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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, Part 2: A Dialogue About Indications for Clozapine, Managing Adverse Effects, and MoreIn this CME article, review management of several clozapine-related adverse effects and outline considerations when addressing inadequate positive symptom response to clozapine.
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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.
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Psychotherapy Supervision (2nd ed)who remarked that the problem with most new books he reads these days is that there is “too much space between the covers.” After all, he queried rhetorically, “Do I really need more than 250 pages or so on any one subject?” Days before this conversation, I had accepted an invitation to write a review of Psychotherapy Supervision and had received the 632-page tome by mail.
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Brain Pathways: New Approaches to Structure-Function LocalizationIs it time again for greater unification of neurology and psychiatry?
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Drugs On Our Minds: Historical, Social Perspectives on 'Modifiers of Affect'To understand our fascination with drugs in the first place, we need to ask some basic questions, such as "Why do we like to take poison in small quantities?" The truthful answer is always some variation of "To feel better." How does this come about, and why do we have so much trouble with it?
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Update on Bipolar Disorder, Part 2: Bipolar Depression and Cyclothymic DisorderThis article reviews DSM-5 changes to symptom criteria for bipolar disorder with a focus on treatment of bipolar depression and cyclothymic disorder.
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An Update on the Diagnosis and Treatment of Bipolar Disorder, Part 1: ManiaThis article reviews DSM-5 changes to symptom criteria for bipolar disorder. The primary focus is on the diagnosis and treatment of mania and hypomania.
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Schizophrenia and Smartphones: Separating Speculation From ScienceCan mobile technologies advance care for schizophrenia? The research literature strongly supports feasibility, although clinical data on validity, safety, and efficacy are still lacking.
