentation, course and treatment of both disorders. Using drugs or alcohol may be a coping mechanism for social anxiety; however, many treatments for addiction are group-based approaches, which would be especially challenging for people with social anxiety disorder. This article provides a brief overview of what is known about the co-occurrence of these disorders, as well as possible treatment interventions for this population.
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Unexplained Physical Symptomshe key manifestations of DSM-IV somatoform disorder are unexplained physical symptoms or complaints that tend to coexist with other psychiatric syndromes or are linked to psychological issues. These symptoms typically lead to repeated medical or emergency department visits; are associated with serious discomfort, dysfunction, and disability; and lead to significant health expenditures.
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Outside the Pill Box: The Systems-Based Practice of PsychiatryMeet "Gary," whose case provides an introduction to the value of systems-based practice.
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Pharmacogenetics to Predict Treatment Outcome in Substance Use DisordersThis brief communication highlights the importance of genetic predictors and moderators of treatment research in the field of substance use.
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Digital Health as an Enabler for Patient-Centric, Outcome-Based CareConsidering challenges and opportunities in digital health solutions for mental health care.
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Managing the Aftermath of Patient-on-Staff ViolenceViolence by patients towards staff members is an inherently complex matter for the physically and/or psychologically injured person. An expert in the field of forensic psychiatry answers a reader's question about what clinicians can do in the aftermath of an assault.
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Creative Media in PsychotherapyNonverbal cues speak just as loudly as words. How can video be used to capture these subtle cues and help patients make progress in therapy?
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Reasons Patients Doubt Medication-Resistant Delusions in SchizophreniaOur study suggests that most delusional patients, even those with high positive symptom scores, may have at least 1 RFD that precedes a clinical intervention specifically directed toward encouraging doubt. These preexisting “islands of doubt” may offer a useful foothold to begin the CBT process.
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Psychocutaneous DisordersPsychological problems are often manifest in the skin. In fact, it is estimated that between 20% and 30% of all skin disorders have some psychological component. Many patients who have psychocutaneous disorders-which are often direct evidence of or secondary to psychological abberations-drift from one physician to another, trying to find one savvy enough to cure their “skin condition.” Furthermore, although they have sought many medical opinions already, patients afflicted with psychocutaneous disorders almost always present as “an emergency.” While pharmacological intervention may benefit such patients, traditional mental health interventions are almost always required if the aberrant behavior is to cease.
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Violence in Bipolar DisorderWhat is the association between bipolar disorder, trauma, and violence? Here: a guide to assessing violence potential in bipolar patients.
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Mini Quiz: DSM-5 BasicsDSM-5 stands out for the introduction of several new specifiers, which will allow for more accurate coding. Which of the items mentioned in this quiz did not change in DSM-5?
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Take 5 Before You Give 5: The Dos and Don’ts of Political ContributionsCommon legal questions about political donations are discussed.
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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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Obsessive-Compulsive Symptoms in SchizophreniaThere is currently great controversy over the issue of obsessive-compulsive behaviors in schizophrenia. Are patients who display these behaviors suffering from a separate subtype of schizophrenia?
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Cognitive Impairment in Patients With Bipolar DisorderIt is widely accepted that patients with schizophrenia have some degree of cognitive deficiency and that cognitive deficits are an inherent part of the disorder. Historically, there has been less focus on cognitive deficits in patients with bipolar disorder; however, numerous studies of cognition in patients with bipolar disorder, including several comprehensive meta-analyses of bipolar patients who were euthymic at the time of testing, have recently been undertaken.1-4 Each of these analyses found that cognitive impairment persists during periods of remission, mainly in domains that include attention and processing speed, memory, and executive functioning.4
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Neoplasm or Demyelinating Lesion?A 32-year-old left-handed woman presented with a 4-week history of progressive left hand numbness, tingling, and clumsiness. Symptoms worsened until she found it difficult to write and perform fine motor tasks. She reported having no transient neurological symptoms in the past. Her medical history was significant only for Dengue fever acquired several years ago while on a visit to Southeast Asia. She was taking no medications, and a review of systems was noncontributory.
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A Case of Gambling DisorderA patient is brought to the emergency department by her daughter for bizarre behavior and symptoms of mania after gambling from the casino for 48 continuous hours.
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Mini Quiz: DSM-5 BasicsDSM-5 stands out for the introduction of several new specifiers, which will allow for more accurate coding. Which of the items mentioned in this quiz did not change in DSM-5?
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New Drug Developments for Bipolar ManiaWhile challenges in treating mania persist, the future discovery of novel therapeutic agents will likely expand our understanding of this devastating illness and provide key insights into future drug development.
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The Intersection of Mental Health and Successful AgingOne consequence of the "graying" of the world's population is that psychiatrists, along with all health care professionals, will increasingly be providing services to older adults. In the United States, the first set of people belonging to the baby boom generation turned 60 in 2005, and the number of people older than 60 will soonoutnumber children for the first time in recorded history.
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A New Tool for Teaching PsychopharmacologyEveryone would probably agree that the practice of clinical psychiatry has changed profoundly over the second half of the past century. One of the most remarkable changes has been the rapid development and expansion of clinical psychopharmacology, which has become, like it or not, a dominant part of the clinical practice of most psychiatrists. Available treatments for mental disorders changed and our armamentarium broadened. We have numerous medications for psychiatric disorders. We even use medications for disorders traditionally considered only amenable to and suitable for psychotherapy.
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Podcast: Pandora's Box and Integrative Treatment of SchizophreniaHere, Dr Ira Steinman, discusses the concept behind "Beyond Pandora's Box: Exploring Integrative Approaches to Treating Psychosis."
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Do We Need Psychiatrists?For a couple of years, I have been a member of the American Society of Clinical Psychopharmacology (ASCP). I guess many of us carry this need to belong from our adolescent years. It always felt good for me to be a part of a professional group, sharing the same interests, united by special education and knowledge. How wrong of me!
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The Relationship Between Anxiety Disorders and Sexual DysfunctionIn this article, we examine the relationship between anxiety disorders and SDs, using DSM-IV-TR categories, although we are conscious of the limits of this approach. In doing so, we will consider not only the dichotomy between normal and pathological functioning but also the issue of sexual satisfaction as part of wellness.
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Can Epigenetics Promote Resilience Without Genetic Reductionism?The emergence of epigenetic models has generated a surge of optimism, opening new possibilities for psychiatric intervention.
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Treating Prodromal Symptoms of PsychosisA review of some of the latest study findings on the pharmacological treatment of prodromal psychosis.
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Alternative Brief Interventions for Mild DepressionDepression has long been recognized as a primary concern for health care providers. Many approaches to treating depression have been developed, ranging from medications, to long-term psychotherapy, to shorter, more structured cognitive-behavioral treatments--all of which help some of the patients, some of the time, to some extent.
