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Lac-yawn? A Jacques-ular Exchange: From our ReadersDrs differ on the advisability of reading a certain famous French psychoanalyst.
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Introduction: Expanding Your Practice and Avoiding BurnoutThe topics in this Special Report provide a broad picture of the issues psychiatrists face as they take a clear-eyed look at the opportunities and challenges in the emerging health care system.
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Treatment-Resistant Anxiety Disorders: Neurotrophic PerspectivesAnxiety disorders are the most prevalent psychiatric disorders in the United States. Although effective treatments are available, such as the SSRIs and cognitive-behavioral therapy (CBT), it is estimated that in about 40% of patients, anxiety disorders are partially or completely resistant to first-line treatment.
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Computers in the Consulting RoomComputerized information resources are being introduced into psychiatric practice settings, but some psychiatrists question whether they are really needed.
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Mini-case: Psychiatry in Pediatric Palliative CareThis case of a 14-year-old female patient with end-stage cystic fibrosis illustrates the psychiatrist's critical role in ensuring quality end-of-life care.
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Inter-Rater Reliability in Psychiatric DiagnosisDSM-5 presents psychiatry with a potential “reset button” for diagnostic reliability.
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The Mythology of Evidence-Based MedicineMedical training is awash in catch phrases and shibboleths. Some can be useful (“When you hear hoofbeats, think horses not zebras”); others, perhaps overly simplistic (“If it’s not in the chart, it didn’t happen”). A current divination clinging to medical consciousness is the concept of evidence-based medicine (EBM).
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Depressive Symptoms After LossTo improve validity, we proposed extending the current MDD bereavement exclusion-which excludes “uncomplicated” (relatively brief, lacking certain severe symptoms) depressive bereavement from diagnosis-to also exclude uncomplicated reactions to other major stressors, such as romantic breakups, job loss, and serious medical diagnoses.
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Psychiatric Issues in the Somali Refugee PopulationThis article highlights several features of medical and social importance that are somewhat unique to the Somali refugee community in the US.
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The Vote on Tutu: Fair Hearing?More details on the APA Assembly meeting in Washington discussing Desmond Tutu being designated as convocation speaker for the American Psychiatric Association’s recent annual meeting.
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The Concept-Laden PrescriptionCompared with the many recent articles addressing medications' multiple meanings for the patients who take them and the psychiatrist-therapists who prescribe them, there has persisted in the literature and in clinical practice a curious literal conception of the prescription itself. This article challenges the idea that the only medication that can be prescribed comes in the form of pills or tablets; on the contrary, ideas constitute some of the most potent "medication" known.
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Cognitive/Neuropsychological Functioning and Suicidal Behavior: A Review of Research and Implications for Clinical PracticeIn this CME, learn to identify 3 patient groups who are characterized by elevated rates of suicidal behavior and co-occurring cognitive/neuropsychological impairment.
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Psychiatric Issues in Children and Adolescents With DiabetesThe diagnosis of T1DM can be devastating to both the child and family. Because of the potential for immediate life-threatening complications of poorly controlled diabetes, family members must readjust their approach to daily living.
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The Evolutionary Calculus of DepressionThe discipline of evolutionary psychology views modern human behaviors as products of natural selection that acted on the psychological traits of our ancestors. A subdiscipline, evolutionary psychiatry, tries to find evolutionary explanations for mental disorders.
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Innovations in Treating Neuropathic Pain: Off-label Pharmaceuticals, Novel Orthotics, and Other New ApproachesManagement of diabetic peripheral neuropathy (DPN) centers on proper footcare, offloading, and various orthotic devices to prevent the development of ulcers. Management trends, however, show that off-label use of some pharmaceutical agents is common and that these agents are proving beneficial in relieving the pain that can accompany DPN in up to 35% of patients. In addition, innovations in orthotic devices and new technologies for patient monitoring are being rolled out.
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Looking BackPatients’ stories (both content and structure) contain more therapeutically useful information than merely identifying and counting symptoms.
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Depressive Disorders in Adolescents: Challenges in DiagnosisMany adolescents experience depressive symptoms and some have episodes that go beyond transient feelings. Risk factors and predictive strategies are thwarted by the power of individual differences. Communicating with patient families; using the available innovative pharmacological, diagnostic and behavioral tools; and individualizing treatment approaches can improve outcomes.
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Treating Child and Adolescent Mental Illness: A Practical, All-in-One GuideTreating Child and Adolescent Mental Illness: A Practical, All-in-One Guide is just what its title promises: a clinically relevant, encompassing yet concise guide to child and adolescent mental health care. Dr Shatkin’s book serves as a useful primer for medical and mental health clinicians who do not specialize in the treatment of children and adolescents but who find themselves faced with the growing demand to provide mental health services to this sector. It is also a handy refresher for child and adolescent clinicians called on to treat disorders seen less often in their practices, as well as a reference for nonphysicians less familiar with psychopharmacological interventions.
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Learning the Ropes of Medical School: A Boxer’s Wisdom"Although at times we may need to wipe away blood and tears, through the process we become better physicians and ultimately, better people. These are the victories that we can attain in our ring," says this 4th-year medical student.
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DSM-5: Continuing the Confusion about Aging, Alzheimer’s and DementiaSince the early twentieth century, when Alois Alzheimer and Emil Kraepelin constructed it as a unified clinical-pathological entity, Alzheimer’s disease has been both one of the most stable and one of the most problematic neuropsychiatric entities.
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Psychotherapy for Treatment-Resistant Depression Is Overlooked, Underused"Evidence indicates that psychotherapy may yield greater durability of treatment gains than pharmacotherapy."
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To Take Care of Others, You Must Take Care of YourselfWhile helping each other, we oftentimes forget to preserve our own health. Dr Gold recommends tips for maintaining your own peace of mind.
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Anxiety Disorders in Later LifeOlder adults can present with anxiety or worries about physical health (illness, changes in vision or hearing), cognitive difficulties, finances, and changes in life status (widowhood, care-giving responsibilities, retirement). Clinicians need to be aware that older adults may deny psychological symptoms of anxiety (fear, worry) but endorse similar emotions with different words (worries, concerns).
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Epidemiology and Treatment of Substance Use and Abuse in AdolescentsThis article covers the spread of substance use problems in adolescents and some of the currently available scientifically proven behavioral treatments for these conditions.
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Suicidal Self-Injurious Behavior in People With BPDUnlike other forms of self-injury, suicidal self-injury has special meaning, particularly in the context of borderline personality disorder. How is suicidal self-injury differentiated from non-suicidal self-injury in these patients, and how can their behavior be properly assessed and treated?
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Healthy Beginnings for a New PsychiatristDuring the first year of her child and adolescent psychiatry fellowship, this psychiatrist received an invaluable lesson regarding the importance of “treating the whole patient” in this case, a 16-year-old patient who is pregnant.
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Not Obsolete: Continuing Roles for TCAs and MAOIsIn lecturing to medical students, residents, and psychiatrists during the past several years, we have encountered widespread hesitancy in the use of MAOIs and even TCAs, mainly because of concerns about their safety but also because of doubts about their effectiveness compared with newer alternatives. Thus, it is timely to review the literature on the efficacy and safety of TCAs and MAOIs, with a view to maintaining an appropriate place for these 2 drug classes in the pharmacotherapy of depression.
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Augmentation Strategies in MDD TherapyFor many patients with depression, full symptom remission remains elusive despite multiple trials of antidepressants. This article focuses on psychopharmacological and related interventions.
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Psychiatric Advance Directives: What Psychiatrists Need to Know NowThis article explains and demonstrates the importance of psychiatric advance directives and the benefits and obstacles involved in implementing them.
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Interpreting Digital Information in Forensic SettingsHow can digital therapeutics overcome barriers to psychiatric treatment in forensic settings?
