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OCD and Bipolar Disorder: Novel InsightsBipolar disorder frequently co-occurs with OCD and complicates treatment of OCD symptoms. Special considerations are discussed.
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Cultural Psychiatry Comes of AgeCultural psychiatry can no longer be thought to involve only unusual syndromes that occur in distant societies. The growing literature in attests to the vitality of this field.
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Evidence-Based Therapies in Child and Adolescent PsychiatryEvidence-Based Therapies in Child and Adolescent Psychiatry by Jon McClellan, M.D. Given the lack of large, randomized controlled studies of psychiatric medications that involve children and adolescents, it can be difficult to establish evidence-based therapies that are effective for this population. However, there are studies that have shown the effectiveness of various medications, as well as for various psychotherapy techniques.
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Management of Mild Traumatic Brain InjuryA considerable overlap exists between TBI and disorders in cognition, behavior, and personality, which can provide even greater clinical challenges. More than 70% of the cases of TBI are mild, which makes this subgroup of particular clinical interest.
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The Joker and the Thief: Persistent Malingering as a Specific Type of Therapeutic Impasse"There must be some way out of here," said the joker to the thief."There's too much confusion, I can't get no relief. . . .""No reason to get excited," the thief, he kindly spoke,"There are many here among us who feel that life is but a joke.But you and I, we've been through that, and this is not our fate,So let us not talk falsely now, the hour is getting late."From "All Along the Watchtower," Bob Dylan
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Video: Treating the Whole Patient: Reversing the Long Day’s Journey Into Night: Mind-Body Perspectives on Treatment-Resistant DepressionThe goal of treating the whole patient, ie, integrating the mind-body connection into mental health care inititiatives, is to provide health care professionals with tactics to effectively identify interdependent conditions of the mind and body that impair psychiatric well-being, as well as strategies for successful treatment and management options in the clinical setting to improve patient care, outcomes, and overall wellness.
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Improving Medical Education for SUDs With TechnologyHow can novel technologies help address stigma and improve care for patients with SUDs?
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Atypical Antipsychotics for Children and Adolescents With Schizophrenia-Spectrum DisordersAlthough the onset of psychotic symptoms before the age of 13 years is exceedingly rare, the incidence of schizophrenia rises sharply after the onset of puberty.1 Only 1% of the population has schizophrenia and 30% of these patients experience an onset of psychotic symptoms by age 18 years.2-8 The period that precedes the onset of frank psychotic symptoms (ie, the prodromal phase) has not been well characterized in early-onset schizophrenia-spectrum disorders (EOSS), but retrospective reports have shown that symptoms include high levels of depression and anxiety, emerging cognitive and social deficits, unusual thought content, and (not infrequently) school failure.
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Police Encounters With the Mentally Ill After DeinstitutionalizationMental health professionals, state-run forensic services, and law enforcement agencies need to come together and discuss the most efficient and safe models when confronting psychiatric emergencies to improve and expand these practices across America.
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Repetitive Transcranial Magnetic Stimulation in Depression: A Changing LandscapeClinicians can feel confident in the evidence base when referring patients with a moderate level of treatment resistance for rTMS. Preliminary results suggest that deep rTMS may be an effective option in patients who have failed to respond to more than one antidepressant treatment.
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Transcranial Magnetic Stimulation in Neuropsychiatry: An UpdateThe potential of TMS as a treatment for cognitive disorders, fatigue, pain, and other manifestations of brain disease is discussed, as is the encouraging prospect for neuropsychiatric management of many patients.
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Consumer Advertisements for Psychostimulants in the United States: A Long History of Misleading PromotionThe prescription of psychotropic medications for children continues to be a controversial area of medical practice. In the United States, academic medical centers, medical researchers, prescribers, and the FDA are all ostensibly committed to the common goal of disseminating accurate information and promoting treatment based on scientific evidence. In the United States, however, medical treatment takes place in the context of legal and pervasive direct-to-consumer advertising (DTCA). There are concerns about the potential for DTCA to affect public health negatively and to increase health care costs.
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Gun Violence, Stigma, and Mental Illness: Clinical ImplicationsThis review critically addresses 4 central assumptions that underlie many US political and popular associations between gun violence and mental illness.
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Questions and Answers About Clozapine: A Dialogue About the Use of Plasma LevelsIn this CME article, read more about best practices for utilizing clozapine plasma levels and the clozapine/norclozapine ratio to monitor clozapine therapy.
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Neuropsychiatry of TBIThis Special Report addresses several specific areas of concern that are of importance to psychiatrists: Can depression be prevented after traumatic brain injury? What are the risks? Are there special issues involved in treatment?
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The Role of Genetic and Environmental Factors in the Development of SchizophreniaRecent research has shown environmental factors may increase the risk of schizophrenia in persons who may already have a genetic predisposition toward the illness.
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The New CPT Codes: A Letter of ProtestThis letter is a plea to the leadership of the APA to develop flexible, user-friendly guidelines for criteria being implemented in the new CPT Evaluation and Management codes.
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Interatrial Communications, Stroke, and Migraine HeadacheThis review will familiarize physicians with the embryology, types, and incidence of various interatrial communications; summarize and highlight the potential association of interatrial communications with stroke, platypnea-orthodeoxia syndrome, neurologic decompression sickness in divers, and migraine headaches; discuss various therapeutic modalities available for closure of interatrial communications; and outline future directions in this rapidly evolving field.
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Psychiatry for Primary Care: An Update on Hoarding DisorderHow can we effectively identify hoarding disorder, the various treatment options, and the research that informs these interventions?
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Managing MCI: Sifting Through the UnknownsIn many ways, the frustration experienced bypatients struggling with mild cognitive impairment(MCI) is matched by the frustration ofclinicians facing the challenge of managing thisheterogeneous condition. The prognosis can bevariable, and no proven therapies exist.
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Are the Media and the Public Still Missing the Clues?It is our responsibility as psychiatrists to educate the media and the public in general.
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Nonvalidated Pharmacogenetic Tests, Part I: Confessions of an Embarrassed Psychiatry ProfessorI started promoting pharmacogenetic tests in the 1990s-before they were fashionable-and now, after going through the 3 phases of pharmacogenetic testing (fear, failure, and hype), I am embarrassed.
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Neuropsychiatric Masquerades: Diagnosis and TreatmentA focus on the differential of CNS disorders that present with neuropsychiatric symptoms, their presentations, and guidelines for treatment.
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Psychiatric Presentations of Autoimmune EncephalopathiesGiven the potential for a significant role in recognition of neurologically complex disorders, psychiatrists should become familiar with diagnostic criteria and appropriate therapeutic option.
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Secondary Trauma Issues for PsychiatristsThe characteristics that bring people into the caring professions are, ironically, the very factors that make them vulnerable to vicarious trauma and job burnout. It is our responsibility to ensure that these adverse outcomes are minimized among those who have chosen such a career.
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Therapist-Patient Race and Sex Matching: Predictors of Treatment DurationMany of the factors purported to influence accessing mental health services by men and ethnic minorities are systemic in nature, ingrained within our culture, and consequently, difficult to change (e.g., gender differences in attitudes toward help-seeking, ethnic differences in the use of alternative healing resources). However efforts have been made within the mental health system to make services more acceptable to men and minority group members who choose to, or are able to, access the system.
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Is There a Common Basis for All Addictions?Addicts are people who have learned how to give themselves a quick chemical fix or achieve an emotional high when they either want to or have to change how they feel, and when they want to ignore real-life problems. Most people do that, but the next morning, they feel sick or foolish. They don't do it again because it didn't work for them. What makes addicts different is that they are willing-or feel compelled-to do it again and again even though they "know" that doing so will get them into trouble.
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Medicare Revenue Enhancement and Consultation-Liaison PsychiatryConsultation-Liaison (C-L) psychiatric services are generally not profit-making enterprises. Indeed, they are hard-pressed to demonstrate that they break even. Some attention has been paid to this issue in the recent literature, and specific recommendations of a most helpful nature have been made. The C-L service at Lehigh Valley Hospital (LVH) in Allentown, Pa., is an example of recommendations that have been put in place for C-L.
